COVID19

[Doobs]

Don't worry everyone Keir is in charge of holding the Government to higher competency levels now - he has stated, quite clearly, categorically, that there should be a national vaccination programme put in place when a vaccine is available.

This kind of insight has been missing so far

I saw that headline earlier, and had the same immediate thought, but that isn't the entirety of what he said.   He also said they should build vaccination centres for when the vaccine is available.  This makes a lot of sense to me; two members of my family need flu vaccines each year and frequently there seems to be a difficulty in getting vaccinated.   If this is an issue when only a smaller part of the population need vaccines then it is going to be a massive issue when most people need one.  

Of course others may have realised this already, but there can be little harm in pressuring for it in now.  Particularly as we don't seem to have had enough foresight on a few occasions so far.

[nirvana]

Don't worry everyone Keir is in charge of holding the Government to higher competency levels now - he has stated, quite clearly, categorically, that there should be a national vaccination programme put in place when a vaccine is available.

This kind of insight has been missing so far

I saw that headline earlier, and had the same immediate thought, but that isn't the entirety of what he said.   He also said they should build vaccination centres for when the vaccine is available.  This makes a lot of sense to me; two members of my family need flu vaccines each year and frequently there seems to be a difficulty in getting vaccinated.   If this is an issue when only a smaller part of the population need vaccines then it is going to be a massive issue when most people need one.  

Of course others may have realised this already, but there can be little harm in pressuring for it in now.  Particularly as we don't seem to have had enough foresight on a few occasions so far.

Yes, I have a feeling others have thought of it too but yr right, you can't be too careful and at least with Starmer in the picture we have more chance of surviving this

[nirvana]

Tbf, I don't think it's a bad thing for people like Starmer to say ' Have you thought of this ? Let's plan' - it's a very difficult situation and perhaps very simple things can get overlooked.

It's the ridiculous posturing I object to. He's going to be involved in meetings with Govt during this crisis - why not mention it there, as forcefully as is necessary, rather than attempting to make capital out of the situation in the press - ie - he's not actually calling for action, he's implying that Government and the scientific community won't have thought of this.

[kukushkin88]

Be very interesting to see how things develop in Sweden, Germany, Austria where the experience of outcomes so far, making a large assumption we're all measuring consistently, is very different from UK, Italy, France, Spain.

Sweden:

https://www.google.co.uk/amp/s/amp.dw.com/en/sweden-seeks-u-turn-on-coronavirus-restrictions/a-53020024

Austria and Germany were amongst the best nations for ICU capacity and so if the numbers are going to take off in those nations we’d expect it to take much longer to happen: (I guess the big unknown on this is still that people who are put on ventilators seem to have poor prospects (I think fatalities in Italy ~57%).  People with no chance of recovery, who are still artificially respirated won’t be counted in the headline German/Austrian figures at this stage)

https://www.researchgate.net/figure/Numbers-of-critical-care-beds-corrected-for-size-of-population-per-100-000-inhabitants_fig1_229013572
This is constantly changing but the U.K. plan seems to be to reach maximum capacity several weeks after when they currently believe the peak will be.


http://

[Woodsey]

Don't worry everyone Keir is in charge of holding the Government to higher competency levels now - he has stated, quite clearly, categorically, that there should be a national vaccination programme put in place when a vaccine is available.

This kind of insight has been missing so far

Inspired thinking from day 1 of his job 

[kukushkin88]

Don't worry everyone Keir is in charge of holding the Government to higher competency levels now - he has stated, quite clearly, categorically, that there should be a national vaccination programme put in place when a vaccine is available.

This kind of insight has been missing so far

Inspired thinking from day 1 of his job 

https://www.doughtystreet.co.uk/barristers/sir-keir-starmer-kcb-qc

Is the problem likely to be you and the media or is the problem like to be an internationally revered QC?

[Woodsey]

Don't worry everyone Keir is in charge of holding the Government to higher competency levels now - he has stated, quite clearly, categorically, that there should be a national vaccination programme put in place when a vaccine is available.

This kind of insight has been missing so far

Inspired thinking from day 1 of his job 

https://www.doughtystreet.co.uk/barristers/sir-keir-starmer-kcb-qc

Is the problem likely to be you and the media or is the problem like to be an internationally revered QC?

You think he would have stated something better than that on day 1. Anyway whatever his previous job was is no guarantee of how he will perform as labour leader. I see momentum seem pleased with his election victory, I foresee split party and another election loss after we are through this nonsense. 

[Ironside]

Meanwhile in Scotland the lockdown being lead from the frontline

https://www.pressandjournal.co.uk/news/politics/scottish-politics/2125525/scotlands-chief-medical-officer-pictured-visiting-second-home/?utm_source=dlvr.it&utm_medium=facebook

[nirvana]

Just watched Marr, decent performance on there from him. Actually did find it a relief hearing from him versus Corbyn in this situation.

[nirvana]

Be very interesting to see how things develop in Sweden, Germany, Austria where the experience of outcomes so far, making a large assumption we're all measuring consistently, is very different from UK, Italy, France, Spain.

Sweden:

https://www.google.co.uk/amp/s/amp.dw.com/en/sweden-seeks-u-turn-on-coronavirus-restrictions/a-53020024

Austria and Germany were amongst the best nations for ICU capacity and so if the numbers are going to take off in those nations we’d expect it to take much longer to happen: (I guess the big unknown on this is still that people who are put on ventilators seem to have poor prospects (I think fatalities in Italy ~57%).  People with no chance of recovery, who are still artificially respirated won’t be counted in the headline German/Austrian figures at this stage)

https://www.researchgate.net/figure/Numbers-of-critical-care-beds-corrected-for-size-of-population-per-100-000-inhabitants_fig1_229013572
This is constantly changing but the U.K. plan seems to be to reach maximum capacity several weeks after when they currently believe the peak will be.


http://

I guess these are the kinds of factors that will make it really interesting to see how the longer term outcomes vary. One of the upsides of all starting from different places is this should make the learning in years to come much more valuable I'd imagine

[MintTrav]

The closing non-essential work is a bit trickier, if we don't go over the ICU capacity then it definitely wasn't needed and if we do go over the ICU capacity there's a chance it would have made a difference.

Crikey. I assume this just slipped through and you don't really mean it.

No. I dont really understand your thinking.

Every measure is aimed at keeping critical cases below ICU capacity so if we don't breach that it implies we don't need any of the few extra restrictions to be put in place.

Can you elaborate on what you mean?

ICU capacity is a critical measure for everything not getting out of control, but it’s not the only thing that matters. You’re saying that stopping non-essential work isn’t required so long as we don’t breach that line, which suggests it doesn’t matter about the grannies who may die as a result. Suppressing the number of infections and deaths is worth doing, irrespective of the ICU limit because, well, fewer people die.

Suppose capacity is 100% and we are currently at 30%. So if allowing non-essential work takes us to 120%, we should stop it, but if it only took us to 90% it’s ok, even though stopping it might have kept us at say 60%? Do the ones between 60% and 90% not matter? And, with more infection going around, the group who don’t even make it as far as ICU will also be larger.

And if we are in a situation where we’re going over IICU capacity no matter what we do, would suppressing demand to 130% not be better than 200%?

(Numbers just for illustration - I’ve no idea what the numbers would be or what the current fill actually is, but it doesn’t matter for this purpose.)

[Pokerpops]

The closing non-essential work is a bit trickier, if we don't go over the ICU capacity then it definitely wasn't needed and if we do go over the ICU capacity there's a chance it would have made a difference.

Crikey. I assume this just slipped through and you don't really mean it.

No. I dont really understand your thinking.

Every measure is aimed at keeping critical cases below ICU capacity so if we don't breach that it implies we don't need any of the few extra restrictions to be put in place.

Can you elaborate on what you mean?

ICU capacity is a critical measure for everything not getting out of control, but it’s not the only thing that matters. You’re saying that stopping non-essential work isn’t required so long as we don’t breach that line, which suggests it doesn’t matter about the grannies who may die as a result. Suppressing the number of infections and deaths is worth doing, irrespective of the ICU limit because, well, fewer people die.

Suppose capacity is 100% and we are currently at 30%. So if allowing non-essential work takes us to 120%, we should stop it, but if it only took us to 90% it’s ok, even though stopping it might have kept us at say 60%? Do the ones between 60% and 90% not matter? And, with more infection going around, the group who don’t even make it as far as ICU will also be larger.

And if we are in a situation where we’re going over IICU capacity no matter what we do, would suppressing demand to 130% not be better than 200%?

(Numbers just for illustration - I’ve no idea what the numbers would be or what the current fill actually is, but it doesn’t matter for this purpose.)

The long term outlook for a country with mass unemployment and massive debt isn’t a good one, for obvious reasons. Not least in health terms. The ongoing damage to the economy that closing businesses is causing can’t be sustained. Our ability to support the vulnerable is being compromised by our current actions. Is that wrong? Does each death avoided have a value that can be measured?

The question is, how do we balance the long-term health of the population against the short-term desire to reduce the death count attributed to Covid19?

I have no answer to this. I have some sense of how I might respond if asked for my opinion of a policy already in action.. I have absolutely no idea of how I might respond if I knew that my decision would have an impact on whether that policy was implemented.

[Jon MW]

The closing non-essential work is a bit trickier, if we don't go over the ICU capacity then it definitely wasn't needed and if we do go over the ICU capacity there's a chance it would have made a difference.

Crikey. I assume this just slipped through and you don't really mean it.

No. I dont really understand your thinking.

Every measure is aimed at keeping critical cases below ICU capacity so if we don't breach that it implies we don't need any of the few extra restrictions to be put in place.

Can you elaborate on what you mean?

ICU capacity is a critical measure for everything not getting out of control, but it’s not the only thing that matters. You’re saying that stopping non-essential work isn’t required so long as we don’t breach that line, which suggests it doesn’t matter about the grannies who may die as a result. Suppressing the number of infections and deaths is worth doing, irrespective of the ICU limit because, well, fewer people die.

Suppose capacity is 100% and we are currently at 30%. So if allowing non-essential work takes us to 120%, we should stop it, but if it only took us to 90% it’s ok, even though stopping it might have kept us at say 60%? Do the ones between 60% and 90% not matter? And, with more infection going around, the group who don’t even make it as far as ICU will also be larger.

And if we are in a situation where we’re going over IICU capacity no matter what we do, would suppressing demand to 130% not be better than 200%?

(Numbers just for illustration - I’ve no idea what the numbers would be or what the current fill actually is, but it doesn’t matter for this purpose.)

Most of the non-essential businesses that are being closed aren't public facing businesses.

i.e. the difference that closing non-essential businesses will make is not likely to be 60% to 90%; or 130% to 200% - it's more likely to be 60% to 70%, or 130% to 140% for example.

So just like closing airports when air traffic is down 90% probably won't make much difference, closing down non-essential businesses probably won't either.


The idea that 'you can't put a price on a human life' is nice but isn't really true. As well as the long term implication of how economic damage can affect future health there's the more prosaic illustration that NICE evaluate the efficacy and cost effectiveness of every drug all the time. If a drug will reduce cholesterol but doesn't improve life expectancy - it's not effective. If a drug can extend a 90 year olds life for an extra 5 years at the cost of a million pounds a year - it's not cost effective.

If closing non-essential businesses cost a billion pounds and saved a million lives - that's cost effective.
If closing non-essential businesses cost a 100 billion pounds and saves a 100 lives - that's not cost effective.

Whatever level you set the threshold at - there is a threshold.

[MintTrav]

The closing non-essential work is a bit trickier, if we don't go over the ICU capacity then it definitely wasn't needed and if we do go over the ICU capacity there's a chance it would have made a difference.

Crikey. I assume this just slipped through and you don't really mean it.

No. I dont really understand your thinking.

Every measure is aimed at keeping critical cases below ICU capacity so if we don't breach that it implies we don't need any of the few extra restrictions to be put in place.

Can you elaborate on what you mean?

ICU capacity is a critical measure for everything not getting out of control, but it’s not the only thing that matters. You’re saying that stopping non-essential work isn’t required so long as we don’t breach that line, which suggests it doesn’t matter about the grannies who may die as a result. Suppressing the number of infections and deaths is worth doing, irrespective of the ICU limit because, well, fewer people die.

Suppose capacity is 100% and we are currently at 30%. So if allowing non-essential work takes us to 120%, we should stop it, but if it only took us to 90% it’s ok, even though stopping it might have kept us at say 60%? Do the ones between 60% and 90% not matter? And, with more infection going around, the group who don’t even make it as far as ICU will also be larger.

And if we are in a situation where we’re going over IICU capacity no matter what we do, would suppressing demand to 130% not be better than 200%?

(Numbers just for illustration - I’ve no idea what the numbers would be or what the current fill actually is, but it doesn’t matter for this purpose.)

Most of the non-essential businesses that are being closed aren't public facing businesses.

i.e. the difference that closing non-essential businesses will make is not likely to be 60% to 90%; or 130% to 200% - it's more likely to be 60% to 70%, or 130% to 140% for example.

So just like closing airports when air traffic is down 90% probably won't make much difference, closing down non-essential businesses probably won't either.


The idea that 'you can't put a price on a human life' is nice but isn't really true. As well as the long term implication of how economic damage can affect future health there's the more prosaic illustration that NICE evaluate the efficacy and cost effectiveness of every drug all the time. If a drug will reduce cholesterol but doesn't improve life expectancy - it's not effective. If a drug can extend a 90 year olds life for an extra 5 years at the cost of a million pounds a year - it's not cost effective.

If closing non-essential businesses cost a billion pounds and saved a million lives - that's cost effective.
If closing non-essential businesses cost a 100 billion pounds and saves a 100 lives - that's not cost effective.

Whatever level you set the threshold at - there is a threshold.

How do you know that?

And even if a relatively small number are in non-essential roles (do we know that is the case?), it wouldn't necessarily mean that their effect would be small. Sometimes the effect of the added small number has a major effect on the whole system - eg the number of people who drive their children to school, who wouldn't be driving to work anyway, is small compared with the numbers going to work, but that extra causes the system to tip into overload. The number of non-essentials (or any other group out and about) is likely to have a disproportionate effect on infections as the network of possible infection routes increases exponentially, even if that group is relatively small (and I thought the non-essentials were a larger group than the essentials).

I agree with the rest of what you've written after that, but it doesn't really relate to the point I made, other than saying that there is a cost/benefit. In this case, we don't know the benefit, cos I don't think the 10% is justifiable. And we don't know the cost.

[Doobs]

This is starting to grate.

https://www.reuters.com/article/us-health-coronavirus-britain-ferguson/uk-coronavirus-deaths-could-reach-7000-to-20000-ferguson-idUSKBN21N0BN

We know that 7,000 can't be a possibility, as we are at 4,000 and rising; I know it went down today, but it is a Sunday do reporting is likely to slow.  Add to that lag in reporting, nursing home deaths, unknown cause deaths, people who have died alone, and unless they get a perfect vaccine, a 2nd wave seems a near certainty.  

20,000 is nowhere near the max either.   We "think" the rules should work, we cannot know they will work.  And the final numbers in scenarios where the rules don't work are subject to much more uncertain outcomes (we don't know the current infected population, how far it spreads, reinfections etc.).