Covid-19 Gambles

[JohnW2]

I am still of the belief that the lockdown prevented a spike in cases that would have seen Nightingale hospitals deployed, and NHS performance thereby drop to a level where it, for all intents and purposes, would be described as "collapsed".

Indeed. I personally cannot see how that could not be the case.

This would have likely had significant effects on all of the areas you have described.

As I've said (probably more than once!), that's one thing I don't understand about those opposed to lockdowns. They usually claim to be concerned about (amongst other things) all the collateral detrimental effects on diagnosis and treatment of cancer, other serious physical illnesses, mental health disorders etc. etc., but don't seem to understand that not having lockdowns makes all those problems worse.

It's not lockdowns, per se, that divert NHS resources away from treating other things but, rather, it's the treatment of Covid patients. Not having lockdowns is what results in more cases, hence more of this diversion of NHS recourses (in the extreme, as you say, amounting to 'collapse of the NHS', by turning it into a 'NCS' - "National Covid-treatment Service") !

Kind Regards, John

 

[Notch7]

Well, in that case we'll be social distancing forever. Don't you think that this is seriously disproportionate? Perhaps you don't, and we'll disagree.
This won't be the last pandemic in my my lifetime. I shudder to think what will be done in the name of public health for a disease which is actually dangerous for more people.

My honest answer is: I don’t know if it disproportionate or not.

A possible route would be to maintain NPIs until UK population reaches vaccine acquired herd immunity, ie 80% or whatever are double jabbed, currently at just over 50%

 

[Notch7]

I am still of the belief that the lockdown prevented a spike in cases that would have seen Nightingale hospitals deployed

nightingale hospitals, werent actually true hospitals and could never have been employed as NHS expansion, their only function was as a holding centre. The reality is there is no spare capacity of clinicians

 

[mikeey84]

nightingale hospitals, werent actually true hospitals and could never have been employed as NHS expansion, their only function was as a holding centre. The reality is there is no spare capacity of clinicians

That was sort of my point. Every nurse or Dr in a nightingale would have to be taken from treating other patients in other hospitals, thereby degrading services even more

 

[JohnW2]

My honest answer is: I don’t know if it disproportionate or not.

As I said, I'm sure there is no 'answer' - all one can hope for is (widely varying) personal opinions. Not only will we never know for sure what would have happened with a different strategy, but I doubt that any two people will agree on what would constitute "proportionate" and "disproportionate".

A possible route would be to maintain NPIs until UK population reaches vaccine acquired herd immunity, ie 80% or whatever are double jabbed, currently at just over 50%

It would. However, as I explained/illustrated in post #237, it might not be possible top achieve 'herd immunity' by vaccination alone, and very probably not unless most of the under-18s (about 20% of the population) are vaccinated - which is clearly not going to happen any time soon, if ever.

As I've said before, short of what you suggest (which would certainly be a big step in a direction which would make me more comfortable), I would have liked them to have at least maintained NPIs until we started seeing some indication of slowing of the 'increases' (if not 'reversal' thereof) with the NPIs still in place (due to the effects of increasing vaccination, which is the entire basis of their 'gamble').

Kind Regards, John

 

[echoes]

You're also asking us to speculate about the answer to your question in a very 'one-sided' fashion, since we don't know what you are postulating as an alternative

I don't have to postulate an alternative. I'm asking the lockdown zealots to justify what they have been advocating whilst taking into account the adverse effects of said lockdown. And I'm not being very successful - possibly because nobody knows, or perhaps because there is an uncomfortable suspicion that the cure will be worse than the disease - I don't think anyone can deny that lockdown will have a grave, long-lasting effect, but who can tell to what extent?

If you insist on an alternative then I would propose the pandemic plan which I have already linked to, but which you have dismissed as unworkable. I would remind you that this is close to the approach followed by Sweden, who has fared better than most of Europe, but I am instead greeted with the tiresome but convenient cherry-picking of her geographic neighbours (and Iceland - a remote island) as the only comparisons worth making.

Lockdowns are an ongoing experiment on billions of people. They have never been done before, and never even been thinkable by western governments until now, and for a disease which is no more dangerous for the majority of the population than seasonal flu. Yet our 'plan' has been to indiscriminately lockdown just about everybody, prolonging the exposure, instead of focusing protection on those who are 1000 times more vulnerable than the least vulnerable. No surprise that this strategy has resulted in a huge concentration of deaths in care home and hospitals - precisely the outcome least desired. Perhaps these tragedies were unavoidable - we'll never know.

The economy, NHS, education etc. will then have carried on largely unscathed (so no 'disproportionate' effects on any of them), whilst maybe 500,000 - 1,000,000 people died

Now who's speculating? You've pulled the lower number from the worst case scenario of an already discredited model. God knows where you have pulled 1,000,000 from.

not having lockdowns makes all those problems worse

More speculation that you can't quantify. It may be that there is very little that we can do to prevent the spread of a respiratory virus.

 

[echoes]

However, the other point he made is, as I said, very valid in that the proportion of hospitalised patients who are fully vaccinated is substantially an indicator of what proportion of the population are fully vaccinated - and that that proportion would inevitably approach 100% if the porporino of the population who were fully vaccinated approached 100%.

Yes, I'm aware of that. With a high proportion of vaccinated population we would expect a corresponding high number of vaccinated admissions, given that no vaccine is 100% effective. Especially, as seems to be the case, that the vaccine is less effective in those for whom the disease poses most danger - a sad fact of life.

I wonder if a detailed analysis of these stats could give us a real-world measure of vaccine efficacy, and if that was consistent with the trial findings.

 

[JohnW2]

I don't have to postulate an alternative. I'm asking the lockdown zealots to justify what they have been advocating whilst taking into account the adverse effects of said lockdown.

No you're not - your asking us whether 'what they have been advocating is "proportionate" or "disproportionate" but, as I said, that is so subjective and undefinable as to be unhelpful. All one can really do is speculate how the overall effects may have differed between different strategies.

I don't think anyone can deny that lockdown will have a grave, long-lasting effect, but who can tell to what extent?

Quite. And I don't think that anyone can deny that 'doing nothing' would also have 'grave effects' - hence the need to discuss comparisons.

If you insist on an alternative then I would propose the pandemic plan which I have already linked to, but which you have dismissed as unworkable. I would remind you that this is close to the approach followed by Sweden ...

As I've said, I don't think anyone really understands what has been happening in Sweden, which seems totally out on a limb in some senses. That's why I always ask those who cite it to suggest one or two other countries with similar experiences, but I never seem to get any answers.

Anyway, in terms of Sweden, give or take the caution that always have to be exercised in interpreting apparent differences/similarities between 'the numbers' from different countries, in terms of Covid itself, Sweden's experience has been much the same as the UK's (for both reported 'cases' and 'deaths', per capita of population, certainly for the first year of the pandemic (see graphs below). The difference is that Sweden seems to have achieved much the same as us (Covid-wise) with appreciably less economic and social etc. disruption - and that (pretty unique to Sweden) is what is poorly understood.

INow who's speculating? You've pulled the lower number from the worst case scenario of an already discredited model. God knows where you have pulled 1,000,000 from.

It's nothing to do with any models, discredited or otherwise, it's just simple ('ballpark') arithmetic. The virus we initially experienced had an R0 of about 3.0, which translates to an HIT of about 67% (of 'totally immune' people). In the absence of any NPIs, the virus will have spread rapidly until at least 67% (undoubtedly more, since immunity in 'the immune' will not have been 'total') had been infected - let's say at least about 45 million. Mortality (CFR) in those early days was estimated as 1-2% (obviously difficult at the time, given the lack of knowledge of 'the denominator') - so maybe 450,000 - 900,000 deaths. However, with that number of cases in a relatively short period of time (probably only a few months), the NHS would, back then (and probably still today), only have been able to treat a small fraction, so mortality would undoubtedly been a fair bit higher than that.

More speculation that you can't quantify.

I see no speculation, and cannot see any scope for speculation except by really extreme 'deniers'. Could any sensible person possibly deny that implementing measures to reduce inter-personal contact/proximity will reduce the number of infections? Once one has accepted that, everything else follows, with no need for any speculation - decreased infections leads to decreased hospitalisation because of Covid and hence reduced diversion of healthcare resources away from non-Covid activities. What is 'speculative' about any of that?

Kind Regards, John

 

[JohnW2]

Yes, I'm aware of that. With a high proportion of vaccinated population we would expect a corresponding high number of vaccinated admissions, given that no vaccine is 100% effective.

Quite so.

I wonder if a detailed analysis of these stats could give us a real-world measure of vaccine efficacy, and if that was consistent with the trial findings.

That doesn't require a particularly 'detailed analysis'. It would presumably merely require that one knew how many people fell into each of the five possible 'vaccinations categories' (as listed by plugwash) - in (a) in the entire population and (b) hospital admissions - data to which I personally do not have access.

Kind Regards, John

 

[EFLImpudence]

Are you not playing with tiny numbers?

If, as reported, 90% of adults have had the first dose and 66% the second, then, that 90% (46 million people) represent only 40% of those in hospital now is surely a good thing.

Apart from that, the 40% is a only around 1,800 (out of the 46 million vaccinated) of the 4,567 in hospital yesterday.

It is never reported how many have co-morbidities and/or are obese (apart from one report in the US that said 80% of hospitalisations were obese).

 

[mikeey84]

convenient cherry-picking of her geographic neighbours

I just thought comparing a country with its nearest neighbours that have similar demographics, geography, health care systems and governance was a valid approach

Seems its what an awful lot of Swedish scientists are doing to try and work out why what happened in Sweden occurred, but of course I'll make sure to let them know that you disagree with the approach

 

[JohnW2]

Are you not playing with tiny numbers?

I'm not sure what you mean by that.

If, as reported, 90% of adults have had the first dose and 66% the second, then, that 90% (46 million people) represent only 40% of those in hospital now is surely a good thing.

Exactly my point - as I said, what one needs to compare is the proportion of the population in a particular 'vaccination category' with the proportion of hospitalised who are in that same 'vaccination category', NOT (as the giovernment has been talking about) the proportion of hospitalised patients who are in the particular category.

As you say, even looking at that '90%' ('blanket') figure, what we see is 'a good thing'. However, it's a bit pessimistic since we know that there is a big difference (in terms of protection) between 'had just the first dose' and '>2 weeks after second dose' (aka 'fully vaccinated). In fact, that 'had one dose' figure (~90%) encompasses 4 out of 5 of plugwash's 'vaccination categories' (all other than 'no vaccine at all').

As I just wrote, to get a proper view of what's happening we need to know the proportion in each 'vaccination category' in the population and in the hospitalisations. In the case of 'fully vaccinated' (>2 weeks after 2nd dose) we would hopefully see a very substantial difference between the population and the admissions.

Kind Regards, John

 

[Adam_151]

Could any sensible person possibly deny that implementing measures to reduce inter-personal contact/proximity will reduce the number of infections? Once one has accepted that, everything else follows, with no need for any speculation - decreased infections leads to decreased hospitalisation because of Covid and hence reduced diversion of healthcare resources away from non-Covid activities. What is 'speculative' about any of that?

Reduce the Rate of infections John, not the number, the curve is flattened, the integral (given suitably wide bands) remains roughly the same untill you bring vacines into the picture. Now you could say thats a good thing, it keeps the rate at which it happens below that which can be dealt with, but there is also a trade off, as you are dragging the who lot out by defering a lot of the lower impact infections, thius leaving a greater propertion of the higher impact in those that remain. The older generations life changed very little, mostly retired they did not work, they still had to go to the supermarket, had home helps come around etc, all esstential services, the under 30s, by constrast were vastly different, many were furloughed, coffee shops, pubs, night clubs, all shut

In September 2020 there was a lot in the papers about university students isolated in their rooms, now if they partied instead they might have all been immune by the time they went home at Christmas, a bit of co-operation with the porters and the local supermarkets could have seen contact with the local resistants kept mimimal for a couple of months. You then do the reverse with care services, you get very careful about limiting spread while the rest is going on.

Like a lot of natural forces, we can hold it back in limited ways for limited time frames, holding back forever is not possible and generally makes the end result worse, best just divert onto the least destructive course possible, its like trying to prevent wild fires, initially it has some success, but it becomes harder and harder and eventually theres a massive one.

 

[JohnW2]

Reduce the Rate of infections John, not the number, the curve is flattened, the integral (given suitably wide bands) remains roughly the same until you bring vacines into the picture.

Sure, that's obviously what I meant.

However, in the context I was discussing (stress on NHS resources - and staff) it is that flattening (reduction of peak) which matters. Not only does a lower peak mean that they have less Covid patients to try to treat but, just as importantly, it means that less resources have to be diverted from other important healthcare activities in order to treat patients with Covid.

... but there is also a trade off, as you are dragging the who lot out by defering a lot of the lower impact infections, thus leaving a greater proportion of the higher impact in those that remain. ...

As I've said repeatedly, if there were no prospect of a vaccine, then a policy of yo-yoing with an everlasting series of 'lockdowns' would drag things out and achieve fairly little. However, we do have a vaccine and what we are trying to do is 'buy time' until vaccines hopefully 'take control of the situation' (whilst, at the same time,trying to limit stresses on NHS and enable them to continue to do as much as possible non-Covid work). The UK is in an almost unique position, in 'being almost there' in terms of vaccination, so it would, at least to my mind, be a pity to allow the NHS to again get stretched to its limit (to the detriment of all non-Covid healthcare, not to mention the sanity and well-being of the staff) by being a little 'impatient'. However, that's just a personal view.

Kind Regards, John

 

[EFLImpudence]

However, in the context I was discussing (stress on NHS resources - and staff) it is that flattening (reduction of peak) which matters. Not only does a lower peak mean that they have less Covid patients to try to treat but, just as importantly, it means that less resources have to be diverted from other important healthcare activities in order to treat patients with Covid.

There are far too few fewers around.