Covid-19 Gambles

[JohnW2]

Here's a scatter of lockdown stringency vs outcome for a range of countries. Source: clicky .... The authors found some factors, age, health etc produced some correlation with morbidity.

Thanks. I've only had a chance to have a very quick glance at the paper, but my first reaction is that one has to regard their analysis of lockdowns with great caution, since they have treated 'lockdowns' so simplistically.

As you say, they have examined the relationship between 'lockdown stringency index' (basically a measure of the strictness/severity of the lockdown) and mortality (not morbidity as you wrote) in many countries. However, as we know only too well from what many people think about the UK's experience, 'stringency' is but one characteristic of something quite complex - to simply reduce a lockdown to a single number, and then plot that on a scatter plot and feed it into regression analyses is a great over-simplification, which I would feel is verging on the naïve. For a start, the timing of a lockdown is probably even more important than its 'stringency'.

As you will be aware, one of the greatest criticisms of the government's management of the initial wave of infection is that, on the basis of retrospective modelling, some believe that had the March 2020 lockdown started just a couple of weeks earlier than it did (which is apparently what some of their advisors were advising), there would probably have been "tens of thousands" less deaths, and some believe that even more tens of thousands of deaths (in Jan/Feb 2021) would have been avoided had our lockdown which started in early November 2020 not been 'interrupted' for most of December. Hence, just a couple of 'political decisions' could probably have dramatically altered where the UK appears on that scatterplot - and the same many be true of many countries.

More generally, as we knows, one has to be very cautious about any attempts to compare countries. Although, as you imply, these folk attempted to look at quite a few factors which could differ between countries (and hence affect morbidity, with or without lockdowns), there are undoubtedly many (maybe 'unknown') factors that they will not have been able to consider. Indeed, although 'mortality' sounds like a pretty hard metric to model, there is very considerable variation between countries (not to mention within the UK!) as to how a "Covid-19 Death" is defined - so one cannot even be certain that the 'deaths' figures are necessarily comparable between countries.

Probably more when I've had a chance to look at the paper properly.

Kind Regards, John

 

[JohnW2]

@echoes ... I've deliberately given you a fair bit of time to realise this, and point it out yourself, but the nature/extent of our exchanges has such that I think the time has come for me to point out that we have been largely talking 'at cross-purposes' and that you have probably been arguing about (and expressing scepticism about) 'the wrong things ....

... in response to some things I wrote, you initially appeared to express 'scepticism' about NPIs (e.g. 'lockdowns') reducing daily new cases during the lockdown (hence peak numbers of active cases during that period). That seemed to be such an extraordinary view (one which I don't recall having heard from anyone else, even those with fairly extreme views about management of the pandemic) that I wondered whether it is really what you meant, so I engaged in discussion with you. However, your responses during that discussion seemed to confirm that such was your view, and even when I cited specific UK lockdowns, and presented graphs showing reductions in daily new cases during those lockdowns, you presented technical arguments about the data analysis/presentation, still suggesting that the fall in new cases during those periods might not be causally related to the lockdown.

I think I could do a far better job than you in presenting the argument that you probably "should have been presenting"

Your interest/concern is presumably not in those 'daily new cases' (or instantaneous levels of total active cases) but, rather cumulative deaths (and maybe cumulative long-term morbidity), for which, if case mortality rate remains constant, the cumulative number of cases is a surrogate.

What I imagine you should be saying is that a series of lockdowns, per se, will not decrease the cumulative number of deaths (and may well increase it), since every time one lifted a lockdown, one would be essentially back to square one. In the absence of any other factors, such a series of lockdowns would, as you have observed, greatly increase all the 'collateral damage/problems (lockdown-related, rather than Covid-related). Few people would disagree with that, so there's not really anything for you to be 'sceptical' about.

What a lockdown can (and inevitably will) do is to reduce the number of new cases, and hence the peak number of active cases, during the lockdown. The primarily value of this is in avoiding a situation in which healthcare resources become 'overwhelmed' (as well as reducing the risk of variant emergence). If that were to happen, additional people would suffer (and die) - since some of them would fail to get any, or optimal, treatment - for Covid and/or anything else.

In the absence of a vaccine, a strategy reliant on an ongoing series of lockdowns would essentially go on 'for ever', with catastrophic lockdown-related consequences and a very large (and forever increasing) cumulative number of 'Covid deaths' (quite apart from all the other deaths, and other problems).

However, virtually every country has, from the very start, based its strategy on the hope/prayer that effective vaccines would come along - although few people would have even dreamed of the speed at which vaccines have been developed, and the speed and extent to which they have been deployed - particularly in the UK.

Whilst one is 'waiting for the vaccine' or 'waiting to fully deploy the vaccines', intermittent lockdowns, as required, are a useful way of buying time - since, although they do not, in themselves, necessarily result in a reduction in long-term cumulative deaths (and could even increase them), they do avoid periods of overwhelming healthcare resources and, as I said at the start (and probably more importantly), by reducing virus prevalence, substantially reduce the risk of new variants appearing, any one of which could theoretically (although, hopefully, not very probably) put the vaccine-related strategy right back to square one.

I suppose that all this now matters less for the UK than it does for most countries, since we are so advanced with our vaccine deployment but the other side of that coin is that it would be rather a pity to 'spoil things' when we are getting 'so close'. Whether we will ever be able to get effective 'herd immunity' without vaccinating the under-18s (which I fear we might not do) is perhaps a little less certain.

So, if I've got this roughly right, I think we are actually far closer than you may have thought, at least in terms of "what I believe you should be arguing".

Having said that, I wonder what you feel the UK should have done back in March 2020. Even with the lockdown, we got very close to 'overwhelming the NHS' and had a large number of cases and deaths during that lockdown. If we had not locked-down at all, I very much doubt that the NHS would have 'coped' and the number of deaths during that initial 3 or whatever months period would have been very much higher than it was - so what, if anything, do you think we should have done instead of having the lockdown (which, as I wrote yesterday, many believe that we delayed for a bit too long)?

Kind Regards, John

 

[EFLImpudence]

Well, I never.

I think the problem is not as you have been stating but, more, have the measures taken reduced the numbers overall?

The first lockdown was said to be to 'flatten the curve', i.e. delay the number of cases until later, to avoid swamping the NHS all at once. It was not to eradicate the virus.
Subsequent lockdowns cannot be expected to achieve different goals just because it is so said.

Presumably, as you say, restricting everyone to their own premises would reduce the number of cases during the time of the lockdown, but then if the numbers just increase after that time it has not reduced 'cases' nor deaths and is it possible that they increased cases and deaths? Not to mention the other effects of closing most of the country.

However, a so-called lockdown which demands people 'stay at home unless they go out' is hardly a lockdown - yes, I know people have to go out, therefore...

Are supermarkets dens of infection?
Did, claimed at the time, calamitous irresponsible happenings, such as the escapes to the beaches on bank holidays last Summer cause any noticeable increases in cases?

Using the numbers for Portugal, which are similar to the UK allowing for population, albeit we nearly missed the first wave altogether, there have been:

916,559 positive tests, i.e. 'cases', no idea how many were ill; total deaths 17,102

Of these:
~130,000 (14%) were over 70 with ~15,000 (88%) deaths,
so ~786,559 (86%) under 70 with ~2,102 (0.27%) deaths - nearly all 50s & 60s.

So, should the death rate be reported as 1.87% to more frighten everyone?

 

[Londoner2]

Just heard from work, number of people self isolating has gone up sharply.

 

[JohnD]

that dido's f-awful track and trace system

£33billion and less use than a chocolate teapot.

Still, it moved money from the taxpayer into the pockets of tory chum consultancies.

Mission accomplished.

 

[JohnW2]

I think the problem is not as you have been stating but, more, have the measures taken reduced the numbers overall?

That is certainly a major part of what matters. The recent extensive diversion in this discussion only arose because scepticism was expressed about my saying that the daily number of new cases (hence also the peak of numbers of active cases, hospitalisations and deaths) would inevitably reduce during (and for a period after) a lockdown - which is the one (and only) thing that any lockdown can (and inevitably will) do.

The first lockdown was said to be to 'flatten the curve', i.e. delay the number of cases until later, to avoid swamping the NHS all at once. It was not to eradicate the virus. Subsequent lockdowns cannot be expected to achieve different goals just because it is so said.

Exactly - that's precisely what I said in my latest post. All that a lockdown can do is limit the number of daily/active cases, hospitalisations and deaths during (and soon after) the lockdown - i.e. 'flattening the (cumulative) curve'.

Presumably, as you say, restricting everyone to their own premises would reduce the number of cases during the time of the lockdown, but then if the numbers just increase after that time it has not reduced 'cases' nor deaths and is it possible that they increased cases and deaths? Not to mention the other effects of closing most of the country.

Again, I think I said exactly all that in my recent post.

As I said, there are two values of lockdowns.

• Firstly, by buying time ('flattening the 'cumulative' curve') they reduce the risk of the NHS being 'overwhelmed' - which, if it happened, would result in considerably more morbidity and mortality (both Covid-related and non-Covid-related) - which makes particular sense as one (hopefully) approaches a target level of vaccination in the population (a luxury which very few countries other than the UK currently have).
• Secondly, by preventing cases (i.e. viral prevalence) soaring one appreciably reduces the development of new variants, any one of which could theoretically put us literally back to the "February 2020 square one". As I think I say before, if a country adopted a strategy which allowed (maybe even encouraged) viral prevalence to soar, that could probably be said to be 'globally irresponsible' - since any catastrophic variant which arose in a particular country would not stay in that country.

Kind Regards, John

 

[SimonH2]

And who would have thought that a seemingly innocuous comment could spark such a long, and interesting, discussion - even without input from BAS
Well I'm double jabbed (as are nearly all the family), but we're all being fairly careful since we have a family member who isn't - and won't be until the baby arrives in Oct. And of course, it's an interesting diversion to consider the relative risks (to mother and baby) of having the vaccine while pregnant, vs the risks to both of them should she catch it - of course, both fairly unquantifiable. Where her partner works they have a weekly PCR test (on-site lab), and over the last couple of weeks they've seen a sharp rise in cases and contacts (though few secondary cases attributable to on-site contact). Not long ago they had several weeks with no cases, from memory (I only have them on my work laptop which is off) this week they are up to 60+ cases and over 100 off work (workforce of about 10k) either positive or isolating after contact. So as employers go, one of the best around in terms of test & trace - though it's relatively easy when you have the power to say "here's the drill - follow it or don't come to work".

 

[JohnW2]

And who would have thought that a seemingly innocuous comment could spark such a long, and interesting, discussion - even without input from BAS

Yes, you're at least partially to blame, but it has, indeed, been a largely interesting discussion so far - albeit with the (I suppose inevitable, in this forum!) not-very-helpful diversion that has occupied most of the last couple of days' posts!

Well I'm double jabbed (as are nearly all the family), but we're all being fairly careful since we have a family member who isn't - and won't be until the baby arrives in Oct. And of course, it's an interesting diversion to consider the relative risks (to mother and baby) of having the vaccine while pregnant, vs the risks to both of them should she catch it - of course, both fairly unquantifiable.

I've recently been on the receiving end of pleas for "advice" from a friend who, rather inconveniently, finds herself to be in the early stages of pregnancy bang slap in between what were meant to be her first and second jabs - and, of course, all the professionals to whom she speaks tell her that "it's her choice" and that they have no reason to advise in one direction or the other - so she turns to me!!

Several proper prospective trials have started in recent times, but results from them will obviously not be available until it's far to late to help my friend or your family member. However, for what it's worth a very large number of pregnant women have now received vaccine (about 100,000, Pfizer or Moderna, in the US alone, so goodness knows how many globally!) and retrospective surveys of them have showed absolutely no evidence that problems with pregnancy or foetus are any more common than one would expect in the absence of vaccination. Given that actually contracting Covid infection whilst pregnant (or in the early weeks/months after giving birth) probably is not too clever an idea, for what it's worth my personal inclination is therefore to suggest that one probably should go ahead with vaccination during pregnancy in the same way that one would in the absence of the pregnancy.

... Not long ago they had several weeks with no cases, from memory (I only have them on my work laptop which is off) this week they are up to 60+ cases and over 100 off work (workforce of about 10k) either positive or isolating after contact. ...

I certainly remain 'nervous'. Just three days before 'Gamble Day', we are still looking at figures which would cause almost any other country (and ourselves in past times) to be substantially tightening restrictions (or even starting a 'full lockdown), rather than abandoning virtually all restrictions, and those figures continue to get appreciably worse by the day. Daily 'new cases' are now up to about 60% of the January peak, hospital admissions approaching 15% of the Jan peak, with ICU occupancy not far behind, and even deaths are now starting to rise quite 'sharply', and there is as yet no so much of a hint of any of the rises 'slowing down' (let alone reversing) - even before we 'do what we are going to do next Monday'.

I therefore remain nervous that 'we' are putting our entire faith/hope in the fact that increasing vaccination (not that there's much scope to do a lot more - see below) will 'turn things around' sometime soon, but there certainly doesn't seem much hope of any signs of that showing itself by Monday, whereafter the vaccine will presumably have an even higher mountain to climb before 'beneficial effects on the current situation start to be seen.

This is all worsened by the fact that the youngest groups currently being offered vaccine (who represent a substantial proportion of those spreading the virus) seem fairly resistant to idea of being vaccinated, and the fact that we haven't yet even decided if we are going to offer vaccine to the under-18s (and I suspect that we won't), who also have a fair bit to do with current transmission. Given the very high level of vaccination in the over-30s that we have already achieved, I'm not sure that there is all that much scope for ongoing vaccination, mainly of the 'hesitant under-30s' to work any great additional magic on 'the figures' in the coming weeks!

Anyway, not long to wait, now. It will probably take a week or two for us to see much of what 'Freedom' is doing to the figures, so we may well have to wait until the end of the month to get a feel for what we are in for. I obviously very much hope that the future proves me wrong, but I wouldn't be at all surprised to see some 'unFreedoming' by the end of August, or fairly soon thereafter!

Kind Regards, John

 

[SimonH2]

I've recently been on the receiving end of pleas for "advice" from a friend who, rather inconveniently, finds herself to be in the early stages of pregnancy bang slap in between what were meant to be her first and second jabs - and, of course, all the professionals to whom she speaks tell her that "it's her choice" and that they have no reason to advise in one direction or the other - so she turns to me!!

Lucky you

However, for what it's worth a very large number of pregnant women have now received vaccine (about 100,000, Pfizer or Moderna, in the US alone, so goodness knows how many globally!) and retrospective surveys of them have showed absolutely no evidence that problems with pregnancy or foetus are any more common than one would expect in the absence of vaccination.

Yes, I was thinking that might well be the case - in fact, it's inevitable given the number of people involved.

Given that actually contracting Covid infection whilst pregnant (or in the early weeks/months after giving birth) probably is not too clever an idea, for what it's worth my personal inclination is therefore to suggest that one probably should go ahead with vaccination during pregnancy in the same way that one would in the absence of the pregnancy.

That was my feeling too. Especially as our 5 year old grand daughter starts that festering petri dish of infections called school about a month before no 3 is due.

But it's not my decision to make ...

 

[JohnW2]

Yes, I was thinking that might well be the case - in fact, it's inevitable given the number of people involved.

Although we have to wait a good while for results of the formal trials, there is a lot of observational data out there and, as I said, none has so far given any indication that any of the vaccines result in any noticeable difference in problems with either the pregnancy or the foetus than one would expect in the absence of vaccination.

That was my feeling too. ...... But it's not my decision to make ...

Indeed. If it were myself, I think I would probably consider it to be a 'no-brainer', given the current absence of any suggestion of a problem with the vaccine, and the fact that Covid infection during pregnancy, or in the months thereafter (when one would also be exposing a non-immune neonate to infection) would potentially be 'bad news' (or, at the least, 'not desirable' - but pregnant women are, understandably, always ultra-sensitive and ultra-cautious about such matters.. My friend is not even all that young (around 40, the pregnancy being the result of the third round of not-very-well-timed IVF!), so the risks to her of serious Covid infection (even including death) are far from zero. Fortunately, the opinion I offered (I certainly wouldn't describe it as 'advice'!) seems to correspond with her own thinking and what others have said to her, so I think she'll probably go ahead with the second dose as scheduled in about 3 weeks time (she's currently around 6 weeks pregnant).

.... Especially as our 5 year old grand daughter starts that festering petri dish of infections called school about a month before no 3 is due.

Indeed. We have two grandchildren, one just over 3 and the other 14-15 months (all of whom were infected with Covid, despite being essentially 'isolated', back in January!). With mother's maternity leave coming to an end and her having to return to work (for the NHS), both children theoretically started going back (for the first time for the little one) to a 'nursery' for a few sessions per week a couple of months ago, but neither has actually attended the nursery very much, since they have repeatedly picked up infections. The poor little one must have had half a dozen Covid tests in as many weeks, because of 'elevated temperature'! Dad refers to the nursery not as a petri dish but, rather as "The Infection Exchange"!

Kind Regards, John

 

[JohnW2]

... On the bigger picture, I also wonder if, at the end of all this (if it does ever end), we will look back in amazement at the damage that has been caused. .... I wonder how many excess cancer deaths we might expect over the coming years. I wonder how the 13 million waiting for NHS treatment will fare over the years they will be kept waiting, how many will commit suicide, how many will be dependent on meagre state provision.

I'm not sure whether you are still 'with us' but, looking back, I don't think I responded very fully to the above, and it becomes even more of an issue in view of how things continue to evolve ...

... a good few people have presented that argument and I have always had to ask them (and now ask you) what you think happens if one does not have NPIs such as lockdowns etc.

As I think most people are agreed, the primary purpose and value of NPIs (such as 'lockdowns') is to limit peak demand on NHS resources ('flattening the {cumulative} curve', as EFLI {and many others} put it) - specifically in order to minimise the collateral effects to which you refer (as well as treating Covid infection itself).

As a result of not have tightened restrictions in recent times, we are already seeing many hospitals cancelling much of their 'non-urgent' surgery, appointments and other activities, so that those waiting lists are already lengthening because of the inadequacy of current restrictions.

With (Covid-related) increases of demand on NHS resources continuing to rise quite rapidly, if it hasn't already happened (which it probably has), we are bound to also see delays in diagnosis and treatment of cancers and many other serious illnesses, including mental health problems (hence potential suicides as you mention), again because of the inadequacy of current restrictions.

So, if those 'collateral' problems which (understandably) concern you are currently getting progressively worse because of the inadequacy of current restrictions, it might be said to be a little odd that we are about to abandon virtually all of those (already 'inadequate') restrictions, mightn't it?

Kind Regards, John

 

[EFLImpudence]

Dad refers to the nursery not as a petri dish but, rather as "The Infection Exchange"!

Does your graph in post #6 not show that schools have had no effect on cases.

 

[JohnW2]

Does your graph in post #6 not show that schools have had no effect on cases.

Yes, more-or-less - which somewhat surprised people. However, when schools first re-opened (and when they again re-opened after the Easter holiday), the prevalence of the virus was extremely low, so it's perhaps not so surprising that there was no marked effect.

However, I was talking about nurseries, which are a totally different kettle of fish from schools. People who start working in nurseries etc., or as 'early years' primary school teachers are commonly almost 'permanently ill' (with assorted viral upper respiratory tract infections) for the first year or two in that role. What, if anything, that means in terms of Covid, I have no idea.

As you can see from that graph, it was the 17th May relaxation (which allowed up to 6 people to meet indoors, in domestic and other environments etc.) that caused things to start going somewhat pear-shaped.

Kind Regards, John

 

[EFLImpudence]

As you can see from that graph, it was the 17th May relaxation (which allowed up to 6 people to meet indoors, in domestic and other environments etc.) that caused things to start going somewhat pear-shaped.

Wasn't that the introduction of the Delta variant?

 

[JohnW2]

Wasn't that the introduction of the Delta variant?

Yes, that's roughly when the delta variant started to become relevant, which obviously makes interpretation ('finger-pointing') difficult.

We had the same problem back in December. The ending of the November lockdown just three weeks before Christmas (which resulted in countless people rushing to shops, hairdressers, pubs and goodness knows where else) more-or-less coincided with the alpha variant becoming significant - so, again, it's difficult to know to what extent the relaxation of restrictions was the cause of the subsequent large increase in transmissions/infections that we saw.

Edit: I forgot to add that, no matter how much more transmissible the delta variant was, and no matter to what extent it was responsible for the rapid increase in cases after 17th May, that increase would inevitably have been less had we not simultaneously ('co-incidentally') relaxed the restrictions on inter-personal contact/proximity.

However, we just need to be a little patient, since it will presumably only be a couple of weeks or so before we know the effect of further relaxations (without the identity of the variant changing).

Of one thing we can be sure. As I've been saying to echoes, one does not need data, mathematics or any knowledge of rocket science to know that if one relaxes restrictions on inter-personal contact/proximity, then the transmission of any variant of any virus will increase. So what we are waiting to discover is 'how much increase', not whether there will be an increase.

Kind Regards, John