Search results for:

Slightly off topic but I thought this recent Graun article on how they eradicated smallpox was really interesting

https://www.theguardian.com/science/2020/nov/21/it-was-a-total-invasion-the-virus-that-came-back-from-the-dead

Tl;dr they used a tracing strategy and vaccinated all the contacts of each case to cut off the spread

Sorry!! Hooked every time

I’m also not brilliant at stats but I’m not sure this is something where “significance” testing would apply as there is no (or very little) uncertainty in the numbers. These aren’t sample means used to estimate the true population figure - they’re hard numbers for the whole population, on a measure (death) which is traditionally hard to miss for recording purposes, so it’s either higher or it isn’t.

Whether the rise is significant in terms of its impact on society/the economy etc is obviously a different question.

Not correct. Deaths have been above the 5 year average for the last 4 weeks according to the ONS data.

Taken from a cohort of 25,000 patients described here:

ISARIC May COVID report

“Any other” includes stuff like muscle pain, confusion, vomiting, diarrhoea.

This is only for patients admitted to hospital though, not milder community cases.

Yeah I wonder if a positive test would have pinged up in the test & trace system and been texted to you outside of the ONS framework. Might be expecting too much though...

Yeah we’ve been told to deactivate the contact tracing function when we’re at work. Meaningless otherwise.

Fair bit written about the track & trace part in Private Eye - some of it was being done by local government, outsourced bit mostly Serco I think?

The 9th July episode of their podcast (Page 94) is good, goes into the relative success of the (in house) furlough scheme + in house portion of track & trace vs the disaster of the outsourced bit.

The care home death numbers are a massive scandal but I think the media focus purely on case numbers & deaths misses the point that hospitalisations are a much bigger problem. From a "keeping the system afloat" perspective care home residents dying without going to hospital places very little strain on the NHS. Large numbers of younger people getting sick and spending a few days in hospital or a few weeks in ITU is a nightmare.

Like you say, there were a lot (~20,000 iirc?) of care home deaths in the March/April wave. If even 5,000 of those had instead been hospitalisations of younger patients the NHS would probably have keeled over, certainly in London/Birmingham. Hospital admissions starting to rise again should be a massive signal that some kind of intervention is needed...not sure what form that should take (hopefully Chris Whitty has some ideas).

They don’t really think it’s more efficient, they’re just ideologically opposed to the state providing any form of services itself. On top of that they’re eyeing up the cabinet -> private sector revolving door and they know the shoddy contracts that prioritise private sector profits keep it spinning.

Looking purely at that paper’s methodology - by meta-analysing each hospital’s odds ratio for a time effect, they all end up equally weighted. Surely higher volume centres should count for more. They also report a significant date of admission x mortality effect for Nottingham, but looking at the numbers they had a pretty consistent 25-30% mortality when there were 100-200 admissions, and then it jumps all over the place when the numbers are smaller.

It’s possible that temperature has an effect, but I’d be interested to see some analysis of air quality in these cities over the course of the pandemic as lockdowns take effect, and some kind of measure of “overwhelmedness” eg analysis of total daily hospital admissions vs normal number of beds & covid mortality.

I don’t think it’s totally implausible that treatment did massively improve. Difficult to overstate how quickly the understanding of the disease changed - even from March to April the way we were treating the patients changed significantly.

https://www.rosebikes.co.uk/schwalbe-g-one-allround-performance-classic-skin-folding-tyre-28-2686865?product_shape=Classic+Skin&article_size=700x35C

Googling the “EAN” number from the Schwalbe site often seems to bring up deals

FWIW I’ve been running the Pirellis (35c, tubeless) for most of the year. They’re lovely. Grippy in the wet, roll well, quite a thick tread so fairly durable. Not sure if they’re as good in smaller sizes/tubed.

A few points:

I agree with you that the government advice on completing MCCD’s is an exercise in arse covering. The advice that putting “COVID19” as a cause without a positive swab would be ok was inserted in late March/April after rising pressure over deaths in nursing homes. Because of a lack of community testing, GPs essentially felt the government was covering up the community death toll (which was happening almost entirely in nursing/resi homes), and getting away with its scandalously poor policies regarding discharges recovered covid patients back to care settings. The ideal situation would obviously have been widespread testing and a track/trace/quarantine approach directed at individuals testing positive. If your contention is that the government is criminally fucking useless, you’ll get no disagreement from me.

It’s very clear from the weekly death figures on the ONS website that total weekly deaths this year approximately track the previous 5 year averages, until the week where covid deaths start rising. At this point the total weekly deaths for England and Wales begin significantly exceeding the previous 5 year average.

https://www.ons.gov.uk/file?uri=%2fpeoplepopulationandcommunity%2fbirthsdeathsandmarriages%2fdeaths%2fdatasets%2fweeklyprovisionalfiguresondeathsregisteredinenglandandwales%2f2020/publishedweek192020.xlsx

I accept that many of the deaths may be due to underlying disease that has been exacerbated by covid. Take it from me that the patient dying of a heart attack brought on by covid and massive hypoxia doesn’t particularly care about the chicken & egg sequence of events. It is likely that significant portions of those people would not have died without this pandemic.

The “deaths due to respiratory causes” count will be lower this year as the ONS is excluding covid from that figure, and the group that are most at risk for respiratory disease are obviously also very high risk for covid. It will still accurately reflect in hospital flu deaths, as it always does, because covid admissions are also tested for flu.

Regarding your assertion that if you test more you find more - I would agree with this, if we had in fact tested more. In practice our testing regime looked very similar to the usual flu set up - those who were sick enough to get to hospital got tested. People who had mild symptoms in the community were told to stay away from GP surgeries and not tested. Many of my colleagues who were ill in the early stages of the pandemic were unable to access testing, such was the shortage of kits.

Completely agree - flu + vaccine vs C19 + shutdown is apples and oranges

Sorry to return to this but the flu/covid comparisons really annoy me.

With regards to the claim that 2018 had 50,000 excess deaths due to the flu vaccine being ineffective - this is not an accurate picture.

The flu report for that season estimates the number of deaths attributable to flu at 15,000 (page 47):

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/740606/Surveillance_of_influenza_and_other_respiratory_viruses_in_the_UK_2017_to_2018.pdf

Covid has already killed 40,000 people in the UK in 10 weeks. This is in addition be deaths due to flu from the 2019/20 season, and other excess deaths from heart disease/respiratory disease exacerbated by cold weather (disproportionately affecting the worst off who are more likely to live with fuel poverty and have less access to preventative medicine).

Even leaving aside the issue of excess mortality and C19 - the strain it places on NHS resources puts it in a totally different league to seasonal flu.

The latest ICNARC report shows that there were 5,782 admissions to ITU with confirmed viral pneumonia between 2017-2019. There have been 8,250 admissions to ITU with COVID in the last 10 weeks. Regardless of how many excess deaths it is causing, COVID is creating massive amounts of work for already stretched critical care departments.

https://www.icnarc.org/DataServices/Attachments/Download/b8c18e7d-e791-ea11-9125-00505601089b

The impact this will have on the way the NHS functions over the next 6 (and possibly 12+) months is staggering and facile flu/covid mortality comparisons completely miss this larger point.

Pirelli Cinturato come in 35mm - have bought a pair to replace my slowly falling apart GK’s.

Wondered about trying the GK plus for a bit more durability but could only find them for ~£50 a tyre.

The final point I will make is that it will take a long time to ascertain the true excess death rate from C19. There will be deaths due to indirect causes, mostly the breakdown in care provision for heart attacks / strokes, and the suspension or limitation of cancer surgery and oncology treatments.

@Mr_Bump The reason (as I’m sure you know) we do not all go into lockdown over flu every year is because there is a (admittedly varyingly effective) vaccine. This allows us to protect the most vulnerable (elderly, COPD, HCW’s) directly and protect the rest of the population indirectly via herd immunity. That option is not available with C19 hence social distancing etc in lieu of that.

Saying that C19 caused less deaths in China that seasonal flu, and that this shows we’re overreacting, is nonsense. The C19 deaths occurred in the context of massive military enforced lockdown and building extra hospitals to cope with admissions. The only relevant statistic would be flu deaths in Wuhan vs C19 deaths in Wuhan.

Additionally, I’m not sure your point about more surveillance for C19 be flu is correct. The detection rate of severe cases of flu should be high atm - all suspected C19 cases that are tested are also swabbed for flu, RSV etc.

An ICU admission rate of 0.22/100k per week would give 13.2 new ICU cases per week assuming a London population of 6 million.

As of yesterday, there are 230 ventilated C19 patients in London. These have presented almost entirely in the previous 10 days. Even if you assume that’s 2 weeks worth of admissions it’s a rate of ~2/100k population, so 10x your flu figure.

The BMI vs age distribution for the UK is similarly shaped so possible red herring. Reports from France that obesity was a common comorbidity in younger critically ill patients so maybe the metabolic component does predispose patients to more severe illness.

Clever Mike: absolutely top notch service. Negotiated me a brand new Arkose off the insurance in no time at all. Will be back for sure.

As you say there’s good evidence that vaccinating over 65s or people with risk factors (emphysema, cancer, heart disease) for pneumococcus as a one off, in addition to the yearly flu shot, reduces mortality. Bacterial pneumonia during/following flu is a big cause of death and the one common cause we can vaccinate against is pneumococcus.

Extrapolating that to COVID:
a) who knows if superinfection will be a big issue - although seems reasonable to assume it will be - the people with risk factors might not make it through the initial viral infection
b) are there any risks to receiving the vaccination potentially days-weeks before a COVID infection (altered immune response etc) - no idea

Basically the point I was making, yeah. They’re using a cocktail of HIV meds and chloroquine as well, again based on some suggestive lab data & anecdotal/case series stuff from China.

Mostly though what the really sick patients need is an ITU bed, with all the bells and whistles (maybe apart from ecmo), with nurses & docs to staff it. Unfortunately in Lombardy the huge peak of infections has overwhelmed their (significantly better resourced than the uk) critical care network.

The latest consensus from north Italy is just that tocilizumab might have a theoretical benefit. It isn’t without side effects and there are difficult decisions about when to use it. If you’re a mild/moderate case who is likely to recover, why risk it. Equally if you’re critically ill on ITU and at huge risk of superinfection, are we really so sure that it works that we’ll risk immunosuppression. Not convinced it’ll be making its way into the treatment guidelines in the UK.