Good points about lockdown from Doublethink. I take the point that releasing it risks fresh peaks. With regard to herd immunity, that figure of half a million dead is unpleasant. It's also producing odd stories, e.g., that keeping schools open helps the virus spread, which we want. Gulp.
Fresh joke, that we are playing Russian roulette with 2 bullets in the chamber. Ha ha.
One of the problems being that UC is designed to be very difficult to claim. To claim UC you need to prove your identity, which is almost impossible unless you have photo-id (passport or driving license) and able to travel to your local job centre to have someone look at that and confirm you're the same person ... presumably the intention is that someone self-isolating doesn't walk into their local job centre.
I believe they are relaxing the conditions - though they hope most self-employed will be able to claim contributory employment and support allowance.
The problem is that both SSP and ESA are paid at a woefully low level compared with even minimum wage, never mind average earnings. If you've no financial cushion you're buggered.
Adam Kucharski (epidemiologist) has some interesting points on his twitter thread. First, that herd immunity need not be pursued, but may be a side effect. Two, the virus is uncontrollable. Three, Wuhan has not removed the virus, nor made people immune. Plus, multiple counter-arguments.
One of the problems being that UC is designed to be very difficult to claim. To claim UC you need to prove your identity, which is almost impossible unless you have photo-id (passport or driving license) and able to travel to your local job centre to have someone look at that and confirm you're the same person ... presumably the intention is that someone self-isolating doesn't walk into their local job centre.
I believe they are relaxing the conditions - though they hope most self-employed will be able to claim contributory employment and support allowance.
The problem is that both SSP and ESA are paid at a woefully low level compared with even minimum wage, never mind average earnings. If you've no financial cushion you're buggered.
Yes, it is crap - but it is something, also we are starting to see some self-interested ‘altruism’ from the gig economy - Deliveroo are setting up something for their riders etc.
I think renters are in a difficult position, banks are starting to say they’ll defer mortgage repayments. What we need to see, is the government also extend housing benefit for existing tenancies above current thresholds on at least a temporary basis - for those whose suddenly lose income.
Yes, I did try to read that book, but I found his rhetorical style rather wearing.
There is a danger of people extrapolating pure mathematical or economic models - they often assume people act rationally, or if they don’t their irrationality is random. But people, and groups of people, have systematic biases in their thinking.
All Episcopal Churches in Northern California are closed for Sunday worship going for video services, Methodist Churches at least in my area are full speed ahead, but saying if you are sick or traveled stay home.
Some good news is: a Dutch group of scientists say they have isolated an antibody to the virus. Obviously, their results still need to be scrutinised - but it is heartening to the see the basic scientific building blocks that will be necessary for a vaccine slotting into place.
I read a paper on the genetic analysis on the covid virus, they’d tracked genetic mutations and reckoned that the disease was detected within weeks of crossing the species barrier into humans. In many ways that is an incredible achievement.
Link? Cautious optimism from Saskatchewan via NOprophet_NØprofit above too.
Some good news is: a Dutch group of scientists say they have isolated an antibody to the virus. Obviously, their results still need to be scrutinised - but it is heartening to the see the basic scientific building blocks that will be necessary for a vaccine slotting into place.
I read a paper on the genetic analysis on the covid virus, they’d tracked genetic mutations and reckoned that the disease was detected within weeks of crossing the species barrier into humans. In many ways that is an incredible achievement.
Link? Cautious optimism from Saskatchewan via NOprophet_NØprofit above too.
It was on the BBC live feed:
The researchers at the Erasmus Medical Centre and Utrecht University describe their discovery as an antibody to Sars2, the coronavirus causing the current pandemic (Covid-19).
The scientists were already working on an antibody for Sars1 and when the new coronavirus broke out, they said they had found that the same antibodies cross-reacted and blocked the infection.
Their findings are still being reviewed and the antibody is yet to be rigorously tested.
I was just thinking, dangerous habit I know, I’m aware that final year nursing students are being invited in to support the NHS.
It’s really hard to make more doctors and nurses and quickly. However, if you need people who understand disease, and understand infection control, and understand how medications work etc etc.
Could you use veterinary surgeons and veterinary nurses as a stop gap, with some induction, for a limited range of functions ? Wound care & basic nursing for example - to free up more professionals for complex care provision ?
Our vets are allowed to undertake human surgery in an emergency (usually discussed in the context of the island being stormbound). Generally it's understood that the stitches might be a bit rough.
They are quite tightly regulated, but both vets and vet nurses do complex stuff like monitor anaesthesia. I know they often also use human drugs off label because there aren’t animal equivalents in many cases, and also often use older second hand medical equipment originally designed for humans.
But I just wonder in a crisis like this - if the prep work were done - they could be drafted to support medical care during the peak weeks of the epidemic. There are about 20,000 vets in the UK and over 12,500 veterinary nurses.
Our vets are allowed to undertake human surgery in an emergency (usually discussed in the context of the island being stormbound). Generally it's understood that the stitches might be a bit rough.
Why?
Some kittens are tiny when they are operated on = tiny tiny stitches.
Our vets are allowed to undertake human surgery in an emergency (usually discussed in the context of the island being stormbound). Generally it's understood that the stitches might be a bit rough.
Why?
Some kittens are tiny when they are operated on = tiny tiny stitches.
Tiny but not necessarily neat or even. Also, our vets have way more experience of bovine caesarians than anything involving small animals.
Adam Kucharski (epidemiologist) has some interesting points on his twitter thread. First, that herd immunity need not be pursued, but may be a side effect. Two, the virus is uncontrollable. Three, Wuhan has not removed the virus, nor made people immune. Plus, multiple counter-arguments.
Here? AFAIK he's would have been one of the epidemiologists who gave evidence to the government.
And a group of behavioural scientists have co-signed a letter which essentially asks the government to show its working:
"While we fully support an evidence-based approach to policy that draws on behavioural science, we are not convinced that enough is known about “behavioural fatigue” or to what extent these insights apply to the current exceptional circumstances."
Our vets are allowed to undertake human surgery in an emergency (usually discussed in the context of the island being stormbound). Generally it's understood that the stitches might be a bit rough.
Why?
Some kittens are tiny when they are operated on = tiny tiny stitches.
Tiny but not necessarily neat or even. Also, our vets have way more experience of bovine caesarians than anything involving small animals.
My pups neutering scars have all been very neatly stitched. I took a photo once it was so neat.
Adam Kucharski (epidemiologist) has some interesting points on his twitter thread. First, that herd immunity need not be pursued, but may be a side effect. Two, the virus is uncontrollable. Three, Wuhan has not removed the virus, nor made people immune. Plus, multiple counter-arguments.
Here? AFAIK he's would have been one of the epidemiologists who gave evidence to the government.
And a group of behavioural scientists have co-signed a letter which essentially asks the government to show its working:
"While we fully support an evidence-based approach to policy that draws on behavioural science, we are not convinced that enough is known about “behavioural fatigue” or to what extent these insights apply to the current exceptional circumstances."
That’s interesting, though I do wonder why the British Psychological Society hasn’t said anything - or signed it.
It’s looks like the initiative started in the University of Warwick.
Adam Kucharski (epidemiologist) has some interesting points on his twitter thread. First, that herd immunity need not be pursued, but may be a side effect. Two, the virus is uncontrollable. Three, Wuhan has not removed the virus, nor made people immune. Plus, multiple counter-arguments.
Here? AFAIK he's would have been one of the epidemiologists who gave evidence to the government.
And a group of behavioural scientists have co-signed a letter which essentially asks the government to show its working:
"While we fully support an evidence-based approach to policy that draws on behavioural science, we are not convinced that enough is known about “behavioural fatigue” or to what extent these insights apply to the current exceptional circumstances."
Interestingly, the Guardian published an article yesterday, based on input from “Prof Susan Michie, director of the Centre for Behaviour Change at University College London and a member of the government’s advisory group, the Scientific Pandemic Influenza Group on Behavioural Science”.
It includes links to some evidence cited by Prof Michie. The Lancet review of studies, which is one of the sources mentioned, is particularly alarming in relation to the negative effects of extended quarantine (e.g. correlations with long term PTSD, alcoholism, substance abuse).
[It’s fair to say there is little direct mention of the term “behavioural fatigue” in the reports cited, but I think that is because it is not a term of psychological research - it could be that the term is rather inexact shorthand intended to be simple for the general public. If you search on behavioural fatigue through (e.g.) Google Scholar, it’s actually a term used in relation to quite a different field. I wonder if this casual shorthand has muddied the waters, or if the government does not wish to say highlight that the most extreme measures might have the negative outcomes foreseen by The Lancet?]
Robert Peston is reporting the government are considering enforcing quarantine for people over 70 in the next 5 to 20 days - for *four months*. This what they were referring to as “cocooning”. It is unclear at what point that will go ahead yet.
Robert Peston is reporting the government are considering enforcing quarantine for people over 70 in the next 5 to 20 days - for *four months*. This what they were referring to as “cocooning”. It is unclear at what point that will go ahead yet.
Problems of that kind would be one of the reasons for delaying these measures as long as possible.
Though in the case of, say, my parents - if they don’t get ill they don’t need carers they live independently. But they would need regular supplies delivering and social contact via phone and email.
Robert Peston is reporting the government are considering enforcing quarantine for people over 70 in the next 5 to 20 days - for *four months*. This what they were referring to as “cocooning”. It is unclear at what point that will go ahead yet.
Robert Peston is reporting the government are considering enforcing quarantine for people over 70 in the next 5 to 20 days - for *four months*. This what they were referring to as “cocooning”. It is unclear at what point that will go ahead yet.
This is probably going to be a long post. Apologies in advance but if you want a one-sentence summary; it's complicated.
The key concept here is Excess Mortality. This is so critical because even talking about Covid-19 deaths is misleading. The problem is that it is only in retrospect that this can be properly calculated. This is a really good paper on excess deaths following Hurricane Maria in Pueto Rico. You see, a hurricane might kill you by destroying the building you happen to be in or by drowning you in a flood. However, that is only a minority of the deaths and the least modifiable of the causes. In this kind of situation, there will also be people who are killed in road accidents directly related to the hurricane. If a tree is blown down on the highway in front of you and you can't swevre to avoid it, that it's clearly both a RTA and a hurricane-related mortality. It gets a lot more complicated when you look at people dying from medical conditions because, obviously people are dying all the time, but if the local medical facilities suddenly have no power or water then clearly your risk of dying from say a chest infection or heart attack is higher than the baseline before the hurricane struck. Equally, not all deaths in the weeks following a hurricane will be actually due to the hurricane (because, as we just noted, people are dying all the time).
One of the things that's important when looking at outcomes from a disease or intervention is to look at the All-cause mortality as opposed to the disease-specific-mortality. A simple example of this is in cancer treatment, the all-cause mortality is much more relevant than the cancer-one in many cases. This is because many chemotherapy agents are cardio-toxic. Hence the proximal cause of death is often cardiac (i.e. a heart attack) but it's still a result of the cancer because (obviously) one would not need the chemotherapy without the cancer in the first place. Hence for a patient with a new diagnosis of cancer, any estimate of their survival that's based on the cancer-mortality alone will be inaccurate - one is just as dead regardless of what the terminal event actually is. So, in most situations, all-cause mortality is the key figure.
As @Doublethink noted above, for all intents and purposes this is not a virus that we can irradicate or prevent from spreading. Theoretically, all sorts of things are possible - if when the virus was limited to China alone, someone had set off multiple nuclear warheads in China, it might have been possible. If we take a step back from the obviously ridiculous, we are talking about a disease that has a low mortality and a very-high infectivity. That from an infection-control perspective is a terrible combination. Contrast that with Ebola, which has a very high mortality (and is actually relatively difficult to catch) and you see why until the 21st century, all Ebola outbreaks burned themselves out very quickly. Killing the host is, for the most part, a dead-end for the virus (if you pardon the pun). Ebola was identified in 1976 (although it no-doubt has existed for thousands of years, unlike HIV which probably began around 1920*) until about 2010 the total number of known deaths from Ebola was only a few hundred. It would spring up, kill off a village or two and then run out of hosts and disappear. If it wasn't for the fact that Ebola exists in a non-human animal host it would die out completely. ** However, each outbreak begins with a species jump from monkeys to humans. Ebola has another quirk in that when people die from it, the body sheds viral particles at an incredible rate. Hence the burial and post-death rituals of the various cultures afflicted are a major means of spread. With each outbreak, the use of specialist burial teams is probably the most important intervention in preventing further infection. I apologise for this tangent but it is relevant in that Ebola is actually relatively easy to control; Covid-19 is the opposite of this; it is very transmissible, by aerosol means and seems to survive very well on human skin and surfaces. Put all this together and you realise that there is no real way to stop the virus spreading through our population. You could do all sorts of aggressive and draconian things (short of a nuclear strike, I mean!) but ultimately they would almost certainly cause more harm than good (and there's a good chance you'd miss something or someone and the disease would escape anyway). If you think about it, restrictive measures have big consequences. In some situations, these consequences will be fatal, indirectly maybe but nonetheless there are real risks to draconian interventions that cannot actually stop the spread of the virus.
The next point that is important to understand is that reported Covid-19 death numbers are not necessarily correct. Coincidentally, the last BBC News radio report I heard had it right as they said Ten more people have died having tested positive for Coronavirus. Though I doubt the distinction will be noted by many, it is important. I do not want to sound callous but the truth is that vulnerable people die. That's pretty-much the definition of vulnerable. Some of the deaths we are seeing happen to be due to Covid-19 but if it wasn't Covid-19, it would be influenza or cardiac disease or a stroke or pneumonia or whatever. Again, the person is just as dead regardless of the cause. What I mean is that if you take a group of say 100 'vulnerable people,' in a year's time only 85 (or whatever) of them will still be alive. If the advent of Covid-19 means that in a year's time the number is still 85 then it hasn't changed the mortality rate at all. It could easily be the case that some of the 15 who died tested positive saying that the deaths are due to Coronavirus is not particularly informative. Especially on a public health level. In reality, probably the number still alive will drop from this theoretical 85 to 50 or 70 or 80 or whatever. The difference between the expected mortality and the actual one with Covid-19 added in is the excess mortality.
It does get more complex still because we must also consider the people dying from other causes who would not have died if Covid-19 wasn't around. Primarily we are talking about people who have other life-threatening conditions who suffer worse outcomes because the healthcare system is swamped by Covid-19 patients.
So, when you put all this together, the aims of any government intervention must be to minimize the number of excess deaths. Given that preventing this virus from spreading through the population is practically not possible, there clearly is merit in slowing the spread in order to flatten the peak of the cases so that healthcare services are better placed to cope with demand. As has been mentioned the nightmare scenario is 20 patients needing a ventilator and only 10 ventilators being available. There is very little spare capacity in UK healthcare. I'll come back to that point because that is the political bit. Closing schools is a debatable point. Childen appear not to be at risk. Even children with respiratory diseases*** thus far do not seem to be suffering severely. Hence closing a school will not benefit them directly although it might slow community spread to the benefit of other groups. However, closing schools would have a big effect on healthcare staffing levels and that could be a major problem.
Robert Peston is reporting the government are considering enforcing quarantine for people over 70 in the next 5 to 20 days - for *four months*. This what they were referring to as “cocooning”. It is unclear at what point that will go ahead yet.
I think it will surprise none of you that I have zero confidence in Mr Johnson as a leader in this crisis. It is also important to note that the NHS has no spare capacity because of a decade's worth of stupid 'efficiency savings'**** - because this government (and its immediate predecessors do not seem to grasp the concept of strategic reserves). It is also important to remember that public health funding was decimated by Osborne because that's not front-line and thus you can fool the public with it. Public health is however the most cost-effective healthcare spending - creating far more benefit for far more people than the work I do. Our public health service has a fraction of the resources it had a decade ago. That's not ideal when faced with a crisis like this one.
However, it is impossible to know how well the government is currently managing the situation - it is entirely plausible that this is best policy - especially when you have to factor in behavioural psychology along with the viral epidemiology.
The excess mortality will be the key indicator.
AFZ
*HIV-1 and HIV-2 separately mutated from SIV (Simian immunodeficiency virus) - the equivalent disease in monkeys. Tracing the variability of the viruses means you can trace back how long HIV has existed and it's only about 100 years.
**The animal host for Ebola has never been found but it's almost certainly simian. We know there is a reservoir because otherwise, the virus would have died out completely. I don't know if Covid-19 has any animal hosts or not - I gather that it has recently been shown that dogs are safe. Again from an infection control perspective; the worst option is asymptomatic infection in animals and thus maximal spread.
***This is where it gets personal, my nephew has Cystic Fibrosis and so is potentially more vulnerable.
****There are efficiency savings to be made in all systems but for the most part, the past decade has seen our NHS stripped to the bone with alleged efficiencies creating significant weaknesses. Strategic reserves are critically important. Literally life and death but in normal circumstances, you can safely do away with them. Safe until it's not!
Israel (State of): all schools and preschools closed from tomorrow till the end of April. Ditto cafes, restaurants, theatres and other "places of entertainment", gyms. No public indoor gatherings over 10 people and the usual social distancing and handwashing protocols. Widespread lay-offs in tourism already and by the middle of next week there will be close to zero tourists.
Call ups of reservists (mostly Home Front battalions) and restricted leave for regular serving soldiers
Banks have given people the next 3 months off (free of) their mortgage payments though.
God alone knows what will happen over Easter, Pessach (8-15 April), and Ramadan (23 April -23 May)
No actual government as yet either ...
The animal host for covid is believed to be a variety of horseshoe bat, possibly via a pangolin being traded in a market in Wuhan. The last SARS virus also came from bats.
(It is possible we have fallen victim to Dracula’s radical change of strategy, now everybody knows to do a cross with their fingers.)
The animal host for covid is believed to be a variety of horseshoe bat, possibly via a pangolin being traded in a market in Wuhan. The last SARS virus also came from bats.
(It is possible we have fallen victim to Dracula’s radical change of strategy, now everybody knows to do a cross with their fingers.)
FYI Corbyn has published his latest letter to the pm, it appears there are ongoing discussions re the emergency legislation, and they have agreed human rights protections, strict time limits to the emergency law and no so called “Henry VIIIth powers” (no messing with primary legislation).
So it will be less democratically risky than the civil contingencies act.
When people say, people pulled together during the war - they forget, for example, the black market profiteering to evade rationing (that the government was trying to enforce) to ensure everybody had enough food and clothing
The wartime example that's come to my mind is evacuation -- as I understand it, there was a pattern of children being evacuated to the countryside in 1939, but families then getting dissatisfied with this and bringing them back to the cities just in time for the bombs to start falling in a big way in 1940. (That's certainly what happened to my mother, although her year in the country was with relatives rather than strangers).
The problem is whether the government has the ability to control either the width or the height of the peak to the degree they appear to think they have. By betting the house on the width (which is, IMO, favours the economy, not public safety), they risk the height.
In general I'm all in favour of prioritising health and the environment over the economy, but I can't help thinking that if too much damage is done to the economy that will be bad for public health in both the short and the long term (stress, suicide in the worst cases, inability to afford a healthy diet, and less money for the NHS for years to come), which could in itself cause quite a lot of deaths.
Also, if people's livelihoods are put at risk by disease control measures, that gives them a strong incentive not to comply (or to encourage others not to).
These are just some thoughts, not policy recommendations. I'm not a big fan of the current UK government, but I have sympathy for anyone (politicians as well as public servants) having to make decisions about this -- no-one knows quite what is going to happen, and it seems likely that if their measures succeed they'll get blamed for over-reacting, and if they don't they'll get blamed for not doing enough.
"We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy."
A reminder that Gordon Brown spent nearly a trillion on bailing the banks out last time they fucked up.
Giving people money no-strings-attached during a lockdown will prevent the scenario you outline above.
That may well be a good idea, but there's probably a need to ensure that people have jobs to go back to as well as ensuring that they can get by while they can't do their jobs; do we know how the cost of the bank bail-out compares with several months of life support for most of the tourism/hospitality industry, the non-essential parts of the retail sector, and anything else that depends on people leaving their homes for non-essential reasons. (This is a genuine question -- I've no idea).
And the more money that is spent, the more the reason/excuse for governments to spend less in the following years.
The animal host for covid is believed to be a variety of horseshoe bat, possibly via a pangolin being traded in a market in Wuhan. The last SARS virus also came from bats.
(It is possible we have fallen victim to Dracula’s radical change of strategy, now everybody knows to do a cross with their fingers.)
If we're allowed a note of humour in this thread, can I ask if anyone else has come across the typo 'corvid-19'. It sounds like some kind of mythological crow symbolising pestilence; I wouldn't be surprised if someone on the Ship knows of an example from actual mythlogy.
By the Next Big One, I mean a murderous pandemic that sweeps around the planet, killing millions of people, as the so-called “Spanish” influenza did in 1918-19, as AIDS has been doing in slower motion, and as SARS might have done in 2003 if it hadn’t been stopped by fast science, rigorous measures of public health, and luck.
They also wrote:
Wild aquatic birds defecate in a village duck pond, passing a new strain of influenza to domestic ducks; the ducks pass it to a Chinese boy charged with their care, after which the boy passes it to his brother and sister. A man in Cameroon butchers a chimpanzee and, elbow deep in its blood, acquires a simian virus that becomes HIV-1. A miner in Uganda enters a shaft filled with bats carrying Marburg virus and, somehow, by ingesting or breathing bat wastes, gets infected.
Stopping all trade in wildlife would be a start.
Food security for everyone in the world would be a start.
Understanding that we're all one human family would be a start.
A reminder that Gordon Brown spent nearly a trillion on bailing the banks out last time they fucked up.
Giving people money no-strings-attached during a lockdown will prevent the scenario you outline above.
That may well be a good idea, but there's probably a need to ensure that people have jobs to go back to as well as ensuring that they can get by while they can't do their jobs; do we know how the cost of the bank bail-out compares with several months of life support for most of the tourism/hospitality industry, the non-essential parts of the retail sector, and anything else that depends on people leaving their homes for non-essential reasons. (This is a genuine question -- I've no idea).
If the government: a) tells the banks not to collect mortgages, b) tells landlords not to collect rents, c) gives everyone a basic income (obviously including bank executives and landlords) then the jobs will be essentially mothballed until the crisis is over.
If you're worried about an excuse for another 10 years of austerity, then I'd suggest that the government simply claws the free money back over the 10 years through the tax code.
(I mean, clearly that's not going to happen, but hey...)
It's not just wildlife that's of concern, domesticated livestock would also be a potential source of a new virus. 'Flu seems to be associated with birds and pigs - so, start with improving conditions for chickens, turkeys, pigs etc, ban battery farming, giving livestock space to move and range freely would make massive cuts in disease rates and chances of new disease strains evolving and spreading. There wouldn't be any need to chlorinate meat products either.
Fun quote from the end of that article which ran page 1 of Section A of the New York Times:
“But I’m not looking to be in a situation where I make the front page of the news for being that guy who hoarded 20,000 bottles of sanitizer that I’m selling for 20 times what they cost me.”
After The Times published this article on Saturday morning, Mr. Colvin said he was exploring ways to donate all the supplies.
Makes you wonder if he really realized he was talking to a reporter.
Robert Peston is reporting the government are considering enforcing quarantine for people over 70 in the next 5 to 20 days - for *four months*. This what they were referring to as “cocooning”. It is unclear at what point that will go ahead yet.
“Additionally, there are many unknowns in how the SARS-CoV-2 virus interacts with the human immune system and how this might play into current scenarios. For example, we don’t yet know if this novel virus will induce long-term immunity in those affected as other related viruses do not. Therefore, it would be prudent to prevent infection in the first place. More research is urgently needed on this front.”
Don't tell anybody, but our go-to doctor when I was young was my uncle, who was a vet. He used to say as a vet he had to know more physiology than a medical doctor because, well, he treated more than one species.
The infection control officer on American military bases is, in fact, a vet. And when they law down the law even the medical staff will follow their orders.
Comments
Fresh joke, that we are playing Russian roulette with 2 bullets in the chamber. Ha ha.
The problem is that both SSP and ESA are paid at a woefully low level compared with even minimum wage, never mind average earnings. If you've no financial cushion you're buggered.
Yes, it is crap - but it is something, also we are starting to see some self-interested ‘altruism’ from the gig economy - Deliveroo are setting up something for their riders etc.
I think renters are in a difficult position, banks are starting to say they’ll defer mortgage repayments. What we need to see, is the government also extend housing benefit for existing tenancies above current thresholds on at least a temporary basis - for those whose suddenly lose income.
There is a danger of people extrapolating pure mathematical or economic models - they often assume people act rationally, or if they don’t their irrationality is random. But people, and groups of people, have systematic biases in their thinking.
Link? Cautious optimism from Saskatchewan via NOprophet_NØprofit above too.
A search on “covid antibody” shows there are lots of groups working in this area.
It was on the BBC live feed:
It’s really hard to make more doctors and nurses and quickly. However, if you need people who understand disease, and understand infection control, and understand how medications work etc etc.
Could you use veterinary surgeons and veterinary nurses as a stop gap, with some induction, for a limited range of functions ? Wound care & basic nursing for example - to free up more professionals for complex care provision ?
But I just wonder in a crisis like this - if the prep work were done - they could be drafted to support medical care during the peak weeks of the epidemic. There are about 20,000 vets in the UK and over 12,500 veterinary nurses.
Why?
Some kittens are tiny when they are operated on = tiny tiny stitches.
Tiny but not necessarily neat or even. Also, our vets have way more experience of bovine caesarians than anything involving small animals.
Here? AFAIK he's would have been one of the epidemiologists who gave evidence to the government.
And a group of behavioural scientists have co-signed a letter which essentially asks the government to show its working:
"While we fully support an evidence-based approach to policy that draws on behavioural science, we are not convinced that enough is known about “behavioural fatigue” or to what extent these insights apply to the current exceptional circumstances."
My pups neutering scars have all been very neatly stitched. I took a photo once it was so neat.
That’s interesting, though I do wonder why the British Psychological Society hasn’t said anything - or signed it.
It’s looks like the initiative started in the University of Warwick.
Interestingly, the Guardian published an article yesterday, based on input from “Prof Susan Michie, director of the Centre for Behaviour Change at University College London and a member of the government’s advisory group, the Scientific Pandemic Influenza Group on Behavioural Science”.
It includes links to some evidence cited by Prof Michie. The Lancet review of studies, which is one of the sources mentioned, is particularly alarming in relation to the negative effects of extended quarantine (e.g. correlations with long term PTSD, alcoholism, substance abuse).
[It’s fair to say there is little direct mention of the term “behavioural fatigue” in the reports cited, but I think that is because it is not a term of psychological research - it could be that the term is rather inexact shorthand intended to be simple for the general public. If you search on behavioural fatigue through (e.g.) Google Scholar, it’s actually a term used in relation to quite a different field. I wonder if this casual shorthand has muddied the waters, or if the government does not wish to say highlight that the most extreme measures might have the negative outcomes foreseen by The Lancet?]
The full article is here.
Stone me. For 4 months? Talk about cabin fever, I get it after a week.
That's about the one thing that's going ahead.
Though in the case of, say, my parents - if they don’t get ill they don’t need carers they live independently. But they would need regular supplies delivering and social contact via phone and email.
This would be why they are worried about restriction fatigue.
Peston is noted for over-reacting and backtracking later, so let's see what comes out of this.
In the meantime there is another letter.
I guess you’d try to get people to co-operate, and redirect people back inside if you saw them on the streets.
The key concept here is Excess Mortality. This is so critical because even talking about Covid-19 deaths is misleading. The problem is that it is only in retrospect that this can be properly calculated. This is a really good paper on excess deaths following Hurricane Maria in Pueto Rico. You see, a hurricane might kill you by destroying the building you happen to be in or by drowning you in a flood. However, that is only a minority of the deaths and the least modifiable of the causes. In this kind of situation, there will also be people who are killed in road accidents directly related to the hurricane. If a tree is blown down on the highway in front of you and you can't swevre to avoid it, that it's clearly both a RTA and a hurricane-related mortality. It gets a lot more complicated when you look at people dying from medical conditions because, obviously people are dying all the time, but if the local medical facilities suddenly have no power or water then clearly your risk of dying from say a chest infection or heart attack is higher than the baseline before the hurricane struck. Equally, not all deaths in the weeks following a hurricane will be actually due to the hurricane (because, as we just noted, people are dying all the time).
One of the things that's important when looking at outcomes from a disease or intervention is to look at the All-cause mortality as opposed to the disease-specific-mortality. A simple example of this is in cancer treatment, the all-cause mortality is much more relevant than the cancer-one in many cases. This is because many chemotherapy agents are cardio-toxic. Hence the proximal cause of death is often cardiac (i.e. a heart attack) but it's still a result of the cancer because (obviously) one would not need the chemotherapy without the cancer in the first place. Hence for a patient with a new diagnosis of cancer, any estimate of their survival that's based on the cancer-mortality alone will be inaccurate - one is just as dead regardless of what the terminal event actually is. So, in most situations, all-cause mortality is the key figure.
As @Doublethink noted above, for all intents and purposes this is not a virus that we can irradicate or prevent from spreading. Theoretically, all sorts of things are possible - if when the virus was limited to China alone, someone had set off multiple nuclear warheads in China, it might have been possible. If we take a step back from the obviously ridiculous, we are talking about a disease that has a low mortality and a very-high infectivity. That from an infection-control perspective is a terrible combination. Contrast that with Ebola, which has a very high mortality (and is actually relatively difficult to catch) and you see why until the 21st century, all Ebola outbreaks burned themselves out very quickly. Killing the host is, for the most part, a dead-end for the virus (if you pardon the pun). Ebola was identified in 1976 (although it no-doubt has existed for thousands of years, unlike HIV which probably began around 1920*) until about 2010 the total number of known deaths from Ebola was only a few hundred. It would spring up, kill off a village or two and then run out of hosts and disappear. If it wasn't for the fact that Ebola exists in a non-human animal host it would die out completely. ** However, each outbreak begins with a species jump from monkeys to humans. Ebola has another quirk in that when people die from it, the body sheds viral particles at an incredible rate. Hence the burial and post-death rituals of the various cultures afflicted are a major means of spread. With each outbreak, the use of specialist burial teams is probably the most important intervention in preventing further infection. I apologise for this tangent but it is relevant in that Ebola is actually relatively easy to control; Covid-19 is the opposite of this; it is very transmissible, by aerosol means and seems to survive very well on human skin and surfaces. Put all this together and you realise that there is no real way to stop the virus spreading through our population. You could do all sorts of aggressive and draconian things (short of a nuclear strike, I mean!) but ultimately they would almost certainly cause more harm than good (and there's a good chance you'd miss something or someone and the disease would escape anyway). If you think about it, restrictive measures have big consequences. In some situations, these consequences will be fatal, indirectly maybe but nonetheless there are real risks to draconian interventions that cannot actually stop the spread of the virus.
The next point that is important to understand is that reported Covid-19 death numbers are not necessarily correct. Coincidentally, the last BBC News radio report I heard had it right as they said Ten more people have died having tested positive for Coronavirus. Though I doubt the distinction will be noted by many, it is important. I do not want to sound callous but the truth is that vulnerable people die. That's pretty-much the definition of vulnerable. Some of the deaths we are seeing happen to be due to Covid-19 but if it wasn't Covid-19, it would be influenza or cardiac disease or a stroke or pneumonia or whatever. Again, the person is just as dead regardless of the cause. What I mean is that if you take a group of say 100 'vulnerable people,' in a year's time only 85 (or whatever) of them will still be alive. If the advent of Covid-19 means that in a year's time the number is still 85 then it hasn't changed the mortality rate at all. It could easily be the case that some of the 15 who died tested positive saying that the deaths are due to Coronavirus is not particularly informative. Especially on a public health level. In reality, probably the number still alive will drop from this theoretical 85 to 50 or 70 or 80 or whatever. The difference between the expected mortality and the actual one with Covid-19 added in is the excess mortality.
It does get more complex still because we must also consider the people dying from other causes who would not have died if Covid-19 wasn't around. Primarily we are talking about people who have other life-threatening conditions who suffer worse outcomes because the healthcare system is swamped by Covid-19 patients.
So, when you put all this together, the aims of any government intervention must be to minimize the number of excess deaths. Given that preventing this virus from spreading through the population is practically not possible, there clearly is merit in slowing the spread in order to flatten the peak of the cases so that healthcare services are better placed to cope with demand. As has been mentioned the nightmare scenario is 20 patients needing a ventilator and only 10 ventilators being available. There is very little spare capacity in UK healthcare. I'll come back to that point because that is the political bit. Closing schools is a debatable point. Childen appear not to be at risk. Even children with respiratory diseases*** thus far do not seem to be suffering severely. Hence closing a school will not benefit them directly although it might slow community spread to the benefit of other groups. However, closing schools would have a big effect on healthcare staffing levels and that could be a major problem.
<continued>
I note in that article, Whitty has said they will publish their models - that will at least give us a level of transparency.
I think it will surprise none of you that I have zero confidence in Mr Johnson as a leader in this crisis. It is also important to note that the NHS has no spare capacity because of a decade's worth of stupid 'efficiency savings'**** - because this government (and its immediate predecessors do not seem to grasp the concept of strategic reserves). It is also important to remember that public health funding was decimated by Osborne because that's not front-line and thus you can fool the public with it. Public health is however the most cost-effective healthcare spending - creating far more benefit for far more people than the work I do. Our public health service has a fraction of the resources it had a decade ago. That's not ideal when faced with a crisis like this one.
However, it is impossible to know how well the government is currently managing the situation - it is entirely plausible that this is best policy - especially when you have to factor in behavioural psychology along with the viral epidemiology.
The excess mortality will be the key indicator.
AFZ
*HIV-1 and HIV-2 separately mutated from SIV (Simian immunodeficiency virus) - the equivalent disease in monkeys. Tracing the variability of the viruses means you can trace back how long HIV has existed and it's only about 100 years.
**The animal host for Ebola has never been found but it's almost certainly simian. We know there is a reservoir because otherwise, the virus would have died out completely. I don't know if Covid-19 has any animal hosts or not - I gather that it has recently been shown that dogs are safe. Again from an infection control perspective; the worst option is asymptomatic infection in animals and thus maximal spread.
***This is where it gets personal, my nephew has Cystic Fibrosis and so is potentially more vulnerable.
****There are efficiency savings to be made in all systems but for the most part, the past decade has seen our NHS stripped to the bone with alleged efficiencies creating significant weaknesses. Strategic reserves are critically important. Literally life and death but in normal circumstances, you can safely do away with them. Safe until it's not!
Call ups of reservists (mostly Home Front battalions) and restricted leave for regular serving soldiers
Banks have given people the next 3 months off (free of) their mortgage payments though.
God alone knows what will happen over Easter, Pessach (8-15 April), and Ramadan (23 April -23 May)
No actual government as yet either ...
(It is possible we have fallen victim to Dracula’s radical change of strategy, now everybody knows to do a cross with their fingers.)
Thanks
and
So it will be less democratically risky than the civil contingencies act.
The wartime example that's come to my mind is evacuation -- as I understand it, there was a pattern of children being evacuated to the countryside in 1939, but families then getting dissatisfied with this and bringing them back to the cities just in time for the bombs to start falling in a big way in 1940. (That's certainly what happened to my mother, although her year in the country was with relatives rather than strangers).
In general I'm all in favour of prioritising health and the environment over the economy, but I can't help thinking that if too much damage is done to the economy that will be bad for public health in both the short and the long term (stress, suicide in the worst cases, inability to afford a healthy diet, and less money for the NHS for years to come), which could in itself cause quite a lot of deaths.
Also, if people's livelihoods are put at risk by disease control measures, that gives them a strong incentive not to comply (or to encourage others not to).
These are just some thoughts, not policy recommendations. I'm not a big fan of the current UK government, but I have sympathy for anyone (politicians as well as public servants) having to make decisions about this -- no-one knows quite what is going to happen, and it seems likely that if their measures succeed they'll get blamed for over-reacting, and if they don't they'll get blamed for not doing enough.
Giving people money no-strings-attached during a lockdown will prevent the scenario you outline above.
and the Fed has just spent 1.5 Tn in the last week or so stabilizing asset prices in the US.
"We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy."
That may well be a good idea, but there's probably a need to ensure that people have jobs to go back to as well as ensuring that they can get by while they can't do their jobs; do we know how the cost of the bank bail-out compares with several months of life support for most of the tourism/hospitality industry, the non-essential parts of the retail sector, and anything else that depends on people leaving their homes for non-essential reasons. (This is a genuine question -- I've no idea).
And the more money that is spent, the more the reason/excuse for governments to spend less in the following years.
If we're allowed a note of humour in this thread, can I ask if anyone else has come across the typo 'corvid-19'. It sounds like some kind of mythological crow symbolising pestilence; I wouldn't be surprised if someone on the Ship knows of an example from actual mythlogy.
More discussion about where Covid-19 came from, and what stupidity humans are up to. Entirely predictable. This was written in 2012: The Next Pandemic: Why It Will Come from Wildlife.
They also wrote:
Stopping all trade in wildlife would be a start.
Food security for everyone in the world would be a start.
Understanding that we're all one human family would be a start.
If the government: a) tells the banks not to collect mortgages, b) tells landlords not to collect rents, c) gives everyone a basic income (obviously including bank executives and landlords) then the jobs will be essentially mothballed until the crisis is over.
If you're worried about an excuse for another 10 years of austerity, then I'd suggest that the government simply claws the free money back over the 10 years through the tax code.
(I mean, clearly that's not going to happen, but hey...)
And another one, this time from the British Society of immunologists:
“Additionally, there are many unknowns in how the SARS-CoV-2 virus interacts with the human immune system and how this might play into current scenarios. For example, we don’t yet know if this novel virus will induce long-term immunity in those affected as other related viruses do not. Therefore, it would be prudent to prevent infection in the first place. More research is urgently needed on this front.”
The infection control officer on American military bases is, in fact, a vet. And when they law down the law even the medical staff will follow their orders.