Not testing frontline HCPs who are symptomatic might be strategy and not due to capacity problems.
If 1 in 4 negative test results are actually wrong (these clinicians actually have Covid19) and the incorrect result means they then go into work with huge numbers of vulnerable patients, then that is very dangerous indeed.
Might be better for them to sit it out and self-isolate for 7 days to be sure.
Perhaps that's what PHE are doing but are reluctant to reveal for obvious reasons. Namely the reaction.. 'what!? the tests are actually wrong!?!!' from the usual idiot crowd.
I thought that the test where more lickly to give a false Positive, and 'relatively' unlikely to give a false negative, have I got that the wrong way around?
But overall I agree with your assessment, Lots of testing a month ago, would have allowed, South Korean Steal, 'test, track and test' and therefor keep infection down and no need for a lock down. but at this stage with 4,000 people a day being identified, how we would track that many people is probably not practical.
Other way round. If you think about the process involved there is a decent chance that the swabbing technique around the mouth and throat doesn't catch the virus - false negative. Moreover, Covid19 impacts more on the lower respiratory tract whereas swabbing grabs material from the upper respiratory tract.
On the other hand, there is a low chance of finding evidence of the virus without it actually being there - false positive. It's not like it's a normal biomarker that you always have in your body.
@Foxy suggested a false negative rate of circa 25% a while back. Not sure where he got this from.
The Oxford Centre for Evidence-Based Medicine did a literature review a few days ago and found that there was only poor quality evidence available re the accuracy of oropharyngeal versus nasopharyngeal swabs for COVID-19, and it was not possible to accurately assess or compare their sensitivity, nor figure out what the effect might be of combining the two methods... I can understand why PHE is working very hard on "getting testing right". Would be a nightmare for them to end up with building an entire testing infrastructure around a testing procedure that's worse than useless (as has been pointed out downthread, false negatives in the healthcare worker context are particularly dangerous).
Re false positives, there was a Chinese paper suggesting there were issues when people lived in the same space as someone who was infected - you might find RNA from viruses that got in the nose etc but hadn't actually caused an infection. This got a bit of an airing on PB but the paper was later withdrawn. https://pubmed.ncbi.nlm.nih.gov/32133832/
30% false negatives with nasopharangeal swabs according to our virologist in Leicester.
Shortly we will hear that armed police have deployed to kill the goat menace.
When wild boar escaped in Wiltshire, a good while ago, plod discovered that 9mm doesn't impress boar. More like mildly irritates. So they tried to borrow firearms from a local hunter. Who they had harassed about his hunting weapons non-stop for years....
The goats will not be shot, believe me I live in Llandudno
The seagulls are more of an issue
It depends on the nature of your armed police. I once encountered a policeman who thought walking across a private field with a broken shotgun (in the company of the farmer) in the crook of your arm was "menacing the public".
Fortunately another armed plod arrived about 30 seconds later and told him to stop being a twat.
Got to be a good shot to kill a seagull. Unless it was a sitting bird, and that wouldn't be sporting, would it? Dashed bad form!
One thing that hasn't received all that much attention is the fact that the lockdown was introduced with different parts of the country at different levels of outbreak. Here are the biggest percentage increases in cases recorded in the last 24 hours:
Warrington - 62.5% Southend-on-Sea - 61.4% St. Helens - 55.6% Cheshire West and Chester - 49.2% Knowsley - 49.1% Blackburn with Darwen - 48.0% Sefton - 38.4% Wigan - 35.8% Bolton - 35.3% Cheshire East - 34.2%
I wonder if the Atletico effect is starting to reveal itself?
It's worth noting too that the data are quite lumpy. The Berkshire LAs, for example, recorded big increases on 27 March and 1 April, but very small increases on days either side.
@Andy_Cooke what is the Y-Axis on your chart? It says Log Deaths but the Y-Axis index goes up linearly not logarithmically or exponentially.
The logarithm (to base 10) of the deaths per million.
So: 0.5 is 3.16 (per million) 1.0 is 10 (per million) 1.5 is 31.6 (per million) 2.0 is 100 (per million) 2.5 is 316 (per million) 3.0 would be 1000 (per million)
Is it possible to label the axis with those numbers? Makes it much clearer.
Mr. kle4, an awful lot of animals in the world today are bred for their deliciousness.
On the other hand, the great tortoises were doomed.
The great tortoises were fantastic eating. "so sweet, that no pullet eats more pleasantly" - descriptions of them "were more like restauarant reviews than natural history"
Is Eddie Large the first celebrity casualty of the virus.
Does that mean everyone loses Dura Ace’s dead pool or is it the first person of those named by peers?
Sadly I expect the obituary writers will be busy for quite some time...
Eddie Large is not the first famous person to have died from Covid19. I have seen reports for at least two others. However I hade never heard of the other two, so Eddie Large is the first one I have heard of.
And as far as I'm concerned the Ace list is open until the first one on the list to join the Choir Invisible.
Mr. kle4, an awful lot of animals in the world today are bred for their deliciousness.
On the other hand, the great tortoises were doomed.
The great tortoises were fantastic eating. "so sweet, that no pullet eats more pleasantly" - descriptions of them "were more like restauarant reviews than natural history"
Err, no. Buying or selling a share has absolutely zero to do with whether you care for the workers, the bosses or anyone else.
That's my point. The markets don't care. They don't give a shit. Back in the old "normal" days, the "US non farm payroll" number would come out on a Friday and it was the moment of the week on the trading floor. It was suffused with tension and excitement. If it came out low - i.e. less jobs created than expected - the stock market would often rise. Rationale being it meant a sluggish environment thus a rate cut was more likely. And even better (!) if it was negative (job losses). That could really get things jumping.
Not testing frontline HCPs who are symptomatic might be strategy and not due to capacity problems.
If 1 in 4 negative test results are actually wrong (these clinicians actually have Covid19) and the incorrect result means they then go into work with huge numbers of vulnerable patients, then that is very dangerous indeed.
Might be better for them to sit it out and self-isolate for 7 days to be sure.
Perhaps that's what PHE are doing but are reluctant to reveal for obvious reasons. Namely the reaction.. 'what!? the tests are actually wrong!?!!' from the usual idiot crowd.
I thought that the test where more lickly to give a false Positive, and 'relatively' unlikely to give a false negative, have I got that the wrong way around?
But overall I agree with your assessment, Lots of testing a month ago, would have allowed, South Korean Steal, 'test, track and test' and therefor keep infection down and no need for a lock down. but at this stage with 4,000 people a day being identified, how we would track that many people is probably not practical.
Other way round. If you think about the process involved there is a decent chance that the swabbing technique around the mouth and throat doesn't catch the virus - false negative. Moreover, Covid19 impacts more on the lower respiratory tract whereas swabbing grabs material from the upper respiratory tract.
On the other hand, there is a low chance of finding evidence of the virus without it actually being there - false positive. It's not like it's a normal biomarker that you always have in your body.
@Foxy suggested a false negative rate of circa 25% a while back. Not sure where he got this from.
The Oxford Centre for Evidence-Based Medicine did a literature review a few days ago and found that there was only poor quality evidence available re the accuracy of oropharyngeal versus nasopharyngeal swabs for COVID-19, and it was not possible to accurately assess or compare their sensitivity, nor figure out what the effect might be of combining the two methods... I can understand why PHE is working very hard on "getting testing right". Would be a nightmare for them to end up with building an entire testing infrastructure around a testing procedure that's worse than useless (as has been pointed out downthread, false negatives in the healthcare worker context are particularly dangerous).
Re false positives, there was a Chinese paper suggesting there were issues when people lived in the same space as someone who was infected - you might find RNA from viruses that got in the nose etc but hadn't actually caused an infection. This got a bit of an airing on PB but the paper was later withdrawn. https://pubmed.ncbi.nlm.nih.gov/32133832/
30% false negatives with nasopharangeal swabs according to our virologist in Leicester.
Suggests the main utility of testing for NHS staff would be to put asymptomatic carriers into isolation rather than getting symptomatic ones out of isolation early!
One thing that hasn't received all that much attention is the fact that the lockdown was introduced with different parts of the country at different levels of outbreak. Here are the biggest percentage increases in cases recorded in the last 24 hours:
Warrington - 62.5% Southend-on-Sea - 61.4% St. Helens - 55.6% Cheshire West and Chester - 49.2% Knowsley - 49.1% Blackburn with Darwen - 48.0% Sefton - 38.4% Wigan - 35.8% Bolton - 35.3% Cheshire East - 34.2%
I wonder if the Atletico effect is starting to reveal itself?
It's worth noting too that the data are quite lumpy. The Berkshire LAs, for example, recorded big increases on 27 March and 1 April, but very small increases on days either side.
That behaviour in Berkshire LAs is standard when taking count data down to a local area. Even more so when counting infections than when counting e.g. traffic accidents.
One thing that hasn't received all that much attention is the fact that the lockdown was introduced with different parts of the country at different levels of outbreak. Here are the biggest percentage increases in cases recorded in the last 24 hours:
Warrington - 62.5% Southend-on-Sea - 61.4% St. Helens - 55.6% Cheshire West and Chester - 49.2% Knowsley - 49.1% Blackburn with Darwen - 48.0% Sefton - 38.4% Wigan - 35.8% Bolton - 35.3% Cheshire East - 34.2%
I wonder if the Atletico effect is starting to reveal itself?
It's worth noting too that the data are quite lumpy. The Berkshire LAs, for example, recorded big increases on 27 March and 1 April, but very small increases on days either side.
I think it's more that the North West is still very early in the epidemic. I heard recently that Warrington hospital was dealing with nine cases of CV19. In total.
It doesn't take much for a low number of cases to go up by a high percentage.
Shortly we will hear that armed police have deployed to kill the goat menace.
When wild boar escaped in Wiltshire, a good while ago, plod discovered that 9mm doesn't impress boar. More like mildly irritates. So they tried to borrow firearms from a local hunter. Who they had harassed about his hunting weapons non-stop for years....
I have vague recollections of stories in the local press about wild boar a few years ago. I expect people were surprised to discover they exist outside of Asterix comics.
They are very tasty to eat - hence the farming.
Ah yes - bit of an evolutionary double edged sword, being found tasty by humans.
In "selfish gene" terms it is a huge advantage if you get humans to breed and feed your species. It's not so great for the individual animals.
@Andy_Cooke what is the Y-Axis on your chart? It says Log Deaths but the Y-Axis index goes up linearly not logarithmically or exponentially.
The logarithm (to base 10) of the deaths per million.
So: 0.5 is 3.16 (per million) 1.0 is 10 (per million) 1.5 is 31.6 (per million) 2.0 is 100 (per million) 2.5 is 316 (per million) 3.0 would be 1000 (per million)
Is it possible to label the axis with those numbers? Makes it much clearer.
Will try next time (Haven't got that much time to do these)
After Saturday he becomes the wise old grandee dispensing svengali like wisdom from the backbenches and the protest rallies, to whom the Leader, initially at least, will need to pay appropriate homage.
Government approval is like leader approval, my general assumption is it's damn rare to be positive, I wonder the last time it was and what was special about that time.
Cheers. I'm a little surprised the tailend of the Labour government, admittedly after a long time in power, was not that far above the nadir of the Brexit argument period.
every so often I go back to The End of the Party and marvel at the almost weekly farragoes that government endured, their tone-deaf responses and the long term, perhaps irreversible, damage they did to the country - not least in the manner of political debate.
The industrial and scientific might of the whole world is working on therapies and/or a vaccine for this. Surely we must succeed?
But the industrial and scientific might of the world is looking for a mighty and industrial solution. That will necessarily take a very long time, and be costly.
After Saturday he becomes the wise old grandee dispensing svengali like wisdom from the backbenches and the protest rallies, to whom the Leader, initially at least, will need to pay appropriate homage.
Just as long as he gets rid of the back office team who played a major part in Labour's GE disaster e.g. Murphy, Milne etc.
Government approval is like leader approval, my general assumption is it's damn rare to be positive, I wonder the last time it was and what was special about that time.
my golden rule for interpreting government approval data is that all governments are unpopular. You've got very, very rare occasions when they're not.
After Saturday he becomes the wise old grandee dispensing svengali like wisdom from the backbenches and the protest rallies, to whom the Leader, initially at least, will need to pay appropriate homage.
If Labour are sane he will be the toxic old fool everyone is embarrassed to mention they were ever associated with.
One thing that hasn't received all that much attention is the fact that the lockdown was introduced with different parts of the country at different levels of outbreak. Here are the biggest percentage increases in cases recorded in the last 24 hours:
Warrington - 62.5% Southend-on-Sea - 61.4% St. Helens - 55.6% Cheshire West and Chester - 49.2% Knowsley - 49.1% Blackburn with Darwen - 48.0% Sefton - 38.4% Wigan - 35.8% Bolton - 35.3% Cheshire East - 34.2%
I wonder if the Atletico effect is starting to reveal itself?
It's worth noting too that the data are quite lumpy. The Berkshire LAs, for example, recorded big increases on 27 March and 1 April, but very small increases on days either side.
I think it's more that the North West is still very early in the epidemic. I heard recently that Warrington hospital was dealing with nine cases of CV19. In total.
It doesn't take much for a low number of cases to go up by a high percentage.
Warrington now at 65 cases. I wonder if the step changes is more a reflection that testing is done in batches and a whole lot for an area get done together.
A good friend's best friend just died of the virus in New York. She was 48.
Somebody else the Wife knows extremely well has it. She won't be put on a ventilator, as she is too old.
Shit got real.
An interesting day back at work. We now have 122 confirmed Covid19 patients as inpatients. 22 fatalities (to yesterday) 38 discharged home.
Thanks for the update @Foxy! If you're allowed to say, are all of the 62 'active' cases in the ICU?
122 active cases, not counting in my figures resolved cases. Currently increasing about 20% per day. Most are on medical wards. ICU only taking those with good Clinical Frailty Scores.
Looking at table 2, we see that out of 50 patients admitted to ICU (representing 26% of all inpatients so perhaps not far different to the situation chez Foxy) there were only 11 survivors (22%) compared to 39 deaths (78%). All three who received ECMO died; 31 out of the 32 who received invasive mechanical ventilation died; 24 out of the 26 who received non-invasive mechanical ventilation died; 33 of the 41 who received high-flow nasal cannula oxygen therapy died. The median ICU stay was 8 days (IQR from 4 to 12) for those who died and 7 days (IQR from 2 to 9) for those who survived.
Volunteers working at the NHS Nightingale coronavirus hospital have been told to prepare for the fact that up to 80 per cent of patients who are on ventilators will die, MailOnline can reveal.
Selfless heroes flocking to staff the emergency 4,000-bed unit in east London have been told to 'be prepared to see death', with a mortality rate of 50 to 80 per cent among those on ventilators.
Are there any reasons to be more optimistic than those Wuhan stats suggest? If the Mail report is accurate (and whenever you write a sentence that starts like that about a medical story, you know the "if" deserves red flashing fairy lights around it, but this one sounds plausible) then it doesn't sound like the top brass are very hopeful.
I think it's been evident for a while that as time went on the fatality rate in China was edging up towards the percentage who had been said to be critically ill.
I wonder whether the effort directed towards increasing the number of ventilators might have been better aimed at providing for the next tier of patients, classified as severely but not critically ill.
Latest figures log rate per million population. Italy definitely seems to be flattening off. Most countries still on an exponential line regardless of steps taken, but that's no surprise at all when you think about it (the deaths being recorded today were probably from infections around 7th-11th of March. Realistically, only Italy has had enough time since lockdowns for any real effect to be taken. (It would be good for journalists to point out the lag issue at some point)
We're still tracking extremely close to Italy + 15 days. Not sure exactly when our lockdown measures came into place vs theirs, though
It is interesting that Sweden's line is the same as other Countries
Thanks for producing this Andy_Cooke
I don't know how simple it would be, but, is there a way of indicating with a X when on that graph each nation implemented its Lock down?
I can have a crack. It looks rather busy and I'm not sure how easy it is to pick them out:
"Andy can you make us another one of those, with the USA below the Norway curve. Thanks" - D. Trump
One thing that hasn't received all that much attention is the fact that the lockdown was introduced with different parts of the country at different levels of outbreak. Here are the biggest percentage increases in cases recorded in the last 24 hours:
Warrington - 62.5% Southend-on-Sea - 61.4% St. Helens - 55.6% Cheshire West and Chester - 49.2% Knowsley - 49.1% Blackburn with Darwen - 48.0% Sefton - 38.4% Wigan - 35.8% Bolton - 35.3% Cheshire East - 34.2%
I wonder if the Atletico effect is starting to reveal itself?
It's worth noting too that the data are quite lumpy. The Berkshire LAs, for example, recorded big increases on 27 March and 1 April, but very small increases on days either side.
I think it's more that the North West is still very early in the epidemic. I heard recently that Warrington hospital was dealing with nine cases of CV19. In total.
It doesn't take much for a low number of cases to go up by a high percentage.
Warrington now at 65 cases. I wonder if the step changes is more a reflection that testing is done in batches and a whole lot for an area get done together.
Indeed. And a change of 25 is noteworthy there percentage wise but I wonder if a comparable SE town would find a change of 25 to be noteworthy.
Probably best not to pay too much attention to daily figures for towns unless a pattern emerges.
Government approval is like leader approval, my general assumption is it's damn rare to be positive, I wonder the last time it was and what was special about that time.
my golden rule for interpreting government approval data is that all governments are unpopular. You've got very, very rare occasions when they're not.
wonder what twitter says about this graph … ?
The first comment on the one showing it was the first positive rating for 10 years, was 'who pays you?'
The industrial and scientific might of the whole world is working on therapies and/or a vaccine for this. Surely we must succeed?
as hinted at by other posts, need to approach this on every cost- and time- scale. On some fronts, many marginal gains might be the difference between a local health service succeeding or otherwise.
A good friend's best friend just died of the virus in New York. She was 48.
Somebody else the Wife knows extremely well has it. She won't be put on a ventilator, as she is too old.
Shit got real.
An interesting day back at work. We now have 122 confirmed Covid19 patients as inpatients. 22 fatalities (to yesterday) 38 discharged home.
Thanks for the update @Foxy! If you're allowed to say, are all of the 62 'active' cases in the ICU?
122 active cases, not counting in my figures resolved cases. Currently increasing about 20% per day. Most are on medical wards. ICU only taking those with good Clinical Frailty Scores.
Looking at table 2, we see that out of 50 patients admitted to ICU (representing 26% of all inpatients so perhaps not far different to the situation chez Foxy) there were only 11 survivors (22%) compared to 39 deaths (78%). All three who received ECMO died; 31 out of the 32 who received invasive mechanical ventilation died; 24 out of the 26 who received non-invasive mechanical ventilation died; 33 of the 41 who received high-flow nasal cannula oxygen therapy died. The median ICU stay was 8 days (IQR from 4 to 12) for those who died and 7 days (IQR from 2 to 9) for those who survived.
Volunteers working at the NHS Nightingale coronavirus hospital have been told to prepare for the fact that up to 80 per cent of patients who are on ventilators will die, MailOnline can reveal.
Selfless heroes flocking to staff the emergency 4,000-bed unit in east London have been told to 'be prepared to see death', with a mortality rate of 50 to 80 per cent among those on ventilators.
Are there any reasons to be more optimistic than those Wuhan stats suggest? If the Mail report is accurate (and whenever you write a sentence that starts like that about a medical story, you know the "if" deserves red flashing fairy lights around it, but this one sounds plausible) then it doesn't sound like the top brass are very hopeful.
I think it's been evident for a while that as time went on the fatality rate in China was edging up towards the percentage who had been said to be critically ill.
And the same in Italy, where earlier on it was said that around 10% needed intensive care. The apparently fatality rate is now above that figure.
Not testing frontline HCPs who are symptomatic might be strategy and not due to capacity problems.
If 1 in 4 negative test results are actually wrong (these clinicians actually have Covid19) and the incorrect result means they then go into work with huge numbers of vulnerable patients, then that is very dangerous indeed.
Might be better for them to sit it out and self-isolate for 7 days to be sure.
Perhaps that's what PHE are doing but are reluctant to reveal for obvious reasons. Namely the reaction.. 'what!? the tests are actually wrong!?!!' from the usual idiot crowd.
I thought that the test where more lickly to give a false Positive, and 'relatively' unlikely to give a false negative, have I got that the wrong way around?
But overall I agree with your assessment, Lots of testing a month ago, would have allowed, South Korean Steal, 'test, track and test' and therefor keep infection down and no need for a lock down. but at this stage with 4,000 people a day being identified, how we would track that many people is probably not practical.
Other way round. If you think about the process involved there is a decent chance that the swabbing technique around the mouth and throat doesn't catch the virus - false negative. Moreover, Covid19 impacts more on the lower respiratory tract whereas swabbing grabs material from the upper respiratory tract.
On the other hand, there is a low chance of finding evidence of the virus without it actually being there - false positive. It's not like it's a normal biomarker that you always have in your body.
@Foxy suggested a false negative rate of circa 25% a while back. Not sure where he got this from.
The Oxford Centre for Evidence-Based Medicine did a literature review a few days ago and found that there was only poor quality evidence available re the accuracy of oropharyngeal versus nasopharyngeal swabs for COVID-19, and it was not possible to accurately assess or compare their sensitivity, nor figure out what the effect might be of combining the two methods... I can understand why PHE is working very hard on "getting testing right". Would be a nightmare for them to end up with building an entire testing infrastructure around a testing procedure that's worse than useless (as has been pointed out downthread, false negatives in the healthcare worker context are particularly dangerous).
Re false positives, there was a Chinese paper suggesting there were issues when people lived in the same space as someone who was infected - you might find RNA from viruses that got in the nose etc but hadn't actually caused an infection. This got a bit of an airing on PB but the paper was later withdrawn. https://pubmed.ncbi.nlm.nih.gov/32133832/
30% false negatives with nasopharangeal swabs according to our virologist in Leicester.
Suggests the main utility of testing for NHS staff would be to put asymptomatic carriers into isolation rather than getting symptomatic ones out of isolation early!
I think the main advantage would be to confirm COVID19 survivors, so that when they rejoin the front line they need not quarantine again, and could work in risky areas.
There would also be the advantage of not returning them to the wards while still shedding virus, which goes on for a couple of weeks post resolution of symptoms.
Government approval is like leader approval, my general assumption is it's damn rare to be positive, I wonder the last time it was and what was special about that time.
my golden rule for interpreting government approval data is that all governments are unpopular. You've got very, very rare occasions when they're not.
wonder what twitter says about this graph … ?
The first comment on the one showing it was the first positive rating for 10 years, was 'who pays you?'
Latest figures log rate per million population. Italy definitely seems to be flattening off. Most countries still on an exponential line regardless of steps taken, but that's no surprise at all when you think about it (the deaths being recorded today were probably from infections around 7th-11th of March. Realistically, only Italy has had enough time since lockdowns for any real effect to be taken. (It would be good for journalists to point out the lag issue at some point)
We're still tracking extremely close to Italy + 15 days. Not sure exactly when our lockdown measures came into place vs theirs, though
It is interesting that Sweden's line is the same as other Countries
Thanks for producing this Andy_Cooke
I don't know how simple it would be, but, is there a way of indicating with a X when on that graph each nation implemented its Lock down?
I can have a crack. It looks rather busy and I'm not sure how easy it is to pick them out:
Bloody hell, you have to feel sorry for the Belgians. One of the earliest countries in relative terms to implement a lockdown and yet the worst numbers for death rates on that graph.
A good friend's best friend just died of the virus in New York. She was 48.
Somebody else the Wife knows extremely well has it. She won't be put on a ventilator, as she is too old.
Shit got real.
An interesting day back at work. We now have 122 confirmed Covid19 patients as inpatients. 22 fatalities (to yesterday) 38 discharged home.
Thanks for the update @Foxy! If you're allowed to say, are all of the 62 'active' cases in the ICU?
122 active cases, not counting in my figures resolved cases. Currently increasing about 20% per day. Most are on medical wards. ICU only taking those with good Clinical Frailty Scores.
Looking at table 2, we see that out of 50 patients admitted to ICU (representing 26% of all inpatients so perhaps not far different to the situation chez Foxy) there were only 11 survivors (22%) compared to 39 deaths (78%). All three who received ECMO died; 31 out of the 32 who received invasive mechanical ventilation died; 24 out of the 26 who received non-invasive mechanical ventilation died; 33 of the 41 who received high-flow nasal cannula oxygen therapy died. The median ICU stay was 8 days (IQR from 4 to 12) for those who died and 7 days (IQR from 2 to 9) for those who survived.
Volunteers working at the NHS Nightingale coronavirus hospital have been told to prepare for the fact that up to 80 per cent of patients who are on ventilators will die, MailOnline can reveal.
Selfless heroes flocking to staff the emergency 4,000-bed unit in east London have been told to 'be prepared to see death', with a mortality rate of 50 to 80 per cent among those on ventilators.
Are there any reasons to be more optimistic than those Wuhan stats suggest? If the Mail report is accurate (and whenever you write a sentence that starts like that about a medical story, you know the "if" deserves red flashing fairy lights around it, but this one sounds plausible) then it doesn't sound like the top brass are very hopeful.
I think it's been evident for a while that as time went on the fatality rate in China was edging up towards the percentage who had been said to be critically ill.
And the same in Italy, where earlier on it was said that around 10% needed intensive care. The apparently fatality rate is now above that figure.
Typically around 10% of active diagnosed cases were on ICU at any given point and around 55% more in hospital. Suggests more than 10% ended up in ICU overall.
Latest figures log rate per million population. Italy definitely seems to be flattening off. Most countries still on an exponential line regardless of steps taken, but that's no surprise at all when you think about it (the deaths being recorded today were probably from infections around 7th-11th of March. Realistically, only Italy has had enough time since lockdowns for any real effect to be taken. (It would be good for journalists to point out the lag issue at some point)
We're still tracking extremely close to Italy + 15 days. Not sure exactly when our lockdown measures came into place vs theirs, though
It is interesting that Sweden's line is the same as other Countries
Thanks for producing this Andy_Cooke
I don't know how simple it would be, but, is there a way of indicating with a X when on that graph each nation implemented its Lock down?
I can have a crack. It looks rather busy and I'm not sure how easy it is to pick them out:
Bloody hell, you have to feel sorry for the Belgians. One of the earliest countries in relative terms to implement a lockdown and yet the worst numbers for death rates on that graph.
I think per capita plots make smaller countries look worse, since the initial stages of an outbreak are independent of population.
Not testing frontline HCPs who are symptomatic might be strategy and not due to capacity problems.
If 1 in 4 negative test results are actually wrong (these clinicians actually have Covid19) and the incorrect result means they then go into work with huge numbers of vulnerable patients, then that is very dangerous indeed.
Might be better for them to sit it out and self-isolate for 7 days to be sure.
Perhaps that's what PHE are doing but are reluctant to reveal for obvious reasons. Namely the reaction.. 'what!? the tests are actually wrong!?!!' from the usual idiot crowd.
I thought that the test where more lickly to give a false Positive, and 'relatively' unlikely to give a false negative, have I got that the wrong way around?
But overall I agree with your assessment, Lots of testing a month ago, would have allowed, South Korean Steal, 'test, track and test' and therefor keep infection down and no need for a lock down. but at this stage with 4,000 people a day being identified, how we would track that many people is probably not practical.
Other way round. If you think about the process involved there is a decent chance that the swabbing technique around the mouth and throat doesn't catch the virus - false negative. Moreover, Covid19 impacts more on the lower respiratory tract whereas swabbing grabs material from the upper respiratory tract.
On the other hand, there is a low chance of finding evidence of the virus without it actually being there - false positive. It's not like it's a normal biomarker that you always have in your body.
@Foxy suggested a false negative rate of circa 25% a while back. Not sure where he got this from.
The Oxford Centre for Evidence-Based Medicine did a literature review a few days ago and found that there was only poor quality evidence available re the accuracy of oropharyngeal versus nasopharyngeal swabs for COVID-19, and it was not possible to accurately assess or compare their sensitivity, nor figure out what the effect might be of combining the two methods... I can understand why PHE is working very hard on "getting testing right". Would be a nightmare for them to end up with building an entire testing infrastructure around a testing procedure that's worse than useless (as has been pointed out downthread, false negatives in the healthcare worker context are particularly dangerous).
Re false positives, there was a Chinese paper suggesting there were issues when people lived in the same space as someone who was infected - you might find RNA from viruses that got in the nose etc but hadn't actually caused an infection. This got a bit of an airing on PB but the paper was later withdrawn. https://pubmed.ncbi.nlm.nih.gov/32133832/
30% false negatives with nasopharangeal swabs according to our virologist in Leicester.
Suggests the main utility of testing for NHS staff would be to put asymptomatic carriers into isolation rather than getting symptomatic ones out of isolation early!
I think the main advantage would be to confirm COVID19 survivors, so that when they rejoin the front line they need not quarantine again, and could work in risky areas.
There would also be the advantage of not returning them to the wards while still shedding virus, which goes on for a couple of weeks post resolution of symptoms.
With the best will in the world, isn't it almost certain that hospitals will be places with a high risk of the virus being spread for as long as this goes on? Vulnerable people should take extra care to avoid ending up in hospital because of accidents.
Not testing frontline HCPs who are symptomatic might be strategy and not due to capacity problems.
If 1 in 4 negative test results are actually wrong (these clinicians actually have Covid19) and the incorrect result means they then go into work with huge numbers of vulnerable patients, then that is very dangerous indeed.
Might be better for them to sit it out and self-isolate for 7 days to be sure.
Perhaps that's what PHE are doing but are reluctant to reveal for obvious reasons. Namely the reaction.. 'what!? the tests are actually wrong!?!!' from the usual idiot crowd.
I thought that the test where more lickly to give a false Positive, and 'relatively' unlikely to give a false negative, have I got that the wrong way around?
But overall I agree with your assessment, Lots of testing a month ago, would have allowed, South Korean Steal, 'test, track and test' and therefor keep infection down and no need for a lock down. but at this stage with 4,000 people a day being identified, how we would track that many people is probably not practical.
Other way round. If you think about the process involved there is a decent chance that the swabbing technique around the mouth and throat doesn't catch the virus - false negative. Moreover, Covid19 impacts more on the lower respiratory tract whereas swabbing grabs material from the upper respiratory tract.
On the other hand, there is a low chance of finding evidence of the virus without it actually being there - false positive. It's not like it's a normal biomarker that you always have in your body.
@Foxy suggested a false negative rate of circa 25% a while back. Not sure where he got this from.
The Oxford Centre for Evidence-Based Medicine did a literature review a few days ago and found that there was only poor quality evidence available re the accuracy of oropharyngeal versus nasopharyngeal swabs for COVID-19, and it was not possible to accurately assess or compare their sensitivity, nor figure out what the effect might be of combining the two methods... I can understand why PHE is working very hard on "getting testing right". Would be a nightmare for them to end up with building an entire testing infrastructure around a testing procedure that's worse than useless (as has been pointed out downthread, false negatives in the healthcare worker context are particularly dangerous).
Re false positives, there was a Chinese paper suggesting there were issues when people lived in the same space as someone who was infected - you might find RNA from viruses that got in the nose etc but hadn't actually caused an infection. This got a bit of an airing on PB but the paper was later withdrawn. https://pubmed.ncbi.nlm.nih.gov/32133832/
30% false negatives with nasopharangeal swabs according to our virologist in Leicester.
Suggests the main utility of testing for NHS staff would be to put asymptomatic carriers into isolation rather than getting symptomatic ones out of isolation early!
I think the main advantage would be to confirm COVID19 survivors, so that when they rejoin the front line they need not quarantine again, and could work in risky areas.
There would also be the advantage of not returning them to the wards while still shedding virus, which goes on for a couple of weeks post resolution of symptoms.
Wouldn't it be nice to do that for everyone with symptoms, just by having a longer self-isolation period than 7 days?
A good friend's best friend just died of the virus in New York. She was 48.
Somebody else the Wife knows extremely well has it. She won't be put on a ventilator, as she is too old.
Shit got real.
An interesting day back at work. We now have 122 confirmed Covid19 patients as inpatients. 22 fatalities (to yesterday) 38 discharged home.
Thanks for the update @Foxy! If you're allowed to say, are all of the 62 'active' cases in the ICU?
122 active cases, not counting in my figures resolved cases. Currently increasing about 20% per day. Most are on medical wards. ICU only taking those with good Clinical Frailty Scores.
Are there any reasons to be more optimistic than those Wuhan stats suggest? If the Mail report is accurate (and whenever you write a sentence that starts like that about a medical story, you know the "if" deserves red flashing fairy lights around it, but this one sounds plausible) then it doesn't sound like the top brass are very hopeful.
Yes all well here. Still a bit quiet where I am.
I think a lot depends on who is admitted to ICU in the first place, but in the UK rare to be admitted if Clinical Frailty Score of 5 or more, because outcomes are so dismal.
In this UK study around 80% were still under treatment, so in neither group.
I note that the oldest in the Chinese study was 76 years old, so may be a similar population.
Latest figures log rate per million population. Italy definitely seems to be flattening off. Most countries still on an exponential line regardless of steps taken, but that's no surprise at all when you think about it (the deaths being recorded today were probably from infections around 7th-11th of March. Realistically, only Italy has had enough time since lockdowns for any real effect to be taken. (It would be good for journalists to point out the lag issue at some point)
We're still tracking extremely close to Italy + 15 days. Not sure exactly when our lockdown measures came into place vs theirs, though
It is interesting that Sweden's line is the same as other Countries
Thanks for producing this Andy_Cooke
I don't know how simple it would be, but, is there a way of indicating with a X when on that graph each nation implemented its Lock down?
I can have a crack. It looks rather busy and I'm not sure how easy it is to pick them out:
Bloody hell, you have to feel sorry for the Belgians. One of the earliest countries in relative terms to implement a lockdown and yet the worst numbers for death rates on that graph.
I think per capita plots make smaller countries look worse, since the initial stages of an outbreak are independent of population.
That was my initial reaction, but the grouping is pretty tight, so there might be something else going on. Norway right at the bottom makes me wonder if population density is a factor somehow?
Overall, it looks a surprisingly close fit, given the variations in testing.
Has some reasons for hope and some for caution. I don't know enough biology to assess whether hope or caution is better placed!
Genuine reasons for hope - both for a vaccine (by early next year) but also, more importantly, for therapies that will mitigate the effect of catching the virus.
Latest figures log rate per million population. Italy definitely seems to be flattening off. Most countries still on an exponential line regardless of steps taken, but that's no surprise at all when you think about it (the deaths being recorded today were probably from infections around 7th-11th of March. Realistically, only Italy has had enough time since lockdowns for any real effect to be taken. (It would be good for journalists to point out the lag issue at some point)
We're still tracking extremely close to Italy + 15 days. Not sure exactly when our lockdown measures came into place vs theirs, though
It is interesting that Sweden's line is the same as other Countries
Thanks for producing this Andy_Cooke
I don't know how simple it would be, but, is there a way of indicating with a X when on that graph each nation implemented its Lock down?
I can have a crack. It looks rather busy and I'm not sure how easy it is to pick them out:
Bloody hell, you have to feel sorry for the Belgians. One of the earliest countries in relative terms to implement a lockdown and yet the worst numbers for death rates on that graph.
I think per capita plots make smaller countries look worse, since the initial stages of an outbreak are independent of population.
That was my initial reaction, but the grouping is pretty tight, so there might be something else going on. Norway right at the bottom makes me wonder if population density is a factor somehow?
Overall, it looks a surprisingly close fit, given the variations in testing.
I think Norway's location might be a function of when t=0 was defined. See it was flat for several days before registering another death. Looks like they just got unlucky with one patient early on.
Muppets. They are missing the important word "illegal" from that sentence.
To be fair considering the picture I would suggest that was a given. When they say you can collect your prescription drugs from Boots I don't think they mean the mean the boot of a fiesta.
Never feel TOO guilty about not posting an Owen Jones article.
So the left`s pressure to lockdown, with the costs that that was bound to entail, will transform into a new Labour Party narrative that getting county`s finances in the direction of sanity post-virus will amount to Tory Austerity Mark2.
Words fail me.
He's good. I've read both his books. "Chavs" and "The Establishment". Bet most people have read at least one of those. New one out in Sept which I'm looking forward to. "This Land: The Story of a Movement".
Trouble is, we will be stony broke after this. So although the Left's ideas and values around community and redistribution will be attractive to many it does not follow that they will be implemented. In fact I don't suppose they will be.
Tough position for the Tories though. Austerity again - and worse this time - or Magic Money Tree and tacit admission that Austerity post 2010 was political choice not financial necessity.
I think they will go Magic Money Tree - effectively printing money to fund public services. Which would normally lead to a debased currency and rampant inflation. But what if everybody's doing it? Maybe we get away with it in that case. Some sort of reset and internationally synced Cunning Plan. Dunno.
A good friend's best friend just died of the virus in New York. She was 48.
Somebody else the Wife knows extremely well has it. She won't be put on a ventilator, as she is too old.
Shit got real.
An interesting day back at work. We now have 122 confirmed Covid19 patients as inpatients. 22 fatalities (to yesterday) 38 discharged home.
Thanks for the update @Foxy! If you're allowed to say, are all of the 62 'active' cases in the ICU?
122 active cases, not counting in my figures resolved cases. Currently increasing about 20% per day. Most are on medical wards. ICU only taking those with good Clinical Frailty Scores.
Are there any reasons to be more optimistic than those Wuhan stats suggest? If the Mail report is accurate (and whenever you write a sentence that starts like that about a medical story, you know the "if" deserves red flashing fairy lights around it, but this one sounds plausible) then it doesn't sound like the top brass are very hopeful.
Yes all well here. Still a bit quiet where I am.
I think a lot depends on who is admitted to ICU in the first place, but in the UK rare to be admitted if Clinical Frailty Score of 5 or more, because outcomes are so dismal.
In this UK study around 80% were still under treatment, so in neither group.
I note that the oldest in the Chinese study was 76 years old, so may be a similar population.
Cheers @Foxy, stay well! Will be interesting to see what happens when the stats are no longer biased towards short stays.
Anyone who wants to see the whole report can find it at the Intensive Care National Audit & Research Centre (ICNARC):
This report contains data on all confirmed COVID-19 cases reported to ICNARC up to midnight on 26 March 2020 from critical care units participating in the Case Mix Programme (all NHS adult, general intensive care and combined intensive care/high dependency units in England, Wales and Northern Ireland, plus some specialist and non-NHS critical care units).
Muppets. They are missing the important word "illegal" from that sentence.
To be fair considering the picture I would suggest that was a given. When they say you can collect your prescription drugs from Boots I don't think they mean the mean the boot of a fiesta.
The police are right of course. I understand the suppliers deliver, so no need to go out.
Id read that as they are paying 80% of everyones wages, but still claiming back the government grants. So topping up the higher paid workers beyond the scheme, but not the lower paid workers.
Id read that as they are paying 80% of everyones wages, but still claiming back the government grants. So topping up the higher paid workers beyond the scheme, but not the lower paid workers.
Ah, I was under the impression the government scheme was either/or.
Shortly we will hear that armed police have deployed to kill the goat menace.
When wild boar escaped in Wiltshire, a good while ago, plod discovered that 9mm doesn't impress boar. More like mildly irritates. So they tried to borrow firearms from a local hunter. Who they had harassed about his hunting weapons non-stop for years....
When we were drilling in Spitzbergen many years ago we were forbidden to go anywhere without a side arm. But its purpose was to scare the polar bears away and we were warned under no circumstances should we try to shoot at them, because basically all we would do was piss them off.
There were also baton charge guns around the rig which could be used to drive bears away but again they were worse than useless. Shoot a bear with a baton charge and they think you want to play.
Possibly but then that's true for most politicians. Peak Tony Blair was 1/5/97 and for any politician their peak being winning a landslide is presumably better than peaking at being popular at Glastonbury.
Yes, I'll give you that. Rocking Glastonbury butters no parsnips.
Certainly it cannot simply be assumed that doing things differently must be wrong, it's why claims (with that as the reason) we did not act correctly first up was unfair (though actions could still be wrong for other reasons rather than due to an expection of, ahem, herding)
I agree. And you can be wrong for the right reasons. That, AIUI, is the government's position, reading between the lines. Jury's out, I think.
Has some reasons for hope and some for caution. I don't know enough biology to assess whether hope or caution is better placed!
Further down that link it says that the BCG vaccine may help blunt the Covid-19 virus.
"studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions. So his team put together the data on what countries had universal BCG vaccine policies and when they were put in place. They then compared the number of confirmed cases and deaths from Covid-19 to find a strong correlation."
In which case the oldies should be benefitting from that, but don't seem to be.
Has some reasons for hope and some for caution. I don't know enough biology to assess whether hope or caution is better placed!
Further down that link it says that the BCG vaccine may help blunt the Covid-19 virus.
"studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions. So his team put together the data on what countries had universal BCG vaccine policies and when they were put in place. They then compared the number of confirmed cases and deaths from Covid-19 to find a strong correlation."
In which case the oldies should be benefitting from that, but don't seem to be.
apparently the Uk only had universal BCG vaccination for kids from 1953. so the 70+ cohort likely never got it.
Has some reasons for hope and some for caution. I don't know enough biology to assess whether hope or caution is better placed!
Further down that link it says that the BCG vaccine may help blunt the Covid-19 virus.
"studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions. So his team put together the data on what countries had universal BCG vaccine policies and when they were put in place. They then compared the number of confirmed cases and deaths from Covid-19 to find a strong correlation."
In which case the oldies should be benefitting from that, but don't seem to be.
Introduced for 14 year olds in 1953 so you have to be under 80 to have benefited. And it may have a time limited effect so less protective the longer ago you had it.
Has some reasons for hope and some for caution. I don't know enough biology to assess whether hope or caution is better placed!
Further down that link it says that the BCG vaccine may help blunt the Covid-19 virus.
"studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions. So his team put together the data on what countries had universal BCG vaccine policies and when they were put in place. They then compared the number of confirmed cases and deaths from Covid-19 to find a strong correlation."
In which case the oldies should be benefitting from that, but don't seem to be.
apparently the Uk only had universal BCG vaccination for kids from 1953. so the 70+ cohort likely never got it.
80plus because given at age 14 (so first cohort born 1939).
Latest Leicester/Leics figures 129 current inpatients 64 now recovered and discharged 26 total deaths
Overflow ICU now in use, but good to see numbers of recovered going up.
I think that criteria for discharge are inconsistent even within healthcare systems, maybe even more so between different countries. I'm struggling to find data for the UK (not just on world-o-meter). The differences in proportions active/resolved cases over time might be indicative of average severity. Do you have a source for that kind of numbers?
Comments
Warrington - 62.5%
Southend-on-Sea - 61.4%
St. Helens - 55.6%
Cheshire West and Chester - 49.2%
Knowsley - 49.1%
Blackburn with Darwen - 48.0%
Sefton - 38.4%
Wigan - 35.8%
Bolton - 35.3%
Cheshire East - 34.2%
I wonder if the Atletico effect is starting to reveal itself?
It's worth noting too that the data are quite lumpy. The Berkshire LAs, for example, recorded big increases on 27 March and 1 April, but very small increases on days either side.
https://www.theguardian.com/books/2004/jul/31/featuresreviews.guardianreview7
And as far as I'm concerned the Ace list is open until the first one on the list to join the Choir Invisible.
https://twitter.com/ianbremmer/status/1245738954860740609
https://twitter.com/KateAndrs/status/1245741362982596609?s=20
https://twitter.com/BethRigby/status/1245733429188210688
Saturday can't come soon enough.
It doesn't take much for a low number of cases to go up by a high percentage.
The NW and London are world's apart.
Pass the mind bleach...
wonder what twitter says about this graph … ?
Has some reasons for hope and some for caution. I don't know enough biology to assess whether hope or caution is better placed!
I wonder whether the effort directed towards increasing the number of ventilators might have been better aimed at providing for the next tier of patients, classified as severely but not critically ill.
Probably best not to pay too much attention to daily figures for towns unless a pattern emerges.
There would also be the advantage of not returning them to the wards while still shedding virus, which goes on for a couple of weeks post resolution of symptoms.
https://www.telegraph.co.uk/politics/2020/04/02/government-coronavirus-update-lockdown-testing-nhs-matt-hancock/
I think a lot depends on who is admitted to ICU in the first place, but in the UK rare to be admitted if Clinical Frailty Score of 5 or more, because outcomes are so dismal.
In this UK study around 80% were still under treatment, so in neither group.
I note that the oldest in the Chinese study was 76 years old, so may be a similar population.
Overall, it looks a surprisingly close fit, given the variations in testing.
Trouble is, we will be stony broke after this. So although the Left's ideas and values around community and redistribution will be attractive to many it does not follow that they will be implemented. In fact I don't suppose they will be.
Tough position for the Tories though. Austerity again - and worse this time - or Magic Money Tree and tacit admission that Austerity post 2010 was political choice not financial necessity.
I think they will go Magic Money Tree - effectively printing money to fund public services. Which would normally lead to a debased currency and rampant inflation. But what if everybody's doing it? Maybe we get away with it in that case. Some sort of reset and internationally synced Cunning Plan. Dunno.
Anyone who wants to see the whole report can find it at the Intensive Care National Audit & Research Centre (ICNARC):
https://www.icnarc.org/About/Latest-News/2020/03/27/Report-On-775-Patients-Critically-Ill-With-Covid-19
This report contains data on all confirmed COVID-19 cases reported to ICNARC up to midnight on 26 March 2020 from critical care units participating in the Case Mix Programme (all NHS adult, general intensive care and combined intensive care/high dependency units in England, Wales and Northern Ireland, plus some specialist and non-NHS critical care units).
There were also baton charge guns around the rig which could be used to drive bears away but again they were worse than useless. Shoot a bear with a baton charge and they think you want to play.
His suggestion that patients should get a test over NHS staff will wind up some.
129 current inpatients
64 now recovered and discharged
26 total deaths
Overflow ICU now in use, but good to see numbers of recovered going up.
Almost loose change in the overall scheme of things!
Lets have a clap for the private sector ..
"studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions. So his team put together the data on what countries had universal BCG vaccine policies and when they were put in place. They then compared the number of confirmed cases and deaths from Covid-19 to find a strong correlation."
In which case the oldies should be benefitting from that, but don't seem to be.
He doesn't risk it after what happened on his TV show last night.
I'm struggling to find data for the UK (not just on world-o-meter). The differences in proportions active/resolved cases over time might be indicative of average severity.
Do you have a source for that kind of numbers?