Neverending Covid-19 Coronavirus

Ed Selley said:
Here's the thing. At first I had a degree of alarm about the proposed UK strategy. A few days in and I'm pretty sold on it.

Why?

First up, I just don’t think containment with a view to elimination is possible any more. I’m absolutely sure that South Korea, Taiwan, Singapore etc can lock down and eliminate their current outbreaks and China probably can too. I imagine it might be technically possible for Europe and the US to do the same thing, albeit at unknown cost to their ability to function as nation states. The thing is that Iran has effectively lost control of their outbreak, there’s a worrying lack of information from Russia (a border 2,516 miles long with China and no cases apparently...) and it is present in Africa and Indonesia too. Unless we lock down travel forever, I can’t see how you can avoid it coming back. It has a significant symptom free period and many of these places have long land borders. Even if COVID19 lacks the ability to flare up on its own- and we'll see about that soon enough- it's out there.

Secondly, having watched people flailing around buying toilet roll like demented acolytes of the Golgothan, it is abundantly clear that we lack the self-discipline for actual, prolonged self-isolation. I am to virology what R-Kelly is to teen mentoring but I have worked from home for a decade and I'm a borderline recluse so I understand the tenets of self-isolation pretty well. Even so, the idea of doing two crushing, fucking weeks with the hatches battened fills me with dread and- feel free to judge me at this point- even with the motivator of not catching a grim illness, I don't think the bulk of people in Europe or the US can do it, let alone longer. Inherent in much of the stuff doing the rounds on social media is that we're sort of up for it (maybe, depending on schedules, work etc) but only so long as there's a ready supply of poor people to keep the niceties running- Deliveroo, Amazon etc.

The UK Strategy (there's a less loaded take on it HERE and further information on how the vulnerable elements of society are to be handled HERE) is cynical or realistic depending on where you sit (and, let's be honest, I've made my views pretty clear above I guess). It makes the in built assumption that the ability of the modern populace to actually lock down for any sustained period of time is very limited and the button won't be pushed until later because it can only be pushed once and only for a limited duration. Now depending on whether you harbour a positive view of humanity or not, this can seem crushingly bleak. Based on feedback from the field though, I don't feel it is.
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alternatively:

Helen E. Jenkins, Boston University School of Public Health
Sarah V. Leavitt, Boston University School of Public Health
Mary E. Bushman, Harvard T.H. Chan School of Public Health
William P. Hanage, Harvard T.H. Chan School of Public Health

The UK is currently embarking on a pandemic strategy that is claimed will generate herd
immunity to SARS-CoV2. The government suggests that by delaying social distancing
interventions, they will allow a larger proportion of the population to become infected with
SARS-CoV2 and subsequently immune so the country suffers less impact during a hypothetical
second wave of COVID-19 in autumn 2020. The goal of generating herd immunity through
exposure to an actual pathogenic virus is not without cost. The UK currently has a total of 4,100
combined intensive care unit (ICU) and high-dependency beds, including those that are
currently being used by people without COVID-191
. We have generated a simple model to
quantify how this proposed strategy is expected to fail due to the requirement for intensive
care unit (ICU) beds.
We have focused on adults aged 20-40 years old, to be conservative, since they have a lower
case fatality rate and risk of hospitalization than older adults2
. We have assumed that the UK
government is seeking interventions that would preferentially infect this age group. We used an
age-specific population estimate of 18,338,3283 and conservatively estimated that 40% (rather
than the UK government’s goal of 60%4
) of this population would become infected over the
coming months, to give a total infected of 7,335,331 people in this age group. We assumed that
2.15% of laboratory-confirmed cases would suffer a final end point of admission to an ICU, use
of mechanical ventilation, or death5
. Laboratory confirmation will miss any infected individuals
that experience zero or mild symptoms, and it has been proposed that in the UK (as of 13th of
March) approximately 8% of infections are laboratory-confirmed6
. Therefore, we multiplied the
estimate of 2.15% by 8%, to give an estimated 0.17% of infected individuals aged 20-40 years
old that would require use of an ICU bed. Since our 8% case detection rate applies to all age
groups, we also modeled a scenario in which the case detection rate was lower at 5%. Data
from China have suggested that these patients will require use of ICU beds for an average of 27
days, until either recovery or death7
. We then visually fit a normal distribution with an initial
trajectory that matches the current daily COVID-19 case count reported from the UK8
, and
again adjusted for the likely number of true infections (8% or 5% case detection rate). This
resulted in a normal distribution with mean of 62 days and standard deviation of 14 days for
the 8% case detection rate scenario, and mean of 63 days and standard deviation of 15 days for
the 5% case detection rate scenario. Our goal is to estimate the peak burden upon healthcare
under each scenario.
We estimate that, at the peak of the epidemic, 8,610 people aged 20-40 years old would
require an ICU bed, if the case detection rate is 8% and 40% of this population becomes infected. This is more than two times the total number of beds available in the UK. If case
detection is 5% in this age group, we estimate that 5,118 beds – still more than are available -
will be required at the peak of this epidemic, for those aged 20-40 years (Figure 1).
If 60% of people aged 20-40 years are infected, assuming a 5% case detection rate, we estimate
that 11,002,997 people aged 20-40 years will be infected, leaving 8,494 people in this age group
requiring an ICU bed.
Our estimates focus on this younger age group to illustrate the phenomenal burden that will be
placed on the National Health Service by using this strategy. Our estimates are extraordinarily
conservative and overall conclusions did not vary when we varied (to a reasonable degree) the
normal distribution parameters. We should assume that ICU bed pressure will be higher than
these scenarios. Our conservative estimates exclude caring for severely affected people aged 41
and over. If choices are made based on life expectancy, we must expect that fatalities in this
older age group will be very high.

References
1. Cook T. I’m an ICU doctor. The NHS isn’t ready for the coronavirus crisis. 2020.
https://www.theguardian.com/…/03/icu-doctor-nhs-coronavirus-
pandemic-hospitals.
2. Riou J, Hauser A, Counotte MJ, Althaus CL. Adjusted age-specific case fatality ratio
during the COVID-19 epidemic in Hubei, China, January and February 2020. medrxivorg 2020.
3. Office of National Statistics. Estimates of the population for the UK, England and Wales,
Scotland and Northern Ireland. 2020.
https://www.ons.gov.uk/peoplepopulationandcomm…/…/population
estimates/datasets/populationestimatesforukenglandandwalesscotlandandnorthernireland.
4. Sky News. Interview with Sir Patrick Vallance. 2020.
https://news.sky.com/…/coronavirus-millions-of-britons-will…
herd-immunity-11956793.
5. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China.
N Engl J Med 2020.
6. The Telegraph newspaper. Up to 10,000 people in UK infected as Boris Johnson warns
'many families will lose loved ones'. 2020. https://www.telegraph.co.uk/global-health/science-
and-disease/coronavirus-news-uk-cases-deaths-numbers-covid-19-latest-live/.
7. Bi Q, Wu Y, Mei S, et al. Epidemiology and Transmission of COVID-19 in Shenzhen China:
Analysis of 391 cases and 1,286 of their close contacts. medrxivorg 2020.
8. Worldometer. 2020. https://www.worldometers.info/coronavirus/country/uk/.
 
One of my sisters lives in the middle of nowhere, Arizona, and one of my niece's teaching aids has tested positive for COVID-19, so now the elementary school's whole 5th and 6th grades have to spend the next two weeks of their spring break at home. To me, the surprising thing was that it was in her town, as it's really not close to any major cities. If it's there, it gonna pop up in a lot of other non-obvious spots.

Another sister is a respiratory therapist in Utah, and she said her hospital is already straining with all the people coming in, and they don't have enough tests, masks, or anything. She also said her unit is the only one that seemed to know what to do (since they focus on respiratory issues), and a lot of the other nurses/doctors were behind the curve and trying to learn fast. She said most of these people aren't terribly sick right now, but it's still more than they're ready for, in material and staff. She was letting us siblings know just to make sure we're taking it serious.
 
For all you white collar types:

BL5d5Tb.jpg
 
Captainfog said:
The last tweet on that thread suggests that someone might have been infected for a second time in Japan. If that has happened then we're fucked because herd immunity isn't going to work.

I think you have to strike a balance between complete lock down and a free for all. The flattening the curve thing is real. There aren't enough hospital beds to cope if we don't do that. There probably won't be enough beds anyway, but what we don't want is a situation where doctors are having to decide who to try and save and who they just let die.

I'm worried that in 6 months we're all going to know someone who died from this.
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news.sky.com

Coronavirus: Japan confirms first case of person being reinfected with COVID-19

The case has health experts worrying that the illness could remain dormant after an apparent recovery.
news.sky.com news.sky.com

www.latimes.com

They survived the coronavirus. Then they tested positive again. Why?

Can you get the coronavirus twice? Scientists say it's highly unlikely, but China is tightening hospital discharge standards as "recovered" patients in multiple provinces appear to get sick again.
www.latimes.com www.latimes.com
 
www.bbc.com

Coronavirus: Isolation for over-70s 'within weeks'

As the UK death toll hits 35, officials say some people will be asked to stay home for "a very long time".
www.bbc.com www.bbc.com

Every Briton over the age of 70 will be told "within the coming weeks" to stay at home for an extended period to shield them from coronavirus, Health Secretary Matt Hancock has said.

He told the BBC the advice will not come into force just yet but when it does it will last "a very long time".

Wartime-like measures will ask car makers to produce medical equipment and turn hotels into hospitals, he said.

"Every single person in this country is going to be affected," he warned.
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Within weeks? Wouldn't that be too late?

Also, the two wartime measures make it sound like they still plan on the whole get it over with as fast as possible approach.
 
When it comes to the C19 virus I don't care what side your on, but take a minute to weigh the consequences of each side, which has more to lose and act accordingly....................you have my full permission to mock me and make fun of me all you want if I was of the wrong opinion.
 
RenegadeMonster said:
www.bbc.com

Coronavirus: Isolation for over-70s 'within weeks'

As the UK death toll hits 35, officials say some people will be asked to stay home for "a very long time".
www.bbc.com www.bbc.com

Within weeks? Wouldn't that be too late?

Also, the two wartime measures make it sound like they still plan on the whole get it over with as fast as possible approach.
Click to expand...

It goes back to what I said last night. This is a button you can push once and one that only works for a relatively short period of time.

It's going to be interesting for my parents; my Dad is 66 and my Mother is 70. I guess we'll have to shut her in the ensuite bedroom with a good supply of books and feed sandwiches under the door.
 
Ed Selley said:
It goes back to what I said last night. This is a button you can push once and one that only works for a relatively short period of time.

It's going to be interesting for my parents; my Dad is 66 and my Mother is 70. I guess we'll have to shut her in the ensuite bedroom with a good supply of books and feed sandwiches under the door.
Click to expand...
When I was a kid my parents used to threaten to lock me in the closet and slide pizzas under the door. While I was disappointed that they never follow through, I never imagined that it would turn into a legitimate pandemic coping strategy.
 
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