Covid-19 in UK
Mar. 15th, 2020 10:44 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
jackETA: There are a bunch of corrections in comments here and on FB, I don't have time yet to try to update the post interactively.
I have a lot of thoughts and emotions and the situation keeps changing so I can't really do an overview, so I'm just going to try to pour out what's in my head at the moment.
In Italy, the whole country is in lockdown. I'm not sure exactly what that means in practice. I think it means everyone is highly encouraged to stay inside except for medical work and food deliveries. But I don't know if the rules are bent a lot more some places than others. Some places have permits to go out, although it sounded like enforcement varied.
I know some people are basically just bored, waiting for it blow over. But I know some (few? many? all?) hospitals are at the point of *only* treating otherwise healthy people under 65, and being forced to let others die.
The UK is on trajectory to be at the same point Italy is now, in two weeks time. Unless the government orders a lockdown now. But in fact, their stated strategy is the opposite, to let it get WORSE than Italy is now, to let a majority of the population catch Covid, so that we're not at risk of relaxing lockdown, and then having another wave of infection start spreading again after.
If that's what's to happen, that means a gamble that the UK deliberately court a situation WORSE than Italy and China are in now, in order to avoid problems they think those countries are GOING to have in a few months of maintaining lockdown for years or courting repeated waves of infection. Am I misreading this??
And also a gamble that the virus won't mutate. And that a vaccine won't arrive in time to help. Which both are likely, but for from known, and not clearly explained by our government's announcements.
What would I do if I were in charge?
I really don't know. I would ask an epidemiologist. It sounds like the government DID ask an epidemiologist. It sounds like this plan came from scientists not politicians. But some people are like, "makes sense", and some people are like, "this is unforgivable". Why so much difference of opinion from people I'd like to trust? Does it depend what you've already accepted as unavoidable?
If I were in charge, I would have lock downs of cities where infections are known, and be clear what the risk in different areas was. I would pour resources into keeping deliveries and essential work, especially caring and medical work, going without risking infection (e.g. forced paid leave for anyone ill, blanket education about avoiding spreading disease and supplies, disinfectant everywhere and clear protocols for what you need to do). I would endorse plans which are happening anyway, like public awareness campaigns "if you're caring for a relative not in your house, drop off supplies and teach them how to use video chat, avoid visits wherever possible."
That slows down the spread, time to develop better treatments, time to produce more tests. I would follow China and WHO and gamble on eradicating it. Including preparing for testing everyone who flies in. I know there's a risk that's not possible and we need to go through "everyone catches it" anyway. But that's a guess, I don't actually know that strategy is best.
What do I think about the government's plan?
It's hard to know what the government is planning or going to do because they don't communicate clearly. A semi-official disclosure to a journalist says they're going to advise complete isolation for anyone over 70. They didn't mention younger but vulnerable people. They talked about "war-footing" isolation of nursing homes. The word "force" was used (?) Do they have a clear plan with resources they just are announcing slowly? Did they have good evidence that more clear communication would lead to premature panic? Are they making it up as they go? Do they not care? The truth is probably somewhere between.
On Thursday they talked about letting the disease spread to 60-80% of the population to get herd immunity. On Friday they talked about this plan for vulnerable people. They ARE taking that seriously. "War-footing" is the level of seriousness which is appropriate. But are they actually acting seriously or just going to issue a lot of useless announcements saying "don't catch it" with no actionable advice or help? It could be either. If they have useful, practical actions (e.g. specific advice for people who are vulnerable, specific action plan for nursing homes that's realistic, not fake) early next week, I'll feel a lot better. If not, I'm still quite worried.
Even if they're right that letting it spread through most of the population is necessary, if they actually intend to help the most vulnerable 10-20% of the population -- for whom it is likely deadly -- avoid it, they should be doing that NOW. It sounds like they do have a plan for what to do when, but when they don't announce any timelines it's really hard to know :(
What am I doing?
Slowing the infection rate is useful. Up till now I've been acting as normal. There's another week or so when I will avoid crowds, gatherings and intercity travel, but continue to go out to shop, to see people one on one. I'm washing hands regularly. Avoiding surfaces. Trying to avoid touching my face when I'm out. Basically not things that keep yourself safe, but things that mean if you're infectious but not symptomatic, you're less likely to spread it to others. Going out for a walk/cycle/drive away from people is probably ok.
There's no point pre-emptively isolating myself if other people aren't. So I will stay at that level of caution until society catches up with it. I will aim to reduce face to face contact except for close family. But if the government goes ahead with "let most people catch it", I will probably just expect that eventually I will catch it. I'm not that worried about me. Most otherwise healthy people have a mild case, and I will just pray that I'm not in the small proportion who need a hospital.
If schools stay open and there's no way for most people to avoid going to work then obviously there's not much to be gained by being much more cautious individually.
Mostly I'm aiming to work out what's sensible to do collectively. I'm not that worried for myself. A bit for Liv. Probably I will at worst just have a bad cough for a week. And even if the numbers were as bad as "1% of healthy people die" (hopefully not?) I would still just continue my life and hope for the best. But I'm trying to be realistic -- not optimistic not pessimistic -- about what to expect.
If I was over 70 or already had a medical condition, I would aim to avoid face to face contact entirely for three months. Getting food delivered. Video chat. Going for walks but not where people are. I feel silly and alarmist saying that. But that sounds like the only sensible decision. [ETA: Think in terms of, if in two months time 50%-100% of the people you know have a deadly disease, can you avoid catching it :( ] I know most people are only slowly adjusting to this idea.
Except maybe if you're in the healthier half of 70 yo, you don't need to, and if you're a 50 yo with a heart condition you do need to. I haven't seen advice here.
If I was in a household with a mix of those categories... I'm not sure what I'd do.
The situation may change entirely tomorrow. Or I may decide that that caution is futile. I don't know.
I went through a lot of worry working this out. Hopefully once I've decided I will just carry on: when I'm not trying to re-decide a decision all the time I'm usually ok just coping with a situation.
What I expect
I deleted a longer thing here. In two weeks, the UK will look like Italy is now, unless we take significantly different decisions than they have. Whether it's isolation or hospitals getting overwhelmed or (touch wood) heroic efforts paying off somehow, it will go on for months. Fingers crossed.
Scary numbers
If infections grow at the rate in Italy, I think that's something like, doubling every two days. Hopefully less with lockdown. More if people haven't taken any precautions at all. When you're thinking "should I hold that event in two weeks", think, in two weeks the situation will be a hundred times more serious. In a month it might be 10,000 times more serious. Maybe the situation will be better than that. But it will be better only if specific steps are taken to make it better, that weren't already taken in Italy.
I really hope my "off the internet" numbers are wrong and the government's plan is right and the sense of "oh, it won't be that serious" is right.
Informally looking at graphs, it looks like the death rate is 0.2% for young-ish otherwise healthy people. And 10-20% for people over 60 or 70. That's probably not directly age, but reflecting how many people in those categories already have weaker immune systems or hearts, etc.
But the hospitalisation rate is probably ten times the death rate, or more. Many of whom need ICU or ventilation or I'm not thinking about this bit too closely. And if the hospital gets overwhelmed, probably everyone who needs hospitalisation dies. It sounds like this is the point some areas in Italy are. They're treating mostly-healthy people who get a bad case of Covid. And giving up on anyone already vulnerable who catches it :(
If the government plan that 80% of people who expect to have mild symptoms or recover on their own catch it, and the other 20% DON'T catch it, that would be a death rate similar to that for under-50s. About 0.2%. With a hospitalisation rate, maybe 10x that? So nearly 10 in a 1000 of the UK needing hospitalisation over the next few months? But IIRC we only have 1 bed per 1000 people. Only a fraction of which are ICU beds.
And if actually, half of the 20% most vulnerable proportion catch it, they might all need hospital beds, another 10 bed per 1000 people needed.
Responses
This is all based off vague internet graphs. Several times over the last week I've changed my mind as I've learned something else I hadn't thought of.
People -- including epidemiologists', and other scientists I trust -- opinions seem very different. Sometimes it's "the government can be a bit useless, but basically they still have the best scientific advice". Other times it's anger at the lack of a prompt response to the first cases. Despite my lack of trust in the current government *in general* I am judging this response on its own merits. And I'm aware that most people's news is still from mainstream sources, so that maybe matters more than what I think.
Friends who know more about the science or medicine than me, PLEASE PLEASE correct those assumptions above. Both in theory and in what's plausible and what isn't.
I have a lot of thoughts and emotions and the situation keeps changing so I can't really do an overview, so I'm just going to try to pour out what's in my head at the moment.
In Italy, the whole country is in lockdown. I'm not sure exactly what that means in practice. I think it means everyone is highly encouraged to stay inside except for medical work and food deliveries. But I don't know if the rules are bent a lot more some places than others. Some places have permits to go out, although it sounded like enforcement varied.
I know some people are basically just bored, waiting for it blow over. But I know some (few? many? all?) hospitals are at the point of *only* treating otherwise healthy people under 65, and being forced to let others die.
The UK is on trajectory to be at the same point Italy is now, in two weeks time. Unless the government orders a lockdown now. But in fact, their stated strategy is the opposite, to let it get WORSE than Italy is now, to let a majority of the population catch Covid, so that we're not at risk of relaxing lockdown, and then having another wave of infection start spreading again after.
If that's what's to happen, that means a gamble that the UK deliberately court a situation WORSE than Italy and China are in now, in order to avoid problems they think those countries are GOING to have in a few months of maintaining lockdown for years or courting repeated waves of infection. Am I misreading this??
And also a gamble that the virus won't mutate. And that a vaccine won't arrive in time to help. Which both are likely, but for from known, and not clearly explained by our government's announcements.
What would I do if I were in charge?
I really don't know. I would ask an epidemiologist. It sounds like the government DID ask an epidemiologist. It sounds like this plan came from scientists not politicians. But some people are like, "makes sense", and some people are like, "this is unforgivable". Why so much difference of opinion from people I'd like to trust? Does it depend what you've already accepted as unavoidable?
If I were in charge, I would have lock downs of cities where infections are known, and be clear what the risk in different areas was. I would pour resources into keeping deliveries and essential work, especially caring and medical work, going without risking infection (e.g. forced paid leave for anyone ill, blanket education about avoiding spreading disease and supplies, disinfectant everywhere and clear protocols for what you need to do). I would endorse plans which are happening anyway, like public awareness campaigns "if you're caring for a relative not in your house, drop off supplies and teach them how to use video chat, avoid visits wherever possible."
That slows down the spread, time to develop better treatments, time to produce more tests. I would follow China and WHO and gamble on eradicating it. Including preparing for testing everyone who flies in. I know there's a risk that's not possible and we need to go through "everyone catches it" anyway. But that's a guess, I don't actually know that strategy is best.
What do I think about the government's plan?
It's hard to know what the government is planning or going to do because they don't communicate clearly. A semi-official disclosure to a journalist says they're going to advise complete isolation for anyone over 70. They didn't mention younger but vulnerable people. They talked about "war-footing" isolation of nursing homes. The word "force" was used (?) Do they have a clear plan with resources they just are announcing slowly? Did they have good evidence that more clear communication would lead to premature panic? Are they making it up as they go? Do they not care? The truth is probably somewhere between.
On Thursday they talked about letting the disease spread to 60-80% of the population to get herd immunity. On Friday they talked about this plan for vulnerable people. They ARE taking that seriously. "War-footing" is the level of seriousness which is appropriate. But are they actually acting seriously or just going to issue a lot of useless announcements saying "don't catch it" with no actionable advice or help? It could be either. If they have useful, practical actions (e.g. specific advice for people who are vulnerable, specific action plan for nursing homes that's realistic, not fake) early next week, I'll feel a lot better. If not, I'm still quite worried.
Even if they're right that letting it spread through most of the population is necessary, if they actually intend to help the most vulnerable 10-20% of the population -- for whom it is likely deadly -- avoid it, they should be doing that NOW. It sounds like they do have a plan for what to do when, but when they don't announce any timelines it's really hard to know :(
What am I doing?
Slowing the infection rate is useful. Up till now I've been acting as normal. There's another week or so when I will avoid crowds, gatherings and intercity travel, but continue to go out to shop, to see people one on one. I'm washing hands regularly. Avoiding surfaces. Trying to avoid touching my face when I'm out. Basically not things that keep yourself safe, but things that mean if you're infectious but not symptomatic, you're less likely to spread it to others. Going out for a walk/cycle/drive away from people is probably ok.
There's no point pre-emptively isolating myself if other people aren't. So I will stay at that level of caution until society catches up with it. I will aim to reduce face to face contact except for close family. But if the government goes ahead with "let most people catch it", I will probably just expect that eventually I will catch it. I'm not that worried about me. Most otherwise healthy people have a mild case, and I will just pray that I'm not in the small proportion who need a hospital.
If schools stay open and there's no way for most people to avoid going to work then obviously there's not much to be gained by being much more cautious individually.
Mostly I'm aiming to work out what's sensible to do collectively. I'm not that worried for myself. A bit for Liv. Probably I will at worst just have a bad cough for a week. And even if the numbers were as bad as "1% of healthy people die" (hopefully not?) I would still just continue my life and hope for the best. But I'm trying to be realistic -- not optimistic not pessimistic -- about what to expect.
If I was over 70 or already had a medical condition, I would aim to avoid face to face contact entirely for three months. Getting food delivered. Video chat. Going for walks but not where people are. I feel silly and alarmist saying that. But that sounds like the only sensible decision. [ETA: Think in terms of, if in two months time 50%-100% of the people you know have a deadly disease, can you avoid catching it :( ] I know most people are only slowly adjusting to this idea.
Except maybe if you're in the healthier half of 70 yo, you don't need to, and if you're a 50 yo with a heart condition you do need to. I haven't seen advice here.
If I was in a household with a mix of those categories... I'm not sure what I'd do.
The situation may change entirely tomorrow. Or I may decide that that caution is futile. I don't know.
I went through a lot of worry working this out. Hopefully once I've decided I will just carry on: when I'm not trying to re-decide a decision all the time I'm usually ok just coping with a situation.
What I expect
I deleted a longer thing here. In two weeks, the UK will look like Italy is now, unless we take significantly different decisions than they have. Whether it's isolation or hospitals getting overwhelmed or (touch wood) heroic efforts paying off somehow, it will go on for months. Fingers crossed.
Scary numbers
If infections grow at the rate in Italy, I think that's something like, doubling every two days. Hopefully less with lockdown. More if people haven't taken any precautions at all. When you're thinking "should I hold that event in two weeks", think, in two weeks the situation will be a hundred times more serious. In a month it might be 10,000 times more serious. Maybe the situation will be better than that. But it will be better only if specific steps are taken to make it better, that weren't already taken in Italy.
I really hope my "off the internet" numbers are wrong and the government's plan is right and the sense of "oh, it won't be that serious" is right.
Informally looking at graphs, it looks like the death rate is 0.2% for young-ish otherwise healthy people. And 10-20% for people over 60 or 70. That's probably not directly age, but reflecting how many people in those categories already have weaker immune systems or hearts, etc.
But the hospitalisation rate is probably ten times the death rate, or more. Many of whom need ICU or ventilation or I'm not thinking about this bit too closely. And if the hospital gets overwhelmed, probably everyone who needs hospitalisation dies. It sounds like this is the point some areas in Italy are. They're treating mostly-healthy people who get a bad case of Covid. And giving up on anyone already vulnerable who catches it :(
If the government plan that 80% of people who expect to have mild symptoms or recover on their own catch it, and the other 20% DON'T catch it, that would be a death rate similar to that for under-50s. About 0.2%. With a hospitalisation rate, maybe 10x that? So nearly 10 in a 1000 of the UK needing hospitalisation over the next few months? But IIRC we only have 1 bed per 1000 people. Only a fraction of which are ICU beds.
And if actually, half of the 20% most vulnerable proportion catch it, they might all need hospital beds, another 10 bed per 1000 people needed.
Responses
This is all based off vague internet graphs. Several times over the last week I've changed my mind as I've learned something else I hadn't thought of.
People -- including epidemiologists', and other scientists I trust -- opinions seem very different. Sometimes it's "the government can be a bit useless, but basically they still have the best scientific advice". Other times it's anger at the lack of a prompt response to the first cases. Despite my lack of trust in the current government *in general* I am judging this response on its own merits. And I'm aware that most people's news is still from mainstream sources, so that maybe matters more than what I think.
Friends who know more about the science or medicine than me, PLEASE PLEASE correct those assumptions above. Both in theory and in what's plausible and what isn't.
no subject
Date: 2020-03-15 10:24 pm (UTC)no subject
Date: 2020-03-15 11:39 pm (UTC)That was from Washington State, where the eighty-twenty number was mild cases versus *hospitalisations* not 'bedridden and unable to work'. I followed that up, and the answers I got were "Everybody turns up to ER if they are too ill to work" and "the numbers are skewed, here, because of the initial outbreak was in a nursing home".
I'm treating that as an outlier and, while I suspect that there probably will be *something* unusual in the USA, I don't think that there are usable numbers available there, yet, even in Washington State.
Right now, I only have two population studies that are mature enough to be reliable, from countries that are actually handling this well - China and South Korea - and very sketchy statistics from emerging outbreaks in countries where it is being handled badly.
Nevertheless, it's worth watching those numbers evolve: climate, population density, general health, partial resistance, air pollution and smoking may well mean that different populations turn out differing statistics.
I would be very keen to see the figures for cities with NOX microparticulate pollution comparable to London; likewise, accurate figures for morbidity and mortality in patients with mild-to-moderate asthma managed by inhaled corticosteroids...
And the moon, with unicorns, and next week's winning lottery numbers, too.
One worrying anecdote - so far, two case histories in the USA - is of patients coming off the ventilator, making good progress to recovery, and then dying form heart failure.
This may or may not be observed elsewhere, and I'm not going through the WHO data again tonight: I mention it here to make a point that people with heart conditions need to start paying attention, the way I needed to, and then re-assess what they're doing as and when better data becomes available.
Waiting for certainty is lethally stupid, and only slightly less dangerous than working on uncorroborated data.
Face it, we're not going to get usable statistics from the United Kingdom at a time when they would be pre-emptively useful: watching what comes in from elsewhere, and guessing how much of it is applicable, is all we are going to get.
And I do not doubt that the disease still has some more surprises for us.
no subject
Date: 2020-03-16 08:49 am (UTC)