To be fair, there is shed loads of info in the public domain already that supports their approach. E.g. the sars study on the quarantine in Toronto I cited some posts back - quarantine compliance was 57%.
When people say, people pulled together during the war - they forget, for example, the black market profiteering to evade rationing (that the government was trying to enforce) to ensure everybody had enough food and clothing.
Even now, there are people are not observing the limited number of things they have been asked to do.
My anger with the Tories re covid, is that they have run down the nhs for a decade - so the overall capacity to cope with a surge in health demand is lower - rather than their approach to trying to manage the dynamics of that demand in the run up to the first and second peaks of the epidemic.
I'm giving up on the Grauniad coverage as it looks to me that they are determined to politicise stuff that (for once) isn't political - e.g. today's headline says 'PM forced into U-turn' - AIUI if anyone has been 'forced' into a 'U-turn' it would be Patrick Vallence and John Whitty - but that would interfere with the narrative of 'public sector workers good, Tory politicians bad'.
The politicians are the ones making the decisions. They choose which advice to follow, and in fact guide what advice they are given by what priorities and goals they set (if you want another example of this, take a look at the work of the "independent" public sector pay review bodies). You can't "politicise" what is already by nature political. Mistrust of tory politicians in general and ABdPJ in particular is rational based on prior evidence. It is a U-turn, a screeching one, that indicates the PM is trying the avoid the appearance of fiddling while Rome burns and the organisers of major sporting events look responsible and cautious by comparison.
1. The PM taking the advice of the Chief Medical Officer and the Chief Scientific Advisor. Both of whom were appointed under a different PM long before the current crisis. Who else's advice is he supposed to take?
2. Do you have any evidence that the CMO or the CSA object to the given priorities?
3. Absolutely mistrust is rational, and I agree with everything Doublethink said about running down the NHS, but that doesn't make it justified in every possible circumstance.
2: we just don't know, do we? We're in uncharted territory with a guy who has previously been sacked for lying, and with form on knowingly putting others in harm's way, in charge. This is why I want to know what the options are and what priorities have been set.
Presumably the behavioral scientists being at the top of their game already predicted all this.
They literally did, and in the future they will close schools for a period too - government advisors have talked repeatedly about introducing measures sequentially.
They talked about not banning public attendance at matches literally 36 hours before they banned mass events.
I think the government has made a rod for its own back by insisting that its plan was entirely an direct extrapolation of pure science, rather than a judgement based around a balance of different and sometimes competing considerations from epidemiology/psychology etc.
I thought they’d been quite clear is a balance of risk, how could it possibly be anything else ?
Also, they haven’t yet banned mass events - they’ve said they may do so next week.
As we reported earlier, the UK government is preparing plans to ban mass gatherings, a government source says. Now the Care Minister Helen Whately has told the BBC it would have limited impact on the spread of the virus, but could free up emergency workers.
"We are following the evidence. As the chief medical officer said, and I have been advised, the evidence tells us that stopping mass gatherings doesn't have a huge impact on the spread of the virus," Ms Whately said.
"But, for example, decisions have been taken in some countries because of the impact on public services and because, when you have a mass gatherings, that draws on the police and the ambulance service you need to support it."
That's very clear - thanks Doublethink. It's playing feedback-control-systems in a very difficult way - like trying to maintain a constant speed in ones car while driving with no lights over unknown terrain, and while operating all controls via stretchy rubber extensions which one has not had any time to practice with - but yes, it looks like a plan.
The nightmare is positive feedback - you open the schools, close the schools, but there's some lag in there and you create great globs of cases just when you can't handle them. In electrical systems a fuse blows, and in mechanics bits fall off. Here...you kill all the vulnerable and think 'shit, that didn't work'. But that is not at all to say that this is the wrong way to do it.
No it doesn’t, if you reduce the speed of transmission you don’t need as larger percentage to get herd immunity. (Hence the isolate if you are symptomatic advice, it functionally reduces the r rate.)
But the basic point, that is probably right, is we can not eradicate the disease - planning a strategy that assumes we will be able to would be futile.
I am reading all this stuff knowing I am vulnerable, I have diabetes and asthma - though I am not elderly. But we can not ignore the reality of what a pandemic is, we can hold down the mortality rate - but we can’t avoid the fact that many thousands will die across the world including the U.K.
Whether the government’s strategy is effective will be fundamentally judgered by what percentage of the population die - rather than if deaths get above some absolute number.
So this requires 70-80% infection rate to produce herd immunity? That produces 400 000 to 500 000 deaths, assuming 1% rate. That's a lot.
I also don't understand how vulnerable people are being protected.
I believe the idea is to cocoon them at the peak of the epidemic, after the peak is passed herd immunity will protect them because most people they have contact with will be immune and not infectious - and if they do get ill they will have access to appropriate healthcare because the system won’t be swamped at that point.
(In the same way immunocompromised people who can’t have the measles vaccine rely upon everyone else having had it in order to protect them,)
Presumably any reduction in the % required for herd immunity is only temporary while social distancing and other measures in place? It will be pretty hard to permanently reduce the transmission rate. Enthusiasm for hand washing will only last so long once the peak of infections has passed, for example.
My anger with the Tories re covid, is that they have run down the nhs for a decade - so the overall capacity to cope with a surge in health demand is lower - rather than their approach to trying to manage the dynamics of that demand in the run up to the first and second peaks of the epidemic.
I'm giving up on the Grauniad coverage as it looks to me that they are determined to politicise stuff that (for once) isn't political - e.g. today's headline says 'PM forced into U-turn' - AIUI if anyone has been 'forced' into a 'U-turn' it would be Patrick Vallence and John Whitty - but that would interfere with the narrative of 'public sector workers good, Tory politicians bad'.
Of course it's politicised. The virus doesn't care about politics, those directly affected may have other things on their mind ... but the overall social response to the virus is political (almost by definition). The particular responses that politicians choose are going to be influenced by their political opinions and looking towards how they expect the public will respond. And, those decisions are constrained by previous political decisions: the decisions of Tories in the last 10 years to gut the NHS has resulted in an overstretched service that even without Covid19 is short of 10s of thousands of medical professionals and beds, cutting funding for local authorities has left the vulnerable in our society particularly at risk in homes already understaffed and under resourced or dependent on food banks when told to stay at home, the decision of a minority to cut ties with the rest of Europe has lead to a situation where even without Covid19 our ability to participate in research into disease epidemiology and medicines has been chopped at the knees, etc.
To say this isn't a political event is functionally the same as those in the US who claim "now is not the time to discuss gun control" after every mass shooting. Which, of course, is a political statement as much as calls to discuss gun control. Declaring that the response to Covid19 shouldn't be discussed in political terms is a political statement.
That's very clear - thanks Doublethink. It's playing feedback-control-systems in a very difficult way - like trying to maintain a constant speed in ones car
Yeah, for one; calibrating an epidemic so as to not overwhelm hospital capacity on an illness with a varying incubation period by opening and closing schools seems a rather ambitious task. All this while not doing mass testing, so you don't actually have accurate figures and where your health care services are going to be small enough in some areas that the law of large numbers doesn't apply.
Also parents are just not going to do this; trying to do varying patterns of school is going to be even more difficult to fit around work patterns.
Furthermore; the UK treats 18-65 year olds with chronic illnesses like shit - at the same time working age people are being asked to take one for the team (at a 5% risk of fairly significant damage to their lungs).
And politically ... well good luck to the politician who has to comment on even a slightly elevated child mortality rate.
A movie theater chain here is taking an interesting approach. For the time being, they are only allowing theaters to be filled up to half capacity, so there will be at least one empty seat between people. They're also increasing cleaning.
Many businesses, organizations, etc. are putting out statements about what steps they're taking to protect both customers/members and staff.
Yeah, for one; calibrating an epidemic so as to not overwhelm hospital capacity on an illness with a varying incubation period by opening and closing schools seems a rather ambitious task. All this while not doing mass testing, so you don't actually have accurate figures and where your health care services are going to be small enough in some areas that the law of large numbers doesn't apply.
Also parents are just not going to do this; trying to do varying patterns of school is going to be even more difficult to fit around work patterns.
Furthermore; the UK treats 18-65 year olds with chronic illnesses like shit - at the same time working age people are being asked to take one for the team (at a 5% risk of fairly significant damage to their lungs).
And politically ... well good luck to the politician who has to comment on even a slightly elevated child mortality rate.
Yes, I think all that is true. But ISTM that our only alternative was to shut the doors for 18 months and then vaccinate everybody once that becomes possible. Do you think that could have worked, or have you another approach?
That's very clear - thanks Doublethink. It's playing feedback-control-systems in a very difficult way - like trying to maintain a constant speed in ones car
Yeah, for one; calibrating an epidemic so as to not overwhelm hospital capacity on an illness with a varying incubation period by opening and closing schools seems a rather ambitious task. All this while not doing mass testing, so you don't actually have accurate figures and where your health care services are going to be small enough in some areas that the law of large numbers doesn't apply.
Also parents are just not going to do this; trying to do varying patterns of school is going to be even more difficult to fit around work patterns.
Furthermore; the UK treats 18-65 year olds with chronic illnesses like shit - at the same time working age people are being asked to take one for the team (at a 5% risk of fairly significant damage to their lungs).
And politically ... well good luck to the politician who has to comment on even a slightly elevated child mortality rate.
We can not eliminate uncertainty with a new disease.
Any strategy we try might not work, and risks unintended consequences.
In terms of trying to manage the population’s behaviour - that is also a feedback between what they are doing at any one time and what we think they will do in the future.
It also depends on the changing state of research and resources - see for example this. (R&D is being funded by the U.K. gov in parallel.)
If I understand the UK plan correctly then for about 6 months it will appear to have been a terrible mistake. Only if things then get even worse elsewhere in the world will its benefits become more evident.
Basically, though the death rate of hospitalised patients should be a usuable comparator.
To expand icu capacity, they will need to use the operating theatres, which will lead to the cancellation most elective surgery - and may triple icu capacity. If it can be staffed. 18000, final year nursing and midwifery students are being registered early in order to support the nhs - presumably to work in other areas so more experienced staff can be freed up for icu.
(We’ve being getting flow charts through on the management of suspected / actual covid patients who present to other bits of the nhs for what feels like a long time now - the same way we did during the Ebola outbreak.)
You’d think they might draft private healthcare staff over into the NHS - but a) it would be simpler to just buy their beds for extra capacity, b) they’ll tend not to have much icu capacity, c) many staff in private facilities are NHS staff doing additional private work.
I was reading Nassim Nicholas Taleb, an amusing writer on probability. Anyway, he tweets that nudge units and behavioural psychology have the reliability of astrology. Do I feel lucky?
Any effective strategic choice with have casualties. I think we're taking about a judgment call about which is the least bad option.
So far as herd immunity is concerned, we're just talking openly about what has always been happening in respect of common infections. So far as death rates are concerned, the best figures I've seen suggest that for most folks under 50, the death rate is very close to zero, but for those in the 70+ age range with pre-existing medical conditions (which is actually most of us) the death rate may be over 10% of those who are infected. This will be an ongoing risk for someone like me, in his late 70s and a long term asthma sufferer. In the short term, I'll be going into self-isolation, in the longer term before any vaccine emerges, I'm keeping my ears open for advice.
I'm trying to steer between complacency and over-reaction. A 10% mortality risk is enough to give anyone pause for thought.
Well, behavioural psychology models of human learning have a *huge* amount of evidence underlying them - so I would argue Taleb is opining outside his area of competence.
Whether models combining multiple bits of evidence from different disciplines are going good enough, we don’t know yet - but I am confident that it is likely our understanding of viral transmission, or restriction fatigue, is more useful than the idea the position of a planet effecting your love life.
To expand icu capacity, they will need to use the operating theatres, which will lead to the cancellation most elective surgery - and may triple icu capacity. If it can be staffed. 18000, final year nursing and midwifery students are being registered early in order to support the nhs - presumably to work in other areas so more experienced staff can be freed up for icu.
The cost of that is that delays to elective surgery will in many cases result in that surgery being more difficult when it happens with greater risks of complications, taking experienced staff off regular wards to work on isolation and ICU capability will leave people with other issues being looked after by less experienced staff, which risks complications being missed or the optimal treatment not being given and potential deaths on non-Covid wards that would otherwise not happen. Saving lives of people with Covid19 is likely to result in loss of lives in other sectors of the community, and will certainly result in loss of quality of life (eg: people needing hip replacements being immobile for another year).
Ideally, our ICU capacity shouldn't have been allowed to get so low, likewise number of nurses and doctors, but it's not possible to reverse 10 years of mismanagement of the NHS in a couple of weeks.
My anger with the Tories re covid, is that they have run down the nhs for a decade - so the overall capacity to cope with a surge in health demand is lower - rather than their approach to trying to manage the dynamics of that demand in the run up to the first and second peaks of the epidemic.
I'm giving up on the Grauniad coverage as it looks to me that they are determined to politicise stuff that (for once) isn't political - e.g. today's headline says 'PM forced into U-turn' - AIUI if anyone has been 'forced' into a 'U-turn' it would be Patrick Vallence and John Whitty - but that would interfere with the narrative of 'public sector workers good, Tory politicians bad'.
To say this isn't a political event is functionally the same as those in the US who claim "now is not the time to discuss gun control" after every mass shooting. Which, of course, is a political statement as much as calls to discuss gun control. Declaring that the response to Covid19 shouldn't be discussed in political terms is a political statement.
I was referring specifically to the Grauniad headline, which seems to be spun to the point of falsehood just to make the PM look bad.
My anger with the Tories re covid, is that they have run down the nhs for a decade - so the overall capacity to cope with a surge in health demand is lower - rather than their approach to trying to manage the dynamics of that demand in the run up to the first and second peaks of the epidemic.
I'm giving up on the Grauniad coverage as it looks to me that they are determined to politicise stuff that (for once) isn't political - e.g. today's headline says 'PM forced into U-turn' - AIUI if anyone has been 'forced' into a 'U-turn' it would be Patrick Vallence and John Whitty - but that would interfere with the narrative of 'public sector workers good, Tory politicians bad'.
To say this isn't a political event is functionally the same as those in the US who claim "now is not the time to discuss gun control" after every mass shooting. Which, of course, is a political statement as much as calls to discuss gun control. Declaring that the response to Covid19 shouldn't be discussed in political terms is a political statement.
I was referring specifically to the Grauniad headline, which seems to be spun to the point of falsehood just to make the PM look bad.
What is false about it? He reversed his position in the space of 24 hours, that's pretty much the definition of a U-turn.
My anger with the Tories re covid, is that they have run down the nhs for a decade - so the overall capacity to cope with a surge in health demand is lower - rather than their approach to trying to manage the dynamics of that demand in the run up to the first and second peaks of the epidemic.
I'm giving up on the Grauniad coverage as it looks to me that they are determined to politicise stuff that (for once) isn't political - e.g. today's headline says 'PM forced into U-turn' - AIUI if anyone has been 'forced' into a 'U-turn' it would be Patrick Vallence and John Whitty - but that would interfere with the narrative of 'public sector workers good, Tory politicians bad'.
To say this isn't a political event is functionally the same as those in the US who claim "now is not the time to discuss gun control" after every mass shooting. Which, of course, is a political statement as much as calls to discuss gun control. Declaring that the response to Covid19 shouldn't be discussed in political terms is a political statement.
I was referring specifically to the Grauniad headline, which seems to be spun to the point of falsehood just to make the PM look bad.
You are therapist, do you think psychology doesn’t work ?
Isn't psychology having a huge reproducibility crisis in its work?
It depends on which bit you are looking at. But in terms of fundamental behavioural psychology - no not really. For example, inconsistently rewarding and punishing behaviour sustains and increases its frequency - this is how gambling works.
My anger with the Tories re covid, is that they have run down the nhs for a decade - so the overall capacity to cope with a surge in health demand is lower - rather than their approach to trying to manage the dynamics of that demand in the run up to the first and second peaks of the epidemic.
I'm giving up on the Grauniad coverage as it looks to me that they are determined to politicise stuff that (for once) isn't political - e.g. today's headline says 'PM forced into U-turn' - AIUI if anyone has been 'forced' into a 'U-turn' it would be Patrick Vallence and John Whitty - but that would interfere with the narrative of 'public sector workers good, Tory politicians bad'.
To say this isn't a political event is functionally the same as those in the US who claim "now is not the time to discuss gun control" after every mass shooting. Which, of course, is a political statement as much as calls to discuss gun control. Declaring that the response to Covid19 shouldn't be discussed in political terms is a political statement.
I was referring specifically to the Grauniad headline, which seems to be spun to the point of falsehood just to make the PM look bad.
What is false about it? He reversed his position in the space of 24 hours, that's pretty much the definition of a U-turn.
His position was not, “we will never ban mass gatherings” - and they haven’t yet done so, and they are still saying the chief benefit of doing so is managing public resources rather than inhibiting viral spread.
I read Ian Donald's tweet thread last night. I, like him, have questions.
The level of fine-tuning - the balance between making sure people are infected (and infecting) at a level that the NHS can cope with the hospitalisations that will inevitably result, and fucking it up and causing needless death - is very, very fine indeed.
I would argue that even if that strategy is one that will work, then it is a dangerous one. If, over the last 10 years, the NHS had been well-cared for, and public health fully funded, and social care provisions not a lottery, I'd be prepared to cut this a lot more slack than I am now. Finding out halfway down the hill that the car has no brakes isn't going to be great.
Herd immunity. This is based on someone's idea in the UK that this virus will interact with immune systems like other viruses. It's a giant experiment. You'll find a number of links if you search for WHO (world health organization), herd immunity, covid. The WHO doesn't think it's a good plan.
No one knows if an infected person who recovers might be reinfected and be symptomatic or not, but be able to pass the infection on. If the herd immunity gamble works out and somehow very few die, bureaucrats will declare it success. If not, inquiry and horror that it wasn't managed properly, like flammable cladding panels on residential buildings.
On reflection after having had a daughter work in the UK, we understood that the UK's approach to flu was not to vaccinate everyone, and only pay for certain groups perceived at risk. She paid for a vaccination, because it's considered mostly stupid not to for Canadians and other countries with universal vaccination policies. There's a cost (death) - benefit (life) analysis with Covid-19 being made which I think reflects a more general willingness in the UK to tolerate some death and serious illness sequelae if the flu is an example. With population disease management being quite differently balanced with individual health risks than in other countries.
Basically what I understand is the UK is making things up re herd immunity and this virus. Suspicious that it's about money calculations. Concerned for you.
We've 2 confirmed cases in a provincial population on 1.1 million, and about twice the size of the British isles all put together. Low density overall but we're mostly clustered into cities and towns due to climate. The UK is a small country with differences: There's people everywhere at high densities. Everything is closed and shuttered here. Suspect we've actually quite a few more cases than the 2 known.
If there is a silver lining in all this, the Italians are singing to each other from their balconies as a way of boosting each other's morale. No toilet paper shortage there, either, thanks to bidets. But the name of the toilet paper on Italian selves is Corona (at least according to the BBC World Report yesterday).
Everything is a giant experiment with a new disease.
The functional effect of underfunding the NHS, is that our healthcare capacity is lower, and more likely to be overwhelmed if we cannot flatten the peak. To minimise the chance of the system of being overwhelmed - or possibly simply to reduce the duration of the time when it is overwhelmed - we need to flatten the peak.
Locking down for three months, say, and then having the peak at the beginning of winter will not mean more people survive. We can not pull trained doctors and nurses out of thin air - there will not be suddenly substantially more trained healthcare professionals at the end of the year.
(@NOprophet_NØprofit you can buy the flu jab if you are not in an at risk group for £6 which is actually less than we routinely pay for a doctor’s prescription, currently we fail to persuade even all the at risk population to accept the free jab.)
To minimise the chance of the system of being overwhelmed - or possibly simply to reduce the duration of the time when it is overwhelmed - we need to flatten the peak.
No one is arguing against this.
The problem is whether the government has the ability to control either the width or the height of the peak to the degree they appear to think they have. By betting the house on the width (which is, IMO, favours the economy, not public safety), they risk the height.
It's interesting that it is called "jab". A little funny to the use of the term here: the word "jab" means a mild attack on someone, when it doesn't mean taking an actual punch at someone. They've made it exceedingly easy to get vaccinated here: any pharmacy will do it, including the ones in grocery stores. You show your health card (identifies you to the health system), fill out a form on the ipad and they vaccinate you.
The issue isn't actually doctors, nurses, respiratory therapists etc. It's preventing the initial infections to start with. You're right that if there's there a shortage, tertiary centres (hospitals, medical centres) will overwhelmed. The secondary centres (physician offices, mediclinics or what ever you call them over there) are not really involved here: the testing is going to all be at off-site places, with assessment of symptoms. Only those with severe symptoms will be going to hospital or the additional contingency centres if hosps are overwhelmed. Primary prevention is not getting the infection in the first place. This is where the UK is departing from most everywhere: not focussing on primary prevention by enforcing isolation. And by paying sick people to stay away from others.
This is where the UK is departing from most everywhere: not focussing on primary prevention by enforcing isolation. And by paying sick people to stay away from others.
We are asking people with symptoms to isolate.
We have increased access to statutory sick pay to first day of illness (and stated it will cover isolation / quarantine)
We are providing ESA and Universal credit to the self employed.
It’s not a perfect financial safety net, but it is not as threadbare as you are suggesting.
One of the problems being that UC is designed to be very difficult to claim. To claim UC you need to prove your identity, which is almost impossible unless you have photo-id (passport or driving license) and able to travel to your local job centre to have someone look at that and confirm you're the same person ... presumably the intention is that someone self-isolating doesn't walk into their local job centre.
To minimise the chance of the system of being overwhelmed - or possibly simply to reduce the duration of the time when it is overwhelmed - we need to flatten the peak.
No one is arguing against this.
The problem is whether the government has the ability to control either the width or the height of the peak to the degree they appear to think they have. By betting the house on the width (which is, IMO, favours the economy, not public safety), they risk the height.
A lot of people are criticising the governments *current* pandemic response, on the basis of its previous NHS underfunding.
But the two things are separate.
Either lockdown is a good option for controlling the pandemic, or it isn’t. At some level we do not know, but there were three peaks to the Spanish Flu epidemic.
It is worth bearing in mind looking at other countries responses - they have different legal systems, they are in different seasons of the year with, therefore, different upcoming prospects of other circulating illnesses, and they have different national cultures and likely levels of compliance to their government. Asia may have more population compliance, and possibly some population resistance to the virus, because they lived through the last SARS epidemic.
Information is starting to circulate about the contents of the upcoming emergency bill - including allowing police to detain people for viral screening, shut schools at the decision of central government, reducing regulatory standards, delay the local elections etc. with powers lasting for upto 2 years. (Presumably because they are expecting a vaccine to take 18 months to develop.) Already, people are complaining this is draconian, a police state etc - but the measures taken by China or South Korea would not be possible here without even more extensive legislation.
One of the problems being that UC is designed to be very difficult to claim. To claim UC you need to prove your identity, which is almost impossible unless you have photo-id (passport or driving license) and able to travel to your local job centre to have someone look at that and confirm you're the same person ... presumably the intention is that someone self-isolating doesn't walk into their local job centre.
I believe they are relaxing the conditions - though they hope most self-employed will be able to claim contributory employment and support allowance.
Some good news is: a Dutch group of scientists say they have isolated an antibody to the virus. Obviously, their results still need to be scrutinised - but it is heartening to the see the basic scientific building blocks that will be necessary for a vaccine slotting into place.
I read a paper on the genetic analysis on the covid virus, they’d tracked genetic mutations and reckoned that the disease was detected within weeks of crossing the species barrier into humans. In many ways that is an incredible achievement.
This is where the UK is departing from most everywhere: not focussing on primary prevention by enforcing isolation. And by paying sick people to stay away from others.
We are asking people with symptoms to isolate.
We have increased access to statutory sick pay to first day of illness (and stated it will cover isolation / quarantine)
We are providing ESA and Universal credit to the self employed.
It’s not a perfect financial safety net, but it is not as threadbare as you are suggesting.
The news here focussed on the UK's herd immunity. Glad there's a better picture than that portrayed.
Some good news is: a Dutch group of scientists say they have isolated an antibody to the virus. Obviously, their results still need to be scrutinised - but it is heartening to the see the basic scientific building blocks that will be necessary for a vaccine slotting into place.
I read a paper on the genetic analysis on the covid virus, they’d tracked genetic mutations and reckoned that the disease was detected within weeks of crossing the species barrier into humans. In many ways that is an incredible achievement.
This organization I referred to above. It's actually not any team doing anything alone. They're all working together on it.
Comments
When people say, people pulled together during the war - they forget, for example, the black market profiteering to evade rationing (that the government was trying to enforce) to ensure everybody had enough food and clothing.
Even now, there are people are not observing the limited number of things they have been asked to do.
2: we just don't know, do we? We're in uncharted territory with a guy who has previously been sacked for lying, and with form on knowingly putting others in harm's way, in charge. This is why I want to know what the options are and what priorities have been set.
They talked about not banning public attendance at matches literally 36 hours before they banned mass events.
I think the government has made a rod for its own back by insisting that its plan was entirely an direct extrapolation of pure science, rather than a judgement based around a balance of different and sometimes competing considerations from epidemiology/psychology etc.
Also, they haven’t yet banned mass events - they’ve said they may do so next week.
(Source BBC live news 09:13)
So this requires 70-80% infection rate to produce herd immunity? That produces 400 000 to 500 000 deaths, assuming 1% rate. That's a lot.
I also don't understand how vulnerable people are being protected.
I read it already. It has an internal logic but I don't think stands up to scrutiny on a number of fronts.
The nightmare is positive feedback - you open the schools, close the schools, but there's some lag in there and you create great globs of cases just when you can't handle them. In electrical systems a fuse blows, and in mechanics bits fall off. Here...you kill all the vulnerable and think 'shit, that didn't work'. But that is not at all to say that this is the wrong way to do it.
But the basic point, that is probably right, is we can not eradicate the disease - planning a strategy that assumes we will be able to would be futile.
I am reading all this stuff knowing I am vulnerable, I have diabetes and asthma - though I am not elderly. But we can not ignore the reality of what a pandemic is, we can hold down the mortality rate - but we can’t avoid the fact that many thousands will die across the world including the U.K.
Whether the government’s strategy is effective will be fundamentally judgered by what percentage of the population die - rather than if deaths get above some absolute number.
I believe the idea is to cocoon them at the peak of the epidemic, after the peak is passed herd immunity will protect them because most people they have contact with will be immune and not infectious - and if they do get ill they will have access to appropriate healthcare because the system won’t be swamped at that point.
(In the same way immunocompromised people who can’t have the measles vaccine rely upon everyone else having had it in order to protect them,)
To say this isn't a political event is functionally the same as those in the US who claim "now is not the time to discuss gun control" after every mass shooting. Which, of course, is a political statement as much as calls to discuss gun control. Declaring that the response to Covid19 shouldn't be discussed in political terms is a political statement.
Yeah, for one; calibrating an epidemic so as to not overwhelm hospital capacity on an illness with a varying incubation period by opening and closing schools seems a rather ambitious task. All this while not doing mass testing, so you don't actually have accurate figures and where your health care services are going to be small enough in some areas that the law of large numbers doesn't apply.
Also parents are just not going to do this; trying to do varying patterns of school is going to be even more difficult to fit around work patterns.
Furthermore; the UK treats 18-65 year olds with chronic illnesses like shit - at the same time working age people are being asked to take one for the team (at a 5% risk of fairly significant damage to their lungs).
And politically ... well good luck to the politician who has to comment on even a slightly elevated child mortality rate.
A movie theater chain here is taking an interesting approach. For the time being, they are only allowing theaters to be filled up to half capacity, so there will be at least one empty seat between people. They're also increasing cleaning.
Many businesses, organizations, etc. are putting out statements about what steps they're taking to protect both customers/members and staff.
Yes, I think all that is true. But ISTM that our only alternative was to shut the doors for 18 months and then vaccinate everybody once that becomes possible. Do you think that could have worked, or have you another approach?
We can not eliminate uncertainty with a new disease.
Any strategy we try might not work, and risks unintended consequences.
In terms of trying to manage the population’s behaviour - that is also a feedback between what they are doing at any one time and what we think they will do in the future.
It also depends on the changing state of research and resources - see for example this. (R&D is being funded by the U.K. gov in parallel.)
To expand icu capacity, they will need to use the operating theatres, which will lead to the cancellation most elective surgery - and may triple icu capacity. If it can be staffed. 18000, final year nursing and midwifery students are being registered early in order to support the nhs - presumably to work in other areas so more experienced staff can be freed up for icu.
You’d think they might draft private healthcare staff over into the NHS - but a) it would be simpler to just buy their beds for extra capacity, b) they’ll tend not to have much icu capacity, c) many staff in private facilities are NHS staff doing additional private work.
Psychology is a big umbrella.
Isn't psychology having a huge reproducibility crisis in its work?
chrisstyles, quetzcoatl
Any effective strategic choice with have casualties. I think we're taking about a judgment call about which is the least bad option.
So far as herd immunity is concerned, we're just talking openly about what has always been happening in respect of common infections. So far as death rates are concerned, the best figures I've seen suggest that for most folks under 50, the death rate is very close to zero, but for those in the 70+ age range with pre-existing medical conditions (which is actually most of us) the death rate may be over 10% of those who are infected. This will be an ongoing risk for someone like me, in his late 70s and a long term asthma sufferer. In the short term, I'll be going into self-isolation, in the longer term before any vaccine emerges, I'm keeping my ears open for advice.
I'm trying to steer between complacency and over-reaction. A 10% mortality risk is enough to give anyone pause for thought.
Whether models combining multiple bits of evidence from different disciplines are going good enough, we don’t know yet - but I am confident that it is likely our understanding of viral transmission, or restriction fatigue, is more useful than the idea the position of a planet effecting your love life.
Ideally, our ICU capacity shouldn't have been allowed to get so low, likewise number of nurses and doctors, but it's not possible to reverse 10 years of mismanagement of the NHS in a couple of weeks.
I was referring specifically to the Grauniad headline, which seems to be spun to the point of falsehood just to make the PM look bad.
What is false about it? He reversed his position in the space of 24 hours, that's pretty much the definition of a U-turn.
Like this or this?
It depends on which bit you are looking at. But in terms of fundamental behavioural psychology - no not really. For example, inconsistently rewarding and punishing behaviour sustains and increases its frequency - this is how gambling works.
His position was not, “we will never ban mass gatherings” - and they haven’t yet done so, and they are still saying the chief benefit of doing so is managing public resources rather than inhibiting viral spread.
As utilitarian as it can be. I'll tell myself that when I'm on a ventilator. Or triage trolley
The level of fine-tuning - the balance between making sure people are infected (and infecting) at a level that the NHS can cope with the hospitalisations that will inevitably result, and fucking it up and causing needless death - is very, very fine indeed.
I would argue that even if that strategy is one that will work, then it is a dangerous one. If, over the last 10 years, the NHS had been well-cared for, and public health fully funded, and social care provisions not a lottery, I'd be prepared to cut this a lot more slack than I am now. Finding out halfway down the hill that the car has no brakes isn't going to be great.
No one knows if an infected person who recovers might be reinfected and be symptomatic or not, but be able to pass the infection on. If the herd immunity gamble works out and somehow very few die, bureaucrats will declare it success. If not, inquiry and horror that it wasn't managed properly, like flammable cladding panels on residential buildings.
On reflection after having had a daughter work in the UK, we understood that the UK's approach to flu was not to vaccinate everyone, and only pay for certain groups perceived at risk. She paid for a vaccination, because it's considered mostly stupid not to for Canadians and other countries with universal vaccination policies. There's a cost (death) - benefit (life) analysis with Covid-19 being made which I think reflects a more general willingness in the UK to tolerate some death and serious illness sequelae if the flu is an example. With population disease management being quite differently balanced with individual health risks than in other countries.
Basically what I understand is the UK is making things up re herd immunity and this virus. Suspicious that it's about money calculations. Concerned for you.
We've 2 confirmed cases in a provincial population on 1.1 million, and about twice the size of the British isles all put together. Low density overall but we're mostly clustered into cities and towns due to climate. The UK is a small country with differences: There's people everywhere at high densities. Everything is closed and shuttered here. Suspect we've actually quite a few more cases than the 2 known.
The functional effect of underfunding the NHS, is that our healthcare capacity is lower, and more likely to be overwhelmed if we cannot flatten the peak. To minimise the chance of the system of being overwhelmed - or possibly simply to reduce the duration of the time when it is overwhelmed - we need to flatten the peak.
Locking down for three months, say, and then having the peak at the beginning of winter will not mean more people survive. We can not pull trained doctors and nurses out of thin air - there will not be suddenly substantially more trained healthcare professionals at the end of the year.
(@NOprophet_NØprofit you can buy the flu jab if you are not in an at risk group for £6 which is actually less than we routinely pay for a doctor’s prescription, currently we fail to persuade even all the at risk population to accept the free jab.)
No one is arguing against this.
The problem is whether the government has the ability to control either the width or the height of the peak to the degree they appear to think they have. By betting the house on the width (which is, IMO, favours the economy, not public safety), they risk the height.
The issue isn't actually doctors, nurses, respiratory therapists etc. It's preventing the initial infections to start with. You're right that if there's there a shortage, tertiary centres (hospitals, medical centres) will overwhelmed. The secondary centres (physician offices, mediclinics or what ever you call them over there) are not really involved here: the testing is going to all be at off-site places, with assessment of symptoms. Only those with severe symptoms will be going to hospital or the additional contingency centres if hosps are overwhelmed. Primary prevention is not getting the infection in the first place. This is where the UK is departing from most everywhere: not focussing on primary prevention by enforcing isolation. And by paying sick people to stay away from others.
We are asking people with symptoms to isolate.
We have increased access to statutory sick pay to first day of illness (and stated it will cover isolation / quarantine)
We are providing ESA and Universal credit to the self employed.
It’s not a perfect financial safety net, but it is not as threadbare as you are suggesting.
A lot of people are criticising the governments *current* pandemic response, on the basis of its previous NHS underfunding.
But the two things are separate.
Either lockdown is a good option for controlling the pandemic, or it isn’t. At some level we do not know, but there were three peaks to the Spanish Flu epidemic.
It is worth bearing in mind looking at other countries responses - they have different legal systems, they are in different seasons of the year with, therefore, different upcoming prospects of other circulating illnesses, and they have different national cultures and likely levels of compliance to their government. Asia may have more population compliance, and possibly some population resistance to the virus, because they lived through the last SARS epidemic.
Information is starting to circulate about the contents of the upcoming emergency bill - including allowing police to detain people for viral screening, shut schools at the decision of central government, reducing regulatory standards, delay the local elections etc. with powers lasting for upto 2 years. (Presumably because they are expecting a vaccine to take 18 months to develop.) Already, people are complaining this is draconian, a police state etc - but the measures taken by China or South Korea would not be possible here without even more extensive legislation.
I believe they are relaxing the conditions - though they hope most self-employed will be able to claim contributory employment and support allowance.
I read a paper on the genetic analysis on the covid virus, they’d tracked genetic mutations and reckoned that the disease was detected within weeks of crossing the species barrier into humans. In many ways that is an incredible achievement.
The news here focussed on the UK's herd immunity. Glad there's a better picture than that portrayed.
This organization I referred to above. It's actually not any team doing anything alone. They're all working together on it.