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Steve Skelton 101/06/2020 15:25:37
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SOD how on earth can you justify the deaths per case column. The UK has no idea (as is probably the case with most nations) how many cases there have been or are occurring each day so this is totally irrelevant.

Steve

pgk pgk01/06/2020 16:15:26
1791 forum posts
288 photos

There are so many variables to consider that analyses are difficult.. Simply consider a country with more than adequate testing capacity testing any and every in-contact and individual that feels slightly unwell and they will have a higher number of +ve cases compared to a country that only tests likely candidates that need hospitalisation. Perhaps more important is also the type of test used since these will vary in % of false positive or negative results (sensitivity v specificity; also depends on the lab and tech doing the test). One should also consider how a death cert re coronavirus is decided upon - actually by a proven test or a convenient reason to put on a certificate - and if it was by proven test was that the real cause of death or a contributing factor only.

It was mentioned earlier in this thread that the original idea of COVID19 was as a respiratory disease but it manifests as a vascular disease in many patients such that ventilators aren't the wonder answer - it's also access to other support measures including dialysis for a subset of those who fall ill and probably access to clinical acumen and clinicians who aren't overwhelmed - more so than technology?.

Just look at some of our own confusing figures: link
Deaths from C-19 38K+
Deaths where C-19 is mentioned 45K+
Deaths higher than usual for the time of year 59K+

Gov published figures for regions vary wildly too Link... but that will be as much down to when it got in there and how the local population has taken to control measures Indeed areas with low pecentage cases are those waiting to catch up...

pgk

SillyOldDuffer01/06/2020 16:17:32
5772 forum posts
1230 photos
Posted by Steve Skelton 1 on 01/06/2020 15:25:37:

SOD how on earth can you justify the deaths per case column. The UK has no idea (as is probably the case with most nations) how many cases there have been or are occurring each day so this is totally irrelevant.

Steve

Steve, I thought I'd explained.

  • The number of cases is determined by a Covid test. It's not an estimate of the number of infections in the community, its the count of confirmed infections, ie people ill enough to be tested.
  • The number of deaths is counted off Death Certificates

On the face of it, the ratio indicates the effectiveness of the health service, ie the likelihood of an unsuccessful outcome after a patient tested positive.

I suggested shortage of ventilators as a cause; not having enough of them means patients who would have survived don't. Likewise, shortage of staff to manage patients on ventilators would have the same effect. It's not a criticism of the Health Service; no matter how caring people are, they can't deliver an effective service unless all the essential resources are available. Another possibility is genetic make-up of the victims, or maybe difficulties in Care Homes allowing the virus to spread rapidly inside vulnerable communities. Possibly it's a statistical artefact caused by different reporting systems. I don't know.

My point is the cause of this disparity between countries has to be explained whatever it is. Not about blame, unless stupidity or corruption was involved. If another country did something clever, we should copy them. If we made a mistake, it should be fixed. The idea is to do better next time, and it can't be done if embarrassments are swept under the carpet.

Dave

blowlamp01/06/2020 16:19:00
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Peter Hitchens latest interview on talkRADIO this morning.

Perhaps listen to the early interviews and see how Mike Graham has gradually changed his outlook on this matter.

 

STOP PRESS!!

Had to LOL at this headline. 

Coronavirus: Sex during lockdown with someone outside your household is illegal from today

 

 
 
Martin.

 

 

 

Edited By blowlamp on 01/06/2020 16:23:11

Edited By blowlamp on 01/06/2020 16:24:22

SillyOldDuffer01/06/2020 16:28:35
5772 forum posts
1230 photos
Posted by Martin Kyte on 01/06/2020 15:07:05:

I suspect the root cause in the UK was shortages, particularly ventilators and the staff needed to run them.

Are you making this up as you go along? Can you point me to a documented case where a patient was not put on a ventilator because none were available?

I may as well add that it will probably never be over because obesity is a major risk factor and therefor the Fat Lady may never sing. Quite happy with your post until you got to "Why ?"

regards Martin

This article in the Daily Telegraph lays out the NICE Triage Policy.

I explained in another post the reason the 'why' question has to be answered. Next time it might be one of us who is assessed 'Critical Care Not Considered Appropriate'.

Dave

Martin Kyte01/06/2020 16:32:17
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1842 forum posts
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On the face of it, the ratio indicates the effectiveness of the health service, ie the likelihood of an unsuccessful outcome after a patient tested positive.

On the Face of It yes. However all it actually does, is tell you how many saves each health service managed with their set of patients. You have to normalise for age, sex, co-morbidity, fitness and ethnicity at least before you can make any kind of comparison.

regards Martin

Martin Kyte01/06/2020 16:47:34
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1842 forum posts
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Posted by SillyOldDuffer on 01/06/2020 16:28:35:
Posted by Martin Kyte on 01/06/2020 15:07:05:

I suspect the root cause in the UK was shortages, particularly ventilators and the staff needed to run them.

Are you making this up as you go along? Can you point me to a documented case where a patient was not put on a ventilator because none were available?

I may as well add that it will probably never be over because obesity is a major risk factor and therefor the Fat Lady may never sing. Quite happy with your post until you got to "Why ?"

regards Martin

This article in the Daily Telegraph lays out the NICE Triage Policy.

I explained in another post the reason the 'why' question has to be answered. Next time it might be one of us who is assessed 'Critical Care Not Considered Appropriate'.

Dave

None of that is based on ventilator availability but what is best for the patient. If you are assessed to be frail and dying with no great expectation of recovery in critical carewhich in Covid19 infections means sedation and ventilation you die without the chance to say goodbye to family albeit by electronic means. It's based on when treatment stops being kind and starts to be invasive.

regards Martin

Steve Skelton 101/06/2020 19:02:37
76 forum posts
3 photos

Dave,

I disagree. In the early days tests, in the majority of the UK, were only carried out on hospital admissions and therefore those needing medical care. This was due to the inability of the UK to carry out large numbers of tests at the time – I am aware of people who were not tested, although they asked to be, and are very likely to have had the CV (they holidayed in Austria at the time of the outbreak there and were poorly at home with the expected symptoms) .

Other countries in Europe and Asia were testing far more people who were not hospitalised and therefore who were counted as cases but probably much milder who recovered. We were not doing that to any great extent. So it is not a like for like comparison.

Thus, it is not a reflection on the effectiveness of the UK health service. Other countries who were testing at a far higher rate than we were will then obviously have a much better death/cases ratio.

Steve

blowlamp01/06/2020 19:21:08
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1346 forum posts
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One of the things that puzzled me about this most 'dangerous' virus, was the government advice, that if you had the symptoms, you should stay at home, NOT go to hospital and NOT go to your doctor.

Can someone please explain?

 

Martin.

Edited By blowlamp on 01/06/2020 19:21:38

Ady101/06/2020 19:27:46
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3688 forum posts
514 photos

Do a lot of dog walking and was struck by the social disparity tonight in the park on an almost perfect evening

Loads and loads of youngsters, almost zero oldies

It looked like one of those dystopian films where everyone over 30 gets sent away

Martin Kyte01/06/2020 22:40:20
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1842 forum posts
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Posted by blowlamp on 01/06/2020 19:21:08:

One of the things that puzzled me about this most 'dangerous' virus, was the government advice, that if you had the symptoms, you should stay at home, NOT go to hospital and NOT go to your doctor.

Can someone please explain?

Martin.

Edited By blowlamp on 01/06/2020 19:21:38

A virus that is very infectious but has a mortality rate of say 1% has the potential to kill 666,000 people (1% UK population) directly if left unchecked. No-one has immunity and everyone can be infected. Given that a huge swathe of the population would also go down with symptoms sufficient to keep them off work that drives a steamroller through essential services causing more death and hardship. As most people will have a relatively mild illness they don't require treatment. The advice was that if symptoms worsen the hospitalisation may be required so seek help. The stay at home directive is to protect the general poulation from unrestricted spread of the virus.

Does that help?

regards Martin

blowlamp02/06/2020 00:41:24
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1346 forum posts
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If the virus did have the potential to kill 666,000 people in the UK, then it seems like dangerous advice to ask the public to self diagnose in this way. It's dangerous in another way too, in that other illnesses with similar symptoms will fail to be diagnosed by doctors, with potentially tragic consequences for anyone following that advice.

I think the current number of deaths in the UK hovers around the 40,000 mark, with a very large proportion being classed in either the 'corona related' or 'covid-19 related' category, rather than the actual cause of death category.

This ~ 40,000 figure also places the the chance of being struck down by the virus in the UK at less than 0.1% which is comparable to some other viruses, which, as a nation, we don't 'lock down' for.

If it's true that large numbers of people in care homes have succumbed to the virus, then it suggests to me that being locked up and off the streets isn't really of any benefit, but reinforces the idea that the older & weaker members of society are the ones most vulnerable. From my own knowledge, these care homes are also the places which doctors will NOT visit to manage their patients.

Martin.

Danny M2Z02/06/2020 05:20:24
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849 forum posts
282 photos

I have refrained from commenting about this pandemic for a while as I am fortunate? to be living in Australia but as I have friends and family living in the U.K. and the U.S.A this is getting a bit to close to the heart.

What prompted this post was a TV program that I viewed recently that reviewed the history of the Spanish Flu epidemic of just over 100 years ago in Australia and the lessons that can be learned from tha t outbreak.

There are many similarities in the mechanism of the spread of Covid-19, in the case of Australia it was maritime and apparently a shipload of troops that were recalled en route to Europe when WW1 ended was instrumental.

On return to Australia, the ship berthed to refuel in New Zealand and although only officers and medical staff were allowed to disembark, that was enough to permit at least one individual to return to the ship and spread the virus.

Once the ship reached Australia (flying the yellow flag) the flu virus was not effectively contained and so slowly spread around the country Australia 1918

Now in 2020, Australia has (apparently) learned this lesson from history and a strict maritime lockdown has been implimented again, even using the same quarantine stations dating back to over 100 years ago. This did not however prevent the Ruby Princess **LINK** from slipping through the ropes, just like the troopship in 1918

100 years ago international air travel was not an issue but nowadays it is under the same lockdown and isolation measures as maritime restrictions. Only Australian air passengers returning to Australia from overseas are permitted to land and they are immediately isolated to selected locations.

The scary part of the program was that (just like discovered in Sorth Korean nightclubs nowadays) one has to be very vigilant when relaxing restrictions as it only takes one person, the so called 'Super Spreader' **LINK**

So lessons to be learned - Stay home, stay safe and be sensible and be careful all my fellow model engineering friends and your families.

The pandemic has not ended, just the goalposts are being moved to get the economy of all countries moving a bit but we are all just as vulnerable as we were last week.

Regards from Australia * Danny M *

Edited By Danny M2Z on 02/06/2020 05:21:33

Ady102/06/2020 06:34:45
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3688 forum posts
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It's the sort of thing all generations have to live with at some point but "times have changed" where life expectancy is concerned

My grandparents would be in the spanish one in the 20s and my mother caught the asian one in the 50s which decked her for a while

c'est la vie

Edited By Ady1 on 02/06/2020 06:37:31

Martin Kyte02/06/2020 09:36:15
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1842 forum posts
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Posted by blowlamp on 02/06/2020 00:41:24:This ~ 40,000 figure also places the the chance of being struck down by the virus in the UK at less than 0.1% which is comparable to some other viruses, which, as a nation, we don't 'lock down' for.

Martin.

No. The infection rate is lower because of the lockdown not because of the virus. That's the whole point. You reduce the spread by reducing contact between people. If you allow the virus to infect the entire nation you would expect 1% of the population to die which is 660,000 people. Maybe you should do a little background reading on epidemiology.

regards Martin

blowlamp02/06/2020 10:26:55
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1346 forum posts
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Posted by Martin Kyte on 02/06/2020 09:36:15:
Posted by blowlamp on 02/06/2020 00:41:24:This ~ 40,000 figure also places the the chance of being struck down by the virus in the UK at less than 0.1% which is comparable to some other viruses, which, as a nation, we don't 'lock down' for.

Martin.

No. The infection rate is lower because of the lockdown not because of the virus. That's the whole point. You reduce the spread by reducing contact between people. If you allow the virus to infect the entire nation you would expect 1% of the population to die which is 660,000 people. Maybe you should do a little background reading on epidemiology.

regards Martin

I understand the theory of the lock down - what other things do you propose we get locked down for to keep us safe?

I just used your percentage rate. You said 666,000 could die from this (or 1%) , so I took the 'actual' number of deaths in the UK of ~ 40,000, which is less than 66,600 (1/10th of your number) and so equates to less than 0.1%.

There is no proof this lock down has had any beneficial effect, in fact, our immunity to other infections is likely impaired due to our immune systems not being excercised sufficiently for weeks on end. It's more likely that many people have been infected and recovered regardless of the lock down.

Why have UK airports remained open with no checks or restrictions over these weeks?

Martin.

SillyOldDuffer02/06/2020 10:40:56
5772 forum posts
1230 photos
Posted by Steve Skelton 1 on 01/06/2020 19:02:37:

Dave,

I disagree. In the early days tests, in the majority of the UK, were only carried out on hospital admissions and therefore those needing medical care. This was due to the inability of the UK to carry out large numbers of tests at the time – I am aware of people who were not tested, although they asked to be, and are very likely to have had the CV (they holidayed in Austria at the time of the outbreak there and were poorly at home with the expected symptoms) .

Other countries in Europe and Asia were testing far more people who were not hospitalised and therefore who were counted as cases but probably much milder who recovered. We were not doing that to any great extent. So it is not a like for like comparison.

Thus, it is not a reflection on the effectiveness of the UK health service. Other countries who were testing at a far higher rate than we were will then obviously have a much better death/cases ratio.

Steve

Hi Steve,

That's true, but surely ability to test is a major part of Health Service effectiveness?

The NHS depends on having sufficient numbers of trained, well-motivated staff. It also depends on those staff having the tools to do the job. Health Service effectiveness drops if there aren't enough bandages, surgeons, nurses, drugs, beds or cleaners. And effectiveness drops when services are overwhelmed by too many patients arriving at the same time. And that's very likely if sufficient tests weren't available when needed to trace and isolate early patients. As you say: 'I am aware of people who were not tested, although they asked to be, and are very likely to have had the CV (they holidayed in Austria at the time of the outbreak there and were poorly at home with the expected symptoms' Exactly!

If other countries were more effective by testing on a large scale, why didn't the UK do the same?

I'm not criticising the NHS as an organisation or it's staff. Both are wonderful. Both occasionally drop the ball, and both are limited by resource availability.

Almost the worst thing that can be done after an event like this is failing to learn from the experience. Recommended reading: 'Better' by Atul Gawande

Dave

Ady102/06/2020 10:45:01
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3688 forum posts
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Why have UK airports remained open with no checks or restrictions over these weeks?

It's partly politics, partly economics, partly helping the system to cope with infection rates

At the end of the day our leaders are trying to herd cats, trying to please everyone at the same time with a weather eye on the future economy

Martin Kyte02/06/2020 11:00:39
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1842 forum posts
33 photos

I suggest you don't understand the theory of the lockdown.

The reason for lockdown is to restrict the spread.

The reson for shielding is to prevent the individual getting infected.

The lockdown was there to reduce the infection rate and therefor the number of infections in the population.This it successfully did. Which indirectly kept the majority of us safe. The death rate is fatalities divided by infections. You have just divided fatalities by the entire population, 90% at least of which have never been infected.

The estimated death rate for the virus is estimated at 1% accross the whole population.

If it infects the whole population that is 1% of 66.6 million = 666,000. We managed to stop that happening by the lockdown.

The number of actual deaths stands at 40,000 whic would give you 4,000000 infections or around 6% of the population which is in line with the antibody surveys currently being carried out.

Thus the effectiveness of the lockdown is seenby dividing the actual deaths with lockdown by the estimated deaths without lockdown which woud be 40,000/666,000 = 0.0006 or 0.6%.

Put it another way because of the lockdown, so far we have had 0.6% of the deaths we could have had if we had carried on as normal which is a pretty good argument for doing as we did.

The reason for lockdown is to restrict the spread.

The reson for shielding is to prevent the individual getting infected.

regards Martin

SillyOldDuffer02/06/2020 11:26:13
5772 forum posts
1230 photos
Posted by Martin Kyte on 01/06/2020 16:47:34:
Posted by SillyOldDuffer on 01/06/2020 16:28:35:
Posted by Martin Kyte on 01/06/2020 15:07:05:

I suspect the root cause in the UK was shortages, particularly ventilators and the staff needed to run them.

Are you making this up as you go along? Can you point me to a documented case where a patient was not put on a ventilator because none were available?

I may as well add that it will probably never be over because obesity is a major risk factor and therefor the Fat Lady may never sing. Quite happy with your post until you got to "Why ?"

regards Martin

This article in the Daily Telegraph lays out the NICE Triage Policy.

I explained in another post the reason the 'why' question has to be answered. Next time it might be one of us who is assessed 'Critical Care Not Considered Appropriate'.

Dave

None of that is based on ventilator availability but what is best for the patient. If you are assessed to be frail and dying with no great expectation of recovery in critical carewhich in Covid19 infections means sedation and ventilation you die without the chance to say goodbye to family albeit by electronic means. It's based on when treatment stops being kind and starts to be invasive.

regards Martin

In normal times one would hope so! But these are not normal times: Metro, Vox Political, Daily Mail. Daily Express Guardian. (A mix of Left and Right opinion, I'm not making a political point.) In the USA, where President Trump has assured the nation there is no shortage of ventilators: BuzzFeedNews.

Telling relatives not being ventilated is kinder isn't a lie. But it's not the whole truth either. It also makes the ventilator and staff available for someone who has a better chance. And some of the people taken off ventilators to say goodbye would have survived. Medical shortages always cause difficult decisions to be made.

Another twist, there have been many Covid deaths in Care Homes, where ventilators aren't available. Who decided these people wouldn't be hospitalised? Was the decision kind or informed by practicalities? Both I expect.

Personally I don't have a moral problem with people being triaged in an emergency. It's a fact of life. But I would prefer triage to be unnecessary if possible. Quite happy if the authorities made reasonable efforts to supply PPE and Ventilators and failed due to shortages. Not happy if it turns out an official gave the contract to an incompetent supplier in exchange for a brown envelope. It happens.

Dave

Edited By SillyOldDuffer on 02/06/2020 11:26:35

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