One-*** efficacy questions

[Chris152]

It will be vital to see how much the UK has learnt this past year and can put into practice with this flare-up. We know that new variants will appear, almost certainly they will be imported from an area with high incidents of covid such as India, so this is to be expected. We have all the tools to supress this flare-up.
1. We have huge Track and Trace capacity, so infections should be able to be isolated locally.
2. We know how to isolate and if necessary lock down locally whilst still opening up the rest of the country
3. We have huge vaccine capacity (ca 500,000 per day) so could choose to ring-vaccinate locally in Bolton all adults and teenagers at the expense of slightly slowing down the national role-out.

This may mean adapting current practice, especially for point 3 - it would necessitate a tweaking the current vaccine roll-out nationally by age to make an exception in Bolton. I would fill me with confidence if our PH can quickly contain this outbreak, whilst continuing to relax restrictions on a national basis.

My understanding is the vaccines, while are not as effective against the Indian variant as against the Kent variants, do reduce both incidence and severity of infection, so should be able to snuff out this outbreak.

Thanks for the reply, Tom. As you say, we have lots of things in place; we now need the right decisions to use them made at the right times. Yesterday's press conference spoke of 'living with the virus' and individuals making their own decisions - fine in the abstract, but it seems they've become euphemisms for avoiding decisions at govt level. You don't need to be an epidemiologist to imagine what happens next without the kind of actions you describe, nor a political or economic theorist to figure out why.
Here's today's Sky News:
'Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.
Minutes of a meeting on Thursday suggest there is a "realistic possibility" that the Indian variant of COVID-19 is 50% more transmissible than the one that emerged in Kent late last year.'
https://news.sky.com/story/covid-19...rns-variant-could-pressure-hospitals-12306738As I said earlier, it does feel a bit like we've been here a few times before, watching things happen in slow motion.

 

[Rorschach]

There are many countries which have falsified that idea by having an effective TTI system. The uselessness is in the implementation. Ours was/is - thank Dido etc.

No countries have an effective T&T system for Covid, what they have was a start from an incredibly low base and probably high levels of natural immunity.

 

[Rorschach]

Thanks for the reply, Tom. As you say, we have lots of things in place; we now need the right decisions to use them made at the right times. Yesterday's press conference spoke of 'living with the virus' and individuals making their own decisions - fine in the abstract, but it seems they've become euphemisms for avoiding decisions at govt level. You don't need to be an epidemiologist to imagine what happens next without the kind of actions you describe, nor a political or economic theorist to figure out why.
Here's today's Sky News:
'Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.
Minutes of a meeting on Thursday suggest there is a "realistic possibility" that the Indian variant of COVID-19 is 50% more transmissible than the one that emerged in Kent late last year.'
https://news.sky.com/story/covid-19...rns-variant-could-pressure-hospitals-12306738As I said earlier, I does feel a bit like we've been here a few times before, watching things happen in slow motion.

Who cares how transmissible it is? The only thing that matters is if it causes hospitals to be overwhelmed.

 

[RobinBHM]

A simple of example of this for the UK is that we are constantly given the 127k deaths figure saying they died "in the past year", this is indeed true (near enough a year anyway) but without the context that it covers two winter respiratory seasons. This 127k figure is then compared against a yearly mortality of approx 600k, but again, that 600k isn't spread out evenly over a year so if you took a year that had two winter respiratory virus seasons added together it would be much higher than 600k. So while the figures they tell us are more or less correct, they are being massaged and used in a way that is misleading in order to generate maximum fear and impact

I think you've forgotten UK flu season is Dec to Feb - excess winter deaths are also in that period.
Coronavirus pandemic only started March 2020.

 

[RobinBHM]

only thing that matters is if it causes hospitals to be overwhelmed

Which is why every country imposed NPIs to avoid that.

The NHS was basically overwhelmed - it let patients in care homes to die there, or it discharged patients with Covid.
Quite a few hospitals in SE had to take over other wards to cope
NHS staff have been at breaking point.

So yes the NHS pretty much was overwhelmed.

 

[sometimewoodworker]

Minutes of a meeting on Thursday suggest there is a "realistic possibility" that the Indian variant of COVID-19 is 50% more transmissible than the one that emerged in Kent late last year.'

That sounds rather like a typical understatement. The transmissibility is probably more than that but the data is not available yet AFIK.

 

[Rorschach]

I think you've forgotten UK flu season is Dec to Feb - excess winter deaths are also in that period.
Coronavirus pandemic only started March 2020.

Covid isn't flu

 

[RobinBHM]

Covid isn't flu

Thank you for admitting you are wrong.

"In the past year" does not cover two winter respiratory seasons.

Back to the drawing board for you......again

A simple of example of this for the UK is that we are constantly given the 127k deaths figure saying they died "in the past year", this is indeed true (near enough a year anyway) but without the context that it covers two winter respiratory seasons

 

[Rorschach]

Thank you for admitting you are wrong.

"In the past year" does not cover two winter respiratory seasons.

Back to the drawing board for you......again

Oh dear, still at it. It's funny that some people call me a troll, when the one doing the trolling is you. Oh well, just getting silly trying to engage with you, there are none so blind as those that refuse to see and you definitely refuse to see. Have a good day.

 

[Jonm]

'Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.
https://news.sky.com/story/covid-19...rns-variant-could-pressure-hospitals-12306738As I said earlier, it does feel a bit like we've been here a few times before, watching things happen in slow motion.

The Sky article, at the beginning in bold, says

Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.

Here is a link to a Sage article Dated 14 May 2021
https://www.independentsage.org/six-point-plan-for-dealing-with-the-b-1-617-2-variant/
It says in the second paragraph “Accordingly, the SAGE modelling group (SPI-M), ........................ proceeding with the roadmap could result in a new wave of infections considerably worse than was seen in January.

It puts forward a six point plan and the last paragraph says “It is incumbent that we act now rather than wait and see if things get worse. The lessons from 2020 have shown that delaying action could increase hospitalisations, overwhelm the NHS and may also cost lives.”

I cannot see where it says anything like the statement in bold above. It actually says “there is still likely to be protection from severe disease. Therefore, in areas experiencing outbreaks of the new variant, surge vaccination should immediately be extended to all age-groups (within the approved age-ranges for the vaccines)“

The point is that lessons from 2020 when there was no vaccine are not necessarily valid in uk in 2021 when we have a vaccine.

Perhaps there are other SAGE “minutes of meeting” but what I have posted looks like their official position.

 

[Chris152]

The Sky article, at the beginning in bold, says

Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.

Here is a link to a Sage article Dated 14 May 2021
https://www.independentsage.org/six-point-plan-for-dealing-with-the-b-1-617-2-variant/
It says in the second paragraph “Accordingly, the SAGE modelling group (SPI-M), ........................ proceeding with the roadmap could result in a new wave of infections considerably worse than was seen in January.

It puts forward a six point plan and the last paragraph says “It is incumbent that we act now rather than wait and see if things get worse. The lessons from 2020 have shown that delaying action could increase hospitalisations, overwhelm the NHS and may also cost lives.”

I cannot see where it says anything like the statement in bold above. It actually says “there is still likely to be protection from severe disease. Therefore, in areas experiencing outbreaks of the new variant, surge vaccination should immediately be extended to all age-groups (within the approved age-ranges for the vaccines)“

The point is that lessons from 2020 when there was no vaccine are not necessarily valid in uk in 2021 when we have a vaccine.

Perhaps there are other SAGE “minutes of meeting” but what I have posted looks like their official position.

Isn't that an Independent Sage article, and the para you refer to is a summary of one part of the SAGE account?

 

[RobinBHM]

Oh dear, still at it. It's funny that some people call me a troll, when the one doing the trolling is you. Oh well, just getting silly trying to engage with you, there are none so blind as those that refuse to see and you definitely refuse to see. Have a good day.

I would politely suggest that if you don't want flaws in your argument pointed out, perhaps avoid posting them.
Honest debating is most straightforward, if you believe I am wrong, you simply need to point where and why.

I noted that the Covid pandemic only spans one winter respiratory period not two as you've claimed.....if I am wrong, that's fine just explain why.

 

[Jonm]

Isn't that an Independent Sage article, and the para you refer to is a summary of one part of the SAGE account?

You are correct. I have been trying to find what the official government SAGE is saying, and it appears to be more like the Sky news article but the logic escapes me. It is widely reported that the vaccine after two doses reduces hospitalisations by 80-90% and deaths by 90%. What the predictions do not say is how many of the hospitalisations/deaths are people who have refused the vaccine.

 

[TominDales]

Thanks for the reply, Tom. As you say, we have lots of things in place; we now need the right decisions to use them made at the right times. Yesterday's press conference spoke of 'living with the virus' and individuals making their own decisions - fine in the abstract, but it seems they've become euphemisms for avoiding decisions at govt level. You don't need to be an epidemiologist to imagine what happens next without the kind of actions you describe, nor a political or economic theorist to figure out why.
Here's today's Sky News:
'Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.
Minutes of a meeting on Thursday suggest there is a "realistic possibility" that the Indian variant of COVID-19 is 50% more transmissible than the one that emerged in Kent late last year.'
https://news.sky.com/story/covid-19...rns-variant-could-pressure-hospitals-12306738As I said earlier, it does feel a bit like we've been here a few times before, watching things happen in slow motion.

After a year of learning how other countries manage this virus, even UK regional responses and with the huge bio industrial infrastructure of vaccines, TTI, etc, we should see a first rate response. Personally I'd feel more confident is concrete decisions were being taken now. My great worry is that we will bumble into a third national crisis/lockdown. Eventually the mass vaccination programme will protect us, but for the next 3 months or so we need to keep the virus under control.

 

[TominDales]

You are correct. I have been trying to find what the official government SAGE is saying, and it appears to be more like the Sky news article but the logic escapes me. It is widely reported that the vaccine after two doses reduces hospitalisations by 80-90% and deaths by 90%. What the predictions do not say is how many of the hospitalisations/deaths are people who have refused the vaccine.

I must say i'm a bit confused. We have an effective vaccine (even against the Indian variant), most of the elderly and very vulnerable have been vaccinated. So why such concern about overwhelming the NHS and worry that it could be more severe than January? I can rationalise/synthesis the points with a few assumptions:
a) there are still a number of vulnerable, although not highly vulnerable, but nevertheless vulnerable people in the 16+ to 38 age group, COPD, asthma etc
b) 5% who haven't taken up the vaccine in the vaccinated groups
c) the vaccines are only 92% effective, and less for the first *** and its less effective against the Indian variant (data is emerging in this area)
d) you add/multiply these first three risk factors together with the fact the virus's R0 is 1.5 times that of Kent (1.7time that of Wuhan) giving a 2.5 times infectivity vs Wuhan.
e) transmission is very high in the young, could so long covid and other complications in that age group be the concern?.
f) the virus is circulating in the south Asian community in Bolton and Darwen etc, there may be less vaccine update in that community
.
So is the concern about local NHS being overwhelmed or is it the whole country as in January? or is it long covid, seem to be still a few too many unknowns.

Personally I'd prefer to see a very vigorous PH response to this variant virus, take extreme TTI measures for 3 weeks or so, and ring vaccination on each outbreak, to hold this variant at bay until all adults have had the offer of a vaccine. Short sharp local responses. Its only about 3to 4 months before all adults will be vaccinated, by which time the population (and the NHS) should be safe.
My worry is that the government will muddle along into another national lock-down mid summer. My colleagues in the NHS are exhausted and looking forward to the summer to re-charge ready for the usual winter rush.

 

[RobinBHM]

After a year of learning how other countries manage this virus, even UK regional responses and with the huge bio industrial infrastructure of vaccines, TTI, etc, we should see a first rate response. Personally I'd feel more confident is concrete decisions were being taken now. My great worry is that we will bumble into a third national crisis/lockdown. Eventually the mass vaccination programme will protect us, but for the next 3 months or so we need to keep the virus under control.

my understanding is there are insufficient people vaccinated to prevent a 3rd wave currently and a highly transmissible variant could see hospital admissions going back up.

We desperately need to keep to the roadmap if at all possible, because we are getting to the point where we will see wholesale loss of pubs, cafes, restaurants etc.

I think you said earlier we have the testing capacity to do targeted local interventions -that sounds sensible, although Im not sure its practical in terms of messaging

 

[Rorschach]

The Sky article, at the beginning in bold, says

Easing lockdown measures in England on Monday could cause "a substantial resurgence" in hospital admissions that is similar to previous peaks or larger, the Scientific Advisory Group for Emergencies has warned.

Here is a link to a Sage article Dated 14 May 2021
https://www.independentsage.org/six-point-plan-for-dealing-with-the-b-1-617-2-variant/
It says in the second paragraph “Accordingly, the SAGE modelling group (SPI-M), ........................ proceeding with the roadmap could result in a new wave of infections considerably worse than was seen in January.

It puts forward a six point plan and the last paragraph says “It is incumbent that we act now rather than wait and see if things get worse. The lessons from 2020 have shown that delaying action could increase hospitalisations, overwhelm the NHS and may also cost lives.”

I cannot see where it says anything like the statement in bold above. It actually says “there is still likely to be protection from severe disease. Therefore, in areas experiencing outbreaks of the new variant, surge vaccination should immediately be extended to all age-groups (within the approved age-ranges for the vaccines)“

The point is that lessons from 2020 when there was no vaccine are not necessarily valid in uk in 2021 when we have a vaccine.

Perhaps there are other SAGE “minutes of meeting” but what I have posted looks like their official position.

SAGE are rapidly feeling their power slip away as people wake up to their agenda.

 

[Rorschach]

I would politely suggest that if you don't want flaws in your argument pointed out, perhaps avoid posting them.
Honest debating is most straightforward, if you believe I am wrong, you simply need to point where and why.

I noted that the Covid pandemic only spans one winter respiratory period not two as you've claimed.....if I am wrong, that's fine just explain why.

It's a waste of time pointing out where you are wrong because you just scream wicker man and then say you were right anyway. Pointless even engaging really, but then you know that, it's why you do it.
If you can't see that covid spanned two winter seasons then there really is no hope.

 

[brocher]

I must say i'm a bit confused. We have an effective vaccine (even against the Indian variant), most of the elderly and very vulnerable have been vaccinated. So why such concern about overwhelming the NHS and worry that it could be more severe than January? I can rationalise/synthesis the points with a few assumptions:
a) there are still a number of vulnerable, although not highly vulnerable, but nevertheless vulnerable people in the 16+ to 38 age group, COPD, asthma etc
b) 5% who haven't taken up the vaccine in the vaccinated groups
c) the vaccines are only 92% effective, and less for the first *** and its less effective against the Indian variant (data is emerging in this area)
d) you add/multiply these first three risk factors together with the fact the virus's R0 is 1.5 times that of Kent (1.7time that of Wuhan) giving a 2.5 times infectivity vs Wuhan.
e) transmission is very high in the young, could so long covid and other complications in that age group be the concern?.
f) the virus is circulating in the south Asian community in Bolton and Darwen etc, there may be less vaccine update in that community
.
So is the concern about local NHS being overwhelmed or is it the whole country as in January? or is it long covid, seem to be still a few too many unknowns.

Personally I'd prefer to see a very vigorous PH response to this variant virus, take extreme TTI measures for 3 weeks or so, and ring vaccination on each outbreak, to hold this variant at bay until all adults have had the offer of a vaccine. Short sharp local responses. Its only about 3to 4 months before all adults will be vaccinated, by which time the population (and the NHS) should be safe.
My worry is that the government will muddle along into another national lock-down mid summer. My colleagues in the NHS are exhausted and looking forward to the summer to re-charge ready for the usual winter rush.

I agree with you on the need for local urgent responses. Local DPH's should be empowered to do so, without waiting for Hancock to give his yes. Do we have too much centralisation?

 

[TominDales]

I agree with you on the need for local urgent responses. Local DPH's should be empowered to do so, without waiting for Hancock to give his yes. Do we have too much centralisation?

yes, I think we do, its too centralised in my view. I'd prefer a very local response, that way you can take your local population with you. Even county wide responses are too wide. It should be at a street level. Just isolate where the infection is. Its what they do in Singapore and Taiwan very effectively. It always was the best solution. But with good vaccines, its actually a really easy thing do do. You can afford to pay those told to self isolate a decent stay off-work payment to keep everyone on side. It would need proper enforcement, so people aren't tempted to break it and nip into a next door neighborhood to party etc. It would need proper payments, food deliveries etc. If it was super local then it would also be shorter as the virus would peter out quickly in very local populations, One of the big issues with large lockdowns is they are only partially effective as key workers etc have to continue to work, so infection rates are slow to come down.

I'm sure this could be communicated to us in a sensible way. The challenge, is that we the public, have lockdown fatigue, I sense that JB has little appetitive for a vigorous response and senses national resistance. So different approach would be needed to get the public on side. It could be explained by empathising ring vaccination, very targeted lockdowns and short duration eg a max of 3 weeks.