COVID-19

[Woodchopper]

EuroMOMO Bulletin, Week 17 is here...

https://www.euromomo.eu/bulletins/2020-17/

What is particularly worrying is that England seems to have by far the largest increase in all-cause mortality in the 15-64 year age group...

https://www.euromomo.eu/graphs-and-maps/

What could be the explanation?

- Overall COVID-19 prevalence being way higher in England than other European countries?
- The NHS being less effective at treating COVID-19 than other health systems?
- 15-64 year olds with other treatable conditions avoiding medical care?

Any ideas?

ONS stats here: https://twitter.com/ons/status/1256139042216951814?s=21

There’s a correlation in the UK between Covid mortality and population density and with deprivation.

If we assume that deprivation is a proxy in this case for general ill health then perhaps it’s a consequence of Britons being less healthy than their counterparts in Italy, Spain or France. Incomes are lower in Spain and Southern Italy, but as far as I know there’s lower levels of chronic illness among the working age population.

Similar in the US with higher mortality among African Americans which is assumed to be partly due to poorer general health due to higher levels of deprivation.
https://www.washingtonpost.com/health/m ... story.html

[PeteB]

Any ideas?

I'd be stunned and amazed if it was anything apart from undiagnosed Covid-19 deaths in care homes (not helped by the NHS policy to send Covid-19 patients back to care homes without testing), the community (only just got an email from my GP asking anyone with symptons to come in so they can check for ''Silent Hypoxia' which is leading to people being hospitalised too late) and hospital (either false negative tests or untested)

English exceptionalism

[PeteB]

And our lockdown was too late - 11 days earlier - death toll would be a tenth

[Woodchopper]

Any ideas?

I'd be stunned and amazed if it was anything apart from undiagnosed Covid-19 deaths in care homes (not helped by the NHS policy to send Covid-19 patients back to care homes without testing), the community (only just got an email from my GP asking anyone with symptons to come in so they can check for ''Silent Hypoxia' which is leading to people being hospitalised too late) and hospital (either false negative tests or untested)

English exceptionalism

Are there many under 65 year olds in care homes?

[shpalman]

And our lockdown was too late - 11 days earlier - death toll would be a tenth

The thing that makes me really angry is that we knew this already on the 12th of March.

From https://medium.com/@tomaspueyo/coronavi ... d3d9cd99ca that Badger linked to. Every day, Boris Johnson is deliberately choosing delay - picking the red curve instead of the green.

[bob sterman]

Any ideas?

I'd be stunned and amazed if it was anything apart from undiagnosed Covid-19 deaths in care homes (not helped by the NHS policy to send Covid-19 patients back to care homes without testing), the community (only just got an email from my GP asking anyone with symptons to come in so they can check for ''Silent Hypoxia' which is leading to people being hospitalised too late) and hospital (either false negative tests or untested)

English exceptionalism

Are there many under 65 year olds in care homes?

Yes - I was specifically wondering about why England is such an outlier for deaths in the 15-64 year age range.

[PeteB]

Just had another look at the euromomo site, hadn't appreciated that the 15-64 was so much worse - England is roughly double Italy's Z-score for all ages but 5 times for 15-64.

[lpm]

There’s a correlation in the UK between Covid mortality and population density and with deprivation.

If we assume that deprivation is a proxy in this case for general ill health then perhaps it’s a consequence of Britons being less healthy than their counterparts in Italy, Spain or France. Incomes are lower in Spain and Southern Italy, but as far as I know there’s lower levels of chronic illness among the working age population.

Similar in the US with higher mortality among African Americans which is assumed to be partly due to poorer general health due to higher levels of deprivation.
https://www.washingtonpost.com/health/m ... story.html

There's also the correlations between working from home and deprivation. I'm safely isolated at home, low waged people are out and about collecting my bins, providing my food and keeping the lights on. There might be a stronger link from African Americans being much more likely to work in risky places, than African Americans being generally poorer.

[bob sterman]

Just had another look at the euromomo site, hadn't appreciated that the 15-64 was so much worse - England is roughly double Italy's Z-score for all ages but 5 times for 15-64.

Yes - this is what I'm struggling to understand. It's all cause mortality - so it can't be attributed to diagnostic differences. And given that Italy's peak was a few weeks back it can't be reporting delays in Italy can it?

[Woodchopper]

There’s a correlation in the UK between Covid mortality and population density and with deprivation.

If we assume that deprivation is a proxy in this case for general ill health then perhaps it’s a consequence of Britons being less healthy than their counterparts in Italy, Spain or France. Incomes are lower in Spain and Southern Italy, but as far as I know there’s lower levels of chronic illness among the working age population.

Similar in the US with higher mortality among African Americans which is assumed to be partly due to poorer general health due to higher levels of deprivation.
https://www.washingtonpost.com/health/m ... story.html

There's also the correlations between working from home and deprivation. I'm safely isolated at home, low waged people are out and about collecting my bins, providing my food and keeping the lights on. There might be a stronger link from African Americans being much more likely to work in risky places, than African Americans being generally poorer.

Of course. But is that much different in France, Spain, Italy? We know that compared to those countries the UK population has, for example, higher levels of respiratory disease.

[JQH]

South African government bans ecommerce.

Allegations of abuse of powers

[Boustrophedon]

Anyway jollity apart it would seem that you can only catch it once and that suggestions otherwise were down to faulty testing. This is perhaps the most important good piece of news for months.

https://news.sky.com/story/coronavirus- ... 1M4r4OGCZ8

[Boustrophedon]

...or to me more precise they are retracing their statement saying you could catch it twice, so now there is no evidence that you can. Not quite as strong but still good.

[shpalman]

Just had another look at the euromomo site, hadn't appreciated that the 15-64 was so much worse - England is roughly double Italy's Z-score for all ages but 5 times for 15-64.

Yes - this is what I'm struggling to understand. It's all cause mortality - so it can't be attributed to diagnostic differences. And given that Italy's peak was a few weeks back it can't be reporting delays in Italy can it?

Is it plausible that the UK has actually had 500,000—1,000,000 cases?

[PeteB]

I guess, based on 50,000 dead (which is what the excess all cause mortality tends to show) - 1% fatality rate = 5,000,000 cases, 0.5% = 10 million ?
(Edited factor of 10 out)

[Bird on a Fire]

But neither can it actually go to infinity in the real world of course; for R_0 > 1 the fraction of the population which gets infected* is something like 1-1/R_0, so even there there's a difference between R_0 slightly more than 1 and R_0 a lot bigger than 1.

Indeed. The exponential is only a very simple model. It's actually a logistic, which is very similar when the growth has not reached much of the population. Except, it's not even that, because people die and more get born, so the population is gradually renewed with newly vulnerable individuals. Except, it's not even that, because natural selection means the population's susceptibility gradually changes over time. And then there's the question of how long immunity lasts after you have had it.

Those latter effects aren't strongly relevant in the case of a pandemic which has gone on for less than half a year so far. It's not even particularly logistic yet, since a substantial fraction of the population remains susceptible in all but the hottest of hot spots, unless you let the maximum value be a free parameter. Lots of people did try fitting logistic curves when the first few days of slowed infection rates came through after the lockdown, but that was the effect of the lockdown lengthening the exponential doubling time, and it only gave the misleading impression that it would saturate on its own. A few days later it was always clear that it was still an exponential growth.

Which is why I think it's best to have models which are so simple their defects are obvious than to have ones so complex the defects are hidden.

Yes, this.

To get R0 from the exponential rate requires an assumption of how many days a case is infection for (because the rate is new cases per day but R0 is new cases per case) but you can just look at the number of new cases per day and see for yourself if the trend is up or down.

The UK's figure of 21678 deaths a couple of days ago was similar to Italy's number on the 15th of April but it turns out that number should have been 25302 which is somewhere between Italy's numbers for the 22nd and 23rd of April.

The most recent tweet about it from the Department of Health and Social Care says that "as of 5pm on 29 April, of those tested positive for coronavirus across all settings, 26,771 have sadly died"

i.e. the number I have in my spreadsheet for yesterday is anyway from the evening of the day before, and it corresponds to the number released in Italy at 5pm on the 27 of April.

So the UK has gone from "four weeks" to two weeks to two days behind Italy.

At least yesterday a decent number of swabs were processed (more than 80,000 while Italy has been averaging about 57,000 for the past couple of weeks) but it predictably led to the highest number of new positives being recorded so far. Italy hasn't had that many new cases per day for over a month and it really makes you wonder how many cases the UK really had at the beginning of April when only about 10,000 swabs were being done per day but there were still between 3000 and 6000 new cases per day.

"Of those tested positive for coronavirus" covers a multitude of sins, though. It can't be enormously worthwhile trying to understand what's going on the UK without addressing who's got access to testing as the situation evolves. I'd hope that availability of tests is now considerably improved from a month ago, so the proportion of cases being included in official figures should be changing (increasing) rapidly.

[shpalman]

I guess, based on 50,000 dead (which is what the excess all cause mortality tends to show) - 1% fatality rate = 5,000,000 cases, 0.5% = 10 million ?
(Edited factor of 10 out)

Yes my calculation was roughly along those lines.

But it means lots of you would be likely to know people who had symptoms but didn't/couldn't get tested.

[shpalman]

So apparently if you save up a weeks' worth of home test kits and then post them all out on the same day that counts in terms of numbers of tests carried out that day?

photo_2020-05-01_19-28-38.jpg

Test capacity takes a while to ramp up, as Italy's data demonstrates:

photo_2020-05-01_19-33-19.jpg

(That spike in "cured per day" yesterday is because a lot of cases from Emilia Romagna only just got reported.)

Oh and it's actually possible that within a few days, the UK will overtake Italy for the number of official covid-19 positives who have died.

The UK is on 27510 but at a rate of 700 per day while Italy is on 28236 but at a rate about half that.

photo_2020-05-01_19-45-10.jpg

(The data for the two countries are shifted by four two weeks with respect to each other.)

[Little waster]

So apparently if you save up a weeks' worth of home test kits and then post them all out on the same day that counts in terms of numbers of tests carried out that day?
photo_2020-05-01_19-28-38.jpg

Test capacity takes a while to ramp up, as Italy's data demonstrates:
photo_2020-05-01_19-33-19.jpg

(That spike in "cured per day" yesterday is because a lot of cases from Emilia Romagna only just got reported.)

Oh and it's actually possible that within a few days, the UK will overtake Italy for the number of official covid-19 positives who have died.

The UK is on 27510 but at a rate of 700 per day while Italy is on 28236 but at a rate about half that.
photo_2020-05-01_19-45-10.jpg
(The data for the two countries are shifted by four two weeks with respect to each other.)

Well I for one am glad that in the midst of a global pandemic our Government can still find time to play silly buggers with peoples lives in order to avoid a bad headline for missing their own arbitrary targets.

[jimbob]

And our lockdown was too late - 11 days earlier - death toll would be a tenth

The thing that makes me really angry is that we knew this already on the 12th of March.

From https://medium.com/@tomaspueyo/coronavi ... d3d9cd99ca that Badger linked to. Every day, Boris Johnson is deliberately choosing delay - picking the red curve instead of the green.

Exactly - it really was utterly incompetent.

And, whilst they have taken some action, 15,000 airline passengers are arriving untested every day, which suggests the government is planning to fail to control the epidemic

[shpalman]

Canale 5 is showing Contagion, the science in it is actually pretty good.

[Bird on a Fire]

A friend of mine has just flown to Germany. Eventually she's taking part in an oceanography research cruise, but first she's got two weeks of quarantine with her colleagues - first week without leaving her room, second week with free run of the hotel as long as she passes a covid test (she had a nasal swab while we were skyping)

Apparently the airport was rather deserted with all the shops shut. Some people were wearing masks, but not the flight crew nor the pilots (who were not observing social distancing in the terminal, mingling with passengers etc). The plane (Lufthansa) was full, so she was sat next to two other people. All seems pretty lax and spooky.

Before that she'd had to get permission from the German border police to enter the country (granted due to the nature of her research), and show it in the UK before being permitted to board the plane.

[raven]

Looking at those graphs reminds me...

Are there graphs of cases or deaths by local region - say by county - for the UK anywhere? I can see the current numbers on the government dashboard but not previous numbers, and nothing came up on a very quick google search. Surely someone is graphing them somewhere.

There's data in this github https://github.com/tomwhite/covid-19-uk-data and there are also various python scripts for getting it out of the csv files.

Cheers for that shpalman.

I have the barest familiarity with spreadsheets, but I managed to a) get a csv file into LibreOffice & sort it so I could pull out individual counties, b) make a bar chart of confirmed cases for my county and c) use a formula so I could make a bar chart of the daily increase. So quite chuffed with myself now.

If numbers aren't being supressed by lack of testing, it looks like my area is over the peak and trending down nicely. The area my parents live in, not so much.

[Woodchopper]

A suggestion that overall R is at about 1 in the US.
https://twitter.com/trvrb/status/1255976675252158465

Which at about 2 000 deaths per day is a horrific place at which to start relaxing.

[Little waster]

BBC News are still running the bogus 100,000 test number as “Breaking News”, natch.