The virus. PPE. Part 1

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Nod said:
From or with? NOT trying to make a huge distinction but I know of at least 2 people who have died with it and both have been expected to die months, if not years ago from their other conditions.
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You tell me, the figure quoted is from the ONS.
 
Nod said:
From or with? NOT trying to make a huge distinction but I know of at least 2 people who have died with it and both have been expected to die months, if not years ago from their other conditions.
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ONS use the term "involving" covid-19, which apparently just means covid-19 was mentioned on the death certificate and is not necessarily considered the cause of death.

At some stage, we are going to have to try and work out how many people have died "with" the virus as opposed to those who died "from" the virus. It seems that some countries are making that decision at the death certificate stage and only counting deaths they believe are "due" to covid-19, if the reports from the daily briefings are correct.
 
nilagin said:
My sister heard Chris Evan's talking, on his breakfast show this morning, to Hancock. He asked him about mass gatherings. His answer was that indoor events are unlikely to be allowed for the remainder of the year, but evidence was showing that outdoor events could be allowed. However, there is likely to be restrictions on people moving about, ie, from one county to another without good reason. So unless the outdoor event is in your county, people should not be attending.
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It beggars belief. If outdoor events are allowed how does Matt Hancock think those attending such an event get there? Do they teleport? Or do they meet with friends and come in cars, buses, trains, tubes?

Dave
 
Tringa said:
It beggars belief. If outdoor events are allowed how does Matt Hancock think those attending such an event get there? Do they teleport? Or do they meet with friends and come in cars, buses, trains, tubes?

Dave
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Nicola Sturgeon, has said that one of the things they are looking at is the possibility of small social groups that could interact without social distancing. You would need to define the group and maintain social distancing outside the group. I think she suggested it could be 10 people.

The idea is a sort of extended family, but it could be your next-door neighbours. Presumably, you could then also share a car.

She hasn't said this is going to happen, but its one of the ideas they are bouncing around.
 
myotis said:
Nicola Sturgeon, has said that one of the things they are looking at is the possibility of small social groups that could interact without social distancing. You would need to define the group and maintain social distancing outside the group. I think she suggested it could be 10 people.

The idea is a sort of extended family, but it could be your next-door neighbours. Presumably, you could then also share a car.

She hasn't said this is going to happen, but its one of the ideas they are bouncing around.
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This sounds like one of those ideas that are fine in theory but less so in practice - if people see others associating in defined social groups, they may be inclined to get together in larger groups generally. Also, what happens when it turns out your best friend has nine better friends than you? :)
 
Retune said:
This sounds like one of those ideas that are fine in theory but less so in practice - if people see others associating in defined social groups, they may be inclined to get together in larger groups generally. Also, what happens when it turns out your best friend has nine better friends than you? :)
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Well, they are obviously still in the brainstorming stage, and they now have a new website set up for anyone to comment on and make "easing lockdown" suggestion. Any ideas I think are going to bring there own problems, and we don't know how this is meant work (but there is a new doc on the Scottish Gov web site expanding on current ideas) but she also emphasised that these are just ideas. Maybe everyone in your social group will have a group id tattooed on their forehead :-)

I think it's safe to assume that police will still be breaking up gatherings that break the guidance/law, but as my answer was linked to the suggestion of some outside events being allowed to run, I was just offering it as a way of allowing four people in a car to attend that outside event. And I suppose if we reached a stage of outside events running this may well coincide with travel being allowed on public transport as long as you wear face-covering and the number of people on the bus is restricted.
 
myotis said:
ONS use the term "involving" covid-19, which apparently just means covid-19 was mentioned on the death certificate and is not necessarily considered the cause of death.

At some stage, we are going to have to try and work out how many people have died "with" the virus as opposed to those who died "from" the virus. It seems that some countries are making that decision at the death certificate stage and only counting deaths they believe are "due" to covid-19, if the reports from the daily briefings are correct.
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I understand that for Covid-19 to be on the death certificate then the virus has had a direct or underlying cause of death, either way Covid-19 likely caused the premature death of that person.
 
jakeblu said:
I understand that for Covid-19 to be on the death certificate then the virus has had a direct or underlying cause of death, either way Covid-19 likely caused the premature death of that person.
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I haven't read anything definitive and just gone on what I have heard people (who should know about this ) have said. is the wording you have given the official definition?

Actually, I've now looked it up https://assets.publishing.service.g...l-certificates-of-cause-of-death-covid-19.pdf

example of death certificate entries below (with three sequential parts fo fill in):

(a) Disease or condition leading directly to death. Interstitial pneumonitis

(b) other disease or condition, if any, leading to I(a) COVID-19

c) other disease or condition, if any, leading to I(b) primary adenocarcinoma of ascending colon


As far as I can make out from the document, from a public health point of view, the most important line is line c, as this is the condition considered to have initiated the fatal sequence of events to death, suggesting that without condition c, condition b would not/may not have caused death. So depending on the question, it would seem that deaths where the final line is Covid-19, are clearly caused by Covid -19, but deaths with a line below the Covid-19 entry are deaths with a more complex cause of death.

EDIT: this way of completing death certificates seems to be a WHO standard, so I wonder what the experts at the daily briefings are referring to when they say that in some of the European countries they aren't always including Covid-19 on the death certificate unless it's considered the cause of death.
 
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woof woof said:
But tens of thousands of people are presumably still infectious and we've seen how early easing of lockdowns has lead to more infections in other countries. Ease too soon and R0.2 soon becomes R2/3. We know this.
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Hasnt been the case in Austria

Austria’s Health Minister Rudi Anschober says the first relaxation of its coronavirus lockdown three weeks ago has not led to a new increase in infections.

Thousands of small shops, garden centres and DIY stores re-opened on 14 April.

"The situation is very, very constant, very, very stable and that is a really very, very positive, good situation,” Anschober said.

But he called on Austrians to be careful, after further steps to ease the coronavirus lockdown were introduced at the beginning of May.

"May will be the decisive month," he said.

All shops, hairdressers and beauty salons have been allowed to reopen in the second step of easing restrictions.

People are now free to leave their homes, although working from home is still encouraged.

Anschober called on people to continue to cover their mouths and noses, to maintain the distance of at least a metre and to wash their hands.
 
mex said:
Yes, I get the bit about being past 'the ' peak, however a second,third or fourth peak is quite a posibilty if the lockdown is lifted too soon. The ecconomy is surely to take second seat to people's lives being lost, no?, although I think the likes of IDS have made the case for lifting the lockdown because he and is funders stand to lose a few bob more than you or I, so you and I can be just a stat as far as they are concerned....show me the money ££££££££.
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At some point the declining economy will cause more lives to be lost, and you need to factor in the cost of mental health and people struggling to survive. Its a fine line and you need a lot of data to review.
 
mex said:
32000 people (hospital & care home) have died from CV-19 in the UK, more than any other European county. Angela Rayner - "Latest ONS stats show that the dire situation in our social care sector is a crisis within a crisis. Any talk of being "past the peak" of this virus is meaningless given these figures. "
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But we are past the peak! The graphs tell you that in terms of deaths, people in hospital etc... I am not saying that 32k is an acceptable figure but it stands to reason that we would be up near the top in terms of numbers of deaths... as we have more people! Even if we had acted perfectly, we would have more than many countries like Croatia, Portugal etc...
 
cambsno said:
But we are past the peak! The graphs tell you that in terms of deaths, people in hospital etc... I am not saying that 32k is an acceptable figure but it stands to reason that we would be up near the top in terms of numbers of deaths... as we have more people! Even if we had acted perfectly, we would have more than many countries like Croatia, Portugal etc...
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South Korea, Germany...
 
cambsno said:
But we are past the peak! The graphs tell you that in terms of deaths, people in hospital etc... I am not saying that 32k is an acceptable figure but it stands to reason that we would be up near the top in terms of numbers of deaths... as we have more people! Even if we had acted perfectly, we would have more than many countries like Croatia, Portugal etc...
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We are 4th in the world in deaths per capita, and we have about 12% of all the reported COVID-19 deaths on the planet.
 
myotis said:
I haven't read anything definitive and just gone on what I have heard people (who should know about this ) have said. is the wording you have given the official definition?

Actually, I've now looked it up https://assets.publishing.service.g...l-certificates-of-cause-of-death-covid-19.pdf

example of death certificate entries below (with three sequential parts fo fill in):

(a) Disease or condition leading directly to death. Interstitial pneumonitis

(b) other disease or condition, if any, leading to I(a) COVID-19

c) other disease or condition, if any, leading to I(b) primary adenocarcinoma of ascending colon


As far as I can make out from the document, from a public health point of view, the most important line is line c, as this is the condition considered to have initiated the fatal sequence of events to death, suggesting that without condition c, condition b would not/may not have caused death. So depending on the question, it would seem that deaths where the final line is Covid-19, are clearly caused by Covid -19, but deaths with a line below the Covid-19 entry are deaths with a more complex cause of death.

EDIT: this way of completing death certificates seems to be a WHO standard, so I wonder what the experts at the daily briefings are referring to when they say that in some of the European countries they aren't always including Covid-19 on the death certificate unless it's considered the cause of death.
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Sorry meant to include the link but its the same one you have used :thumbs:

I'm not sure I would agree with your assessment, although I've not read it properly as on a mobile, but the most important section as far as I can see is

1(a). Disease or condition leading directly to death.

and

1(b) other disease or condition, if any, leading to I(a)

I'm assuming that with most deaths where Covid-19 is a factor then I understood its always going to be a complication of the disease rather than the virus itself.

Of course, I have never completed a death certificate so I could be completely wrong, It has been known :)
 
jakeblu said:
I'm not sure I would agree with your assessment, although I've not read it properly as on a mobile, but the most important section as far as I can see is

1(a). Disease or condition leading directly to death.

and

1(b) other disease or condition, if any, leading to I(a)
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That wasn't my assessment, I was semi-quoting from the document:

"You are asked to start with the immediate, direct cause of death on line Ia, then to go back through the sequence of events or conditions that led to death on subsequent lines, until you reach the one that started the fatal sequence. If the certificate has been completed properly, the condition on the lowest completed line of part I will have caused all of the conditions on the lines above it. This initiating condition, on the lowest line of part I will usually be selected as the underlying cause of death, following the ICD coding rules. WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain. Most routine mortality statistics are based on the underlying cause. Underlying cause statistics are widely used to determine priorities for health service and public health programmes and for resource allocation. Remember that the underlying cause may be a longstanding, chronic disease or disorder that predisposed the patient to later fatal complications."

EDIT: giving this more thought, that last line about statisticians would seem to suggest that the "normal" mortality cause used by WHO and statisticians in the sample given would be "primary adenocarcinoma of ascending colon" but ONS are counting deaths where there is any mention of covid-19 wherever it occurs in the hierarchy. So maybe some countries are only counting deaths from covid-19 where there is no underlying cause. This would appear to be "normal" practice.

But of course, I am just guessing and trying to make sense of what is being said.
 
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Retune said:
We are 4th in the world in deaths per capita, and we have about 12% of all the reported COVID-19 deaths on the planet.
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https://www.theguardian.com/world/2...-suffered-less-from-coronavirus-than-the-west

... and Czech Republic, Slovakia, Austria, Greece, etc, have much lower incidence and deaths per thousand population than us (and most of Western Europe) possibly due to earlier lockdown. From that page we had 359 deaths at lockdown, Spain 50, and the others many fewer. Shockingly laggard U.K. government.
 
myotis said:
That wasn't my assessment, I was semi-quoting from the document:

"You are asked to start with the immediate, direct cause of death on line Ia, then to go back through the sequence of events or conditions that led to death on subsequent lines, until you reach the one that started the fatal sequence. If the certificate has been completed properly, the condition on the lowest completed line of part I will have caused all of the conditions on the lines above it. This initiating condition, on the lowest line of part I will usually be selected as the underlying cause of death, following the ICD coding rules. WHO defines the underlying cause of death as “a) the disease or injury which initiated the train of morbid events leading directly to death, or b) the circumstances of the accident or violence which produced the fatal injury”. From a public health point of view, preventing this first disease or injury will result in the greatest health gain. Most routine mortality statistics are based on the underlying cause. Underlying cause statistics are widely used to determine priorities for health service and public health programmes and for resource allocation. Remember that the underlying cause may be a longstanding, chronic disease or disorder that predisposed the patient to later fatal complications."

EDIT: giving this more thought, that last line about statisticians would seem to suggest that the "normal" mortality cause used by WHO and statisticians in the sample given would be "primary adenocarcinoma of ascending colon" but ONS are counting deaths where there is any mention of covid-19 wherever it occurs in the hierarchy. So maybe some countries are only counting deaths from covid-19 where there is no underlying cause. This would appear to be "normal" practice.

But of course, I am just guessing and trying to make sense of what is being said.
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It’s a minefield isn’t it? Man get killed by car, then found to have COVID and had bad fever and making his way to hospital when run over. Did the COVID “contribute” to his death by affecting his attention, vision etc? :(
 
cambsno said:
At some point the declining economy will cause more lives to be lost, and you need to factor in the cost of mental health and people struggling to survive. Its a fine line and you need a lot of data to review.
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Give it until to the end of May and see where we are then, three more weeks is nothing in the grand scheme of things.
Its only been six or seven weeks so far, the way some people are complaining you would think that was seven months
Could all be wasted if we jump too soon and then cost a damn sight more than it already has in health and financial terms.
 
Tringa said:
It beggars belief. If outdoor events are allowed how does Matt Hancock think those attending such an event get there? Do they teleport? Or do they meet with friends and come in cars, buses, trains, tubes?

Dave
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Well if it is only people from the county in which the event is taking place are allowed to attend, attendances are going to be very low. I go to 4 or 5 British Touring Car Championships race meetings a year, each meeting gets on average 30k attendees on race day and some people travel from all over the country, some from other countries. The same goes for gigs etc. If only people living in Kent are allowed to attend the Brands Hatch races for example, I would be surprised if they had as many as 5k spectators. As most spectators drive there, they can still drive there, they don't all have to travel in one car.
 
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KitsuneAndy said:
South Korea, Germany...
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Like I said, we have got things wrong BUT looking at the headline rate of deaths does not tell the answer and quite pointless. You have to look at deaths per million for example to make it fair. Then you also have other factors that will influence like age and health of populations, density and location. The bbc did allude to this when comparing Italy highlighting we have a bigger population and London for example is a much bigger city than Rome. The fact we have more deaths than Italy is neither here nor there. Countries like NZ for example would always do better than us.

There are so many factors to consider and one of them is additional deaths over and above the norm. We will not know this for a while. We can then have an inquiry and show shortcomings in what we did. Some will be simple human error, no one is perfect and will sometimes choose the wrong option. Some will be incorrect data or scientific advise. Some will also be stupidly like having a trial pandemic run 4 years ago and not learning any lessons.
 
tijuana taxi said:
Give it until to the end of May and see where we are then, three more weeks is nothing in the grand scheme of things.
Its only been six or seven weeks so far, the way some people are complaining you would think that was seven months
Could all be wasted if we jump too soon and then cost a damn sight more than it already has in health and financial terms.
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Which is what the government need to communicate. Ie if trends carry on we can likely do x y z. Give people the hope that by being good for just 3 more weeks should result in x y z. At the moment people are not seeing the light so hence the frustration (and thereby the number of people not sticking to the rules?
 
sphexx said:
It’s a minefield isn’t it? Man get killed by car, then found to have COVID and had bad fever and making his way to hospital when run over. Did the COVID “contribute” to his death by affecting his attention, vision etc? :(
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Isn't it just.

I think the Doctor filling in the death certificate probably needs to think about the rationale behind how the data in the death certificate might be used..

And any extraction of the data for statistical analysis needs to be very carefully tailored to the question being asked.

I've been trying to find some decent references, but all I am finding are comments from interviews with statisticians, which show a clear consensus that any meaningful comparison of death counts between countries is impossible at the moment. They just repeat differences in approaches to filling in death certificates and that not all deaths are being reported,
 
nilagin said:
Well if it is only people from the county in which the event is taking place are allowed to attend, attendances are going to be very low.
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Really? How many attend a premier league football match, or the FA Cup Final? How may attend the Challenge Cup Final?

Dave
 
Retune said:
I dug out the paper here:

https://www.sciencedirect.com/science/article/pii/S0924857920301643

I wonder why they didn't just test the samples from all 124 patients? There might be co-infections with SARS-CoV-2 in the 44 excluded for positive PCR results with other respiratory pathogens, and perhaps other cases in the 60 excluded for symptoms 'not typical' of COVID-19 (for whatever reason, nasal swabs had been taken from these patients). 1/14 of the remaining cases with flu-like symptoms and ground-glass opacity on CT scans tested positive for SARS-CoV-2, which makes me wonder what the other 13 cases had (how many significant respiratory pathogens aren't in the standard PCR screen?).
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It seems likely to me that there may have been some co-infections, but not certain. Inan ideal world we'd get every hospital lab with banked swabs to run them all through a revised PCR panel to get an idea of when the virus first arrived & how it spread, but that's a major undertaking (and expense) for another time, and I suspect few hospitals even bank swabs.

Now considering the WHO timeline suggests the outbreak became 'public' at the end of December, it's intriguing that there's a Frenchman without travel history who's sick enough to go to hospital 1st December. Disregarding ideas that it started somewhere else that Wuhan, this makes me think that it had already spread covertly a long way before being recognised. I'm intrigued to contrast south Korea with France, since I'd have *thought* there would be much more contact with China than the French would have, but perhaps not, or maybe this particular chap was just unlucky with who he met a week or so before.

The PCR result is a reasonable one (crossing threshold at 31 cycles is a clear positive) so *probably* correct.
 
Tringa said:
Really? How many attend a premier league football match, or the FA Cup Final? How may attend the Challenge Cup Final?

Dave
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Well unless the game is a local derby, only one lot of spectators are going to attend. Could that cut attendance by half? FA Cup final is at Wembley, so unless a London club is playing, there won't be any spectators. Same probably goes for Challenge Cup Final if it is played at Wembley. There has already been talk of football games being played behind closed doors this year anyway.
 
ancient_mariner said:
It appears the present version of the NHS tracking app isn't actually viable: https://www.theregister.co.uk/2020/05/05/uk_coronavirus_app/
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I don’t think the app is about the virus, it’s about data collecting. A quick perusal of the comments (often the best part :)) to El Reg article produces:
”The people behind this app (Marc and Ben Warner) were involved in the illegal Cambridge Analytica operations in 2016. They have shown to be law breakers with nefarious intentions funded by foreign far right groups. What makes you think they've suddenly bettered their lives and won't do it again?”

and:

“For once its not Crapita, but a company called Faculty.

Faculty, formerly ASI Data Science and Advanced Skills Initiative Ltd, was hired to work with Cummings on the Vote Leave campaign and has since, quelle surprise, been awarded at least 7 government contracts in the last 18 months. Want to guess what political party one of its shareholders is associated with?

Further still, Ben Warner, former principle of Faculty and brother of the founder, was hired by Cummings to work at Downing Street, after running the Conservatives private election model and (are you sitting down?) worked closely with Cummings on the Vote Leave campaign.”

I can’t vouch for the accuracy of these comments, but it’s worth watching and fits the pattern of what Hancock is doing by further hollowing out the NHS.
 
sphexx said:
I don’t think the app is about the virus, it’s about data collecting. A quick perusal of the comments (often the best part :)) to El Reg article produces:
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For the virus/app I'd say it's a bit of both.

Agree about the comments, but just as certain posters here aren't interested in reality, so some posters there are similarly inclined towards a good conspiracy theory or 2, especially if it's anti-government.
 
ancient_mariner said:
It seems likely to me that there may have been some co-infections, but not certain. Inan ideal world we'd get every hospital lab with banked swabs to run them all through a revised PCR panel to get an idea of when the virus first arrived & how it spread, but that's a major undertaking (and expense) for another time, and I suspect few hospitals even bank swabs.

Now considering the WHO timeline suggests the outbreak became 'public' at the end of December, it's intriguing that there's a Frenchman without travel history who's sick enough to go to hospital 1st December. Disregarding ideas that it started somewhere else that Wuhan, this makes me think that it had already spread covertly a long way before being recognised. I'm intrigued to contrast south Korea with France, since I'd have *thought* there would be much more contact with China than the French would have, but perhaps not, or maybe this particular chap was just unlucky with who he met a week or so before.

The PCR result is a reasonable one (crossing threshold at 31 cycles is a clear positive) so *probably* correct.
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It would be nice to see some sort of confirmation (e.g. in case of cross contamination) as this is such an outlier. They could request blood from the family members and look for antibodies - according to news reports, both his kids got ill, but his wife, who worked at a fish market (presumably not in Wuhan!) had no symptoms. But of course a positive antibody test might come from a more recent infection. If they have frozen blood from his stay in ICU, might they be able to pick up IgM? It would also be nice to get the virus from the swab sequenced if possible - where does it fit in the phylogenetic tree with the early samples from China? I suppose if this is real, it won't be the last early case found retrospectively in Europe. If it remains an outlier, then it begins to look more questionable.
 
Retune said:
If they have frozen blood from his stay in ICU, might they be able to pick up IgM?
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They should have serum samples too if they kept a throat swab, so certainly when there's a functional antibody test they should find IgM. There is still a possibility that this is a false positive, but they did run the test 3 times so it would have to be contamination as you say (how do you contaminate a throat swab!?).
 
cambsno said:
The fact that we are past the peak, R is below 1 and other factors like that (i.e. not overwhelming the NHS). The fact that we have to balance a lot of factors and if we dont start relaxing soon the economy will suffer even more and this will affect poor/vulnerable the most. We cant go back to heading down the football this weekend after a few pints at lunchtime, but we can start easing back. If DIY stores can open why not other retail shops providing some distancing rules are followed etc..
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LOL, brilliant, ah you are good. Honestly, thats like Eddie Large and the other Chuckle brother rolled into one. You definitely have a place in comedy. :ROFLMAO::ROFLMAO::ROFLMAO:
 
cambsno said:
But we are past the peak! The graphs tell you that in terms of deaths, people in hospital etc... I am not saying that 32k is an acceptable figure but it stands to reason that we would be up near the top in terms of numbers of deaths... as we have more people! Even if we had acted perfectly, we would have more than many countries like Croatia, Portugal etc...
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hierarchy by Donnie Canning, on Flickr
 
cambsno said:
At some point the declining economy will cause more lives to be lost, and you need to factor in the cost of mental health and people struggling to survive. Its a fine line and you need a lot of data to review.
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I remember watching the mayor of Amity island who was so concerned about the ecconomy he said it was safe to go back into the water.:p
 
mex said:
I remember watching the mayor of Amity island who was so concerned about the ecconomy he said it was safe to go back into the water.:p
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Now there‘s a real world example and not one of these fairy stories we get from Trump or de Piffle:)
 
Apologies, Neil.

I didn't read you post at #7178 carefully enough. I read 'county' as 'country'. :oops: :$

Dave
 
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