I was talked through the choices that this government is making on the epidemiology of coronavirus by someone who has some insight into the subject yesterday. Let's call them a doctor, for the sake of convenience.
They drew my attention to a tweet by Richard Horton, who is editor of The Lancet, which is the UK's premier medical journal. He pointed out that the government is not following scientific advice on coronavirus. Scientific advice is to do what Italy is doing and create maximum social isolation at present. This will have the benefit of significantly slowing the spread of this epidemic.
What the government is refusing to consider is social isolation at present. Their choice considerably speeds the spread of this epidemic.
What was explained to me is that in both cases the epidemic will spread, and there may be just as many people catch it in either case. But, the impact is very different.
If there is no social isolation and then the virus spreads very quickly, very large numbers of people are ill, all at once, the NHS is overwhelmed, doctors and nurses are stressed to their limits and also become extremely vulnerable to the virus, and the number of deaths among medics rises rapidly, but, crucially as far as this government is concerned, the economic impact is fairly short-term and those who die are mainly amongst the elderly population, where it can be said that they had 'an underlying medical condition' because that is true for almost everyone above 75 or so.
On the other hand, if there is social isolation the epidemic will still spread, but at a much slower rate. The number of people who can have hospital treatment will, proportionately, rise because that number depends not just on how many are ill, but also on how many beds that there are, and if the period of treatment is extended then the number of available beds will, inevitably, increase. In that case the number of deaths from coronavirus will, without a shadow of a doubt, fall. So too, incidentally, will the number of medical staff who die from the virus fall as well. But, and again crucially for this government, the economic impact of this will last a lot longer.
To be blunt, the social epidemiology of this is quite simple: there is a trade-off between how quickly we allow the virus to spread, and how many people die and what the economic impact of the epidemic is. We can go for saving people, or we can go for saving the economy, but we cannot go for both.
What you need to know is that the government is choosing the economy.
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“those who die are mainly amongst the elderly population,”……..who mostly vote Tory.
So this falls into the category of “Baldricks cunning plan” – the Tories kill the people who vote for them
I suppose, if enough old people die it will re-inject dormant money into the economy, working on the basis that the old have savings etc which somebody, still alive, inherits.
This could then lead to a spending boom & a feel good effect.
Sort of.
Whilst many Tory voters are elderly, not all elderly vote Tory.
The elderly who don’t vote Tory tend to be from “working class” areas. There are many people who are “working class” that have worked in heavy industry, mining and other dirty jobs and have a history of industrial diseases. For example, my grandfather had pneumoconiosis as he was a coal miner. Additionally, in areas of high pollution (inner cities and industrialised areas) the general population may suffer from other chronic lung conditions.
People who are middle class may live in the suburbs and less polluted areas.
Additionally there are other practical problems, Many older people struggle with the basics. They may have kept the house spotless … but when disabilities, like arthritis, take over, they just can’t simply clean as well as they like to. It’s no judgement, they aren’t dirty people. But middle classes are more likely to be able to afford to pay for a cleaner.
It’s the same with food. If you don’t have a lot of money and can’t prepare fresh veg (for example) people are more likely to use ready meals. Whereas, if you have the cash you can afford to buy food that is already preprepared and chopped up. Diet can be both healthy and varied.
I also think that certain “at risk” health conditions affect working class people, such as diabetes and Chronic heart disease.
So, it may be that it with reduce the amount of voters against them.
This area (NE Lancashire) is as working class as it gets. Former textile area, largely low aspirations and educational achievements (with more successful high achievers mostly leaving to go to Uni and not returning).
Most are Sun, Express, or Daily Mail readers.
An alarming number are openly, brazenly xenophobic racists in an area known for open conflict between indigenous and a long-established Asian-heritage communities.
And the vast majority are ardent Conservatives and Brexiters – though I haven’t yet met one who knows what or where the EU is, let alone how it works.
They elected a right-wing Tory Bojo acolyte as MP.
It is only the more educated middle-class who saw through all the Brexit lies and empty Tory promises who didn’t and never would vote for either Brexit or more Conservative Government.
Try to explain either and you can bank on being verbally abused and threatened with physical violence by those who don’t want to hear.
Mike are you suggesting that because people are old and voted tory that’s ok?! My parents are old and didn’t vote Tory.. but even if they did, what a callous remark!
It would seem that the Tory government does think it OK
Since its policy of so-called ‘herd immunity’ necessarily requires co miserable numbers dying and most will be elderly I think you might be best to target your ire at the real culprits here
Even if the Government has chosen the economy I have little confidence the Government understands the economy, and as for business?
I just heard this unforgettable ‘insight’ from a spokesman for the Institute of Directors on BBC Radio Scotland GMS this morning. Asked about the current business challenges of the virus, the spokesman acknowledged that COVID-19 would have a major impact on the economy, and hit business hard; but he hoped that (if the Government eased tax payments schedules for smaller businesses) the effect would be ‘merely cash flow, not a P&L impact’ (I think that is only slightly paraphrased).
I am still trying to deconstruct the full signficance of that explanatory jewel, with no success. Anyone care to help?
Of course there will be a P&L hit
What sort of idiot did they find to comment? M
Yes, I know. My question was rhetorical and a little mischievous: playfully I hope – we do need our sense of humour these days. At the same time, lack of cash flow kills a business stone-dead long before anyone produces the P&L; which is, after all an ex-post, abstract and too often calculatedly recondite exercise in score-keeping. Thinking of humour:
Remember, this was the Institute of Directors….
Indeed….
I agree.
It is interesting to see how companies and individuals are handling this.
They don’t seem to be following the governments lead.
More people working from home and less travel between offices.
Premier league games being postponed. Etc
I think this might be what you get when no one trusts the government.
Of course there still seems to be a large group of people still in denial about the whole thing!
Like you, I am not an epidemiologist but I’m not sure that your analysis is valid
* The spread so far hasn’t been exponential in the UK. A continuous low level, waiting for the full outbreak may be more disruptive, getting to the “optimum spread level asap” might be the right policy.
* Yes, If it is a pandemic, everyone will be exposed, its just the timing. the ones suffering in the peak will be less well cared for, but how many extra deaths?
* The impact of a recession on the death rate is probably higher than the extra deaths from above, so prioritising the economy may well be the best health policy
TRhe spread in all European countries is epidemiologically identical – we 13 just 13 days behind Italy
This is exponential – just at the very early stage of that
Peter
Your logic is completely flawed. You presume the level of health care we can provide is dependent on the state of the economy and that is utterly untrue: we can afford excellent healthcare, always. We just have to be willing to pay people to work, and in real terms doing so in periods of economic downturn is effectively costless whilst the resulting deficits are meaningless, as Japan has proved.
Richard
I look at the full death rates. People die earlier the poorer they are. Health spending only makes a difference at the margin.
The UK COVID19 curve is currently as close to linear as it is to exponential. It is certainly not (currently) like the Italy exponential curve ( thanks for the link). I fancy this is to the credit of the people operating the “report, trace and quarantine” policy.
On another point
I wonder what proportion of population needs to be immune ( recovered) for the spread to die-out and become long-term background infection. Is this what is happening in Wuhan?
Every epidemiologist I have read disagrees with you on rate of progression….
Time will tell
Opinion is on my side right now
It’s exponential in the UK. See my data visualiser here: https://homepages.inf.ed.ac.uk/ngoddard/covid19/index.html
Switch to the Log Count scale and you can see it’s close to a straight line. That’s exponential.
Soon I’ll add a view that allows you to compare countries and slide one countries line back and forward in time to see how it compares to another country. I expect it will then be obvious that the U.K. is on a similar path to others ahead of us, like Italy.
Thanks
Ah………….the good old BBC did I hear someone say………………..no, don’t worry – enough said. I rest my case. Again.
Well……………..update from me.
I have disclosed that my 17 year old daughter has been asked not to attend school as of this week as her best friend’s Mum has ‘flu like symptoms’ although there is no confirmation that said Mum has the Coronavirus. We have spent hours on the 111 line asking for advice and cannot get through. Our 14 year old son who attend the same school is allowed to go. The internet site for the virus is just dumb factual delivery platform based on broad facts.
My employer (who is still writing their ‘Coronavirus’ policy) have asked me to work from home until I am asked to return.
And all I can think of is ‘How come Nadine Dorries has been tested but no-one else seems able to get one?’. I live in a rural area.
It all feels a bit wrong.
Analysis of the spread of coronavirus and how to reduce the effects. Not to read by the nervous.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
We should be contacting our leaders to close the whole of the UK down today. Shame budget is of no help.
This article by the Moon of Alabama blog makes a similar point very powerfully. Here’s an excerpt:
“Wuhan city in China was shut down on January 23. Twelve days later, on February 4, the newly confirmed cases in Wuhan reached their peak and declined from there. This gives us the time delay from an infection to become a diagnosed and counted case as the shutdown increased the social distance and lowered the number of new infections.
Each newly infected person infected two or three other persons. The growth rate was thereby exponential until they shut the city down. Had the city not been shut down on January 23 the numbers beyond February 4 would have gone higher and higher. That will happen in our cities and countries as our authorities are unwilling or unable to act as early and as decisively as the Chinese authorities did…”
….when the authorities decided to shut down the city there were 400 diagnosed new cases – but, given the number that were still asymptomatic it turns out there were really 2,500 new cases that day but that only became clear later….
The writer of the MoA blog also cites what happened in two US cities during the 1918 flu epidemic
“As the disease was spreading, Wilmer Krusen, Philadelphia’s health commissioner, allowed a huge parade to take place on September 28; some 200,000 people marched. In the following days and weeks, the bodies piled up in the city’s morgues. By the end of the season, 12,000 residents had died.
In St. Louis, a public-health commissioner named Max Starkloff decided to shut the city down. Ignoring the objections of influential businessmen, he closed the city’s schools, bars, cinemas, and sporting events. Thanks to his bold and unpopular actions, the per capita fatality rate in St. Louis was half that of Philadelphia. (In total, roughly 1,700 people died from influenza in St Louis.)”
https://www.moonofalabama.org/2020/03/coronavirus-the-hidden-cases-why-we-must-shutdown-everything-and-do-it-now-.html#more
From an economic point of view this is a powerful case for the imposition of a particular form of economic degrowth – so that people survive – a lot will not survive an exponentially growing epidemic AND a simultaneous collapse of the medical infrastructure…especially as it will probably pull the economic system into the collapse…
Thanks
I have seen a couple of things that indicate how the government want to treat this pandemic I want to share.
In Boris’ video today with him interviewing Dr Jenny Harries, Deputy Chief Medical Officer, at around 4:20 she says in relation to timing “If we put it in too early we will just pop up with another epidemic peak later on”.
https://mobile.twitter.com/BorisJohnson/status/1237760976482598913
Then Hancock in parliament said “We do not expect numbers to peak in the next fortnight, we expect numbers to continue to rise after that and the peak would be after a matter of a couple of months, rather than in a matter of a couple of weeks. This is a marathon and not a sprint.”
I read that to mean they are looking to get this virus over in one go, by letting it spread to enough people that we get herd immunity so it won’t come back. If you are elderly or have underlying health conditions tough. Then no need to wait for a vaccine.
The triage is going to be horrific.
I can’t believe this is the best scientific advice.
I’ve heard that people infected at the beginning of the epidemic are now showing symptoms again i.e. they have not become immune. That further undermines the ‘herd immunity’ argument.
The government are of course too incompetent to be able to manage modern disease control; so they’ve decided to double-down on their incompetence, make it policy and treat us like cattle. Foot and mouth? Let them die. The scientists from abroad, interviewed on BBC Radio 4 News at Ten last night, tried their hardest to be polite whilst saying that England seemed to believe the science that applied to everyone else didn’t apply to them. The tame government scientists from England havered and equivocated; everyone else, including the Scots and the Irish, can barely hide their astonishment and pity.
[…] Cross-posted from Tax Research UK […]
Will those of us who socially isolate as a matter of course, due to having pre-existing, often invisible conditions that attract stigma (eg migraine) be recognised and rewarded for all our efforts to date? Asking for a friend …
Some of us with ME have been self-isolating for years now, but no parade so far, not on purpose of course, but as a natural consequence However, we have become expert at it! I am thinking of writing a blog to help folk through those tricky problems like ‘How to manage when you are not well enough to shop’, or ‘What to do to alleviate boredom while lying in bed for the 12th day running’, and that old chestnut ‘How to live on £73 pw’ ,which is also something many of us are expert at. Maybe it would be a best seller now? Our day has come
Write it…..
In Cummings I feel like we have our own Dr Strangelove at the helm. Fatalities are just numbers to him, just interesting results from his latest experiment.
I wish I could be more confident that genuine medical experts were guiding this. The evidence out there from both recent experience and history some of which has been posted here, seems to be pretty consistent. We need more radical action sooner, in particular on social distancing.
We can at least follow that advice as individuals – it all helps.
Richard Stafford, if history is anything to go by, the working class serfs, sorry staff, who serve the political classes will soon carry this modern day plague into their masters’ houses, just as they did bubonic plague and TB. The uncaring Conservatives may yet reap their just rewards for their idiocy.
I think we should let the weak and those who are not fundamentally healthy die off, hoping they will be replaced by the younger, fitter, and more agile which will benefit the whole economy. Businesses, that is. Not people. I’m not a Nazi.
Quite simply the government are in a predicament as 2008 has been a continuous disintegration of the economy, services and underlying infrastructure across UK.
Brexit was a self inflicted shot in the foot but cloaked again the downward spiral as the administration fumbled through.
Current circumstances expose that the ‘emperor has no clothes’ and the systems and ability to manage a crisis simply does not exist in the UK. Best to delay the acknowledgement of ‘I’m an alcoholic’ just yet for public confidence!! Disillusioned by their own sense of importance – power & politics than being human.
The great British Empire presents itself with a depression and a spiralling economic position in the world as it has ostracised itself over the past number of years out of complete ignorance.
They subliminal message is that our loved ones are statistics and many families will face loss and compromise as a consequence of inability of the nations leadership.
A ‘Churchill’ speech on bringing the nation together and for personal responsibility to have a duty to each other is long overdue!!
All will appreciate the beauty of simplicity once the clouds pass but ensuring no longer term diverse global and political disintegration essential.
”There will be great earthquakes, famines and pestilences in various places.”
“For it will come on all those who live on the face of the whole earth. Be always on the watch, and pray that you may be able to escape all that is about to happen, and that you may be able to stand before the Son of Man.”
I submit to the author that perhaps a long term economic downturn would cause deaths due to austerity and poverty. Hence biasing a policy towards the economy may also save lives in the long term: not a black/white scenario.. Having said that, if the government are to pursue this approach then they need to tell the old and vulnerable to self isolate 100% now while the rest of us get on with gaining immunity (cough, splutter!)
There is absolutely no reason for an economic downturn to result in the loss of life due to austerity or poverty, because the expenditure that we make on the NHS is entirely unrelated to the capacity of the economy to raise tax, because the government can always pay for whatever is necessary so long as there is not full employment because it can always create the cash required to make swettlemnt, and clear the debt(which is purely notional, in any event) whenever it wishes using quantitative easing. In other words your hypothesis is based upon an entirely false premise
Couldn’t agree more. Their delay phase doesn’t make sense. Makes me v concerned and people just still think it’s over reaction. The Tories have systematically reduced beds in hospitals and ITU’s. Any deaths due to lack of beds should be on their conscience. And the people voted for this
Please, all of you, go home, stay home, and flatten the curve.
Agreed
The optimum time to get the virus is now at the end, when the medical expertise is high, and demand is low, assuming that the medicines are still available. Second choice was to be one of the first.
I for one, have fulfilled the appointments I made before the virus was endemic in the UK, and made no new ones. My diary is now empty for he foreseeable future.
I am having a fairly normal family life, on the basis that if I do succumb, I’d have maximised what I value the most.
As well documented, if my family survive, but the economic depression is dire, we have a redoubt which will keep us in comfort, if not luxury. 15 years of planning and preparation, does not go unrewarded!
The government suggested today (Friday 16/3/20) that they are hoping their policy will lead to ‘herd’ immunity which will in their theory protect more of the population more quickly.
I’m not expert enough to know the finer points of this argument but it feels like overall the government are going a completely different direction to the rest of the world which feels like a big gamble where we are all the pawns and don’t seem to matter if we are unfortunate and die. After all getting rid of more sick disabled and elderly (of which I’m one) will benefit the government because they no longer have to pay for health care, pensions or disability benefits. We have long known we are just a national insurance number!
I agree with you
It is wrong to even say mainly the elderly die, if the infection from the virus causes ARDS, the mortality rate is not that greater difference , fit healthy young people die from ARDS and some may survive but with weakened lungs and ongoing problems, it goes deeper than survival rates, ARDS can be through other infections to, even the common flu virus..
I am told by those who know more than me that Covid19 appears to have an immunosuppressant effect in some of all ages. That may be due to overexposure e.g. amongst medics. But the overall evidence is very clear that the elderly are most at risk and that is because of co-morbidities which the young tend to have many fewer of