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COVID-19: The Current Situation in the UK and June. May 30, 2020

Posted by mwidlake in COVID-19, Perceptions, Private Life, rant, science.
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I’ve not said anything about Covid-19 for much longer than I expected, but really it has been a case of watching the coming peak come and go, pretty much following the pattern of Italy, Spain, Belgium and France. I plan to do a post soon which pulls together the current scientific position, but for now I wanted to record where we are and where my gut feeling (based as ever on reliable scientific sources and not so much on what the daily government updates would like us to think) says we will be in a month or so.

The number of UK recorded deaths where C-19 was present, and detected cases

We’ve not done very well in the UK. If you are based in the UK you may not be aware of the fact that most of Europe think we have,as a nation, been idiots – failing to learn from other countries, late to lock-down, lock-down was not strict enough, too early to open up, our PPE fiasco… I can’t say I can disagree with them. We have one of the highest deaths-per-million-population rates in Europe, exceeded only by Spain and Belgium. But it could have been worse. A lot worse.

I’m truly relieved my predictions in my last post were (for once) too pessimistic. I misjudged when the peak in deaths would be by over a week – it was 9 days earlier than I thought, happening around the 11th April. As a result of coming sooner, the peak was lower than my little model predicted. Even allowing for that, the increase in number of deaths did not mirror the increase in cases (I used the cases pattern as my template for deaths). I think this is because the UK finally started ramping up it’s testing rate. The more testing you do, the more of the real cases you detect, so some of the increase in cases was simply better testing and not continuing spreading. That’s what happens when the source of your metrics changes, your model loses accuracy.

Deaths are directly related to real case numbers, it does not actually matter how many cases you detect. This is part of why case numbers are a much poorer metric for epidemics, whereas deaths are better. The best metric is a random, large sample for those who have had the disease – but we still do not have reliable, large-scale antibody or similar tests to tell us this.

If you look at the actual figures and compare to what I predicted for the peak of deaths, I seem to have been pretty accurate. I said 1,200 to 1,500 around the 20th April and the peak was 1,172 in the 21st April. But I was predicting hospital deaths only. Up until 29th April this was the number reported each day but since then the daily number of deaths reported included community (mostly care home) deaths. The previous figures were altered to reflect this and the graphs to the right are based on these updated figures. Hospital deaths seem to have peaked at 980 on the 11th April, so I was wrong.

I think it is crucial in science and technology (and actually, just in general) that you be honest when you are wrong – even if (like in this case) I could made a fallacious claim to have hit the nail on the head.

The bottom line is, we are well past the first peak and it did not overwhelm the NHS. It got really close and our issues with personal protective equipment was a scandal and must have resulted in more illness and some avoidable deaths to our front-line NHS staff. But, apparently, saying so is Political.

All in all we followed the pattern of European counties that were impacted by Covid-19 before us and implemented similar country-wide lock-downs.

One difference between us and other European countries that have been hit hard is our tail of cases is thicker and longer. We have not been as rigorous in our lock-down as those other countries (e.g we did not have to have written permission to leave or enter an area and children were not utterly forbidden from leaving home, which are just two examples how our lock-down was softer). I know it might not feel like it, but we were not.

What really concerns me is that we are easing lock-down measures so soon in the UK. Our daily new case rate and number of deaths are both still really quite high. The figures always drop over the weekend, especially Sunday and Monday (due to the numbers reported being for the day before). Over the last 3 days (Wed to Fri) we averaged 1998 new cases and 371 deaths per day. If you think Covid-19 has gone away, every single day there are 371 families who sadly know different.

I understand that the economy is important, that unless things are being manufactured, services provided, money earned and spent, that a large part of our society is not functioning. Maybe I don’t really appreciate how important it is as economics has always looked more like a dark art based on greed than anything logical, but some people feel getting back to normal business is critical and the long-term impact of not doing so is potentially as serious as Covid-19.

I also know that not being able to go to places, eat out, have a drink in the pub, meet up with friends in a building or in more than small numbers is frustrating. For many, not seeing your family and loved ones who are not in your home is very upsetting.

I’m sure that parents are desperate for kids to go back to school (partly for education and partly as it turns out kids are a lot of work), couples need a bit of time apart, people are missing their jobs. Nearly all of us have never had to spend so much time with a very small number of other people.

But I’m also sure that what we don’t want is in 4-8 weeks to have to go into the same level of lock-down as we spent most of this spring in. And the next lock-down may be even more draconian as there is a difference now to where we were at the second week of March when we should have locked down first.

SARS-Cov-2 is now endemic and prevalent across the UK. It is everywhere.

At the start of an epidemic the disease is growing in a small number of places, so usually (such as was the case with MERS and SARS) you can contain it by strong isolation and tracking efforts in those areas it occurs, as most of the population are not exposed. This is why you cannot contain seasonal ‘flu epidemics by isolating people, it does not work if it is wide-spread enough. ‘Flu simply flows through the population and it does in some years kill a lot of people.

With Covid-19 right now, If our R(e) – the effective reproduction number – goes above 1 anywhere across the UK, Covid-19 cases will rapidly increase in that area. And with restrictions being lifted across the whole UK and in England especially, I am privately convinced the disease will burst fourth again in many, many places and it is going to go very wrong again. I think the government is being utterly disingenuous about the impact of opening up schools and my friends who are teachers and medics have no doubt this is a significantly more dangerous step than it is being sold as. It might be the right move, but lying about it’s potential impact is not helpful long-term.

Not only are we relaxing social distancing steps too early, but I feel the government has utterly bolloxed up (technical term meaning “done a jolly poor job of”) the messaging. As examples:

  • The very clear “Stay at Home” became the vacuous “Stay Alert”, which no one seems to be able to clearly define and every one seems to have a different interpretation of.
  • We were given contradicting and non-nonsensical rules such as you could see one family member from outside your household in the park, but you could have people come and view your house. So if you want to see your mum & dad at the same time, put your house up for sale and have them view it.
  • Parts of the UK (Wales, Northern Ireland, Scotland) have said they were not consulted on changes, they do not agree with them, and they are doing their own thing. That’s not confusing to people is it?
  • The whole Cummings affair. Dominic Cummings did break the rules, he acted like a selfish idiot, he lied about what he did, he had pathetically stupid excuses (“I drove my child around in a car to test my eyesight” which shows he either does not care at all for other people’s safety or has too low an IQ to be allowed out on his own). The issue is not that one arrogant, self-important person decided the rules do not apply to him. It is that the government fail to understand that not sanctioning him is being interpreted by many to mean they can make up their own minds about which rules apply to them and which they can ignore. Continuing to say “look, get over it” is simply coming across as telling us all to bugger off.

To help steer us through this crisis, we really needed a government with both the mandate to introduce new rules and also the acceptance by most of the population of those rules, and at least acquiescence from the majority to put up with limitations placed upon us. What we have now is a not just the hard-core “we won’t be told what to do” people that would always be a negative factor in limiting the spread of a disease, but a large number of angry, confused, worried people across the country. Almost everyone I personally know in the UK feel angry, confused, worried, and mostly with a progressively declining respect for the government and their advice.

I know I’m not very good at understanding people, it does not come naturally to me. If someone does not think like I do, I can have a devil of a job working out why. But I’m pretty sure that here in the UK a lot of people are going to start saying “to hell with the lock-down rules, everyone else is ignoring them and I’ve not seen anyone die in front of me…”

I went to see my Mum this week. I had to drive 100+ miles to do it. Unlike in Dominic’s case, it’s allowed now and I have no Covid-19 symptoms. I took a mask, I took my own food, we sat in her garden (I got sunburn, so Covid-19 might not get me but skin cancer might). I assured myself she was OK and that her tech will keep working so we can stay in touch. And I felt a little naughty doing it.

But I made a conscious decision to do it now – as I think SARS-CoV-2 is about at it’s lowest prevalence in our population right now (end of May 2020) than it is going to be for months. Admissions and deaths are going down and I expect at least deaths to continue to do so for another week or two. Personally I am deeply worried that in 4 weeks time new cases, hospital admissions, and deaths will be going up again. I don’t want them to be but I’ll be (very happily) surprised if they don’t go up  – what we see in cases & deaths at any point in time is based on the level of spread one or two weeks ago respectively. I suspect that as I type our R(e) number is going up and will exceed 1 this week.

If you don’t agree with me, just keep an eye on what the scientists are saying. Some are already making noises of anxiety as an article on the BBC is already saying today. Scientists tend to make cautious statements such as “we do not think this is wise” or “we feel there is a danger in this choice of action”. It’s a normal person’s equivalent of screaming “Are you bloody idiots?!?”.  Once again, the experts are saying we should do one thing and the government are doing another. It’s not gone too well to ignore the scientists so far.

There is a T-shirt you can get at the moment, which I really must order a dozen of.

“All disaster movies start with someone ignoring a scientist”.

 

 

Comments»

1. oraclebase - May 31, 2020

I agree with pretty much everything you say here, especially about greater numbers of people starting to give up on the lockdown rules. A lot of people were already bending them. I can see this going horribly wrong. I’m already hearing people starting to talk about holidays etc. Not good! 😦

2. jason arneil - June 1, 2020

Martin,

Do you have evidence in regards to lockdown being effective, and the date the lockdown occurs (as in earlier good, later bad)?

I think there is evidence that may dispute that lockdown was effective (for example the peak being too soon for the lockdown to have impacted it – rather than social distancing that was occuring without lockdown).

Also there should be a correlation between early lockdown and lower deaths. This does not seem to be the case:

https://www.ft.com/__origami/service/image/v2/images/raw/https%3A%2F%2Fd6c748xw2pzm8.cloudfront.net%2Fprod%2F90f26d70-a0d0-11ea-9bec-2b7f5ee3f0e9-standard.png?fit=scale-down&quality=highest&source=next&width=700

There seems very little correlation between number of infections at lockdown and excess deaths.

https://thebattleoftours.blogspot.com/2020/05/are-lockdowns-effective-bit-nerdy.html

mwidlake - June 1, 2020

Thanks for that Jason. I intend to do a post later this week that pulls together scientific papers on the current situation and analysis of how this all went.

However, a very simplistic answer is that pretty much all professional epidemiologists pushed for lock-downs as it is recognised as effective when track-and-trace has failed to stop an epidemic. In fact, it is pretty much your only tool at that point if the disease is highly contagious and you have no effective treatment. Most countries implemented wide-ranging lock-downs and only saw a the number of deaths drop after lock down, and within 2-4 weeks. I’d say that is pretty clear.

In the UK our lock-down was delayed and we now have more deaths per million than France, Italy, and soon it will be higher than Spain, all of which experienced their exponential growth in cases before we did – so should have more total deaths than us all be similar. https://www.worldometers.info/coronavirus/ and order by deaths per million then check the graphs for each country.

The saving grace for the UK is that many companies and a lot of the general public decided before the UK officially locked down that lock-down was the right move and they did it themselves. If you were travelling around before the 24th March lock-down it was very quiet and most companies had already started shifting to working from home and banning physical meetings.

Our peak was 11th April for hospital deaths – over two weeks after the official lock-down and a little early given the incubation period and then time to succumb. But The next week was almost as bad for deaths. Allowing for the weekend dip, I’d say there was a double peek or plateau. This is a result of the self-imposed lock-down and then the official one. All in all I say that it matched what you would expect from the impact of lock-down.

There are so many compounding factors in this that you could argue many things if you pick your figures. That’s why I look to the scientific experts, the epidemiologists.

3. jason arneil - June 1, 2020

Hi,

You say

“In the UK our lock-down was delayed and we now have more deaths per million than France, Italy, and soon it will be higher than Spain”

But we locked-down with a LOWER infection per-million population than France, Italy and Spain. You can see that in the FT graph:

https://www.ft.com/__origami/service/image/v2/images/raw/https%3A%2F%2Fd6c748xw2pzm8.cloudfront.net%2Fprod%2F90f26d70-a0d0-11ea-9bec-2b7f5ee3f0e9-standard.png?fit=scale-down&quality=highest&source=next&width=700

So that is saying we locked down earlier than those countries.

That being said, I fully accept there is a danger in cherry picking data to fit a hypothesis. I am less convinced there is a consensus amongst epidemiologists on this.

4. Stephen Butterworth - June 1, 2020

I’ll bet your mum was happy to see you. I agree your circumstances were much different to Cumming’s coming and goings… When is he going to get fired???

5. bigdaveroberts - June 1, 2020

Ok, so you met your mum in her garden. That seems a tad against the rules to me. Of course, if you’d waited till today, it would have been fine.

6. sydoracle1 - June 2, 2020

One of our TV channels produced a helpful chart to highlight how the lockdown is currently at around our various states

It would be nice to think that would serve as a useful experiment to see what elements of a lockdown are useful and which are just window dressing. However our local cases have fallen so much, they are all pretty much superfluous in practice (though most states are still imposing border restrictions for interstate travel).

Those low cases numbers have given an insight into where the disease is spreading. Australia has had some big clusters around aged care homes and a meat processing plant. These are pretty much outside any possible lockdown (though Tasmania went as far as closing two hospitals there to contain an outbreak). NSW produces weekly surveillance reports and last week’s specifically covered children (who were returning to school around that time) and found the few cases we had were mostly acquired at home, and children were unlikely to infect family members.

https://www.health.nsw.gov.au/Infectious/covid-19/Pages/weekly-report.aspx

We do get some interesting ‘open data’ from NSW, such as reports by location/infection source

https://data.nsw.gov.au/data/dataset/nsw-covid-19-cases-by-location-and-likely-source-of-infection/resource/2776dbb8-f807-4fb2-b1ed-184a6fc2c8aa

We can even run straight SQL on the data from the URL

https://data.nsw.gov.au/data/api/3/action/datastore_search_sql?sql=SELECT%20notification_date,%20postcode,%20lhd_2010_name,%20lga_name19%20,%20likely_source_of_infection%20from%20%222776dbb8-f807-4fb2-b1ed-184a6fc2c8aa%22%20WHERE%20notification_date%3E%272020-05-15%27

Once you start looking, you immediately wish for all the other columns that would be essential for any usable modelling (age, outcome, estimated date of infection, severity of symptoms etc). Without those details any prediction is going to be more based on how other diseases have spread rather than the particulars of this outbreak. I’m assuming those making recommendations to government have access to data details that can’t be provided openly.


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