UK Politics: Drawing Priti Patterns

[Chaircat Meow]

2 hours ago, Werthead said:

 There is a plan, but this plan, like most of Boris's, is not even tenuously connected to reality. Letting the virus spread at will through the general population will ensure the at-risk groups are absolutely hit no matter what precautions are taken. There is no way to "manage" it, and it is preposterous to think it is possible to do so.

We either adopt stricter and more stringent measures for the entire country like Taiwan and South Korea, or we agree to say fuck it and let it go wild and see what happens (and what happens is we get Italy and increasingly Spain).

That's not a fair summary of the plan.

The idea isn't to let it spread 'at will'; we want to manage the spread like every other government who has decided this can't ultimately be contained (and that may include Germany, France, Spain as well as Italy, although it is a little unclear to me). We want to flatten the peak of epidemic so the NHS isn't overwhelmed. We're not trying to stop it spreading at all though: it has to spread at the right speed.

2 hours ago, Werthead said:

 'm glad you're okay with it. There will be thousands and tens of thousands of people who are very much not going to be okay with it, because they will be dead.

Not what I meant. 

 

[Free Northman Reborn]

For those who urge immediate shutdowns and whatnot (like the hysterical Piers Morgan), what is the plan after the 2 week shutdown ends? Is the expectation that the virus will then have been eradicated? Obviously this can’t be the case, so if infections keep popping up, do you shut the country down for another 2 weeks, and another and another? This is not sustainable.

Clearly getting the timing right is crucial, and this is what’s driving the UK government’s strategy.

[Which Tyler]

The gamble the UK seems to be taking, is to desire a shorter, but higher peak to the curves I'm sure we've all seen - gambling that the virus will behave in exactly the way we hope it will; and that the population will respond the way we hope they will; with a willingness to sacrifice the number of lives that that model suggests is likely.

Watching the C4 programme on it Saturday night; it seems that their reasoning is that they simply don't trust the British public (which cynicism is fair enough) to do the right thing for a prolonged period of time - so they hope that when they apply draconian measures, so they want to minimise the time spent at the peak. The trouble with this, is that it 100% will lead to the overwhelming of the NHS (as will a flattened curve btw) - it's that they seem to be willing to overwhelm the NHS for 3-4 months to the tune of a million per month (most of whom will drown from the fluid in their lungs); rather than spreading it over 16 months or so, but overwhelmed to the tune of a few thousand a month. In the mean time, they talk a good game about flattening the curve, but are refuse to take the measures that will see a flattening of the curve (closing gatherings, pubs and clubs).


The government's fear is that COVID19 will see a second spike around October / November; and thus they want to have achieved herd immunity by then - the theory being that flu is seasonal, and therefore so will this be. But this isn't the 'flu, and being summer doesn't seem to be flattening the curves that much in places like Australia. Though there is a good point that seasonal flu will still exist, so let's free up NHS serVices by the time that starts up in October. When we get those draconian measure put in place is probably when the estimates say that 60% coverage (thought to be enough for herd immunity) is inevitable. There is good cause to thing that herd immunity rate will be something like 70% (see below) based on the science; which suggests that the infection rate per person is 2-3 - whilst something like measles is 12-18, meaning that 95% need to be immune in order to acheive herd immunity - we had herd immunity before Wakefield's immorality, and now have pockets where it's been lost.
The other factor for the government appears to be economics presumably, by delaying draconian actions, they hope the economy will continue for longer; and having a shorter peak, the economy will start recovering sooner, giving us a head-start in the post-pandemic world. Weighed against that is that we'll be recovering from a higher death toll, and the economic and psychologic scars of that. That death toll will still mostly be in the retired population, which in terms of cold logic, would be an economic plus; but tory party negative. But not to the levels seen elsewhere; as the NHS will be swamped; so those that should recover, will be left to die.
To achieve 60% immunity, we need 60+% infection rate within the total population (some won't gain immunity having recovered from infection) - you also need to overshoot in case A] your modelling is wrong; and B] when you average it over a population, you'll get pockets which drop below that level - see measles since Wakefield's anti-science fear-mongering. So call it 70%.
Our model WANTS 70% of the population (67M) infected and recovered, before the weather turns in October. Recovery seems to be about 4-6 weeks, so we need 47 million people to have been infected by mid-July. 4.7% (2.2M) of those will need intubation and a respirator to breath for them, another 13.8% (6.47M) will need hospitalisation. Now beds can be re-used over that 5.5 month period (4 months + 6 weeks); so each bed can take 4-6 people. We currently have 167,000 hospital beds of all sorts (NHS and private), NHS occupancy rates are somewhere around 90% (I can't find figures for private beds). For inensive care (intubation and respirator) we have less than 4,000 beds. To be optimistic, let's say that each bed can take 6 people in the required time - so that means we can (currently) look after 24,000 of the 2.2M intensive care people; and 0.98M of the 6.47M who need hospitalisation.
Now, we CAN increase the number of beds, and even of ICU beds by throwing money at it - converting hotels to hospitals; buying specialist eqipment etc. We MIGHT be able to provide enough beds for the hospitalisation category; but ICU?... There are 730k hotel rooms in the UK - if they are all requisitioned, and all take 6 patients, we're up by another 4.38M beds, out of the 8.6M needed - so all those hotel rooms would need to double up (which leaves the NHS beds free to take their current load). Equally, money can only take you so far in terms of staffing, which we won't have time to train, so will have to import. We'll have to import knackered, demoralised staff from China, Italy, Iran - assuming they can spare them by then (equally, once we've acheived herd immunity, we can export staff). That all looks possible. To do this, would require the NHS to increase in size, from looking after 125,000 beds to looking after 1.58M beds (current NHS + 2 per hospital room).
Taking that 70% figure: Assuming we had the capacity to convert all those hospital bed, buy all the equipment and import all the staff, then our death toll should remain at around 0.5M for a non-overwhelmed health service. Assuming we can do none of that; and the NHS remains the size it is; then the death toll will be somewhere around 5 Million people (possibly a lot more). The reality will be somewhere in between. Of course, get the timing of the draconian measures wrong, and we may "only" infect 55% of the population, and not acheive herd immunity; or infect 85% of the population; bringing the beds needed (and death toll) ever higher. Or we may have it wrong as to what percentage of the population needs exposure to create herd immunity. Or it may mutate and become less lethal (highly likely to happen, but reasonably random as to when); or it may be the immunity is only conferred temporarily, or that the virus will mutate and side-step current immunity - these are all gambles.
Of course, the matsh assumes a flat curve; not bell - reality will be way more complicated.



Other governments (and WHO recommend) are taking measures to flatten the curves, so that the peak is shallower, but last longer (18 months - by which time, even if they haven't acheived herd immunity, a vaccine MAY be available - there already seems to be some promise there, but extremely tentative at this stage).
Those same maths applied to the UK above would mean that each hospital bed would take 18 patients, not 6. The overall financial cost will be the same, but spread over 18 months, not 6. The numbers infected at any one time remain low enough that there are always hospital beds, equipment, and staff to care for them - keeping the death toll at or around the 1% figure. They can also be more reactive to the facts on the ground; as they're dealing with a shallower curve. It doesn't really matter with that model, if they can slow progression enough to take 24 months, or long enough for a vaccine to be produced, and confer immunity with 0 extra deaths from that point - the point is that their health services are much less likely to become overwhelmed - which can easily mean an order of magnitude on the death toll.


In a nut shell, our government seems to be saying "We can't stop this thing" - which is correct. "We can't apply severe measures for long enough" - sadly, probably correct. "So let's get it over and done with, in as managed a way as we can" - which means more-or-less unchecked, until we're further along the exponential curves. "Sadly, some of us will die" - which could mean 10 times as many as if different decisions were made.
The hope is that we emerge out of the other side of this a good year or so before the rest of the world, and start rebuilding (with a younger demographic) sooner.

Equally, stressing social distancing, and hygeine issues isn't "nothing" - it may even have been enough for the plan to work and spread over the desired time frame.

For the record - the more I think about it, the more sympathy I have for the governments position - in terms of cold, hard calculation. It probably also a case that it's already too late for other options to actually work, which may well explain Wednesday's delay.

 

NB: The above making several non-valid assumptions - it's assuming linearity of curves that aren't liner (so reality will be worse than the above), it's assuming that cocooning will have no effect whatsoever (it will have an effect, but I doubt that it will be particularly close to what's hoped for - though it may help flatten the curves initially once implemented - so reality will be better than the above).

ETA: I originally wrote the above for another forum a couple of days ago; PHE leak has subsequently more-or-less confirmed my maths, with an expectation for 7.9 million hospitalisations (as opposed to my 8.67M) - where I worked off an assumption that we wanted 70% of the population infected within 4 months to give us a safe margin above the 60% predicted for herd immunity, PHE are working off 64% (42.88M people). Their "Spring 2021" timeframe isn't for peak, or for herd immunity granted - that's for it to tail off once we're well past the peak; they want herd immunity granted before the weather turns and we enter 'flu season.

[Heartofice]

8 hours ago, Free Northman Reborn said:

For those who urge immediate shutdowns and whatnot (like the hysterical Piers Morgan), what is the plan after the 2 week shutdown ends? Is the expectation that the virus will then have been eradicated? Obviously this can’t be the case, so if infections keep popping up, do you shut the country down for another 2 weeks, and another and another? This is not sustainable.

Clearly getting the timing right is crucial, and this is what’s driving the UK government’s strategy.

I think the loud mouths like Piers seem to think if we all sit in our houses for a couple of weeks, keep our heads down, watch a bit of tv, then when we re-emerge the whole thing will be over and we can all dance and frolic and enjoy our new worry free lives. It won't happen like that. I mean you could potentially end the pandemic pretty soon if you wanted to, but it would result in a lot of people dying. 

I don't know how China is planning to counter any second wave, I suspect they can do more to counter one than we can, their ability to just knock up hospitals overnight as well as getting people to stay on lockdown for longer might make it work. But we aren't them.

I think the British position makes a lot of sense. I HOPE it works.

[Ser Reptitious]

10 hours ago, DaveSumm said:

I can totally accept he might be wrong, but I really can’t buy into any grander reasoning like he’s spiting the EU / he wants to save his friends some cash / he wants to save money buy killing off people who claim a pension. I’m hoping his reputation means more to him than that.

I definitely wouldn’t expect him to do it consciously, but I was wondering whether a subconscious instinct might kick in (given that so far he has refused to extend the negotiations with the EU, for example). But yeah, he most likely is simply taking a gamble here, since no one knows yet which is the best path going forward. I hope for the sake of the UK population that it pans out.

[DaveSumm]

19 minutes ago, Which Tyler said:

Equally, stressing social distancing, and hygeine issues isn't "nothing" - it may even have been enough for the plan to work and spread over the desired time frame.

I was going to mention this, there’s no reason to think there’s a linear relationship between how severe a measure appears and how effective it is. Maybe hand washing is better than closing schools?

[Heartofice]

3 minutes ago, DaveSumm said:

I was going to mention this, there’s no reason to think there’s a linear relationship between how severe a measure appears and how effective it is. Maybe hand washing is better than closing schools?

Closing schools could potentially do more harm than good if it means everyone leaving work or old people looking after children 

[BigFatCoward]

5 minutes ago, Heartofice said:

Closing schools could potentially do more harm than good if it means everyone leaving work or old people looking after children 

Schools should have to stay open for emergency service workers, and anyone who works in the toilet roll or pasta industry. 

[Gorn]

From what I understand, the UK strategy requires sticking to limited measures for the duration of the crisis with the hope of weathering it sooner, am I correct?

The big and obvious flaw that I see is, once numbers of the dead start growing exponentially, pretty much every tabloid in the county will start screaming for a lockdown at the tops of their voices, and there will be some pretty awful job approval polls. Somehow, I don't see the current government simply ignoring those and staying the course.

That would give you the worst of both worlds - both the deaths from unchecked spread early on, and the economic pain from the later lockdown.

[Heartofice]

4 minutes ago, Gorn said:

From what I understand, the UK strategy requires sticking to limited measures for the duration of the crisis with the hope of weathering it sooner, am I correct?

No the strategy seems to be to time the measures so that they have the most benefit at the right time. It's not to 'do nothing'.

[Free Northman Reborn]

3 minutes ago, Gorn said:

From what I understand, the UK strategy requires sticking to limited measures for the duration of the crisis with the hope of weathering it sooner, am I correct?

The big and obvious flaw that I see is, once numbers of the dead start growing exponentially, pretty much every tabloid in the county will start screaming for a lockdown at the tops of their voices, and there will be some pretty awful job approval polls. Somehow, I don't see the current government simply ignoring those and staying the course.

That would give you the worst of both worlds - both the deaths from unchecked spread early on, and the economic pain from the later lockdown.

The issue is rather that supposedly 60% of the population will get it eventually. But that the “curve needs to be flattened” Now, by flattening it, you are by default spreading the outbreak over a much longer timeframe. So if your “flattening” methods include social distancing, hand washing and self isolation, that can be maintained over this longer timeframe of many months. 
 

But total lockdowns CANNOT be maintained over such a long period. So your longer term “flatten the curve” efforts have to be limited to the less disruptive methods, with total lockdowns reserved for the most intense part of the peak.

[Gorn]

31 minutes ago, Free Northman Reborn said:

The issue is rather that supposedly 60% of the population will get it eventually. But that the “curve needs to be flattened” Now, by flattening it, you are by default spreading the outbreak over a much longer timeframe. So if your “flattening” methods include social distancing, hand washing and self isolation, that can be maintained over this longer timeframe of many months. 
 

But total lockdowns CANNOT be maintained over such a long period. So your longer term “flatten the curve” efforts have to be limited to the less disruptive methods, with total lockdowns reserved for the most intense part of the peak.

As someone who lived in a warzone for 3.5 years, I assure you that lockdowns can be maintained indefinitely.

[Which Tyler]

1 hour ago, Heartofice said:

No the strategy seems to be to time the measures so that they have the most benefit at the right time. It's not to 'do nothing'.

But by reducing testing, they have no idea how to time new actions. You can't manage what you don't measure. Which reinforces my belief that they're being "too clever by half" and putting too much faith in theoretical models.

As for changing tack, and switching to a different model - it's probably too late; and trying would give the worst of both worlds.

 

We've gone for the (comparatively) "short sharp shock" approach - build herd immunity as slowly as possible within a 5.5 month time frame (as opposed to a 12, 18 month, or even longer) - in the belief that A] Our modelling is 100% accurate (and it has to be, we've ceased measuring to give us the opportunity to react to reality on the ground B] we won't need to be as draconian at any point C] Our most draconian measures aren't in force for too long D] Herd immunity will occur when predicted E] The virus won't mutate or confer immunity in such as way that herd immunity is irrelevant for any future waves F] By "get[ting] it done" we can move on earlier than most, and put it behind us earlier - even if the death toll is higher.

[DaveSumm]

What’s concerning me much more is the reports of average ages in ICU being much lower than the initial fatality rate. I heard average age of 51 in France currently. Seems like that rather fucks our plan of limiting the healthcare burden by quarantining just over 70’s.

[mormont]

15 hours ago, Werthead said:

 There is a plan, but this plan, like most of Boris's, is not even tenuously connected to reality. Letting the virus spread at will through the general population will ensure the at-risk groups are absolutely hit no matter what precautions are taken. There is no way to "manage" it, and it is preposterous to think it is possible to do so.

I'm normally a vocal critic of Johnson, as you know, but I do agree the 'spread at will' bit is unfair. 

As for managing it, if that's a preposterous idea, it's still the only one available to any government anywhere. It's a bit like being in a speeding car without brakes. Yeah, there's a limited amount you can do and you probably can't avoid a crash, but you still have to try to minimise the danger. The issue is how you manage it and what sort of nudges you can take at the right time to reduce the inevitable damage. 

15 hours ago, Werthead said:

 

I'm also baffled as to this idea that we cannot try these measures because there will be widespread disobedience because of the implication that we're independently-minded, frontier-spirited freedom loving white folk who will ignore common sense even if it kills a lot of people, unlike the Asian drones who do as they are programmed (which, amongst other things, demonstrates some ignorance towards both how independent and democratic Taiwan and South Korea operate). As people like to point out every five seconds, we put up with much worse during the Blitz and they didn't even have Netflix to keep them occupied.

The 'we' who did this pretty much don't exist any more. The current UK population are entirely different in culture. Much as they may like to think, and the tabloids may like to encourage the idea, we're not the blitz generation. I'm pretty sure the rosy picture of that is nonsense anyway. They didn't have ARPs because everyone was following the restrictions. 

 

[Werthead]

One of my friends has contracted the coronavirus in Chelmsford and is currently having a lovely time of it. Even though she has every symptom in the book, the 111 service has said she can't be tested and told her to stay at home, so even though she has it she is not on the official statistics as having the virus.

The small town in Spain where my mum lives which is out of the way and was expected to weather the situation reasonably well has one confirmed case and multiple unconfirmed ones. My mum is in excellent health for her age, but she is 72 so this is very concerning.

17 hours ago, ljkeane said:

Come on. I'm not Boris Johnson's biggest fan by any means but it's pretty clear this is being driven by the government's public health officials and science advisors. They may well turn out to be wrong, there's obviously a lot of guess work involved, but they're, more than likely, far more qualified to have an opinion on the subject than you, me or anyone else on the board.

The government's public health officials and science advisors are driven by political concerns. They can give scientific advice in private but once the government has decided what they're going to do, the advisors then have to agree with that position in public (or look for new jobs).

This is why the opposition parties have asked for their advice to be published, because it sounds like pure BS to them.

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Honest question from an outsider: could it also be that the current UK government simply feels instinctively inclined to do the opposite of what EU countries are doing?

Not as such, but there is almost certainly some modelling of how the UK could benefit if it takes a different tack and goes for a "short, sharp shock" rather than a long-term spread.

The fact that the difference in death toll between the two extremes may be up to a million people (if not higher) seems to have passed Johnson by. I agree he's not a psychopath (despite his other issues) and he would not take deliberate action which resulted in such a death toll, but he is also highly blinkered and he believes that gumption is a substitute for data. Once he convinces himself that something is a good idea, nothing is going to deter him without overwhelming evidence to the contrary (by which time it will be too late).

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The idea isn't to let it spread 'at will'; we want to manage the spread like every other government who has decided this can't ultimately be contained (and that may include Germany, France, Spain as well as Italy, although it is a little unclear to me). We want to flatten the peak of epidemic so the NHS isn't overwhelmed. We're not trying to stop it spreading at all though: it has to spread at the right speed.

Once again, it is not possible to do this. We cannot control the outbreak, we cannot influence it to determine if elderly people get infected or not. We either put measures in place to control the entire outbreak - as people are ignoring, as South Korea has done successfully after an initial massive explosion of cases and as Taiwan, Israel and New Zealand have done ahead of major outbreaks, and even El Salvador which had no cases at all a few days ago - or we let it spread at will. Those are the only two options on the table. The government can pretend they're doing something to control the outbreak but, unless their advisors are much thicker than it appears, there's no way they really believe that.

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For those who urge immediate shutdowns and whatnot (like the hysterical Piers Morgan), what is the plan after the 2 week shutdown ends? Is the expectation that the virus will then have been eradicated? Obviously this can’t be the case, so if infections keep popping up, do you shut the country down for another 2 weeks, and another and another? This is not sustainable.

No, the 2 week window option passed some time ago. New Zealand appears to be looking at that, but they're a much more isolated country with less than a dozen cases who've already taken draconian measures to prevent new cases of the virus reaching the country.

What we can do is shut down large gatherings of people (all sporting events, concerts, nightclubs etc), put strict measures in place for secondary schools, colleges and universities, make working from home mandatory where possible and put a strict bar on people coming in and out of the country, and maintain that for ~18 months, probably significantly less (based on South Korea's experience). You can't lock down the entire country for that long, but you can take much more stringent measures than we have at the moment because it is the difference between thousands or maybe tens of thousands of deaths and hundreds of thousands to a million and a half deaths.

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From what I understand, the UK strategy requires sticking to limited measures for the duration of the crisis with the hope of weathering it sooner, am I correct?

 The big and obvious flaw that I see is, once numbers of the dead start growing exponentially, pretty much every tabloid in the county will start screaming for a lockdown at the tops of their voices, and there will be some pretty awful job approval polls. Somehow, I don't see the current government simply ignoring those and staying the course.

Correct, and you're also right that the government strategy cannot work because once the death toll mounts into the thousands, the media will absolutely tear them to shreds and force them to take much more stringent action even if it is past the point of effectiveness.

We know that Johnson is not keen on scientific data, ignores inconvenient truths and prefers to "go with his gut" on everything else, so it is unsurprising that he is doing the same thing here. He also responds to large amounts of media pressure so I wouldn't be surprised to see him give into this approach and we end up with a "worst of both worlds" approach.

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As someone who lived in a warzone for 3.5 years, I assure you that lockdowns can be maintained indefinitely.

Absolutely, but the government perspective is that we can't force people to stay indoors, not gather etc. In a war situation the dangers and the situation is clearer, you stay indoors, you take shelter from attacks etc, but from this superficially things look fine, so it's much harder to enforce, once people's livelihoods are in danger.

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The 'we' who did this pretty much don't exist any more. The current UK population are entirely different in culture. Much as they may like to think, and the tabloids may like to encourage the idea, we're not the blitz generation. I'm pretty sure the rosy picture of that is nonsense anyway. They didn't have ARPs because everyone was following the restrictions. 

That much is clear. My grandfather was an ARP warden in London during the height of the Blitz and he had stories about people who really were fucking idiots and ignoring the warnings and wandering around in the middle of bombing raids. The point was that there weren't that many of them and the numbers of people doing that dropped off significantly as the Blitz continued (only to resurface later on during V1 and V2 attacks because people had gotten used to there being very few raids for the year or two beforehand).

[Toth]

The one thing I'm wondering whether there are any actual scientists who are convinced that the UK hospital system can brave the onslaught of severe cases or whether this whole thing is something Papa Nurgle whispered into Johnson's ear in his sleep.

[Werthead]

The biggest threat at the moment in the UK is the abandoning of testing and tracing the lines of contact, which is what has brought the outbreak in South Korea relatively under control. The WHO, among others, has been clear that testing is the most powerful weapon in defending against the virus.

[Which Tyler]

18 minutes ago, Werthead said:

The biggest threat at the moment in the UK is the abandoning of testing and tracing the lines of contact, which is what has brought the outbreak in South Korea relatively under control. The WHO, among others, has been clear that testing is the most powerful weapon in defending against the virus.

Agreed entirely - you cannot manage what you do not measure - it's simply not possible.

 

So either, we're not trying to manage it; or, we're just intending to make educated guesses based on models that have never been tested in the real world.

[ljkeane]

3 minutes ago, Which Tyler said:

Agreed entirely - you cannot manage what you do not measure

They aren’t trying to manage the total number of cases. They’re trying to manage the number of cases which require hospitalisation.