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Covid-19 #40: Hoping for Endings


Fragile Bird
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1 hour ago, Paxter said:

I think it would be much more of a surprise if cases didn't go up. The question mark for me is the extent of pressure on health care systems. England as an example has been dealing with elevated caseloads for a number of months but hospital admissions have never exceeded 800 per day during that time. That compares to a (quite staggering) 3,500 per day in January. 

We've gone past 800 plenty of times per day over the last month so I'm not sure where you're getting the 'never exceeded' - I also do not think you should really be comparing the current number of admissions per day to the peak in January, that doesn't really make much sense to me.

The NHS is under significant pressure and there are plenty of signs about it affecting patient care & routine care, we're not going to be doing anything about it though :)

We're blessed with one spineless health secretary after the next.

Edited by Raja
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1 hour ago, Raja said:

We've gone past 800 plenty of times per day over the last month so I'm not sure where you're getting the 'never exceeded' - I also do not think you should really be comparing the current number of admissions per day to the peak in January, that doesn't really make much sense to me.

The NHS is under significant pressure and there are plenty of signs about it affecting patient care & routine care, we're not going to be doing anything about it though :)

We're blessed with one spineless health secretary after the next.

I was using Our World In Data, so I defer to your Govt source on the numbers.

I didn’t mean to imply though that the health care system wasn’t under pressure now. It absolutely is. I’m just wondering what the impact will be as things deteriorate this winter, including as compared to previous stages of the pandemic.

Edited by Paxter
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1 hour ago, Paxter said:

 The UK time series is different and wasn’t what I referred to in my post.

You can edit it by nation and see England and it'll show you that we've gone past 800 on a number of days.

Never mind, just seen your edit! I apologize that my original post sounded a little antagonistic!

As to impact - the health system is currently performing as badly as it gets across a number of indications ( here, if you're curious), there has never been a lot of give in the system to begin with given the cuts to the service over the last decade, we *should* already be doing what our SPI-MO suggested a month ago, but we're not, which was this

Quote

If enacted early enough, a relatively light set of measures could be likely be sufficient to curb sustained but slow growth. As well as encouraging home working, more light touch measures could include clear messaging that recommends people acting cautiously, more widespread testing, a return to requiring all contacts of cases to isolate, and more mask-wearing.

The key thing with the govt seems to be weather or not to proceed with the so called 'Plan B', which our health minister says is not needed at present - Plan B involves some significant changes to how lots of things are operating at the moment, specifically introducing vaccine certification in night clubs, big events etc, mandatory face masks in certain settings and advice to work from home. I get that maybe they think vaccine certification might be very disruptive, but I think legal guidance regarding masks an working from home should both come back in now, and really one can argue that they should never have been removed in the first place.

What they really should have done is not ignored SPI MO's suggestions last month, but it's too late for that, I think.

 

Edited by Raja
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3 hours ago, Paxter said:

I think it would be much more of a surprise if cases didn't go up. 

The scale of it has surprised me.  At least when it comes to Ireland.  We have relatively high numbers, despite high vaccination levels.  Up to now, we have been protected from serious fatality numbers but the number of deaths seems to have escalated in recent days too.  They are now no longer "low" numbers.  And sure, we are way below January levels but that isn't the benchmark.  That was the nightmare.  You can still end up with serious loss of life without getting close to the January situation.

Hospitals are definitely under pressure too.

The UK is a little exceptional, since it opened first, before COVID was particularly under control.  I'm sure other countries learned from it.  But having so much easily transmissable COVID around has meant that people are going to get sick, even if vaccinated, because they are exposed to so much of it.  Which has meant that COVID levels remains quite high and around we go.

Ireland has similar trends, just not as bad, because we opened later.

Other countries in Western Europe are generally much better but nearly all of them are seeing growing numbers of cases, or the end of a decline in cases.  I would be less surprised by those shifts, as overall numbers are generally low.  The concern is that this may just be the beginning and its not an easily controlable jump in cases.

Trends in the US and Canada are very different right now but they've always been a month or so behind us when it comes to COVID.

On the other hand, Israel's recent trends did show what could happen with Delta. So maybe I shouldn't have been surprised at what is happening here. The level of vaccination here did give me more hope though.

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North America will probably be in the same situation as Ireland in a month or so. I don't see how more indoor gatherings + waning immunity (throw in a variant too) can't be a recipe for increased caseloads. 

I take the point that January is not the best reference point. I guess I'm trying to be somewhat hopeful for what lies ahead (but have learned better!) 

Edited by Paxter
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1 hour ago, Paxter said:

North America will probably be in the same situation as Ireland in a month or so. I don't see how more indoor gatherings + waning immunity (throw in a variant too) can't be a recipe for increased caseloads. 

PLUS November 9th opening all the borders to anyone who is vaccinated, or tested or something something supposedly.  Also Our City's Mayor is running very expensive commercials in other countries to COME TO NYC!

They never learn and They always do this: things are getting really good, so let's OPEN FULL THROTTLE, just as all around us, things are going arse uo.

Edited by Zorral
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3 hours ago, Raja said:

We've gone past 800 plenty of times per day over the last month so I'm not sure where you're getting the 'never exceeded' - I also do not think you should really be comparing the current number of admissions per day to the peak in January, that doesn't really make much sense to me.

The NHS is under significant pressure and there are plenty of signs about it affecting patient care & routine care, we're not going to be doing anything about it though :)

We're blessed with one spineless health secretary after the next.

If you want a decent sort of comparison. The daily hospital admission rate 7 day rolling average on 16 Oct 2020 with a vaccination rate of 0% was 1031. On 16 Oct 2021 the 7 day average daily hospitalisation rate with a double jabbed vaccination rate of 79% is 867 (84% of the 2020 rate). Superficially it appears that vaccination to date has only achieved a 16% reduction in hospital admissions.

But the 7 day average of daily cases on 16 Oct 2020 was 16K, on 16 Oct 2021 it is 40K. Which means vaccination has done a shit job at reducing daily case numbers, but it has done an excellent job of reducing hospitalisation in proportion to total cases. The bad news is the capacity of the healthcare system doesn't really care about proportions, since healthcare capacity does not rise in proportion to case numbers, it is static and will eventually reach capacity if patient inflow exceeds patient outflow. So what's that looking like? Patient numbers currently in reached its low point at the start of October and is now starting to rise, slowly and the rate of increase appears to be lower than in 2020, one can only hope that the rate of increase remains low throughout the winter. It appear the current action the govt is planning to take to keep that rate of increase low is to cross fingers AND toes.

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6 hours ago, Padraig said:

Other countries in Western Europe are generally much better but nearly all of them are seeing growing numbers of cases, or the end of a decline in cases.  I would be less surprised by those shifts, as overall numbers are generally low.  The concern is that this may just be the beginning and its not an easily controlable jump in cases.

 

Germany went into accelerated growth this week, exactly one year after the beginning of the last winter wave. This is absolutely a seasonal effect, at least here. We had a nice summer, though since July all cases were delta. Now it starts again.

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I haven't watched the UK's situation closely. The situation looks bad (thanks @Raja and @The Anti-Targ for the numbers). Sure, we aren't in Autumn 2020 when the situation was bleak, but we are far from an rosy situation.  I suppose that other countries in Europe will soon feel the same pressure, despite high vaccination rates. Yes, they are reducing massively the rate of hospitalizations and deaths, but without additional measures, vaccination alone appear insufficient.

It seems clear to me, that somehow society wants to go to normal too fast. People are being asked to go back to their offices. Vaccinated people are being rewarded with being excluded of tests (in fact now you have to pay unless you are feeling sick).

4 hours ago, Zorral said:

PLUS November 9th opening all the borders to anyone who is vaccinated, or tested or something something supposedly.  Also Our City's Mayor is running very expensive commercials in other countries to COME TO NYC!

They never learn and They always do this: things are getting really good, so let's OPEN FULL THROTTLE, just as all around us, things are going arse uo.

Things is that COVID is not the only problem the world is facing. There too much problems and governments can barely handle any of them with some sort of competence. The shit show of the supply chains, the inflation, the energy crisis, the labor crisis, geopolitical problems, the nightmare that internet has became, etc.

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So the flat phase of our wave 4 is officially over. Suddenly we are at 2000+ cases per day. And frankly I don’t believe that we’ll see the Western European scissor. If the case count soars, so will the death toll, potentially to an unprecedented height. And no I have no clue why it was so slow for 6 weeks but is running wild now. What’s worse, after 1.5 years in this shit nobody has. It’s such an apocalyptic feeling. Again. Maybe it’s just that ridiculous show I watched last night. Well, maybe we’ll see the other side in another 1.5 years. Or not :dunno: 

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7 hours ago, The Anti-Targ said:

Which means vaccination has done a shit job at reducing daily case numbers, but it has done an excellent job of reducing hospitalisation in proportion to total cases.

Last year we were pre-alpha, so a lot has changed.  But it does seem that while vaccinations has helped a lot, alpha and then delta has also changed the rules in reverse.  I suppose we were lucky it wasn't around this time last year (pre-vaccination).

This is why you'd wonder whether a new vaccine, recalibrated to Delta, would have made a difference.  Probably not around serious cases but infection rates are important too.  Too late now though.

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So someone (an actual authority figure who does press conferences about covid but I don’t know his exact title) says that roughly 45% of hospitalized patients are vaccinated, though this is not an official number. And that they were vaccinated with Pfizer. And that this is because the elderly were vaccinated with Pfizer. And that a third vaccine will provide the protection from hospitalization.  I mean… a shitton of people got Pfizer from any and every demographics. This statement A. Alienates people from Pfizer, B. Strengthens the public conviction that vaccines do shitall and C. kinda undermines its own closing thought that people should take up a third vaccine (which is recommended to be Pfizer for the many who got vector based vaccines the first two times). 
This topic exhausts me. I need to get off the news. 

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13 minutes ago, RhaenysBee said:

So someone (an actual authority figure who does press conferences about covid but I don’t know his exact title) says that roughly 45% of hospitalized patients are vaccinated, though this is not an official number. And that they were vaccinated with Pfizer. And that this is because the elderly were vaccinated with Pfizer. And that a third vaccine will provide the protection from hospitalization.  I mean… a shitton of people got Pfizer from any and every demographics. This statement A. Alienates people from Pfizer, B. Strengthens the public conviction that vaccines do shitall and C. kinda undermines its own closing thought that people should take up a third vaccine (which is recommended to be Pfizer for the many who got vector based vaccines the first two times). 
This topic exhausts me. I need to get off the news. 

I had to laugh. Sorry. It's a shitshow. Everybody agrees.

As much as I like to throw dung to politicians (often well deserved), I wouldn't like to be in their shoes, in charge of a big crisis they barely understand, try to manage an unruly population to do what the some experts recommend and try to do as little damage as possible to already fragile economies. I would have quit long time ago. 

I think it's hard to communicate what it's happening and the issue is the risk for the elderly is so high that vaccines by themselves do not make it even compared to unvaccinated young individuals. But if you say that straight, why the 20yo should ever take the vaccine? Why children should?

I think politicians failed to build a receptive environment after the first waves when everybody was afraid and showed solidarity towards the most vulnerable. They should have picked from there and try to organize the society around this crisis. Sure the moral standing of current authorities is not up to that challenge.

 

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1 hour ago, Padraig said:

This is why you'd wonder whether a new vaccine, recalibrated to Delta, would have made a difference.  Probably not around serious cases but infection rates are important too.  Too late now though.

There are a couple of problems regarding variant specific vaccines. One is vaccine roll-out is proving to be slower than serotype replacement. Think that vaccine designed to target the original strain and rolled-out when Alpha was dominating (in the S. Hemisphere other variants were circulating). The campaign was not even done when Delta hit and Alpha is nearly extinct. If we do a variant specific vaccine, who is to tell it's going to be effective against the following

The other problem is related to the antigenic original sin. From my limited understanding a variant specific vaccine will only boost antibodies to the parts of the virus that do not change, instead the parts that they did. You might want to read this

https://www.cell.com/trends/immunology/fulltext/S1471-4906(21)00177-0

The third problem is that Delta is causing a high fraction of breakthrough cases due to kinetics, no immune evasion, although there is some. Basically it's so infectious and reproduce so fast that the body cannot mount a response that quickly once the antibodies has faded under a certain level. So, if Delta specific antibodies fall under that level, re-infection might be possible. We need to watch India.

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1 hour ago, Padraig said:

Last year we were pre-alpha, so a lot has changed.  But it does seem that while vaccinations has helped a lot, alpha and then delta has also changed the rules in reverse.  I suppose we were lucky it wasn't around this time last year (pre-vaccination).

Another thing that makes it difficult to compare against a year ago is that there were still restrictions in place then which aren't in place now.

Something that has changed is the demographics of who is being infected, there's a larger proportion in children with the 10-19 age group having by far the most infections right now, unsurprisingly given that many of them only became eligible for vaccination around the time they were going back to school.

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47 minutes ago, rotting sea cow said:

I had to laugh. Sorry. It's a shitshow. Everybody agrees.

As much as I like to throw dung to politicians (often well deserved), I wouldn't like to be in their shoes, in charge of a big crisis they barely understand, try to manage an unruly population to do what the some experts recommend and try to do as little damage as possible to already fragile economies. I would have quit long time ago. 

I think it's hard to communicate what it's happening and the issue is the risk for the elderly is so high that vaccines by themselves do not make it even compared to unvaccinated young individuals. But if you say that straight, why the 20yo should ever take the vaccine? Why children should?

I think politicians failed to build a receptive environment after the first waves when everybody was afraid and showed solidarity towards the most vulnerable. They should have picked from there and try to organize the society around this crisis. Sure the moral standing of current authorities is not up to that challenge.

 

I know, I really feel for these poor souls, I could never bear the pressure they are under, even without a pandemic, let alone with one. There’s no right action they can take. Whatever they do, someone somewhere some way is going to be hurt. I really don’t know how they can cope with it. 

But yes, that doesn’t change the fact that what they are doing isn’t working. 

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@RhaenysBee If your empathy stretches as far as Boris Johnson, then it goes further than mine. I might feel some empathy for him if I believed that he actually cared about the consequences of his actions to anyone other than himself.

More generally, while I agree that a rising death toll is more likely to force the UK government into belated action, it should be the number of hospitalisations that should be watched. A tipping point will be reached when the hospitalisations are such as to once more overload the NHS. leading to worse outcomes for all. And here I think that the different ratio of cases to hospitalisations is going to be an issue. By the time they take action then the proportion of infectious people in the population may be so great that any measures are going to have a lot of difficulty bringing it down.

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54 minutes ago, A wilding said:

@RhaenysBee If your empathy stretches as far as Boris Johnson, then it goes further than mine. I might feel some empathy for him if I believed that he actually cared about the consequences of his actions to anyone other than himself.

More generally, while I agree that a rising death toll is more likely to force the UK government into belated action, it should be the number of hospitalisations that should be watched. A tipping point will be reached when the hospitalisations are such as to once more overload the NHS. leading to worse outcomes for all. And here I think that the different ratio of cases to hospitalisations is going to be an issue. By the time they take action then the proportion of infectious people in the population may be so great that any measures are going to have a lot of difficulty bringing it down.

I don’t know enough about Boris Johnson to tell. In fact, I know next to nothing about him. But my empathy generally stretches rather far. 

well we are making the same mistake we did last autumn. We are waiting for shit to unfold. instead of immediately imposing damage control measures, we are doing nothing because things are not that bad yet. However, this is how things do get bad. Hospitals are slowly but surely filling up and we just cannot keep people alive. 15% of hospitalized patients are on ventilators and very few get off those alive. We have the highest mortality rate in the region and double the global average. And the more patients we have for the minuscule amount of medical staff, the higher that mortality rate will go. Great prospects. 

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7 hours ago, rotting sea cow said:

It seems clear to me, that somehow society wants to go to normal too fast. People are being asked to go back to their offices. Vaccinated people are being rewarded with being excluded of tests (in fact now you have to pay unless you are feeling sick).

Some jurisdictions have been strong and fairly consistent on mask-wearing, reduced capacities for high-risk settings, vaccine passports, no return to the office etc. But I agree that other jurisdictions (notably the UK; many US states) have gone the other way at their peril. 

Edited by Paxter
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9 hours ago, rotting sea cow said:

It seems clear to me, that somehow society wants to go to normal too fast. People are being asked to go back to their offices. Vaccinated people are being rewarded with being excluded of tests (in fact now you have to pay unless you are feeling sick).

One pull of vaccination was the rewards. At least that was what catalyzed the vaccination program here. whenever we hit a milestone they lifted a restriction. Then they ran out of restrictions to lift and now nothing motivates/obligates people either to get vaccinated or to be cautious. 

Ahahahahahaha, that’s adorable, here you always had to pay unless you were verifiably bedridden. €54 per PCR on the current exchange rate. Plus extra cost for a potential house call or English lab results. *ironic chef’s kiss* sorry.

2 hours ago, Paxter said:

Some jurisdictions have been strong and fairly consistent on mask-wearing, reduced capacities for high-risk settings, vaccine passports, no return to the office etc. But I agree that other jurisdictions (notably the UK; many US states) have gone the other way at their peril. 

And how’s that working out for them?
from where I stand the public morale and opinion is that the pandemic over. In this climate people’d grab torches and pitchforks if anybody told them to get their asses home again. Even though someone absolutely should. 

Edited by RhaenysBee
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