NHS crashes

As expected we have reached, or are reaching, the first critical point where the NHS crashes. For obvious reasons given the failings of the SNP in Scotland, we see it first here:


As they would say on an plane:

BRACE!

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The Waiting Game

On the 30th of January I warned politicians that we would be short of ventilators … nothing happened.

On the 3rd of March I asked politicians to force medics to wear PPE. (Never in a million years, did it occur to me they wouldn’t have ordered the PPE need – Boris even sent a load to China!!)

In retrospect, I totally underestimated the cock-up by the UK government and I should have just ordered a new freezer and filled it with material, rather than listening to my wife who kept asking “where are you going to put it”. Because, not only did the UK & Scottish government fail to prepare, but I then arrived back last night with a freezer load of material and my son who had suddenly decided he didn’t want to stay on his own. And hence another rather speedy shopping expedition to get more supplies (I should have worn my face masks as many others were).

The fridge is now bulging at the seams, the window sills are cramed full of seed boxes, etc. And can you guess what the best thing I got was? 5 bird feeders and a huge bag of seed, which is now the best TV on offer as everyone else is talking about CV19.

Chaning Trends

Looking at the UK figures, the trend has been pretty steady at about 0.26 or a 10 fold increase every 9 days. But if we now look the end of the curve is now marginally below the trend.

Number of reported cases (blue & red) and deaths (yellow) in the UK since the first case was reported.

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A plan to beat CV19

Having looked at the modelling of the CV19 epidemic in the UK, there is no viable way to stop the majority of the UK becoming infected long before even the most optimistic forecast of a vaccine being available. All we can practically do is to try to manage that process to minimise the loss of life.

If the majority are infected in a “wildfire” burning out of control it will come in a wave which like a tsunami will so swamp our health services, they will look like a war zone where doctors are not so much “treating” people, and rationing what little treatment is available so that many people who could otherwise be saved will die.  Does a doctor treat a 60year old diabetic with organ failure from CV19 or a young mother in labour or a car crash victim?

However, there is still a way to beat CV19. Perverse as it seems, we let, even encourage, the majority to become infected, but we do all we can to prevent infection amongst the minority who are most at risk, and therefore most at risk of swamping the health services when they become infected.

This plan needs courage & determination to succeed, not just by younger people who will have to have the courage to take CV19 “on the chin” and carry on, but by older people and those with health conditions, who will need the determination to self-isolate, and then, when it is time they too need the courage to rejoin society and take “their turn” at accepting the potential for CV19 infection “on the chin”.

Because for the vast majority of under 60s, the risk from CV19, whilst significant, is not dissimilar to everyday activities like driving. People can and do accept these risks in their normal lives, however the risk if our society freezes normal life and suffers huge economic collapse is massive and that will have dire consequences particularly for young people. And in any event, even if we wanted to, there is no way we can practically stop most people being infected. So, for the vast majority of under 60s in good health the message should be “carry on with your normal lives”.

However, those over 60 & those with pre-existing illnesses pose a severe threat to our health services, not if, but when they become infected. We need to delay or “ration” their use of the health services until those younger people have got over the virus and are able to keep the country going when the most vulnerable are affected – in the NHS, in pharmacies, in shops and delivery services.

If we can strictly isolate and quarantine those most at risk, we can beat CV19, because not only do we limit the numbers needing treatment, but once enough people in the population get “herd immunity”, CV19 will find it incredibly difficult to take hold in society and the risk to those groups most at risk then goes down so that even those in the high risk groups may be able to regain social contacts with a much lower risk of infection.

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A possible strategy – infect people!

The more I look at the figures, the less it looks possible that any “delay” strategy will have any meaningful effect on the coronavirus except a complete clamp down on all social meetings for about a year till a vaccine is possible. That in itself could kill many people through the economic collapse it causes.

So, I am thinking of a new strategy. If the old is “delay”, this strategy might be called: “advance” or “infect”.

The idea would be to intentionally infect large groups of people and to create a huge group of people who are immune. Obviously, those we infect first would be those least likely to have severe symptoms, so we can let quite a large group of the population get infected with relatively little stress on the NHS (certainly less than a “war zone” stress as it is becoming in Italy). Once the first group have been immunised by mass infection, then we have a huge workforce that should (hopefully) be immune & can keep the economy going, so we can allow the next to get infected, etc.

But who would want to get intentionally infected? Well, unfortunately, everyone else who is not being infected has to be more or less welded into their houses for this period to totally isolate them from the virus. There would be a high incentive to take the risk.

It may seem an odd strategy, but it could dramatically reduce the death rate and allow us to keep our economy going whilst the minority (20%?) who are most at risk of collapsing the health service if they get ill could be kept in strict quarantine for about a year till a vaccine is available (or until the inevitable failures of quarantine mean they are all infected).

However the weekly rate of infection will be much less and it could allow the level to be brought down to something that would be a severe stretch rather than a “war zone” in the NHS.

Key to this working, however, is advancing the rate of infection amongst those least susceptible and most useful to the economy. This is not risk free for them – the rate of death could be 10x that of giving birth. But the rate of death for them could be 10x worse if they get ill when the beds are filled with other people.

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Coronavirus Forecast Model

After a bit of work, I’ve managed to make my spreadsheet more presentable. It is largely the same as that described in the Scottish Forecast, the main difference being that it now contains two extra sheets. The first “overview” contains the key parameters.

If you click on the first box (country) it will display a list of counties and will automatically populate, the population, starting date, and a few other parameters from the list as shown in “parameters”.

CVModel2

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Why official testing is not revealing community spread

Most cases of CV are mild. So, most people with CV won’t go for testing. But to add to that, even with severe symptoms, most health professionals will not be testing for CV unless there is a “reason” to believe they could have been in contact with someone from outside the UK with CV.

The result is that the vast majority of cases currently show links outside the UK, not because that is the vast majority of CV cases, but because those are the only ones that are being tested.

I’ve no doubt that many of those who are being found to have CV and that being attributed to travel abroad, actually caught it in the UK. But only those people are being found whilst the vast majority are hidden, because they aren’t allowed to get testing.

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Update March 11th

just done some analysis on the latest figures and present UK trend. It is possible that the rate of growth over last few days has reduced (yellow portion). This change is currently very small and could be a statistical blip, so don’t get any hopes up, but there have been similar changes in other countries so it could be real. If true this would reduce the rate from 10 fold increase in ~7 days to 10 fold increase in ~14days. That may not sound very much, but with my model that means current peak on 26th April is pushed back to 6th Jun. That would give us another month to prepare for the peak. However the peak is still well beyond our capacity to cope, but on the other hand, we’ll all be quarantined in the sunshine and maybe the virus is less virulent in the summer.

On a less pleasant note, I see that the death rate in Italy has been rising for the last three days. That may indicate that they’re now operating beyond their capacity and so can no longer save those lives which could have been saved otherwise. This suggests that Italy’s healthservices started collapsing at around 6000 cases. Given they have twice as many intensive care units as the UK and about the same population, this suggests our own UK NHS will stop functionining when there are around 3000 people reported with CV.

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Scottish Coronavirus Forecast

I have been developing a model to try to predict the effect of coronavirus (CV) in Scotland. I will go through each point. CVModel

Disclaimer, I make no guarantee this is correct and it is provided as is, intended only as a discussion document containing my own best guess. It must be checked to ensure validity and suitability by others.

Assumptions of model
This model assumes that the population is divided as follows:

  1. unsusceptible – which is a group that never get the virus. I have assumed 20% of the population will not get the virus.
  2. visible infected – which is the group that correspond with the “number of tested positive cases”.
  3. Invisible infected – which are people who have the virus but whose symptoms are so mild that they do not pro-actively seek to be tested. (2+3 = total population -1)
  4. Hospitalised – consists of those who required hospitalisation (in Wuhan – which may not be the same as the UK)
  5. Intensive Care – I am extremely dubious as to what this actually means. It seemed to mean “requires ventilation”, but I’m not sure what that meant in practice and in particular I am not certain the definition used in Wuhan matches the UK definition of “Intensive Care Unit”.
  6. Death – I believe means “having been tested for CV and being found positive and then dying”. I presume this doesn’t include people who die and then the death is later attributed to CV?

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Clueless Chief Medical Officer

“Modelling suggests that there will be a a bit of a delay in peaks between different bits of the country … it will not be huge it might be only four or five weeks …”.

This is why the UK is FCKED!!

The truth is that any delay is closer to 4 or 5 DAYS not WEEKS difference between the timings in different areas. But what it shows is a total lack of understanding of the rate of spread of CV which largely explains the arrogant lack of action that we are seeing.

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Suggested ways to cope with the Pandemic

I’ve already suggested:

  • Mecial students being trained for specific CV treatments
  • Vets being turned into doctors and their equipment being redeployed for humans
  • Closing of Universities and redeploying students into a host of roles
  • Everyone is suggesting using the army

In addition other strategies

Prisons

In the worst case scenario, we are not going to have enough beds. Therefore we should release all low-risk category prisoners for a couple of months and turn their prisons into hospitals.

Sale of Alcohol & other age-related goods

People delivering supermarket food to homes cannot be asked to ask for proof of id to verify age. As such, there is a strong rational to ban age-related goods from being sold. However it may be possible to permit it in specific casess where age verification  can be done online via a means like a driving licence.

Reducing A&E need

I couldn’t find good evidence on the causes of A&E (except alcohol) so instead I’m trying to remember what are the commons causes.

We will be banning all social gatherings, which means pubs and nightclubs, so the level of drunken injuries will reduce. But we cannot afford to allow drunk injuries to then occur at home, so limiting alcohol sales may also be prudent for that reason.

Many A&E injuries are caused by sports, but organised sports should be banned or will be self-stopped

Car accidents are another big contributor. But if travelling is curtailed, then this may naturally drop.

DIY is another cause of A&E attendance.

Education

The Chief medical officer is not very supportive of the idea of closing schools. I personally thought it was a no brainer, but perhaps there are issues with the effect this has on the NHS as mothers tend to have to look after children, and perhaps the rest will be looked after by grandparents – who if anything ought to be kept away from children who are very likely to pass on CV.

But it’s pretty obvious that any large gathering like an assembly needs to stop.

However, we still ought to attempt to limit the spread of CV within schools. One simple approach is to keep each class separate from all other classes. This ought to be easy in a primary school but could be very difficult in a secondary school when pupils are streamed to take a variety of mixed subjects. Fortunately, those taking mixed subjects are probably largely old enough to look after themselves. So, the best strategy may be to have strict segration of classes in schools and either put older pupils into “single subject” classes or they will have to be schools remotely.

Another simple approach is to simply close the schools for the “summer break” when the crisis hits and to re-open them during the summer “break” to let pupils catch up and to take exams.

This however isn’t the perfect solution, because CV will still spread between pupils in a class, and then within families to other pupils in other classes in the school. So, another refinement is to “surname” segregate pupils. That is, all people with the same surnames share a very limited group of classes (perhaps doubling or trebbling years). That will dramatically low the spread.

Workplaces

Companies should be following a similar approach to education. Workers should be prevented from co-mingling and large gatherings such as using work canteens should end. Also where possible companies should encourage people to break the pattern of a “normal day” and to travel at times of lower demand on the transport network

Stop Public transport

Where possible, people should avoid public transport. Instead, it would be sensible to car share. As such, most parking restrictions in towns and cities should be temporarily suspended.

Public gatherings

At the moment there are ~150 known cases and probably ~600 unknown. As such there is one infected person per 100,000 people. For obvoius reasons no one should be attending any indoor event with more than 100,000 people. But even an event with 10,000 means there is a 1 in 10 chance of being in the room with someone with CV. Next week the chances are 1 in 10,000 and the week after most large schools of 1000 pupils will likely have one person infected in them.

Medical Doctors & Nurses MUST start wearing face masks

There is a great reluctance amongst doctors to endorse the use of face masks, but we have to ignore them, and think of what is best for the patient, and what is best for the patient is not doctors & nurses either being ill from CV or worse spreading it. As such we are going to have to mandate that medical staff wear face masks even if they protest strongly about it and come up with lame medical excuses why they are immune to CV. (It’s always the same people have no problem insisting that others take health seriously, but as soon as they have to wear protective equipment, there is always a host of reasons why accidents never happen to them).

Isolate the elderly?

There is a rational for the elderly to self-isolate. But I strongly suspect from the elderly people I know, that they will not do so. Instead they will “self-isolate” by only seeing their own grandchildren and daily gonig to the shops to get the paper.

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