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?

Continue reading

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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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Coincidence?

I have just been examining data for various countries and extrapolating back the growth to the date at which there would have been one carrier. Here they are:

  • Italy 6th Feb
  • S.Korea: 8th Feb
  • Iran: 15th Feb
  • UK 18th Feb
  • France: 18th Feb
  • US: 20th Feb
  • Germany: 21st Feb

There is clearly a cluster of starting dates around the 18th – 20th of Feb.

To change the subject entirely? It is interesting to note that the Iranian epidemic which postdates S.Korea by a week, is centred around the city of Qom which was the birth place of Qasem Soleimani the Iranian major general killed by the US on 3rd Jan this year.

It is almost as if someone flew from S.Korea, to Iran, then to UK or France, and then the US.

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Somethings gone wrong

After nearly an hour waiting for the current figures on coronavirus, the data has still not been updated and I’m starting to see “distract” type aticles from the press with very little detail. These seem to have been written to “fill a hole” that was left for a real article about the stats and they are not being allowed to do that.

Have the press been gagged? Very worrying!

Possibilities:

  • A death or deaths
  • A very large increase
  • Someone particularly prominent has it
  • They have realised there is not a chance in hell of the NHS coping.

Addendum

Some 2 hours after they were supposed to be released, the department of health have said there are now 115 cases. (of which 6 are in Scotland). I say “claim”, because this kind of delay is usually for a reason. I was predicting around 107-112 cases today so 115 is not massively different, so that doesn’t explain the delay.

Current prediction (assuming we’ve had real data)

11th march (6 days = Wed) I expect to see our first death by then (but it could be a lot earlier)

16-17/march (10 days) we reach the 3000 cases level at which S.Korea’s health service stopped coping.

30th March (3 weeks 4 days) there will be as many cases as there were NHS beds before any emergency increase.

New Addendum

It is regretable that my earlier comments about 3pm now appear to be correct. Today the UK experienced our first UK based death from CV this is obviously appalling news for those invovled. Worse for everyone else, it appears to be UK based person-to-person transmission which means I was right that those being discovered were the tip of the ice-berg of unknown cases.

Based on the sequence of events, I believe news of the death came to those with the figures shortly before 2pm. There then followed a couple of hours when they deliberated as to whether to give out the news, but decided instead to issue the up-to-date number of cases instead at 4pm. The death was then announced just after the 6pm news started, presumably to minimise the amount of time journalists had to investigate.

Exactly 7 days ago I predicted a death in the UK “in the next 7 days”. Sadly I was right. I expect around 9 more in the next ~7days which means by the 12th March it is likely there will be one in Scotland.

 

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How do you fancy being treated by a vet?

The government are already talking about using trainee doctors for the critical period. In addition there is another huge resource which is easily available and that is the large army of vets.

Vets are trained to work on any animal species, and the only thing stopping them treating humans is the law. And if I were faced with no doctor or a vet, I would pick the vet any day (indeed it’s arguable they are better than doctors as they have far wider experience and can be more innovative with treatments).

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What “overtopping the ability of the NHS” means in reality.

Finally, we’re getting the truth from the gov:

“Half of coronavirus cases in the UK are likely to occur over just three weeks, and the NHS does not have enough beds to cope with them, the chief medical officer has warned.”

“Depending on how high the peak, this could be anywhere from a rather bad winter for the NHS but in spring or summer for the NHS through to huge numbers way overtopping the ability of the NHS realistically to put everyone in beds and that obviously would have big pressures on the service,” he told the Health and Social Care Committee.”

https://www.telegraph.co.uk/news/2020/03/05/half-coronavirus-cases-uk-likely-occur-horror-three-weeks/

Although his “overtopping the ability of the NHS” sounds like a gentle wave getting someone’s feet wet on the beach, if 4% of the population need hospitalisation, 80% get the infection and half get it in these critical three weeks we are talking ~1million patients.

There are something like 150,000 beds in the UK with suggestions that ~90% are occupied. If we assume an average hospital stay on 10 days, then there are up to 600,000 patients trying to fit in 150,000 beds or 4 patients to a bed.

But at least we are starting to get realistic numbers and there is obviously some thought going into them as:

Medical students could be asked to perform roles on hospitals normally done by doctors, in the event of a coronavirus epidemic

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L & S forms of the virus

Apparently CV has already mutated into two forms, a later L which is more virulent and an original S which is less. However, being more virulent is not necessarily worse. Because it tends to be picked up quickly as people fall ill and so it is more rapidly removed from the population. That’s why we don’t have the  SARS which killed a very high number of people, but we do have flu, which kills many orders less of those people that it infects, but because it’s not enough to take the action to stop, the result is that it yearly kills more than SARS ever did. So, paradoxically the less virulent and deadly form of CV may end up being much more deadly (in terms of total deaths).

And it is too early to know whether immunity from one form gives immunity to the other or whether a vaccine can be developed for both.

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