SARS CoV-2 coronavirus / Covid-19 (No tin foil hat silliness please)

Pogue Mahone

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Some of your posting (maybe 10%) is starting to be pretty scaremongerish.
I’m worried.

You spend time on medical Twitter so you know how extremely worried some well qualified people are about what happens from here. I’m not there yet but I’ve seen this fecking thing throw us curveballs that completely derailed our recovery twice already (alpha and delta). So my reserves of optimism are running low. At this stage I’d rather be pessimistic and proved wrong than have my hopes crushed a third time!
 

Ecstatic

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I honestly don’t know. I do know the UK is taking a huge gamble. I also think that even if a lockdown is avoided there will be a huge collateral cost to the health of the nation (both covid-related and non-covid related) from the government’s refusal to delay the full reopening.

The uk electorate will have to live with the decisions of the uk government. And I don’t live there (any more) so that’s not my business. What will really boil my piss though will be if the decision to allow covid run riot in a partially vaccinated population ends up spinning off a variant that is as contagious but more vaccine resistant than delta. Because if you wanted to create a variant like that, these are exactly the conditions you’d create.
Thanks for the answer.

The emergence of a variant seems to be an unpredictable event that comes from a remote place through specific circumstances (say interactions between contaminated humans and animals)

We have a global disease that seems to perpetually generate new variants, and the famous ones are the most devastating.

Continental Europe will look at the UK.
 

massi83

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I’m worried.

You spend time on medical Twitter so you know how extremely worried some well qualified people are about what happens from here. I’m not there yet but I’ve seen this fecking thing throw us curveballs that completely derailed our recovery twice already (alpha and delta). So my reserves of optimism are running low. At this stage I’d rather be pessimistic and proved wrong than have my hopes crushed a third time!
Log-off from twitter, have a pint of Guinness and enjoy that famous Irish summer weather!
 

Brwned

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They reduce hospitalisation. They don’t prevent it. We’ve seen the PHE data on deaths and hospital admissions. We know for a fact that at least some vaccinated people are ending up in hospital/dead. At this stage the only unknown is how many more will follow that same path.
Isn't that just another semantic argument? While the term "break" was used, and you can argue about how precisely that should be interpreted, the KPI related to the re-opening was:
Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated
There's some subjectivity in what sufficiently effective means, some people in SAGE will disagree among themselves, you'll disagree with other people, but don't you think the evidence you've shared generally provides a good base to make a legitimate argument that they are "sufficiently effective"? It is undoubtedly not completely effective, and there is still room for uncertainty, but those things were known when that KPI was set, that wasn't the bar.
 

Pogue Mahone

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Isn't that just another semantic argument? While the term "break" was used, and you can argue about how precisely that should be interpreted, the KPI related to the re-opening was:


There's some subjectivity in what sufficiently effective means, some people in SAGE will disagree among themselves, you'll disagree with other people, but don't you think the evidence you've shared generally provides a good base to make a legitimate argument that they are "sufficiently effective"? It is undoubtedly not completely effective, and there is still room for uncertainty, but those things were known when that KPI was set, that wasn't the bar.
My personal opinion is that if hospital admissions are growing exponentially then the connection between cases and bad outcomes hasn’t been broken enough. Exponential growth in any context is scary, when it’s using up a finite resource (hospital beds) then you’re heading for trouble. IMHO.
 

stw2022

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If we’re not going to open up to benefit from the vaccine then the vaccine itself was unless. We could have saved billions and just locked down to suppress

Rising cases and hospital admissions was a trade off we all knew was coming and we see them rising much slower than when cases were at similar levels before.

The govt have got most things wrong but the anti-relaxation cause looks increasingly hardline and has no logical end beyond perpetual attempts at zero COVID that seems to be widespread debunked as a strategy

Hospital admissions are rising but much slower, people are much less sick once admitted and the deaths increase is even slower. I think it’s astonishing the desperation to turn that into bad news. If it is then good news can’t exist in this situation so just bolt the door and wait for the rapture
 

F-Red

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So about this idea that vaccines have broken the link between cases and hospitalisations…
It has, there's tonnes of data out there that suggests the link has been broken. Certainly in the UK case rate curve is in an aggressive upwards trend in this current wave, and the hospitalisation rate is not at the same trend as it was in wave two. The clear difference between the two is the vaccination programme. That would suggest that the vaccines are breaking the link, otherwise we would see the same ratio and trajectory. I recall reading that duration of stay in hospital is decreasing for covid inpatients, most likely linked to the age profile and not being vaccinated.

Are you insinuating that vaccines don't break the link? The data here is clearly missing how many of these admissions have either had a both vaccine's or not. That provides a much more of a stronger context to your discussion.

Mr Hopson from NHS Providers said it was important to “look at who’s being admitted into hospital and how clinically vulnerable and what level of acuity they’ve got”.


“What chief executives are consistently telling us is that it is a much younger population that is coming in, they are less clinically vulnerable, they are less in need of critical care and therefore they’re seeing what they believe is a significantly lower mortality rate which is, you know, borne out by the figures.”

“So it’s not just the numbers of people who are coming in, it’s actually the level of harm and clinical risk.”
https://www.independent.co.uk/news/health/covid-vaccines-infections-deaths-nhs-b1862412.html
 

Brwned

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My personal opinion is that if hospital admissions are growing exponentially then the connection between cases and bad outcomes hasn’t been broken enough. Exponential growth in any context is scary, when it’s using up a finite resource (hospital beds) then you’re heading for trouble. IMHO.
Agreed it’s a strong argument to delay and I’m sure some folks in SAGE are saying the same. It’s unquestionably taking a risk that just weeks ago they were suggesting was very unlikely, following the trends in Bolton and the like. There’s enough uncertainty there to make either choice quite risky, in my view. Government backed themselves into a corner again with their timeline and messaging weeks ago, and I just don’t think they’d get compliance, so it’d create new problems. I just don’t see the same certainty in it leading to trouble, it’s a risk, a serious one like others.
 

hobbers

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Curious as to how Scotland is so far ahead of the curve on the latest spike.

I do think we're going to be heading into a very dodgy period 3 or 4 months down the line when the most vulnerable are (probably) losing protection from vaccines en masse and winter flu season rolls back into town. Not allowing for the emergence of even more troubling variants in the mean time.
 

stw2022

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Curious as to how Scotland is so far ahead of the curve on the latest spike.

I do think we're going to be heading into a very dodgy period 3 or 4 months down the line when the most vulnerable are (probably) losing protection from vaccines en masse and winter flu season rolls back into town. Not allowing for the emergence of even more troubling variants in the mean time.
The regionality of areas where infections is spiking is probably a fairly unexplained element to what drives it.

From bits and pieces we get it seems that maybe even this latest surge is being driven by regional increases rather than a uniform national projection. In some of the poorest parts of east London where deprivation is high, demographics are among those considered most vulnerable and vaccine hesitancy is very high, there doesn’t appear to be much of a surge in terms of hospital admissions.
 

Pogue Mahone

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It has, there's tonnes of data out there that suggests the link has been broken. Certainly in the UK case rate curve is in an aggressive upwards trend in this current wave, and the hospitalisation rate is not at the same trend as it was in wave two. The clear difference between the two is the vaccination programme. That would suggest that the vaccines are breaking the link, otherwise we would see the same ratio and trajectory. I recall reading that duration of stay in hospital is decreasing for covid inpatients, most likely linked to the age profile and not being vaccinated.

Are you insinuating that vaccines don't break the link? The data here is clearly missing how many of these admissions have either had a both vaccine's or not. That provides a much more of a stronger context to your discussion.



https://www.independent.co.uk/news/health/covid-vaccines-infections-deaths-nhs-b1862412.html
This “link” isn’t binary. Either broken or fixed. Vaccines obviously cause a reduction in the % of cases that end up in hospital. We know that for a fact. What’s not clear is exactly how big a reduction. Especially with this delta variant, where the UK is acting a Petri dish for the rest of the world.

Other facts we know from bitter experience:

a) There is a long delay between cases increasing and hospitalisations/deaths increasing.
b)The nature of exponential growth means things can go from “not too bad” to “omg we’re screwed” very quickly and turning things round once they get out of hand can take a very long time.

Combine these facts with data showing that hospital admissions are currently increasing exponentially and I think it’s reasonable to wonder if the link between cases and bad outcomes is as broken as we would like/need it to be.
 

Wolverine

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Another interesting thing to monitor will also be not just hospitalisations but number of people in hospital, ICU bed occupancy, length of hospital stays. Whether vaccines play a part in that we'll found out pretty soon.
A significant part of the problem in previous waves with covid was length of hospital stays, oxygen dependancy which took up beds, which needed us to create more space (through transforming other parts of the hospital).
If we can discharge people quickly, if they are hospitalised but don't need high flow oxygen, if we can wean them off and move them back into community etc all will be useful in preventing the system from being overwhelmed.
 

stw2022

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It’ll never not make sense to wait.

Why not wait until everyone has been fully vaccinated? By then why not wait until the vulnerable have had their winter booster? Then why not just sit it out until winter? Then what’s the harm in waiting until the second vaccinations start, then why not hold off until the holidays…?

There is no problematic free time to lift restrictions and lifting restrictions will lead to an increase in cases so arguing we shouldn’t lift restrictions because of an increase in cases is beginning to look indistinguishable from arguing we should never lift restrictions at all, without actually saying it.

The conditions people seem to want us to meet to lift restrictions are those that I’m not sure logically they themselves think can ever exist. The virus isn’t being eradicated and surprise that it spreads outside of strict lockdown conditions seems disingenuous.

And so it begins to looks Julia Hartley Brewer-level of contrarianism but from the other side of the argument.
“Let’s not open up until we achieve a position I honestly do not feel is achievable” isn’t sensible.
 

jojojo

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If you're curious about what the modelling is actually looking like and what the appraisal was in June (that led to the opening being delayed until July) this will give you an overview:
https://www.covid-arg.com/post/modelling-the-return-of-freedoms

You need to download the pdf file to see the modelling summaries from Sage. Basically they have three models - imperial College, Warwick and LSHTM. These start with various scenarios relating to how much more infectious Delta is, what the hospitalisation rate would be (unvaccinated) and how well the vaccines are working. Then they try and describe what might happen if...

Currently cases are rising as fast as predicted in early June but hospitalisations are lower (but rising). The black/orange lines were the Warwick predictions of what would happen if we reopened fully on June 21 as planned v July 19. The blue is the actual hospitalisation data so far.


This seems to be down to the cases not really moving out of the under 29 group in the same way as they did in previous waves. That's assumed to be part vaccine and part behaviour related (the vaxxed mixing mostly with the vaxxed for example). Unfortunately it now looks like it's spreading into the very highest risk group 80+ probably from unvaxxed or single vaxxed family members or carers, hence why hospitalisations are starting to rise, having not risen as early as was expected.

Next week's data will give people an idea of how the infection is moving through age groups and the vaccinations given in June are part of the equation.

Right now it really is too close to call, but there is an assumption in all the Sage scenarios that not only will there be an exit wave, there will be a lot of hospitalisations over the next year and thousands more deaths. That's what "living with covid" means - we're just not used to seeing it as a calculation.
 
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Pogue Mahone

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Another interesting thing to monitor will also be not just hospitalisations but number of people in hospital, ICU bed occupancy, length of hospital stays. Whether vaccines play a part in that we'll found out pretty soon.
A significant part of the problem in previous waves with covid was length of hospital stays, oxygen dependancy which took up beds, which needed us to create more space (through transforming other parts of the hospital).
If we can discharge people quickly, if they are hospitalised but don't need high flow oxygen, if we can wean them off and move them back into community etc all will be useful in preventing the system from being overwhelmed.
Yeah, those are good points. Admission numbers only tell you part of the picture.
 

stw2022

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The average time between symptoms and death is around 19 days. Obviously shorter period for hospitalisation.

38 days ago cases were 3,491. 19 days later on 16th June the death total was announced at 11.
On 16 June cases were 10,786. 19 days later today’s death figure for UK is 9.


Even with established case numbers given the increase we’ve seen in the last 40ish day period deaths are significantly lower than where they should be. Of course it’s possible the vaccines are simply increasing the time between symptoms and death but seems unlikely
 

groovyalbert

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Anyone else having a fecking nightmare with this track and trace app disrupting everything??

Despite being double vaccinated for a well over a month, I got pinged and was isolating for 6 days. The only place I could have come into contact on the day listed was sat at an outdoor bar far away from anyone else who was also double vaccinated.

My fiance has now just been told to isolate for 8 days - where the only place she could have come into contact was on a train where she was masked and has also been double vaccinated for ages.

Seriously, people are just going to start deleting it/keeping bluetooth off.

(For the record, I observed my time and took lateral flows tests every day).
 

MayosNoun

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This Peru variant seems a real head scratcher for scientists. This could become the next dominant variant going by reports.
 

jojojo

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Someone asked about the age profile of hospital admissions. The average age of those being hospitalised is now 46, down from 66 in February, and over 70 before that.



That's partly the vaccines reducing cases in the older almost entirely double vaxxed groups, and partly them reducing the severity of illness.

The great unknown now is can that pattern be maintained when case rates are so high. Broadly speaking the odds are that a double vaxxed person is unlikely to catch covid from another double vaxxed person. Not zero chance of course, but low.

Unfortunately vaccines aren't 100% so where the vaxxed/unvaxxed meet (like granny meeting grandkid or bus passenger or carer) those 90% effective stats still mean rising cases and those will translate into hospitalisations and deaths. We just don't know quite how many yet.

Incidentally I'm not ignoring those under 45s who are unlucky enough to be contributing to that reduction in average hospital admission age. It's just that those numbers are more predictable as they track the overall case rates and individual vaccination status more closely.
 

jojojo

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Wales has already managed to vaccinate around 90% of adults (at least one dose) and that's over 75% of their population, and are ahead of the rest of the UK on second doses as well.

For them it's now getting like the question of the old/at risk in the rest of the UK. Can they sustain their success when they've got England on the doorstep and tourists on the move. That's why they're also being relatively cautious on removing restrictions.
 

Nytram Shakes

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the Uk is basialy been made in to a real world test bed to see if the vaccines are effective enough going forward.

i don’t get the feeling anyone really know what is going to happen. Fairly sure it was a political and financial decision not “data” decision.

I guess as cases are rising at such a rapid speed even with the minimal current restrictions, so logicallin order to reduce cases we would need to tighten restrictions and probably even lock down again. Which I don’t get the feeling the population would accept.

So seems like the Government has gone F it let’s see if the vaccines work as well as-we hope.
 

jojojo

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the Uk is basialy been made in to a real world test bed to see if the vaccines are effective enough going forward.

i don’t get the feeling anyone really know what is going to happen. Fairly sure it was a political and financial decision not “data” decision.

I guess as cases are rising at such a rapid speed even with the minimal current restrictions, so logicallin order to reduce cases we would need to tighten restrictions and probably even lock down again. Which I don’t get the feeling the population would accept.

So seems like the Government has gone F it let’s see if the vaccines work as well as-we hope.
Or for the rest of Europe, as this epidemiologist/statistician working in Ireland suggests:
 

Massive Spanner

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Or for the rest of Europe, as this epidemiologist/statistician working in Ireland suggests:
That would be a lovely analogy if we didn't have a big open border with them.

That cliff edge actually has a bridge that they can cross over here on rather than jumping off.
 

Ady87

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I’m just watching the news now and they’re talking about the England cricket team and how they’re all self isolating because 7 have COVID.

It got me thinking, surely without any restrictions or limits on people in venues etc, people from all walks of life this are going to get this quickly. If Premier League players get this in August, do they isolate? Do I need to isolate when I return to the office in a fortnight if I catch it? Is isolation futile and going to be scrapped?
 

Santos J

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I’m just watching the news now and they’re talking about the England cricket team and how they’re all self isolating because 7 have COVID.

It got me thinking, surely without any restrictions or limits on people in venues etc, people from all walks of life this are going to get this quickly. If Premier League players get this in August, do they isolate? Do I need to isolate when I return to the office in a fortnight if I catch it? Is isolation futile and going to be scrapped?
You currently still need to isolate but there's expected to be an announcement today on the change in isolation rules for double jabbed people.
 

Zlatan 7

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I’m just watching the news now and they’re talking about the England cricket team and how they’re all self isolating because 7 have COVID.

It got me thinking, surely without any restrictions or limits on people in venues etc, people from all walks of life this are going to get this quickly. If Premier League players get this in August, do they isolate? Do I need to isolate when I return to the office in a fortnight if I catch it? Is isolation futile and going to be scrapped?
To the average person like me it seems cases are going to go through the roof very soon with all these massive crowds anyway.

I’ve got tickets for Silverstone next week, if you’re not vaccinated all you have to do is do a flow test and then log in your own results to get a text back, think it was the same with euro Wembley tickets.

If you’re there for more than one day you basically need to do a test for each day, I have absolutely no faith in people leaving Silverstone on campsites etc while getting pissed and having bbqs to do an accurate flow test or even a truthful one to be allowed in the following day, they just need flow test barcode and a text message, once inside Silverstone no masks or distancing required. I’m pretty nervous about it all tbh.
 

jojojo

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I’m just watching the news now and they’re talking about the England cricket team and how they’re all self isolating because 7 have COVID.

It got me thinking, surely without any restrictions or limits on people in venues etc, people from all walks of life this are going to get this quickly. If Premier League players get this in August, do they isolate? Do I need to isolate when I return to the office in a fortnight if I catch it? Is isolation futile and going to be scrapped?
For now it continues to be a self isolate if you're a contact rule. It's likely that will change to a testing policy for people who are double vaxxed - which will at least shorten the quarantine period, but might get rid of it completely. I'm guessing that change won't happen straight away (maybe September when most over 18s will have had both doses) but who knows.
 

Pogue Mahone

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I’m just watching the news now and they’re talking about the England cricket team and how they’re all self isolating because 7 have COVID.

It got me thinking, surely without any restrictions or limits on people in venues etc, people from all walks of life this are going to get this quickly. If Premier League players get this in August, do they isolate? Do I need to isolate when I return to the office in a fortnight if I catch it? Is isolation futile and going to be scrapped?
@Wolverine @africanspur

What’s the NHS policy for vaccinated staff who are close contacts? HCPs having to self isolate has been a big problem in previous waves. Any plans to relax this approach for this wave?
 

Santos J

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@Wolverine @africanspur

What’s the NHS policy for vaccinated staff who are close contacts? HCPs having to self isolate has been a big problem in previous waves. Any plans to relax this approach for this wave?
Not sure what it is at the minute but the announcement today is expected to be that double jabbed close contacts won't be needing to isolate anymore.
 

Balljy

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Not sure what it is at the minute but the announcement today is expected to be that double jabbed close contacts won't be needing to isolate anymore.
When I read that earlier, I thought it does make some sense as a way forward for the double jabbed. No self-isolation, but take daily tests and obviously isolate if one comes back positive.
 

Snowjoe

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Found a pub near me if a staff member tests positive on a lateral flow the manager makes them take 4 more and whichever result “wins” is the one they take. So 2 positive and 3 negative he expects them to come in rather than go get a proper test to confirm :lol:
 

Pexbo

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Found a pub near me if a staff member tests positive on a lateral flow the manager makes them take 4 more and whichever result “wins” is the one they take. So 2 positive and 3 negative he expects them to come in rather than go get a proper test to confirm :lol:
That is mental. Any customers who get COVID should sue him.