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 Post subject: Tuesday 12th May 2020
PostPosted: Tue 12 May, 2020 5:55 am 
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Morning all.


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PostPosted: Tue 12 May, 2020 9:20 am 
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Good morning.

I just paid a rare visit to facebook for a local pub's takeout menu, my brother in the US has been on there arguing with anti-lockdown nutters talking about herd immunity and how Sweden's doing it right. Does he know these people irl?

Whenever you despair of our country, you can always look across the pond for marginal consolation.

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PostPosted: Tue 12 May, 2020 9:41 am 
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This is a good short twitter thread about responsibility...

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PostPosted: Tue 12 May, 2020 10:17 am 
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Let's get at least one thing clear right away - Sweden is not just doing nothing and letting "herd immunity" take its natural course.


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PostPosted: Tue 12 May, 2020 10:36 am 
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Quote:
"Our success containing the virus so far has been hard fought and hard won."


Johnson, in his introdction to the 'new roadmap' published yesterday.

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PostPosted: Tue 12 May, 2020 10:45 am 
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AnatolyKasparov wrote:
Let's get at least one thing clear right away - Sweden is not just doing nothing and letting "herd immunity" take its natural course.


Hi all

Absolutely agree - the Swedish approach is based on a different assumption and one that is proposed by a very distinguished epidemiologist. The idea there is an agreed way to tackle this pandemic and that all agree is not correct - epidemiologists are looking at and using different models. they are also not experts on virology or on the consequential effects on public health so they should not be treated as the fountains of all knowledge - in some ways I am extremely challenging of epidemiology as it is based on predictive models that are only as good as the data contained within them and the assumptions made (this is why complete transparency of these models is critical) - anyone who has worked with predictive models tend to want to see that they actually have the ability to predict real outcomes rather than just existing in their own right. There is also a real danger of trying to overfit them which is often the case the more complex the model.

The Swedish assumption is that the virus is here for the long term and that at some point exposure of the population to it is unavoidable. Their approach is to a 'soft' lockdown advocating best practice and behaviour that becomes a new normal without recourse to the strict lockdowns seen elsewhere. The argument is that going into lockdown is one thing but actually coming out again is where the problem lies and how to avoid continually moving in and out of strict lockdowns.

I personally think (from a non expert opinion point of view) is that a strict lockdown was essential in countries that lost control in order to start again from a lower base - instigating track, trace and isolation to detect outbreaks, a continual soft lockdown (perhaps with more strict in areas with outbreaks) and protecting the vulnerable as much as possible (Sweden messed up in this latter requirement as have most countries, particularly in care homes).

Also, I am continually intrigued at this selling of the 2nd wave as 'deadly' - why will it be more deadly than the first? We are pretty much in the dark about how this pandemic materialised in Europe and how many cases there have been - indications are coming out that it may have been for some weeks earlier than we thought and so the infections were already high when we started taking notice. The difference now is we have a much better idea of who has it (well in well-managed countries we do) and so can control it better. It seems this deadly second wave view is based mainly on 1918 Spanish flu which is a completely different disease and at a different time and possibly due to a more virulent mutation having occurred.

As to who has had the right approach we will only know that at the end....I doubt the shambolic UK, US and Brazilian efforts will be much commended though

In the end though this is all about risk management of a hazard. To do good risk management we need to understand the consequence and the likelihood as well as having a clear understanding of what the residual risk is we are prepared to accept and that will drive our mitigation strategy

A residual risk of 0 cases will have a completely different mitigation measure to one where we accept a level of continued infection. We do this commonly in other diseases and do not target 0. Seasonal flu is not targeted at 0 and we do not even make vaccination compulsory in order to help manage it - never mind lockdown or other means to prevent 0 cases (or deaths)

I have seen very little about what the residual risk is for all these measures and what we are targetting. If it is complete suppression of the disease then we are in for a very rough ride as even vaccination will not give us that in the short to medium term. If we say it is not 0 then we accept that there will be ongoing deaths linked to it and we have to then discuss the acceptable number of these - not a very edifying thought but this is how we manage risk - it is about depersonalised numbers and not about individual cases.


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PostPosted: Tue 12 May, 2020 10:57 am 
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I think I may have been unfair to Germany in that last post as they have a target

I think 50 cases per 100000 people over a week would lead to a response (can argue if too low or two high).

The have this as their lag measure and their lead measure seems to be a measure of R but this is a tricky one as it is not very 'lead' in how it is defined and it also is pretty imprecise. It is better than nothing though and refining it to be more sensitive would be a great advancement.

Germany again leading the way in a pragmatic and sensible way to manage this.....

If there is a target that is >0 then we can see what relaxation we can do without going above it....if we target 0 then we will be in for a challenging time


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PostPosted: Tue 12 May, 2020 11:00 am 
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AnatolyKasparov wrote:
Let's get at least one thing clear right away - Sweden is not just doing nothing and letting "herd immunity" take its natural course.

I know, but the daft Americans my bro's talking to don't.

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PostPosted: Tue 12 May, 2020 11:08 am 
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Quote:
The Swedish assumption is that the virus is here for the long term and that at some point exposure of the population to it is unavoidable.

Treatments improve though, even if a vaccine doesn't become available soon.

So someone who dies from the virus early in the pandemic might not have if they'd caught it later?

Also, Sweden's demographics are unusual, many single person households.

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PostPosted: Tue 12 May, 2020 11:09 am 
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Morning all.

Have we seen this?

UK Stats Authority not happy with Hancock...

https://twitter.com/UKStatsAuth/status/ ... 0357297152

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PostPosted: Tue 12 May, 2020 11:11 am 
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RogerOThornhill wrote:
Morning all.

Have we seen this?

UK Stats Authority not happy with Hancock...

https://twitter.com/UKStatsAuth/status/ ... 0357297152

I'd guess No10 won't mind.

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PostPosted: Tue 12 May, 2020 12:20 pm 
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gilsey wrote:
Quote:
The Swedish assumption is that the virus is here for the long term and that at some point exposure of the population to it is unavoidable.

Treatments improve though, even if a vaccine doesn't become available soon.

So someone who dies from the virus early in the pandemic might not have if they'd caught it later?

Also, Sweden's demographics are unusual, many single person households.


Plus, without stereotyping *too* much, fairly "obedient" social norms.


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PostPosted: Tue 12 May, 2020 12:47 pm 
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Despite already knowing Johnson's only interested in himself and clinging onto power, it's still pretty chilling to see the rationale behind the weekend's change of tone spelled out in so much detail:

https://medium.com/@jonjalex/johnsons-m ... 36cae96348
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Johnson’s message is very deliberate and very dangerous: here’s how to combat it

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PostPosted: Tue 12 May, 2020 12:53 pm 
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Angela Rayner saying yesterday "if you aren't already in a union, join one if you can" - excellent to see.

And given the comparisons some are making, not something Blair would naturally have done.


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PostPosted: Tue 12 May, 2020 4:53 pm 
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I just watched the daily press conference and international comparison graph seems to have mysteriously vanished.

Can't possibly imagine why.


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PostPosted: Tue 12 May, 2020 5:16 pm 
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Also when Prof Stephen Powis was asked by someone from LBC why the model that predicted the lockdown could keep deaths down to 7-20000 had been so wrong his answer was utterly misleading. He did a Boris Johnson and said half a million deaths were originaly predicted. But that of course was a prediction based on no action being taken whatsoever.

So we had the medical director of NHS England being as economical with the truth as our useless lying shit of a Prime Minister.

The amount of arse covering going on by the some of the medics and scientists involved in this is shameful, they're a disgrace to their professions.


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PostPosted: Tue 12 May, 2020 5:39 pm 
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Last few days have been quiet here, not least because cJA seems to be taking one of her breaks. As ever, hope they are OK.


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PostPosted: Tue 12 May, 2020 5:41 pm 
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howsillyofme1 wrote:
Also, I am continually intrigued at this selling of the 2nd wave as 'deadly' - why will it be more deadly than the first?


It's because they're afraid it will happen in Winter on top of flu and all the other seasonal maladies which stretch the NHS at that time of year.

Radio 5 had an epidemiologist from New Zealand on last night saying that sending people back to work in the UK when they still had nearly 200,000 active Coronavirus cases was insane and only made sense if our government was trying to force a second spike earlier in the year when the NHS would be better able to cope with it.


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PostPosted: Tue 12 May, 2020 6:17 pm 
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Sky'sGoneOut wrote:
howsillyofme1 wrote:
Also, I am continually intrigued at this selling of the 2nd wave as 'deadly' - why will it be more deadly than the first?


It's because they're afraid it will happen in Winter on top of flu and all the other seasonal maladies which stretch the NHS at that time of year.

Radio 5 had an epidemiologist from New Zealand on last night saying that sending people back to work in the UK when they still had nearly 200,000 active Coronavirus cases was insane and only made sense if our government was trying to force a second spike earlier in the year when the NHS would be better able to cope with it.


I can understand that argument a bit but that is not what is being made by a lot of people as they keep referring back to 1918 and previous pandemics (which were mainly flu based) - also, it then raises the point that seasonal flu is also a big issue and surely we should be looking at limiting the impact of that as well - compulsory vaccination? If CV is somewhat under control then it could be that during that period it is flu that is the main contributor, not CV.

It does not look like CV is that seasonal (still awaiting data) and is also likely to become endemic we will need to reappraise the winter load on the health system

I agree that the handling of the whole situation by the UK Government is a lesson in ineptness and would suggest a hard lockdown until the end of the month then relaxing would be more appropriate than what they are doing now.


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PostPosted: Tue 12 May, 2020 6:26 pm 
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I know, stopped clock and all that but...Peter Bone is right.

https://twitter.com/Channel4News/status ... 9304017923

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PostPosted: Tue 12 May, 2020 7:09 pm 
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Sky'sGoneOut wrote:
Also when Prof Stephen Powis was asked by someone from LBC why the model that predicted the lockdown could keep deaths down to 7-20000 had been so wrong his answer was utterly misleading. He did a Boris Johnson and said half a million deaths were originaly predicted. But that of course was a prediction based on no action being taken whatsoever.

So we had the medical director of NHS England being as economical with the truth as our useless lying shit of a Prime Minister.

The amount of arse covering going on by the some of the medics and scientists involved in this is shameful, they're a disgrace to their professions.


I am a bit concerned that we end up talking about 'the model' as though it has some magic predictive properties - there is a lot of discussion within the statistics and epidemiological communities about the spread of this virus and this model is not always favourably looked on.

The extreme lockdown will provide some respite but it has its own weaknesses with dealing CV itself and also it may cause significant collateral damage if used inappropriately (economic impact on public health services, infectious disease treatment problems eg malaria, TB, political instability, repression etc).

I have no predisposition to any solution but it needs to be continually assessed - we could use the 'lockdown' approach to stop a lot of things if we so desired, it doesn't mean that it is the most effective or desirable solution.

I do find it concerning that anyone challenging the appropriateness of the lockdown as a means to mitigate the risk is immediately shouted down. Some of the arguments put forward are completely ridiculous it is true but it doesn't mean that they are necessarily wrong!

Decisions are made with the information in hand at the time and for that I have sympathy with anyone making decisions if they do not have much to go on. In that respect a cautious and precautionary approach is very much appropriate and a lockdown is understandable from that point of view

Lockdowns have not been consistent in severity though - Switzerland has had a fairly loose one compared to our French neighbours and yet we have managed to reduce the case incidence from 1500 to <50 - possibly due to us testing a lot here too. Sweden is also an example of no real lockdown but the take off in numbers that was predicted for that approach has not happened - the numbers are also made to look worse by the mess made of managing care homes (a common and entirely preventable issue across Europe) - we can make arguments about culture and population density etc but I have a feeling that these are not based on quantitative modelling but rather to explain away an inconvenient result.....if the model was good at predicting then things like population density and demographics should be relatively simple additions

However, as data comes in we should be reappraising the models and the recommendations - the effects of superspreading events is starting to gain some traction and also assessments of actual susceptibility to infection - the early models will be based on 100% susceptibility as it is a new virus but is that actually the reality in an inhomogeneous community?

As we see more community contact etc we should be ensuring that we are gathering data in order to make the right decisions. We do not want to allow contact that allows significant community transmission (so nightclubs, large sporting events etc seem unlikely any time soon) but at the same time we do not want to be yo-yoing back and forward into extreme lockdown as that has its own problems. We should also be monitoring the community for outbreaks, super spreader events (seems to be a big issue in meat plants in Germany at the moment) and reacting locally to these - this is how other epidemics have been managed. It is a real amazement to me that we have not used protocols already in place for notifiable disease management which are locally managed and should be scaled up - yes people will need training but there are a lot of bright people around who would be able to pick the basics up relatively quickly and be of help to the professionals - there are apparently 750000 people who have volunteered to help!

I would much rather see resources being spent on data gathering, rapid local responses and a true community response to this including the protection of vulnerable people and PPE rather than harsh lockdown conditions that seem to be creating a lot of hidden damage to our wellbeing and may actually end up not helping that much.

If we said that we were going to institute a punishment where people are not able to see their family members for potentially months or (if you listen to those who insist on being completely 'safe' and requiring a vaccine - which does not remove all risk either by the way) years you would call it a cruel and unusual punishment! We should look to make sure that it is only ever used as a lot resort and is of absolute necessity.

We should ensure we separate the ineptness of the UK Government and support for them from valid challenges to the approaches being used - many people seems to suggest that anyone who challenges even mildly or points out that pandemic modelling looks at societal risk not individual is a right wing murdering scumbag (yes I have been called that).


Last edited by howsillyofme1 on Tue 12 May, 2020 7:12 pm, edited 1 time in total.

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PostPosted: Tue 12 May, 2020 7:10 pm 
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As a long term West Wing "sceptic", I can't disagree with the MP for Wellingborough either.


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PostPosted: Tue 12 May, 2020 7:15 pm 
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I am not sure if this has been shared here yet but this is an interesting link to the EUROMOMO site which looks at death rates (morbid I know) and how they compare to the norm

As we can see there is a massive spike due to CV that has now moved down so shows that in these circumstances the lockdown is working as intended.....Sweden's is interesting though.

https://www.euromomo.eu/graphs-and-maps/


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PostPosted: Tue 12 May, 2020 7:48 pm 
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AnatolyKasparov wrote:
Last few days have been quiet here, not least because cJA seems to be taking one of her breaks. As ever, hope they are OK.
Thank you, AK, I've missed you all too. I'm not ill and neither is Mr citizen.


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PostPosted: Tue 12 May, 2020 8:03 pm 
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'Evening, everyone.


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PostPosted: Tue 12 May, 2020 9:24 pm 
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Hello there :)


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PostPosted: Tue 12 May, 2020 9:38 pm 
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Rory Kinnear.

My sister died of coronavirus. She needed care, but her life was not disposable

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Maybe we might transfer our common sense of purpose, our shared determination to “defeat” an “enemy” that “preys” on the needy, once “the fight against coronavirus” has been “won”, to invest – financially and emotionally and with a similar level of heroism and selflessness – in the lives of those who will continue to need it most.

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PostPosted: Tue 12 May, 2020 9:56 pm 
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howsillyofme1 wrote:

I would much rather see resources being spent on data gathering, rapid local responses and a true community response to this including the protection of vulnerable people and PPE rather than harsh lockdown conditions that seem to be creating a lot of hidden damage to our wellbeing and may actually end up not helping that much.


Unfortunately there is no sign at all of resources being spent as you suggest, and until that changes lockdown is just about all the protection we have.

Whether you oppose lifting lockdown because you don't understand the alternatives, or because you do understand them and realise the govt isn't taking the necessary action, imo it's no wonder people are scared.

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PostPosted: Tue 12 May, 2020 9:59 pm 
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gilsey wrote:
Rory Kinnear.

My sister died of coronavirus. She needed care, but her life was not disposable

Quote:
Maybe we might transfer our common sense of purpose, our shared determination to “defeat” an “enemy” that “preys” on the needy, once “the fight against coronavirus” has been “won”, to invest – financially and emotionally and with a similar level of heroism and selflessness – in the lives of those who will continue to need it most.


I understand the sentiment and it is clear that vulnerable people have been let down by the appalling management of this pandemic by the Government

We should not have needed a virus to do this and it has been apparent for years that the Tory party have no interest in helping the needy, and they are voted in by the electorate as well who take some of the blame.

As to the disease itself though - my father died as a vulnerable person from sepsis originally caused by him catching flu. Along with around 40000 other people who died of it that year. How many people went around unvaccinated, and how many people went out in public when ill who could be said to have contributed to the transmission of this infectious disease? This is the problem with looking at this whole situation through the lens of an individual story - CV-19 poses a unique challenge to society and we have to respond. I hope that we see the country that Rory Kinnear wants to see and his sister's sad death will clearly affect his views on this whole subject.

Those lessons have been apparent for years though and yet we have never learnt - every year since 2010 we have seen the NHS creaking under the impact of seasonal flu and hospitals being on black alert - what did we do about it?

I am sorry to be so blunt but the whole response to the current situation seems to have become so polarised with little nuance - I have been called a right-wing scum murderer for suggesting that we should have relaxing lockdown as soon as we possibly can (and that does not mean now by the way) and aim to restart society and the things that make life pleasurable as soon as we can whilst mitigating the risk to the right level. This may mean some things have to stay off-limits clearly


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PostPosted: Tue 12 May, 2020 10:08 pm 
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gilsey wrote:
howsillyofme1 wrote:

I would much rather see resources being spent on data gathering, rapid local responses and a true community response to this including the protection of vulnerable people and PPE rather than harsh lockdown conditions that seem to be creating a lot of hidden damage to our wellbeing and may actually end up not helping that much.


Unfortunately there is no sign at all of resources being spent as you suggest, and until that changes lockdown is just about all the protection we have.

Whether you oppose lifting lockdown because you don't understand the alternatives, or because you do understand them and realise the govt isn't taking the necessary action, imo it's no wonder people are scared.


so lockdown is protection against the virus (although how effective it is is not really that clear - and what measures are actually useful) but there is also other damage it is causing to mental health and other things as a consequence.

If the current shambolic Government don't provide these resources then does the UK just stay under a hard lockdown (no schools, no visiting family outside household, no travel etc) ad infinitum?

What gets you out of this?

What do you think of Sweden which has not had lockdown to any real extent and has not been testing like the Koreans but their number of cases is dropping down - slowly but still not rising rapidly? Their excess deaths have not been as high as other countries who have locked down much harder.

I am not sure that all epidemiologists are on the same page regarding how this disease is behaving in the community - there is a real concern on care homes across Europe and the appalling death rates there which in some places seems to have been a deliberate policy decision and nothing to do with 'lockdowns'


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