Number of Deaths

[PILTDOWN MAN]

Your co-scientists seemed to be saying that if 65% or more of us have had the virus, that’s the nucleus required for restrictions to start be lifted. Inherent in that, that many of us have already had the virus and never knew, or had mild symptoms.

A question, how then should any country act, without a vaccine, to bring life back to normal?

Things are moving quickly elsewhere, without any reference to that 65%. The BBC just reported that construction and manufacturing in Spain are to resume with immediate effect. Hundreds of Spaniards are still dying daily, thousands of new cases reported today.

I remember way back when I first took an interest in the economy I listened to an "expert" who sited construction and manufacturing sectors as the main triggers for a country's economy to recover. This is always promoted especially with infrastructure projects as a kick start therefore one assumes this is the reason for these sectors to be allowed back. Any business that needs social gatherings will be far far behind.

Risk against reward

 

[yxee]

Wow, that's shocking. With a UK poulation of 66.6 million, and Germany's current 1 death per 43 cases (BBC data of yesterday), that means that of the 43.3 million brits who will have had the virus (for the 'safe' 65% to be reached), there will have been one million deaths. If we use the UK's current 1 death per 8 cases, that rises to just under five and a half million deaths.

I appreciate the level of uncertainty about total numbers of cases and total numbers of deaths, but these are the only numbers we have. So I don't think that waiting till a million or more people are dead in the UK before releasing our lockdown is a strategy. We must develop a vaccine.

Current death to positive test ratio is very high as we're only testing people who are admitted to hospital. So it doesn't make sense to multiply that number by the UK population unless you think the entire population is going to be hospitalised.

You can't just say "this is the best we have", the calculation is clearly wrong.

 

[Weststander]

Possibly the corollary for the easing of the lockdown will be a perpetuation of high levels of the disease? I felt uneasy with that news as I wonder if it will prove to be too soon.

A common theme seems to be that economies must be allowed to recover as soon as possible. That there’s a balancing act of preserving life from covid19, against not sending nations into a depression that will take many years to recover from (with its own adverse effect on livelihoods, mental health and mortality). Denmark, Austria, the Czech Republic and now Spain have blinked first.

 

[Swansman]

Current death to positive test ratio is very high as we're only testing people who are admitted to hospital. So it doesn't make sense to multiply that number by the UK population unless you think the entire population is going to be hospitalised.

You can't just say "this is the best we have", the calculation is clearly wrong.

At the same time, he is seemingly not counting the deaths from NHS overload and other untreated diseases. There could be a worse case scenario where a million or more die from this (directly or indirectly).

But yea... we need that antibody mass testing.

Did anyone take a closer look at the Bill Gates coronavirus simulation from last October and how it reached the conclusion that 65 million people could die?

 

[Weststander]

Current death to positive test ratio is very high as we're only testing people who are admitted to hospital. So it doesn't make sense to multiply that number by the UK population unless you think the entire population is going to be hospitalised.

You can't just say "this is the best we have", the calculation is clearly wrong.

That exact point has been mentioned by several scientists. For example, Germany are testing the same younger and healthier people over and over again.
https://www.bloomberg.com/news/articles/2020-03-24/coronavirus-less-deadly-in-germany-because-of-youthful-patients

 

[jabba]

Unfortunately can't get "back to normal" any time soon, but there will be an easing of restrictions. Apart from the most vulnerable still in their extended self-isolation, there will still be self-isolation for anyone with symptoms and their household. The important factor is testing to see if you've got/had it before we can get some people safely back to work.

 

[Swansman]

A common theme seems to be that economies must be allowed to recover as soon as possible. That there’s a balancing act of preserving life from covid19, against not sending nations into a depression that will take many years to recover from (with its own adverse effect on livelihoods, mental health and mortality). Denmark, Austria, the Czech Republic and now Spain have blinked first.

International media seems to be jumping to conclusions about some of these countries though. Denmark and Norway is opening kidergartens/schools because a) closing them seems to have no effect at all on transmission according to studies and b) important workers are forced to stay at home with their kids. Less sure about why Austria is opening small stores again but from what I've heard its more about avoiding increasing transit and queues at big stores than actually "easening" the lockdown.

It seems many countries are changing/removing restrictions because of practical reasons rather than letting their guard down.

Could see Spain being the exception, its a weird place.

 

[Mellotron]

Ignore.

 

[Harry Wilson's tackle]

Current death to positive test ratio is very high as we're only testing people who are admitted to hospital. So it doesn't make sense to multiply that number by the UK population unless you think the entire population is going to be hospitalised.

You can't just say "this is the best we have", the calculation is clearly wrong.

Well, I can. It may be wrong but it is the best we have.

Incidentally, one of my neighbours had COVA. She was diagnosed down the phone by a nurse practitioner. She has not been to hospital (same as Spence). Are you saying that people like this are not included in the infection statistics because they haven't been to hospital? I am asking not to be 'funny' but because I don't know.

 

[Mellotron]

Current death to positive test ratio is very high as we're only testing people who are admitted to hospital. So it doesn't make sense to multiply that number by the UK population unless you think the entire population is going to be hospitalised.

You can't just say "this is the best we have", the calculation is clearly wrong.

This.

There are far, far, far more people in Germany with the virus than have tested positive - obviously even more so in the UK, given our fatality rate and our low testing.

We are seeing more and more reports every day that back up a suggestion that somewhere between 50-80% of cases are asymptomatic. Even when you don't take that huge number of people into account, it is bearing out that only 10% of moderate-to-severe cases actually require hospitalisation. A conservative version of this data should be factored into calculations.

 

[Harry Wilson's tackle]

This.

There are far, far, far more people in Germany with the virus than have tested positive - obviously even more so in the UK, given our fatality rate and our low testing.

We are seeing more and more reports every day that back up a suggestion that somewhere between 50-80% of cases are asymptomatic. This should be factored into calculations.

So the official 'tested positive' data from Germany does not include people with the virus who have not been tested?

So how do you or anyone else know they have had the virus?

Separately, to know that 50-80% of cases are asymptomatic you need to test asymptomatic people and show they have the virus. Not only that - the majority of asymptomatic patients (more than 50-80%) would need to test positive!

I'm not suggesting you are wrong (the same is being stated now on radio 5) but where are the published data? Are Germans screening (testing) large numbers of people with no symptoms and finding 50-80% are infected with the virus and symptom free (and remain symptom free)? That would all need to be the case surely?

 

[Mellotron]

So the official 'tested positive' data from Germany does not include people with the virus who have not been tested?

So how do you or anyone else know they have had the virus?

Separately, to know that 50-80% of cases are asymptomatic you need to test asymptomatic people and show they have the virus. Not only that - the majority of asymptomatic patients (more than 50-80%) would need to test positive!

I'm not suggesting you are wrong (the same is being stated now on radio 5) but where are the published data? Are Germans screening (testing) large numbers of people with no symptoms and finding 50-80% are infected with the virus and symptom free (and remain symptom free)? That would all need to be the case surely?

I'm assuming Germany are only counting official tests done, much like us and other European countries - i.e. phone diagnoses won't count towards totals, I'd be very surprised if they did but willing to be put right if so.

Re: Asymptomatic - Have you seen the studies from Iceland (50% asymptomatic, based on mass testing of the entire population), https://edition.cnn.com/2020/04/01/europe/iceland-testing-coronavirus-intl/index.html

Italy - case study of a town of 3,000 called Vo all being tested, suggesting 75%-80% were asymptomatic

and (less reliable but) China (paper published that suggested 78% asymptomatic across Wuhan)?

That is exactly what they have done in a number of places - tested people showing no symptoms. My 50-80% is based on the higher and lower figures from these studies. Quite a bit of reference to these studies in the Coronavirus Good News Thread. Of course they do not prove anything in and of themselves yet...but they are starting to show more promising trends, and it absolutely should be factored into our thinking.

Another example that I'm still looking for the source article on, which was in the Good News Thread - in Italy they took blood from 60 people in the Bergamo area who were all completely asymptomatic and believed themselves to have not had the virus. The antibodies count showed that 40 of them had had COVID-19.

 

[Green Cross Code Man]

International media seems to be jumping to conclusions about some of these countries though. Denmark and Norway is opening kidergartens/schools because a) closing them seems to have no effect at all on transmission according to studies and b) important workers are forced to stay at home with their kids. Less sure about why Austria is opening small stores again but from what I've heard its more about avoiding increasing transit and queues at big stores than actually "easening" the lockdown.

It seems many countries are changing/removing restrictions because of practical reasons rather than letting their guard down.

Could see Spain being the exception, its a weird place.

Please provide a link for this. There was one study, largely derided, that claimed shutting schools made around a 5 percent difference. Zero difference is something else.

 

[atomised]

Well, I can. It may be wrong but it is the best we have.

Incidentally, one of my neighbours had COVA. She was diagnosed down the phone by a nurse practitioner. She has not been to hospital (same as Spence). Are you saying that people like this are not included in the infection statistics because they haven't been to hospital? I am asking not to be 'funny' but because I don't know.

As far as I know the infection statistics just relate to those who have tested positive so diagnosed over the phone wouldn't be included

 

[Bakero]

Could see Spain being the exception, its a weird place.

The majority of Spanish people are still very much under lockdown. It was confirmed to me today that I'll be working at home till the end of June at least.

 

[Harry Wilson's tackle]

I'm assuming Germany are only counting official tests done, much like us and other European countries - i.e. phone diagnoses won't count towards totals, I'd be very surprised if they did but willing to be put right if so.

Re: Asymptomatic - Have you seen the studies from Iceland, Italy and (less reliable but) China? That is exactly what they have done - tested people showing no symptoms. My 50-80% is based on the higher and lower figures from these studies. Quite a bit of reference to these studies in the Coronavirus Good News Thread. Of course they do not prove anything in and of themselves yet...but they are starting to show more promising trends.

Cheers for that. I will check all that out.

Instinctively I would argue that when testing asymptomatic people and finding they are genuinely infected you would need to be sure the illness doesn't manifest in the following 14 days. Carrying the antibody but claiming to have never had the disease (symptoms) would also be persuasive. But the provenance of the data is key.

I would add that I would be skeptical of any data from China or Italy. Both nations are notorious (in general, and specifically in my personal experience as a research journal editor) for scientific poor practice, self-deception and even deliberate fraud.

 

[Mellotron]

Cheers for that. I will check all that out.

Instinctively I would argue that when testing asymptomatic people and finding they are genuinely infected you would need to be sure the illness doesn't manifest in the following 14 days. Carrying the antibody but claiming to have never had the disease (symptoms) would also be persuasive. But the provenance of the data is key.

I would add that I would be skeptical of any data from China or Italy. Both nations are notorious (in general, and specifically in my personal experience as a research journal editor) for scientific poor practice, self-deception and even deliberate fraud.

Please don't think me intentionally abrasive by the way. I rate you highly as a poster.

My understanding is that in at least a couple of the cases (Iceland) it is an antibodies test, not a "do you have it now" test, but again could be wrong.

 

[Harry Wilson's tackle]

As far as I know the infection statistics just relate to those who have tested positive so diagnosed over the phone wouldn't be included

Chris Witty just said on the radio that the deaths includes those with COVID on their certificate, updated every few days, plus the running hospital total. It isn't clear to me how the number of cases can be estimated accurately unless it includes those with COVID on their death certificate who have never been tested.

Anyway, I seem to be arguing the toss about issues raised after I did my estimate of rate of death per nation per cases declared. Getting distracted now!

 

[Harry Wilson's tackle]

I'm assuming Germany are only counting official tests done, much like us and other European countries - i.e. phone diagnoses won't count towards totals, I'd be very surprised if they did but willing to be put right if so.

Re: Asymptomatic - Have you seen the studies from Iceland (50% asymptomatic, based on mass testing of the entire population), https://edition.cnn.com/2020/04/01/europe/iceland-testing-coronavirus-intl/index.html

Italy - case study of a town of 3,000 called Vo all being tested, suggesting 75%-80% were asymptomatic

and (less reliable but) China (paper published that suggested 78% asymptomatic across Wuhan)?

That is exactly what they have done in a number of places - tested people showing no symptoms. My 50-80% is based on the higher and lower figures from these studies. Quite a bit of reference to these studies in the Coronavirus Good News Thread. Of course they do not prove anything in and of themselves yet...but they are starting to show more promising trends, and it absolutely should be factored into our thinking.

Another example that I'm still looking for the source article on, which was in the Good News Thread - in Italy they took blood from 60 people in the Bergamo area who were all completely asymptomatic and believed themselves to have not had the virus. The antibodies count showed that 40 of them had had COVID-19.

Right, I just found a paper (already cited 65 times) that states : "Our estimated asymptomatic proportion is at 17.9% (95%CrI: 15.5–20.2%), which overlaps with a recently derived estimate of 33.3% (95% confidence interval: 8.3–58.3%) from data of Japanese citizens evacuated from Wuhan"

This is NOT based on raw testing data as such. It is based on statistical modelling. The paper is:

"Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020"

https://eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180

The Wuhan data they cite is clearly similar, but the confidence interval is massive - 8-58%.

My feeling about this is that it would be way too soon to hope that a good number of folk can get the virus and not become ill, thus generating herd immunity at no health cost, let alone 50-80%. I'll have a look now to see what the data are on ordinary flu virus.....

 

[Mellotron]

Right, I just found a paper (already cited 65 times) that states : "Our estimated asymptomatic proportion is at 17.9% (95%CrI: 15.5–20.2%), which overlaps with a recently derived estimate of 33.3% (95% confidence interval: 8.3–58.3%) from data of Japanese citizens evacuated from Wuhan"

This is NOT based on raw testing data as such. It is based on statistical modelling. The paper is:

"Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020"

https://eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180

The Wuhan data they cite is clearly similar, but the confidence interval is massive - 8-58%.

My feeling about this is that it would be way too soon to hope that a good number of folk can get the virus and not become ill, thus generating herd immunity at no health cost, let alone 50-80%. I'll have a look now to see what the data are on ordinary flu virus.....

I'm not suggesting for a second that we've generated herd immunity yet, I don't think we have. But we are seeing a reasonable enough number of asymptomatic that they should be factored into any extrapolations onto wider population, in my opinion. That's all. As you say, we have studies suggesting anywhere from 8-80%, so I know it's hard to say with any surety.

It is also of course logical that the Diamond Princess ship - with a much higher average age than the general population - will have a much higher incidence of moderate-to-severe (i.e. symptomatic) cases.