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Covid-19 in the UK in May 2020

We’re starting this thread a couple of days early, because here in the United Kingdom a variety of things have changed regarding the reporting of Covid-19 “statistics”.

First of all the daily reports from the Department of Health and Social Care: now include “all deaths where a positive test for COVID-19 has been confirmed”, not just those “in hospital”. As the explanation on the DHSC web site puts it:

From 29 April 2020, DHSC are publishing as their daily announced figures on deaths from COVID-19 for the UK a new series that uses improved data for England produced by Public Health England (PHE). These figures provide a count of all deaths where a positive test for COVID-19 has been confirmed, wherever that death has taken place. Figures for Scotland, Wales and Northern Ireland have already begun to include deaths outside hospitals, so this change will ensure that the UK-wide series has a shared and common definitional coverage. This updated statement explains what the new data are and how they differ from both the data series previously published by DHSC and the figures produced by the ONS.

Separately, to improve the timely availability of data on deaths in care homes involving COVID-19, the ONS and the Care Quality Commission (CQC) agreed to publish from 28 April 2020 provisional counts of deaths in care homes, based on statutory notifications by care home providers to CQC. A separate explanatory statement about these new data has been published jointly by the ONS and CQC.

In addition to that change there is now a new section of the UK Government web site devoted to “National COVID-19 surveillance reports“. The most recent report at the moment:

Summarises the information from the surveillance systems which are used to monitor the Coronavirus Disease 2019 (COVID-19) pandemic in England.

The report is based on week 16 (data between 13 April and 19 April 2020) and where available daily data up to 22 April 2020.

COVID-19 is the disease name and SARS-CoV-2 is the virus name.

The report includes sections devoted to UK “Community surveillance”, “Primary care surveillance”, “Secondary care surveillance”, “Virological surveillance” and “Mortality surveillance”. In the latter section it points out that:

In week 16 2020 in England, statistically significant excess mortality by week of death above the upper 2 z-score threshold was seen overall, by age group in the 15-64 and 65+ year olds and sub nationally (all ages) in all regions (North East, North West, Yorkshire & Humber, East & West Midlands, East of England, London and South East & West regions) after correcting GRO disaggregate data for reporting delay with the standardised EuroMOMO algorithm (Figure 18). This data is provisional due to the time delay in registration; numbers may vary from week to week.

The recent “spike” appears to be statistically significant! However despite that, this report and the rest of the virtual paperwork emanating from the UK Government still fail to address the question we posed last week:

How will the UK Government build on the amazing community solidarity we have seen in the past few weeks and reassure the citizens of the nation that lifting the lockdown won’t result in further out-of-control outbreaks?

Whilst we continue to wait for an answer, here are the new “positive test” daily death numbers from the DHSC:

They do of course beg the question of how many “untested” deaths due to Covid-19 are occurring. Regular readers will be aware that we have been following the modelled future death projections of James Annan. Here’s his first update using the DHSC’s new numbers:

[Edit – May 5th]

The Office for National Statistics have released their latest weekly “death certificate” data. Here are the “main points” from their report:

  • The provisional number of deaths registered in England and Wales in the week ending 24 April 2020 (Week 17) was 21,997, a decrease of 354 deaths registered compared with the previous week (Week 16); this is the first decrease in the number of deaths since the week ending 20 March 2020 (Week 12) but is 11,539 more than the five-year average for Week 17.
  • Of the deaths registered in Week 17, 8,237 mentioned “novel coronavirus (COVID-19)”, which is 37.4% of all deaths; this is a decrease of 521 deaths compared with Week 16 (39.2% of all deaths).
  • The number of deaths in care homes (from all causes) for Week 17 was 7,911, which is 595 higher than Week 16. The number of deaths in hospitals for Week 17 was 8,243, which is 1,191 lower than Week 16.
  • In London, over half (50.5%) of deaths registered in Week 17 involved COVID-19; the North West and North East also had a high proportion of COVID-19 deaths, accounting for 38.8% and 38.0%, respectively, of deaths registered in these regions.
  • In Wales, there were 413 deaths registered in Week 17 involving COVID-19, accounting for 36.7% of all deaths registered in Wales.
  • Of deaths involving COVID-19 registered up to Week 17, 71.8% (19,643 deaths) occurred in hospital with the remainder mainly occurring in care homes (5,890 deaths), private homes (1,306 deaths) and hospices (301 deaths).

Here are those numbers in graphic detail:

[Edit – May 12th]

The latest weekly Covid-19 update has been issued by the Office for National Statistics. Here’s the summary on Twitter:

33,337 / 21,647 = 1.54

[Edit – May 19th]

The latest weekly update from the ONS has been published:

Plus some additional detail:

Deaths in care homes made up 36.0% of all deaths in Week 17, 35.7% in Week 18 and 33.6% in Week 19 (Figure 7). Between Week 18 and Week 19, the number of deaths in care homes decreased by 33.7% to 4,248. However, the proportion of care home deaths that involved COVID-19 continued to increase, and 39.2% of all deaths in care homes involved COVID-19 in Week 19.

Watch this space!

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Matt Hancock’s “scientifically valid” answers

Yesterday evening Matt Hancock was behind the lectern for the latest of Her Majesty’s Government’s Covid-19 “daily briefings”. Here’s a recording of the whole show:

There follows our edited highlights. First of all note that at around 5:00 into the video Matt says:

Building on successful pilots, we’ll be rolling out testing of asymptomatic residents and staff in care homes in England and to patients and staff in the NHS. This will mean that anyone who is working or living in a care home will be able to get access to a test whether they have symptoms or not. I’m determined to do everything I can to protect the most vulnerable and we now have the capacity to go further still. So from now, we’re making testing available to all over 65s and their households with symptoms and to all workers who would have to leave home in order to go to work and members of their households, again, who have symptoms. So from construction workers to emergency plumbers, from research scientists to those in manufacturing. The expansion of access to testing will protect the most vulnerable and help keep people safe and it’s possible because we’ve expanded capacity for testing thus far.

However he doesn’t go so far as to commit to a time scale for that “roll out”! Allegedly front line NHS staff are having problems getting tested, so when will the necessary extra testing capacity for OAPs and care workers be rolled out? Matt didn’t say.

We have previously mentioned the New Scientist’s coverage of the coronavirus crisis, and their chief reporter Adam Vaughan asked the final question of the evening at ~56:15:

Hi, you said you were recruiting 18,000 contact tracers. I wanted to ask, how many do you have today, what date will you hit 18,000 and how important are those tracers as a strategy for controlling the virus after the lockdown? And secondly, we heard today that the NHS contact tracing out where will be ready within three weeks. What’s your goal for the number of people you want to download it and how will you incentivise them to do so?

After a brief(ish) hesitation Matt answered as follows:

I knew we’d get some tough questions from the New Scientist! The answer to your questions are as soon as possible and as many as possible. But I know that’s not exactly a numerical answer. We’re recruiting the contact tracers. I’m sorry I don’t have the information to hand as to exactly how many we’ve recruited, but that is underway. We hope to have the contact tracers who will help when we find a positive test to work out who they’ve been in contact with and make sure they do the appropriate thing. We hope to have the contact tracers in place before or at the same as the app goes live and you’re right on the app.

We’re expecting that to be ready by the middle of May and both of these things together, because they work together along with the testing and they’ll help us to keep the level of new cases down once we’ve used social distancing measures to get those new cases down. That’s the best thing for health and it’s the best thing for the economy. It’s a work in progress. I appreciate that, other than saying the middle of May, I haven’t given you numerical details. I don’t have the data to hand, but I’ll try to find that for you. And then on the how many people, the more people who download the app and keep their Bluetooth on, the more effective the app is going to be.

So there is no answer other than as many as possible because if everybody downloads it will just be more effective at spotting who people have been in contact with through contact tracing and helping alongside the human contact tracing for people to be able to keep the R down by catching those who they may have transmitted the disease to. It’s also of course tied with the rules around isolation because if you are … What really also matters is if you’ve been in substantial contact with somebody who’s tested positive, making sure we get the right rules around what that person is then required and asked to do is also a critical part of this, this infrastructure that we’re building.

It seems Adam wasn’t entirely happy with that answer, so he asked a supplementary question:

From what you’ve just said, you said that the human contact traces and the app will work in tandem, and you’re saying if the app is coming in three weeks, does that mean the target for the 18,000 is in three weeks?

Mr. Hancock retorted, quick as a flash:

Before or at the same time as the app. Yeah.

Okay. Good stuff. Thank you very much indeed. Great to have the New Scientist at the Downing Street briefing and I hope my answer was scientifically valid. Thank you very much for joining us and no doubt see you again soon.

I paraphrase the Health Minister’s words only slightly:

“I know that’s not exactly a numerical or a scientific set of answers.”

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Boris Johnson returns to work

Last night an article by Gordon Rayner in the online edition of the Daily Telegraph assured us that:

Boris Johnson is expected to announce plans for easing the lockdown as early as this week after he returned to Downing Street on Sunday night to take full-time control of the coronavirus crisis.

The Prime Minister will on Monday morning chair his first meeting of the Covid-19 “war cabinet” since he was taken to hospital more than three weeks ago, and is ready to resume his role hosting televised Number 10 press conferences.

I took a dim view of that suggestion on Twitter:

This morning the Prime Minister had returned to Downing Street from his country residence and gave this speech to the nation:

According to The Daily Telegraph’s Twitter feed this morning:

However according to The Independent’s Twitter feed:

Meanwhile according to The Times’ Twitter feed this morning:

Here are some of the Prime Minister’s actual words, transcribed from the recording above:

It follows that this is the moment of opportunity, this is the moment when we can press home our advantage. It is also the moment of maximum risk because I know that there will be many people looking now at our apparent success and beginning to wonder whether now is the time to go easy on those social distancing measures.

I know how hard and how stressful it has been to give up even temporarily those ancient and basic freedoms, not seeing friends, not seeing loved ones, working from home, managing the kids, worrying about your job and your firm.

So let me say directly also to British business, to the shopkeepers, to the entrepreneurs, to the hospitality sector, to everyone on whom our economy depends: I understand your impatience, I share your anxiety. And I know that without our private sector, without the drive and commitment of the wealth creators of this country, there will be no economy to speak of, there will be no cash to pay for our public services, no way of funding our NHS.

And yes I can see the long term consequences of lock down as clearly as anyone. And so yes I entirely share your urgency. It’s the government’s urgency. And yet we must also recognise the risk of a second spike, the risk of losing control of that virus and letting the reproduction rate go back over one, because that would mean not only a new wave of death and disease but also an economic disaster and we would be forced once again to slam on the brakes across the whole country and the whole economy and reimpose restrictions in such a way as to do more and lasting damage.

And so I know it is tough and I want to get this economy moving as fast as I can. But I refuse to throw away all the effort and the sacrifice of the British people and to risk a second major outbreak and huge loss of life and the overwhelming of the NHS. And I ask you to contain your impatience because I believe we are coming now to the end of the first phase of this conflict.

And in spite of all the suffering, we have so nearly succeeded. We defied so many predictions. We did not run out of ventilators or ICU beds. We did not allow our NHS to collapse. And on the contrary we have so far collectively shielded our NHS so that our incredible doctors and nurses and healthcare staff have been able to shield all of us from an outbreak that would have been far worse. And we collectively flattened the peak.

And so when we are sure that this first phase is over and that we are meeting our five tests – deaths falling, NHS protected, rate of infection down, really sorting out the challenges of testing and PPE, avoiding a second peak – then that will be the time to move on to the second phase in which we continue to suppress the disease and keep the reproduction rate, the R rate, down, but begin gradually to refine the economic and social restrictions and one by one to fire up the engines of this vast UK economy.

And in that process difficult judgements will be made and we simply cannot spell out now how fast or slow or even when those changes will be made though clearly the government will be saying much more about this in the coming days.

And I want to serve notice now that these decisions will be taken with the maximum possible transparency. And I want to share all our working and our thinking, my thinking, with you the British people. And of course, we will be relying as ever on the science to inform us, as we have from the beginning, but we will also be reaching out to build the biggest possible consensus, across business, across industry, across all parts of our United Kingdom, across party lines, bringing in opposition parties as far as we possibly can, because I think that is no less than what the British people would expect.

Which version of this Covid-19 “story” do you prefer to believe?

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Wear homemade masks when you venture outdoors

The Guardian repeats today what we have been saying for quite some time:

The public should wear homemade masks when they venture outdoors to help reduce the spread of coronavirus, according to scientists who claim Britain’s masks policy does too little to prevent infections.

Prof Sian Griffiths, who led the Hong Kong government’s investigation into the 2003 Sars epidemic, said Britain should adopt the same approach as the US, where people are advised to make their own “cloth face coverings” and wear them in public spaces.

Trish Greenhalgh, a professor of primary care health sciences at Oxford University who recently completed a review on face masks, also advocated the use of masks in public and suggested an old T-shirt combined with kitchen paper would suffice.

The Guardian has some suggestions on how to make your own face mask, as indeed do we. Take a look here.

However some would have you believe that wearing a face mask is not such a great idea. The New Scientist for example. According to Jessica Hamzelou in a possibly paywalled article:

As cases of covid-19 continue to rise, many people are choosing to wear a face mask when out in public – but do they work?

Some have also been using cloth face coverings, but these aren’t up to the job, says Raina MacIntyre at the University of New South Wales in Sydney.

In 2015, MacIntyre and her colleagues ran a clinical trial pitting cloth masks against medical ones. The team provided 1607 healthcare workers at 14 hospitals in Hanoi, Vietnam, with either disposable medical masks or reusable cloth ones, which could be washed at home at the end of the day they were worn. Those that wore cloth masks were significantly more likely to catch a virus, the team found.

It seems that I need to point out to Jessica that just because an academic study finds that DIY masks aren’t as effective as pukka medical masks that doesn’t mean that they are useless. She continues:

But what about the rest of us? In an attempt to answer this question, Paul Hunter at the University of East Anglia, UK, and his colleagues looked at 31 published studies on the efficacy of face masks.

Overall, the evidence suggests there may be a small benefit to wearing some kind of face covering. They do seem to prevent sick people from spreading the virus, but the evidence is weak and inconsistent, says Hunter.

“Our view is that there was some evidence of a degree of protection, but it wasn’t great,” he says. “So we still don’t effectively know if face masks in the community work.”

It seems masks “prevent sick people from spreading the virus”. You can spread the SARS-CoV-2 virus before you show any symptoms, so wear a mask to prevent other people possibly catching your bugs!

Scientists say so, and somewhat grudgingly so does the New Scientist. In the current climate I wouldn’t go out in a public place without one:

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The Green Party’s Community Shield

This morning the Green Party announced their vision of a novel coronavirus “Community shield” via a press release on the web site of Caroline Lucas:

I have called on the Government to adopt the advice of the World Health Organisation on community-based testing and contact-tracing to prevent the further spread of Covid-19 and as a precondition for any relaxation of the lockdown. 

The First Minister of State, Dominic Raab, has set out five conditions for the lifting of the lockdown but they do not include the clear WHO advice that health systems must have the capacity to “detect, test, isolate and treat every case and trace every contact”.

A Green Party report, published on Tuesday and put together by the party’s health team with input from other experts, makes the case that we will prevent further Covid-19 outbreaks and new lockdowns only if there is a network of community-based protection schemes, or “community shields”, which can respond quickly to any re-emergence of Covid-19 once the current lockdown is lifted. 

These “shields”, co-ordinated by Public Health England’s regional Outbreak Management Teams, would be created by bringing together and building on existing systems including the NHS 111 phone service, GP surgeries and local authority public health teams to identify those with symptoms, arrange for their testing and then, crucially, trace all their contacts in order to stamp out outbreaks of the virus in the communities where it’s happening. 

It seems as though the Green Party have been considering an idea we have been putting considerable thought into over recent weeks as well! It further seems as though the concept will be brought before the UK’s “virtual” parliament this afternoon:

If attempts to lift the lockdown are made before this infrastructure is in place, we’re likely to see a repeating cycle of national lockdowns as surges of new cases of the virus occur. 

I plan to table an Early Day Motion on Tuesday when Parliament re-opens calling for community-based protection schemes to be put in place.

It will be very interesting to see if the issue does get debated, and whether anything changes as a result! As Caroline Lucas puts it:

The Government record on testing in this crisis has been poor, with a change in strategy which squandered vital time, and mixed signals coming from ministers and scientific advisers who have even suggested that WHO advice doesn’t somehow apply to Britain. It would be criminally negligent if it compounded this error by failing to listen to the WHO’s advice on the criteria which need to be in place before lifting the lockdown.  It is profoundly worrying that the “Five Conditions for Exit” announced by First Minister Dominic Raab last week made no mention of this advice.

A community shield approach wouldn’t only help trace outbreaks of the virus where they occur and allow a swift response, it would also provide support to Covid-19 patients by monitoring their condition by phone and app, leaving them safely at home but not isolated.  This would give people the reassurance they need to exit lockdown with confidence when the time is right.

Preparations need to be made now to allow these “shields” to be in place for the ending of lockdown once the upward curve of infections has been brought down.  The system could be activated immediately in communities where the infection rate is low, and rolled out more widely as the number of cases declines.

People need the reassurance that lifting the lockdown won’t result in further out-of-control outbreaks and this would help give it to them – and build on the amazing community solidarity we have seen in the past few weeks.

The full report is available on this link – Building a Community Shield to Suppress the Coronavirus April 2020.pdf

How will the UK Government “build on the amazing community solidarity we have seen in the past few weeks” and reassure the citizens of the nation “that lifting the lockdown won’t result in further out-of-control outbreaks”?

Watch this space!

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How Britain sleepwalked into disaster

It’s not often that I praise the reporting in the assorted organs of News UK. Usually quite the reverse! However this morning I commend to you this frankly shocking article by the Sunday Times Insight team, including on this occasion Jonathan Calvert, George Arbuthnott and Jonathan Leake:

Coronavirus: 38 days when Britain sleepwalked into disaster

I strongly suggest that you read the article from start to finish, always assuming that you have a strong enough stomach. Here are a few brief extracts:

On the third Friday of January a silent and stealthy killer was creeping across the world. Passing from person to person and borne on ships and planes, the coronavirus was already leaving a trail of bodies.

The virus had spread from China to six countries and was almost certainly in many others. Sensing the coming danger, the British government briefly went into wartime mode that day, holding a meeting of Cobra, its national crisis committee.

But it took just an hour that January 24 lunchtime to brush aside the coronavirus threat. Matt Hancock, the health secretary, bounced out of Whitehall after chairing the meeting and breezily told reporters the risk to the UK public was “low”.

This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.

Unusually, Boris Johnson had been absent from Cobra. The committee — which includes ministers, intelligence chiefs and military generals — gathers at moments of great peril such as terrorist attacks, natural disasters and other threats to the nation and is normally chaired by the prime minister.

Johnson had found time that day, however, to join in a lunar-new-year dragon eyes ritual as part of Downing Street’s reception for the Chinese community, led by the country’s ambassador.

It was a big day for Johnson and there was a triumphal mood in Downing Street because the withdrawal treaty from the European Union was being signed in the late afternoon. It could have been the defining moment of his premiership — but that was before the world changed.

Over on the “Consequences” section of the Arctic Sea Ice Forum we have been discussing the “Chinese coronavirus” since January 25th, and before that in other threads on the forum. By way of just one example:

Judging by footage from a hospital in Wuhan, it is a serious problem over there.

An epidemic would also overwhelm healthcare here in Sweden. Which patients would be given the few available respirator beds when there are too many very sick people?

Since he obviously didn’t heed that early warning signal I can only assume that BoJo isn’t too concerned about an Arctic sea ice tipping point either?

The Insight team continue:

Sure enough, five days later, on Wednesday January 29, the first coronavirus cases on British soil were found when two Chinese nationals from the same family fell ill at a hotel in York. The next day the government raised the threat level from low to moderate.

On January 31 — or Brexit day, as it had become known — there was a rousing 11pm speech by the prime minister promising that withdrawal from the European Union would be the dawn of a new era, unleashing the British people, who would “grow in confidence” month by month.

By this time there was good reason for the government’s top scientific advisers to feel creeping unease about the virus. The WHO had declared the coronavirus a global emergency just the previous day, and scientists at the London School of Hygiene and Tropical Medicine had confirmed to [Professor Chris] Whitty in a private meeting of the Nervtag advisory committee on respiratory illness that the virus’s infectivity could be as bad as Ferguson’s worst estimate several days earlier.

It sounds as though Boris Johnson had his eye firmly fixed on just one ball. Juggling two was beyond him. “Get Brexit Done” now belatedly reads “Stay Home, Save Lives” on his Twitter feed:

Please do read the entire article, but for now let us skip to the conclusion of the Sunday Times cautionary tale of staggering incompetence in high places?

A Downing Street spokesman said: “Our response has ensured that the NHS has been given all the support it needs to ensure everyone requiring treatment has received it, as well as providing protection to businesses and reassurance to workers. The prime minister has been at the helm of the response to this, providing leadership during this hugely challenging period for the whole nation.”

Merely business as usual in the age of “Fake News” and “Truth Decay“.

[Edit – April 20th]

Last night the Department of Health and Social Care “tweeted” a response to the Sunday Times article:

Clicking through to the DoH blog we read:

A Government spokesman said: ‘This article contains a series of falsehoods and errors and actively misrepresents the enormous amount of work which was going on in government at the earliest stages of the Coronavirus outbreak.’

‘This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided at all times by the best scientific advice.

‘The Government has been working day and night to battle against coronavirus, delivering a strategy designed at all times to protect our NHS and save lives.

‘Our response has ensured that the NHS has been given all the support it needs to ensure everyone requiring treatment has received it, as well as providing protection to businesses and reassurance to workers.

‘The Prime Minister has been at the helm of the response to this, providing leadership during this hugely challenging period for the whole nation.’

Followed by a long list of rebuttals of specific points in the Sunday Times article. How about this one for starters?

Claim –  ‘This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.’

Response –  The editor of the Lancet, on exactly the same day – 23 January – called for “caution” and accused the media of ‘escalating anxiety by talking of a ‘killer virus’ and ‘growing fears’. He wrote: ‘In truth, from what we currently know, 2019-nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.’ The Sunday Times is suggesting that there was a scientific consensus around the fact that this was going to be a pandemic – that is plainly untrue.

Here’s one interpretation of these events:

Will Michael Gove shortly become our next Prime Minister?

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Wearing face masks in the community

Hopefully we’ve made our own views on this topic clear by now, but what does the science say about the pros and cons of “the average person in the street” wearing a mask in public? Here’s an extract from a new paper in The Lancet entitled “Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity“:

The WHO ha[s] not yet recommended mass use of masks for healthy individuals in the community (mass masking) as a way to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its interim guidance of April 6, Public Health England (PHE) has made a similar recommendation.

By contrast, the US Centers for Disease Control and Prevention (CDC) now advises the wearing of cloth masks in public and many countries, such as Canada, South Korea, and the Czech Republic, require or advise their citizens to wear masks in public places.

An evidence review and analysis have supported mass masking in this pandemic. There are suggestions that WHO and PHE are revisiting the question.

People often wear masks to protect themselves, but we suggest a stronger public health rationale is source control to protect others from respiratory droplets. This approach is important because of possible asymptomatic transmissions of SARS-CoV-2.

Authorities such as WHO and PHE have hitherto not recommended mass masking because they suggest there is no evidence that this approach prevents infection with respiratory viruses including SARS-CoV-2. Previous research on the use of masks in non-health-care settings had predominantly focused on the protection of the wearers and was related to influenza or influenza-like illness. These studies were not designed to evaluate mass masking in whole communities.

The authors go on to address that failing of previous studies:

Absence of evidence of effectiveness from clinical trials on mass masking should not be equated with evidence of ineffectiveness. There are mechanistic reasons for covering the mouth to reduce respiratory droplet transmission and, indeed, cough etiquette is based on these considerations and not on evidence from clinical trials. Evidence on non-pharmaceutical public health measures including use of masks to mitigate the risk and impact of pandemic influenza was reviewed by a workshop convened by WHO in 2019; the workshop concluded that although there was no evidence from trials of effectiveness in reducing transmission, “there is mechanistic plausibility for the potential effectiveness of this measure”, and it recommended that in a severe influenza pandemic use of masks in public should be considered. Dismissing a low-cost intervention such as mass masking as ineffective because there is no evidence of effectiveness in clinical trials is in our view potentially harmful.

Mass masking is underpinned by basic public health principles that might not have been adequately appreciated by authorities or the public. First, controlling harms at source (masking) is at least as important as mitigation (handwashing). The population benefits of mass masking can also be conceptualised as a so-called prevention paradox—ie, interventions that bring moderate benefits to individuals but have large population benefits. Seatbelt wearing is one such example. Additionally, use of masks in the community will only bring meaningful reduction of the effective reproduction number if masks are worn by most people—akin to herd immunity after vaccination. Finally, masking can be compared to safe driving: other road users and pedestrians benefit from safe driving and if all drive carefully, the risk of road traffic crashes is reduced.

So there you have it. Mask up if you’re out and about in public. You know it makes sense!

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What Constitutes a “Reasonable Excuse”?

The United Kingdom’s National Police Chief’s Council has published new guidance on what constitutes a “reasonable excuse” to leave your residence during the current novel coronavirus lockdown. You can download a copy from:

https://www.college.police.uk/What-we-do/COVID-19/Documents/What-constitutes-a-reasonable-excuse.pdf

Of particular interest to me as a “silver surfer” is the part that states:

Exercise can come in many forms, including walks.

Exercise must involve some movement, but it is acceptable for a person to stop for a break in exercise.

It is lawful to drive for exercise.

Whilst surfing is not explicitly mentioned in the new document the current Police Commander for Cornwall has previously issued guidance on that form of exercise for the county:

According to “Cornwall’s top cop” before the new guidance was published:

Police BCU Commander for Cornwall, Temporary Chief Superintendant Ian Drummond-Smith said the recent guidance from the London-based National Police Chiefs Council was consistent with what his officers were doing on the ground but he reiterated that the public should not try and take advantage of the guidance.

He said: “Surfing has not been banned. It’s exercise and in Cornwall we know it’s a popular exercise. People can still surf. The question of driving a reasonable distance as per the NPCC guidelines, is ‘how far is reasonable’.

“The NPCC guidelines does not say whether you can or cannot drive to do your exercise. I am telling my officers people can surf and some may well drive to surf.”

Now all we denizens of the North Coast need to do is wait for the swell to be onshore and the wind to be offshore once again.

And to stay well over 2 meters away from anybody else with the same idea at the same time at the same beach!

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Covid-19 in South West England

Easter is almost here, and COVID-19 is already here:

http://cov-ehealth.org/2020/04/18/covid-19-in-the-united-kingdom/

Traditionally at this time of year the highways and byways of Devon and Cornwall fill up with pristine white caravans and camper vans. What will happen this year? According to Cornwall Live:

One of the leading officers at Devon and Cornwall Police has issued a strong message to people not to consider travelling to the region over the Easter weekend.

Chief Superintendent Ian Drummond-Smith, the police commander for Cornwall, said people found holidaying in the county face being fined and that officers will be out on two of the main routes into the region to prevent tourists arriving.

It comes after a caravan crashed on the M5 on Wednesday afternoon (April 8) near the Somerset-Devon border which led to criticism to the driver for flouting coronavirus lockdown travel advice from the Government, which says should be for “essential” trips only. Three people were arrested at the scene.

Mr Drummond-Smith said: “Our officers will be patrolling this weekend, firstly on the M5 and A30 in an attempt to prevent visitors from entering the force area, and then locally to enforce the restrictions.

According to Mr Drummond-Smith’s Twitter feed:

This extract from the Kings College COVID Symptom Tracker map provides some baseline data on the presence of cases of the novel coronavirus in this part of the world on April 1st:

This is no joke! Anecdotal evidence from the North Coast suggests that the percentage of people self identifying with coronavirus symptoms in the area is likely to increase over the next few weeks:

Here is an explanatory music video:

Watch this space!

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Covid-19 in the United Kingdom

Nassim Taleb is fond of one pagers these days, but he’s also into the precautionary principle, fat tails and “black swans”. Based on those principles he has argued for action on “climate change”:

We have only one planet. This fact radically constrains the kinds of risks that are appropriate to take at a large scale. Even a risk with a very low probability becomes unacceptable when it affects all of us – there is no reversing mistakes of that magnitude.

By way of a change, here’s an extract from a recent COVID-19 “note” of his:

The general (non-naive) precautionary principle delineates conditions where actions must be taken to reduce risk of ruin, and traditional cost-benefit analyses must not be used. These are ruin problems where, over time, exposure to tail events leads to a certain eventual extinction. While there is a very high probability for humanity surviving a single such event, over time, there is eventually zero probability of surviving repeated exposures to such events. While repeated risks can be taken by individuals with a limited life expectancy, ruin exposures must never be taken at the systemic and collective level. In technical terms, the precautionary principle applies when traditional statistical averages are invalid because risks are not ergodic.

Cartoon by John Farmer

I’m more used to posting the the University of Washington’s Polar Science Center’s modelled Arctic sea ice volume graphics, but here’s the UoW’s Institute for Health Metrics and Evaluation‘s UK COVID-19 death projections for a change:

Here in the once Great Britain we won’t have to wait a few decades to get a feel for how good Chris Murray’s coronavirus model is:

Here are the current official statistics from the United Kingdom’s Department of Health and Social Care:

As of 9am on 7 April, 266,694 tests have concluded across the UK, with 14,006 tests carried out on 6 April. Some individuals are tested more than once for clinical reasons.

213,181 people have been tested, of whom 55,242 tested positive. Today’s figure for people tested does not include Manchester and Leeds due to a data processing delay. The tests concluded figure excludes data from Northern Ireland.

As of 5pm on 6 April, of those hospitalised in the UK who tested positive for coronavirus, 6,159 have died.

and Office for National Statistics:

The provisional number of deaths registered in England and Wales in the week ending 27 March 2020 (Week 13) was 11,141; this represents an increase of 496 deaths registered compared with the previous week (Week 12) and 1,011 more than the five-year average.

A total of 150,047 deaths were registered in England and Wales between 28 December 2019 and 27 March 2020 (year to date), and of these, 647 involved the coronavirus (COVID-19) (0.4%); including deaths that occurred up to 27 March but were registered up to 1 April, the number involving COVID-19 was 1,639.

For deaths that occurred up to 27 March, there were 1,568 deaths in England registered by 1 April involving COVID-19 compared with 1,649 deaths reported by NHS England for the same period in a newly published dataset.

Of the deaths registered in Week 13, 539 mentioned “novel coronavirus (COVID-19)”, which is 4.8% of all deaths; this compared with 103 (1.0% of all deaths) in Week 12.

This is slightly lower than the figures reported by the Department of Health and Social Care (DHSC) for Week 13 (739) as it takes time for deaths to be reported and included in Office for National Statistics (ONS) figures.

Of deaths involving COVID-19 in Week 13, 92.9% (501 deaths) occurred in hospital with the remainder occurring in hospices, care homes and private homes.

Please note, where Easter falls in previous years will have an impact on the five-year average used for comparison.

[Edit – April 8th PM]

Here’s the current Kings College COVID Symptom Tracker map for South West England, dated April 1st:

For some strange reason North Devon is even more of a hot spot than Cornwall. Second home owning surfers down from London for the weekend?

Here’s the symptom tracker explanatory webinar:

Meanwhile, and only marginally off topic, whilst Donald Trump berates the World Health Organization for being too China-centric:

the IHME projects peak COVID daily deaths in the once United States will occur in a mere 4 days time:

P.S. James Annan, a “climate modeller though probably doing more epidemiology in the last couple of weeks”, has published a pertinent article on his blog entitled “Dumb and dumber“:

All these people exhorting amateurs to “stay in their lane” and not muddy the waters by providing analyses and articles about the COVID-19 pandemic would have an easier job of it if it wasn’t for the supposed experts churning out dross on an industrial scale.

The article describing [the IHME] method is here, it’s some sort of fancy curve fitting that doesn’t seem to make much use of what is known about disease dynamics. I may be misrepresenting them somewhat but we’ll see below what a simple disease model predicts.

James goes on to present the outputs of his “simple disease model” for the UK:

My model predicts a total of 8k deaths next week, with a 5-95% range of 4-19k. Yes it’s a wide uncertainty range, I think my prior on Rt is probably still too broad as I don’t really expect to see a value lower than 0.5 or higher than 1.5 (and these are just the 1sd spread limits in the above). But I am very optimistic that the median estimate generated by this method is better than the experts have provided, and they don’t seem to believe that anything in the lower half of my range is possible at all.

It will be exceedingly interesting to discover how all the numbers look on or about April 16th!

[Edit – April 9th]

Today let’s take a look at the “official” UK novel coronavirus death forecasts from Neil Ferguson’s team at Imperial College, with the help of James Annan’s latest article. He covers a variety of countries, but sticking with the United Kingdom for the moment:

Here is the current UK forecast…before today’s figure comes out.

This is the IC forecast for the UK for this week again (pink plume again, below). The data were already outside their range by yesterday. What on earth were they thinking?

What indeed! The Imperial College model seems to habitually “over forecast” the number of deaths due to COVID-19 here in the UK. Of course time will tell how much “under reporting” there has been during the pandemic.

[Edit – April 12th]

James Annan has produced an animation showing how his model evolves over time as more data becomes available:

His current forecast looks like this:

[Edit – April 14th]

Another week’s worth of COVID-19 mortality data has been released by the ONS. Included in the news release is this graph:

As suspected:

Nick Stripe, head of health analysis and life events at the ONS said:

“The latest comparable data for deaths involving COVID-19 with a date of death up to 3 April, show there were 6,235 deaths in England and Wales. When looking at data for England, this is 15% higher than the NHS numbers as they include all mentions of COVID-19 on the death certificate, including suspected COVID-19, as well as deaths in the community.

“The 16,387 deaths that were registered in England and Wales during the week ending 3 April is the highest weekly total since we started compiling weekly deaths data in 2005.”

[Edit – April 15th]

James Annan has submitted a paper about his Covid-19 epidemic model to medRxiv:

What’s more the R Markdown source code is available via GitHub!

https://github.com/jdannan/COVID-19-operational-forecast

[Edit – April 18th]

I discovered something deeply disturbing today. Whilst I happily admit to being an old sceptic, I generally subscribe to the “cock up” theory of history.

However today I noticed that my surfing tweet in the comments below, and retweeted at the time by Andrew “Cotty” Cotton, looked rather strange. I clicked through the link to Twitter, only to discover this:

Now I didn’t delete that Tweet, and Cotty wouldn’t have been able to do that even if he wanted to. Which does rather beg a question or two:

Who did delete my (subversive?) surfing images? And what are they so concerned about?

[Edit – April 21st]

The latest batch of weekly death certificate data has been released by the ONS. Would you like to play “spot the difference”?

  • The provisional number of deaths registered in England and Wales in the week ending 10 April 2020 (Week 15) was 18,516; this represents an increase of 2,129 deaths registered compared with the previous week (Week 14), is 7,996 deaths more than the five-year average and is the highest weekly total since Week 1 in 2000.
  • Of the deaths registered in Week 15, 6,213 mentioned “novel coronavirus (COVID-19)”, which is 33.6% of all deaths; this compares with 3,475 (21.2% of all deaths) in Week 14.
  • In London, over half (53.2%) of deaths registered in Week 15 involved COVID-19; the West Midlands also had a high proportion of COVID-19 deaths, accounting for 37.0% of deaths registered in this region.
  • Total deaths registered by place of occurrence between Week 11 (when first COVID-19 deaths were registered) and Week 15, the number of deaths in care homes has doubled by 2,456 deaths (99.4% increase); whilst we have seen a 72.4% increase (3,603 deaths) in hospitals, and 51.1% increase in private homes (1,392 deaths).
  • Of deaths involving COVID-19 registered up to Week 15, 83.9% (8,673 deaths) occurred in hospital with the remainder occurring in care homes, private homes and hospices.
  • Week 15 included the Good Friday bank holiday; the five-year average does show a decrease in registrations over the Easter holiday; however, the Coronavirus Act 2020 allowed registry offices to remain open over Easter, which may have reduced any drop in registrations for Week 15 2020.

[Edit – April 28th]

The ONS have released their latest weekly “death certificate” data:

  • The provisional number of deaths registered in England and Wales in the week ending 17 April 2020 (Week 16) was 22,351; this represents an increase of 3,835 deaths registered compared with the previous week (Week 15) and 11,854 more than the five-year average; this is the highest weekly total recorded since comparable figures begin in 1993.
  • Of the deaths registered in Week 16, 8,758 mentioned “novel coronavirus (COVID-19)”, which is 39.2% of all deaths; this compares with 6,213 (33.6% of all deaths) in Week 15.
  • In London, over half (55.5%) of deaths registered in Week 16 involved COVID-19; the North West and North East also had a high proportion of COVID-19 deaths, accounting for 42.3% and 41.1% respectively of deaths registered in these regions.
  • Of deaths involving COVID-19 registered up to Week 16, 77.4% (14,796 deaths) occurred in hospital with the remainder occurring in care homes, private homes and hospices.
  • The number of overall deaths in care homes for Week 16 was 7,316; this is 2,389 higher than Week 15, almost double the number in Week 14 and almost triple the number in Week 13.
  • Week 16 included the Easter Monday bank holiday, and the five-year average shows a decrease in registrations over the Easter holiday; however, the Coronavirus Act 2020 allowed registry offices to remain open over Easter, which may have reduced any drop in registrations for Week 16 2020.

Here’s the cumulative totals graph

Continued over here:

Covid-19 in the UK in May 2020