I am optimistic that this will feel very different and better by the spring
It is not just that we have ever better medicine and therapies, and the realistic hope of a vaccine in the first quarter of next year
We now have the immediate prospect of using many millions of cheap, reliable and above all rapid turnaround tests
Tests that you can use yourself to tell whether or not you are infectious and get the result within ten to 15 minutes
And we know from trial across the country in schools and hospitals that we can use these tests not just to locate infectious people but to drive down the disease
And so over the next few days and weeks, we plan a steady but massive expansion in the deployment of these quick turnaround tests
Applying them in an ever-growing number of situations
From helping women to have their partners with them in labour wards when they’re giving birth to testing whole towns and even whole cities
The army has been brought in to work on the logistics and the programme will begin in a matter of days
Working with local communities, local government, public health directors and organisations of all kinds to help people discover whether or not they are infectious, and then immediately to get them to self-isolate and to stop the spread
The precise nature of all these “cheap, reliable and above all rapid turnaround tests” is rather vague though. Presumably Boris has his “Operation Moonshot” in mind?
Shortly after the initial Moonshot revelations in September the BMJ had this to say:
The documents talk about “buying large scale capabilities” from partners such as the drug company GSK to “build a large scale testing organisation.” However, under “potential partners for increasing laboratory capacity” the documents list only the company AstraZeneca. Under logistics and warehousing, the documents list potential partners as Boots, Sainsbury’s, DHL, Kuehne+Nagel, G4S, and Serco. Under workforce are listed universities, the Society of Microbiologists, and the British Society of Immunology.
Alongside mainly commercial partnerships, the documents also state that a number of new tests and technologies would need to be used, including some that do not yet exist.
“Delivering testing at the scale and level of ambition set by the prime minister is likely to mean developing, validating, procuring, and operationalising testing technology that currently does not exist,” the plans state. Lower sensitivity testing for “screening/enabling purposes” could also be used, with polymerase chain reaction (PCR) testing then used to “confirm positive results or in situations where accuracy is needed for highest risk individuals.”
Testing technology listed in the documents includes qrt-PCR, Endpoint PCR, LAMP, LamPORE, lateral flow antigen test, and whole genome sequencing. Two of these tests—lateral flow antigen tests and LAMP—are listed as having a “lower sensitivity” of between 80% and 100%.
I cannot help but wonder how development of those “tests that do not yet exist” is coming along? According to the Financial Times today:
As England prepares to enter its second national lockdown on Thursday, the government’s Operation Moonshot plan to deliver a mass population testing programme is back under the spotlight. According to documents reviewed by the Financial Times, the Department of Health has awarded contracts worth at least £1bn to companies providing rapid testing. Many of the technologies relating to these contracts will feed into the Liverpool trial, in which everyone living or working in the city will be eligible for a test from Friday. The strategy will hinge on new lateral flow tests, which give results in 20 minutes and can be performed on a throat or a saliva sample, as well as conventional swab tests and loop-mediated isothermal amplification (LAMP) technology.
The pilot is expected to last about two weeks, with tests being deployed by the army, and could allow teachers, pupils and hospital staff to be tested weekly. But scientists have raised concerns over the accuracy of some of the lateral flow tests being used, which are prone to missing cases of active infection. Meanwhile, delays in assessing technologies produced in the UK have led to frustration over government contracts being awarded to overseas companies.
The government has signed at least 10 contracts with companies based in the UK, US and China, totalling more than £1bn, for rapid testing technology and logistics, according to publicly available contracts on the EU public procurement site, Ted, and information shared with the non-profit legal firm the Good Law Project.
My apologies for the rather more than brief hiatus in this series of articles. One reason is that on June 18th The Guardian reported that:
The government has been forced to abandon a centralised coronavirus contact-tracing app after spending three months and millions of pounds on technology that experts had repeatedly warned would not work.
In an embarrassing U-turn, Matt Hancock said the NHS would switch to an alternative designed by the US tech companies Apple and Google, which is months away from being ready.
Another reason is that I am currently sat at my keyboard on Burrator Ward at Derriford Hospital in Plymouth, where I am recovering from a non trivial triple coronary artery bypass operation, and have just washed my hands in accordance with the instructions in the unisex toilets:
There are other reasons too, but for now let’s continue with the latest news from the Downing Street propaganda machine:
Amongst a variety of other words uttered during yesterday evening’s press conference Boris Johnson had this to say:
Even in the South West, where incidence was so low, and still is so low, it is now clear that current projections mean they will run out of hospital capacity in a matter of weeks unless we act.
And let me explain why the overrunning of the NHS would be a medical and moral disaster beyond the raw loss of life
Because the huge exponential growth in the number of patients – by no means all of them elderly, by the way – would mean that doctors and nurses would be forced to choose which patients to treat
Who would get oxygen and who wouldn’t
Who would live and who would die,
And doctors and nurses would be forced to choose between saving covid patients and non-covid patients
And the sheer weight of covid demand would mean depriving tens of thousands, if not hundreds of thousands, if not millions, of non-covid patients of the care they need
It is crucial to grasp this that the general threat to public health comes not from focusing too much on covid, but from not focusing enough, from failing to get it under control.
I am told that it is quite normal to experience a wide range of emotions when recovering from a major operation.
This morning I awoke in a howling rage. My blood pressure is currently 134/82.
[Edit – November 6th]
A video update from Ann James, Chief Executive of University Hospitals Plymouth NHS Trust:
Our [Covid-19] numbers are beginning to rise, and they’re rising quite quickly. So at a really important time, a critical time, we set out what our next steps are to make sure that we can keep everyone safe and supported during what I know is another really difficult time for everyone.
We have already needed to make some changes to the hospital. We’ve had to change the use of some of our wards as we increasingly care for a growing number of Covid patients, and we’re looking to change some of our other services.
For the start of our UK “Covid-19 messaging” series please click here.
This is the message Boris Johnson apparently wanted to impart to the citizens of England on May 22nd 2020:
Then came the news that BoJo’s “senior aide” Dominic Cummings had risked spreading the virus by driving from London to Durham. By the morning of May 24th the front pages of the “conservative” mainstream media looked like this, with thanks once again to Neil Henderson‘s Twitter feed:
On the evening of May 24th Boris retweeted a message from 10 Downing Street, then somewhat unusually stood behind the lectern at the Covid-19 daily briefing and refused to throw his top aide to the dogs. Try starting to watch the video at around 4:30:
The following morning I found myself agreeing with a Daily Mail headline for probably the first time in living memory:
Alternative points of view were less critical of Mr. Cummings’ actions:
I wonder how the Times’ promised “cabinet backlash” will pan out? I also cannot help but wonder how many Great British citizens will ignore the messages imparted in any future Tweets by Boris Johnson.
The hints are dropping with greater frequency. My Member of Parliament writes to tell me that:
The Prime Minister has said today during Prime Ministers Questions that he will be setting out the next steps that the UK will take this coming Sunday. I await his comments with bated breath – as I am sure many others do.
I certainly have my breath bated! The note continues:
On the subject of tracing and tracking cases, the Health Secretary Matt Hancock said this yesterday:
“We are developing a new test, track and trace programme to help to control the spread of covid-19, and to be able to trace the virus better as it passes from person to person. This will bring together technology through an app, an extensive web of phone-based contract tracing and, of course, the testing needed to underpin all that. The roll-out has already started on the Isle of Wight, and I pay tribute to and thank the Islanders for the enthusiasm with which they have taken up the pilot. I hope that we learn a lot from the roll-out, so that we can take those learnings and roll the programme out across the whole country.”
He added that “…the more people who download the app, the more people will protect themselves, their families and their communities.”
Here’s a recording of this evening’s Covid-19 daily briefing in Downing Street, hosted on this occasion by Robert Jenrick, Secretary of State for Housing, Communities and Local Government:
At 49:30 Keith Rossiter, representing the Western Morning News and Cornwall Live, asks some South West specific questions. One of his questions was:
Sir Patrick Vallance suggested on Tuesday that regions with fewer cases of Covid-19 could come out of lockdown early. How would that work and, if it were to be implemented, what support might there be for Devon and Cornwall Police – already over-stretched – to prevent a large scale invasion of the Westcountry?
We’re providing additional funding to forces and the Home Secretary is speaking with national police chiefs to ensure they have the right guidance and consistent messaging they can use to enforce the lockdown rules when that’s required. As we’ve seen so far the vast majority of members of the public have chosen to do so and adhere to the messaging and most police forces have been able to support the lockdown measures through consent which is the way we want to do things in this country but in the isolated number of cases when this has not been possible they’ve had tools at their disposal to fine and enforce the lockdown.
So no confirmation that easing of the UK lockdown will start in South West England, but no denial either. Whilst we wait for Sunday’s announcement, here’s what Sir Patrick Vallance had to say yesterday. According to Cornwall Live:
England’s chief scientific adviser has hinted that rural regions, such as the Westcountry, might have their Covid-19 lockdown eased sooner than big cities.
Sir Patrick Vallance told MPs on the Health and Social Care Committee that the disease was more prevalent in cities and densely populated places than in rural areas.
But he acknowledged that a regional approach would require the flow of people between regions to be controlled.
Last month former health secretary Jeremy Hunt, who is now chair of the Health and Social Care Select Committee, named Cornwall as an area that could have its restrictions lifted before the rest of the UK.
[Edit – May 7th]
Does this retweet tell this morning’s horror story adequately?
Absolutely disastrous #Covid19UK framing courtesy of all the usual suspects.
We have reported recently on both the United Kingdom’s attempts to meet their stated “100,000 tests per day by the end of April” target and the subsequent setting up of the “Independent SAGE” committee by Sir David King, which we initially dubbed the “Alternative SAGE” committee, or “Alt SAGE” for short.
The first Independent SAGE committee meeting will be broadcast on YouTube at 12:00 BST today. We cannot help but wonder if they will discuss the concept of “Mass Periodic Testing”, or MPT for short.
In Editor’s Choice of 19 March Godlee mentions the urgent need for increased capacity to test frontline healthcare workers serologically to verify their immunity to the covid-19 virus. Even more urgent is capacity for weekly viral detection in the whole UK population. This, together with intensive contact tracing, could enable the country to resume normal life immediately. The virus could only survive in those who are untested, and contact tracing would often lead to them. Within the tested population anyone infected would be detected within about a week (0 to 7 days plus sample transport and testing) of becoming infectious.
Prof. Peto’s suggestion involves testing the vast majority if the population of the UK for Covid-19 every week. His letter continues:
Centrally organised facilities with the capacity to test the entire UK population weekly (in 6 days at 10 million tests per day) can be made available much more quickly and cheaply than a vaccine, probably within weeks. This heroic but straightforward national effort would involve a crash programme to enlist all existing PCR (polymerase chain reaction) facilities, acquire or manufacture the PCR reagents, and agree protocols including a laptop program for barcode reading in smaller laboratories. The US Food and Drug Administration (FDA) has just authorised a test kit for detecting the Covid-19 virus that can be run on machines used in the NHS for HPV screening. Only laboratories that do PCR routinely would participate, subject to central quality control and at cost price. The Wellcome Sanger Institute, UK Biocentre, and smaller academic laboratories, together with all commercial facilities, should have enough machines or can get more immediately from the manufacturers. The 24-hour extra staffing to run their machines continuously would be bioscience students, graduates, and postgraduates familiar with PCR who already work in or near the laboratory. Processing capacity equivalent to 4000 Roche COBAS 8800 systems is needed, and the UK may already have both the machines and the trained staff in post or immediately available.
As you may have noticed, such a “heroic effort” has not yet begun. We have not yet achieved a consistent 100,000 tests per day, let alone the 10 million tests per day envisaged by Julian Peto. Skipping to his conclusion:
By the time the first test is done there may be more than a million infected people who must be treated or remain quarantined at home or in care until all residents at the address test negative. That unavoidable crisis for the NHS would be ameliorated by earlier diagnosis and treatment, and hence reduced pressure on intensive care, and by having all staff as well as patients tested regularly. Contacts of positive people who test negative could choose continued home quarantine or, at little extra risk, choose to join a group of up to 10 test-negative contacts (usually with other family members). Subsequent weekly national testing, together with behavioural changes and efficient contact tracing, would find progressively fewer infections and might soon be extended to a month. This emergency system would only be needed for about 2 months but could be rapidly reintroduced to control any future epidemic caused by a new virus.
Five weeks have elapsed since the letter was published, and an avoidable crisis for the NHS is still ongoing. According to Boris Johnson’s Twitter feed over the weekend:
Five – We must make sure that any adjustments to the current measures do not risk a second spike that would overwhelm the NHS. – 6/6
— Boris Johnson #StayHomeSaveLives (@BorisJohnson) May 3, 2020
When today’s lunch time meeting has concluded will the Alt SAGE committee have recommended an “end [to] the absurd, dystopian and tyrannical lockdown”, mass periodic testing or some alternative “middle way”?
Idly perusing the online version of The Sunday Times in anticipation of more BoJo bashing I instead stumbled across some discreet Dom bashing from an illustrious source. According to an article by Caroline Wheeler, Deputy Political Editor of the Sunday Times:
The government’s former chief scientific adviser is convening a rival panel of experts to offer advice on easing the lockdown.
Tomorrow Sir David King will chair the first meeting of the group, which is designed to act as an independent alternative to the government’s Scientific Advisory Group for Emergencies (SAGE).
The move comes after weeks of unease about the transparency of SAGE decision-making. It has emerged that 16 of the 23 known members of the committee, which meets in secret, are employed by the government.
The independent group will broadcast live on YouTube and take evidence from global experts. It aims to present the government with “robust, unbiased advice” and some evidence-based policies to tackle the Covid-19 pandemic.
The committee will formally submit its recommendations to the health and social care select committee, heaping pressure on Boris Johnson as he draws up the government’s lockdown exit strategy.
The whole idea sounds crazy, until you consider how the official Covid-19 daily briefings are already spinning like crazy!
Sir David also has his very own Twitter feed, via which he announced:
Science is a discipline based on peer review, therefore it is critical scientific advice is transparent. We are convening this meeting not to criticise the scientists on SAGE but to ensure that what we believe is the best science is available and in the public domain. https://t.co/ZaZXJuI1TT
Speaking before tomorrow’s meeting, which will be followed by a news conference, King said: “Science is fundamentally a system based on peer review. When it comes to scientific advice of any kind, transparency is essential.”
He added: “I am not at all critical of the scientists who are putting advice before the government . . . but because there is no transparency the government can say they are following scientific advice but we don’t know that they are.”
Dominic Cummings, a top aide to the prime minister, has attended the secret meetings of SAGE.
“Cummings is an adviser to the prime minister. And the chief scientific adviser is an adviser to the prime minister. So there are two voices from the scientific advisory group and I think that’s very dangerous because only one of the two understands the science,” King said.
The committee has a draft agenda and is seeking to end the pandemic “with the fewest casualties possible”.
Currently the YouTube URL at which tomorrow’s Alt SAGE meeting will be broadcast has not been revealed, so…..
[Edit – May 12th]
The Independent SAGE committee have just published their recommendations. We “retweeted” them forthwith!
To summarise the committee’s recommendations to Her Majesty’s Government concerning “Transitioning from lockdowns and closures”:
Four key components to managing transitions and modulating restrictive measures
Public health and epidemiological considerations must drive the decision-making process.
Available capacity for dual-track health system management to reinstate regular health services, while at the same time continuing to address COVID-19.
Leveraging social and behavioural perspectives as tools for responsive engagement with populations.
Social and economic support to mitigate the devastating effects of COVID-19 on individuals, families and communities.
Six conditions should be used as the basis to implement/adapt transitioning of measures
Evidence shows that COVID-19 transmission is controlled.
Sufficient public health and health system capacities are in place to identify, isolate, test and treat all cases, and to trace and quarantine contacts.
Outbreak risks are minimized in high vulnerability settings, such as long-term care facilities (i.e. nursing homes, rehabilitative and mental health centres) and congregate settings.
Preventive measures are established in workplaces, with physical distancing, handwashing facilities and respiratory etiquette in place, and potentially thermal monitoring.
Manage the risk of exporting and importing cases from communities with high-risks of transmission.
Communities have a voice, are informed, engaged and participatory in the transition.
Four cross-cutting mechanisms that are essential enablers throughout the transition process
Governance of health systems.
Data analytics to inform decisions.
Digital technologies to support public health measures.
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 wastaken 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?
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:
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:
The Sunday Times article published today 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. Read our full response here: https://t.co/J0cNHH92Dm
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.
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.
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.
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.
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.
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:
President Trump said he was looking into putting a hold on the U.S. contribution to the @WHO, claiming ‘they’ve been wrong about a lot of things’ related to the coronavirus and accusing it of being too China-centric pic.twitter.com/whkUDJ743w
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!
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:
Saturday’s forecast. Assuming that 917 really is the right number, I’m saying this is the peak. If Whitty is right about hospital admissions rising (and it’s due to clinical need not expanded capacity) I may be proved wrong, but death data alone say a decline is likely imminent. pic.twitter.com/6cu2KOXJfW
Another week’s worth of COVID-19 mortality data has been released by the ONS. Included in the news release is this graph:
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:
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.