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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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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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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