But WHY do we need to flatten the curve? (anxiety warning!)

DeVore

You might think you know why, but there are some things that are going to shock you here.

WARNING:
Look, there are some things here that are Not Good [tm]. If you arent up for that, feel free to close the browser and play with your dog or go for a 2km walk and back. Your mental health is paramount. Other people have got this. Take the day off, we're good.

So, remember when Boris Johnson suddenly changed his mind and went from "I shake hands with everyone" to "for God's sake stay at home" practically overnight.... Well its because of a report from the Imperial College London. I've attached the report below and its good, if scary, work. Its a pretty terrifying read to be honest.

So, not wanting to scare people unnecessaraily I want to explain WHY we need to flatten the curve and what that actually looks like.

You might have seen this explanation or something like it.



Some of you are thinking "yes yes, I know about this".... but heres the problem: the jist of that graph is true (we need to not over load the health care system), but its soooo badly out of scale as to be almost fake.

The concept is good. The scale is deceptive.

Lets look at the UK.

The graph is pretty simple. On the bottom is Time Passing. On the left is the number of ICU beds needed per 100,000 population.

To be clear, thats not ventilator beds, thats Intensive Care Beds.
We have 1229 vents, with 900 arriving (should be here) and 100 a week on order.
Thats about 30-50 per 100k (this is good news).

So, the black line is the "do nothing" line and its pretty grim. The other lines arent much better but the orange line (the tactic Ireland is following) is a lot better than the others.

The terrifying thing is the red line. Yeah, that red line. The one almost at the bottom. That red line is the estimate surge capacity ICU beds in the NHS. Not the current capacity, the surge capacity. So, in the "Do Nothing" strategy, the peak has about 280 ICU beds needed per 100k population and 8 available.

Everyone, everyone above that red line isnt getting an ICU bed. Ireland has a very similar red line, if anything slightly worse but on this scale it hardly matters.



Just to zoom in on that line:



Now, being on a vent isnt a life saver, in fact there are a lot of bad numbers around vent usage at all. I dont want to go into that but really... needing a vent at all is very bad news. Needing a vent and not getting one.. I don't think I need to finish that sentence.

So when we say we need to flatten the curve. Thats the curve. We need to flatten that.


So we're doomed, dooooomed?!? Well, no. No we're not!

I'm going to write something tomorrow to explain why we arent doomed but here's the spoilers.
1. We are doing all the right things and our numbers look good day on day. Keep doing this. Our curve is flattening (we hope!).

2. The red line wont stay flat. We, the public, are buying time for the medical people, the army, the engineers and the politicians to build/supply/source more.

3. We're buying time for the world to maybe find a good way of treating/triaging this.

4. This is a model. Its a pretty good one but its still only a projection and a prediction. There are reasons why it might be wrong and more importantly there are things we can do to affect it, substantially.

I have staff to look after today and family, but I'll be here if anyone wants to ask questions.

Dont be scared. Be alert. Be informed.
Wash your hands. Stay inside.

Podge201

How will Sweden get on?

DeVore

Podge201 wrote: »

How will Sweden get on?

I dont have data for Sweden nor do I have a model built for them.

Ill see what I can find. There seems to be a reasonable variance between country predictions as each will be at a different point in the initial upward curve, with different compliance and different response approaches.

We have no medical indication that this virus is mitigated (or encouraged) by any genetic or medical property of a population.

In English that means it doesnt seem to be more vicious for one nation or another and we shouldnt expect to see differences *solely* on nationhood. It will depend on their actions.

You can see where they stand in comparison to other nations on sites like WorldOfMeters (which is excellent).

https://www.worldometers.info/coronavirus/#countries


ps: there does seem to be a susceptibility of men vs women, and pooooossibly some blood types BUT we need to be very careful making those kinds of statements because if you list 20 properties of people (hair colour, eye colour, height etc) and then look to see if any of them have a propensity to be susceptible or not susceptible to COVID, there is a very good chance that asking that many "questions" will return a positive/negative answer which SEEMS statistically significant simply by random chance.

Rufeo

The original post was a long post.

DeVore

Rufeo wrote: »

The original post was a long post.

It did have pictures.....

DeVore

Podge201 wrote: »

How will Sweden get on?

So quick look at their figures shows they have 1.5 times our cases (roughly) but 3 times our deaths.

That would lead me to believe they arent testing enough and are further up the graph than they believe. (my opinion).

Beasty

Podge201 wrote: »

How will Sweden get on?

Well they're not going to win the European Song Contest this year anyway

DeVore

Beasty wrote: »

Well they're not going to win the European Song Contest this year anyway

I think this IS the new ESC and one where Null Pointe is the top prize!

Sweet.Science

All very depressing . We are just slowing down Armageddon

manonboard

No questions. Just wanted to say i found it a clear and useful explanation.

Its making me thing about the lock downs and distance only lasting 5 months. I hate them. HATE them.. but to save alot of people in that orange line.. I'd be willing to deal with some suffering to help those.

I've got bad asthma and its not well controlled at the moment. Been badly controlled for nearly 10 weeks now.. I'm very scared. Trying my best though, and i very very much appreciate efforts of those without issues doing it for people like me.

It's odd to be in a high risk group. I'm 34. I run like the wind. I climb like a monkey. I eat 'well'. It's so oddly humbling to see its like a random lottery pick who is high risk.

manonboard

Do you think there is likely to be much increase in our surge capacity? Could we get to 30? 50 beds per 100k?

PaybackPayroll

Podge201 wrote: »

How will Sweden get on?

I believe (from something I saw) that they have far more one person households and they kind of 'naturally' socially distance themselves.

Hogzy

Am I correct in saying that the orange line above suggests that the UK will peak towards the end of 2020 if the current social measures remain in force? What is driving it to peak so late if all the social measures are adhered to between now and December 2020? I don't understand what is driving the December peak of the orange line in that graph.

Wibbs

Sweet.Science wrote: »

All very depressing . We are just slowing down Armageddon

Oh FFS. NO. No we are not. This is not armageddon or anything bloody like it.

Right. Imagine it's not 2020, but 1920. Imagine your class at school, look around that classroom. About a third would be dead before they were adults. Two years previously in the middle of a world war no less which killed millions, 50 plus million would be dead from influenza. Smallpox which kills a third of infected people and spread like this covid 19 was still a thing. Measles killed millions, polio crippled kids and adults and if you got an infection, well good luck, because no antibiotics. And in twenty years time you'd be looking down the barrel of another wider and more vicious world war which killed 80 million. And yet no armageddon then. In fact life and lifestyles in the west and elsewhere kept going in an upward curve and in short enough order we were flying to the moon and chugging martinis on Concorde.

People need to be aware, but they also need to get a bloody grip too.

GreeBo

So the obvious question seems to be, how long to we need to maintain social distancing to keep the numbers at or below the red line?
i.e. how long is the flat curve?

Vic_08

Hogzy wrote: »

Am I correct in saying that the orange line above suggests that the UK will peak towards the end of 2020 if the current social measures remain in force? What is driving it to peak so late if all the social measures are adhered to between now and December 2020? I don't understand what is driving the December peak of the orange line in that graph.

The later surge is what happens after the restrictions are lifted.

hmmm

The second wave per the models hits in the middle of flu season, which would be a disaster on the face of it.

However, every bit of time we buy ourselves gives us more time to develop therapeutics and build capacity. There are multiple drug trials ongoing, and some of the more interesting will be reporting results in April (Remdesivir in particular). Regeron's antibody is due to go into trials in June, and we should know within weeks if it is working or not.

If you're going to get this, get it last. That's when we'll know what works to treat this and what doesn't.

160 free ICU spaces two days ago and more coming on stream this week.
If we all adhere to the guidelines we can hopefully ensure everyone who needs ICU gets it and we can also minimise the numbers needing it.

RiseAbove4

So ...

We’re fúcked then?

All we’re really doing is slowing down the inevitable?



(Anyone else’s mental health in absolute bits more and more each day?)

deathbomber

Somewhat of a dramatic post, it is well known the number of ICU beds per head of population. People should adhere to the guidelines, full stop!

it irritates me when non medical professionals post up and then "explain" reasoning behind such reports, it is actually just as bad as the crap circulating on social media. There is information being made available to various healthcare professionals on a daily basis which you won't see published in mainstream media and for good reason.

Leave it to the professionals and behave and 99% chance you and loved ones will be fine!

darklighter

manonboard wrote: »

I've got bad asthma and its not well controlled at the moment. Been badly controlled for nearly 10 weeks now.. I'm very scared. Trying my best though, and i very very much appreciate efforts of those without issues doing it for people like me.

It's odd to be in a high risk group. I'm 34. I run like the wind. I climb like a monkey. I eat 'well'. It's so oddly humbling to see its like a random lottery pick who is high risk.

This is me to a tee.....except to make things worse, the gf is pregnant as well, so not ideal for either of us at present.

Its extremely depressing to see people not grasping the concept of adhering to social distancing, the typical Irish mentality of "sure it'll be grand" is not the approach to be taking at present :mad:

RiseAbove4

My gut feeling on this as soon as the schools were closed was “There’s no fùcking way our hospitals can handle this”

Whilst we have some absolutely incredible healthcare workers, our HSE system has felt akin to a Second World country’s for over a decade now

RiseAbove4

RiseAbove4 wrote: »

So ...

We’re fúcked then?

All we’re really doing is slowing down the inevitable? ...............

Not at all.

If we continue as we are going and more ICU spaces are made available anyone needing an ICU space might well get one. That's the best case scenario.
Results / number of cases up until now are more or less pre the measures brought in last Fri night to an extent.........






Green Total number hospitalised.
REd Total number admitted to ICU.

Earthhorse

I don't understand the point you're trying to make. We need to flatten the curve to prevent huge over capacity on beds and also to give us time to add more capacity.

What am I missing?

Earthhorse

Earthhorse wrote: »

I don't understand the point you're trying to make. We need to flatten the curve to prevent huge over capacity on beds and also to give us time to add more capacity.

What am I missing?

I am in same boat as you, I presume his key point is "The concept is good. The scale is deceptive.", in reference to the really simple graphs bandied about.

It's a strange post to start a topic with IMO.

deathbomber

deathbomber wrote: »

it irritates me when non medical professionals post up and then "explain" reasoning behind such reports, it is actually just as bad as the crap circulating on social media. There is information being made available to various healthcare professionals on a daily basis which you won't see published in mainstream media and for good reason.

Leave it to the professionals and behave and 99% chance you and loved ones will be fine!

This isn't crap. You can download the numbers yourself and do the same calculations and get the same conclusions if you have a reasonable knowledge of statistics. It corresponds with the best knowledge out there.

It irritates me that someone who has built a career and business on mathematical and statistical modelling and the understanding of same is somehow dumb when it comes to modelling medical emergencies and medical personnel are experts at it when the medical professionals turn to people like DeVore when faced with this.

If we ignore people like DeVore, we should just adapt the "herd immunity" strategy and our wonderful heroic medical personnel can end up like those in Italy, Spain, and very soon, the UK and the US.

Don't get me wrong, the medical professionals are fantastic, I have nothing but praise and admiration for them, but they aren't superhuman as some seem to think, they make mistakes too as we well know in this country.

I think they are currently doing a fantastic job, but the Irish people are doing a fantastic job too. The vast majority (99.99+ %) are adhering to social distancing, at least where I live, which wouldn't be the richest part of Cork city by a long shot.

Muahahaha

How many ICU beds does Ireland have per 100k population? Think I heard before we are lower than the UK who themselves are lower than some other European countries?

ITman88

Wibbs wrote: »

Oh FFS. NO. No we are not. This is not armageddon or anything bloody like it.

Right. Imagine it's not 2020, but 1920. Imagine your class at school, look around that classroom. About a third would be dead before they were adults. Two years previously in the middle of a world war no less which killed millions, 50 plus million would be dead from influenza. Smallpox which kills a third of infected people and spread like this covid 19 was still a thing. Measles killed millions, polio crippled kids and adults and if you got an infection, well good luck, because no antibiotics. And in twenty years time you'd be looking down the barrel of another wider and more vicious world war which killed 80 million. And yet no armageddon then. In fact life and lifestyles in the west and elsewhere kept going in an upward curve and in short enough order we were flying to the moon and chugging martinis on Concorde.

People need to be aware, but they also need to get a bloody grip too.

I have never agreed with a post more!

We have lived in the most privileged times ever experienced

Augeo

Augeo wrote: »

It's a strange post to start a topic with IMO.

Is it? I think it's a lot less strange than some media articles that report some random celebrity's opinion on the whole thing.

rossie1977

Muahahaha wrote: »

How many ICU beds does Ireland have per 100k population? Think I heard before we are lower than the UK who themselves are lower than some other European countries?

Both are around 7 per 100,000 about half of what Italy has or less than 1/4 of Germanys roughly 30 per 100k

deathbomber

Deleted User wrote: »

This isn't crap. You can download the numbers yourself and do the same calculations and get the same conclusions if you have a reasonable knowledge of statistics. It corresponds with the best knowledge out there.

It irritates me that someone who has built a career and business on mathematical and statistical modelling and the understanding of same is somehow dumb when it comes to modelling medical emergencies and medical personnel are experts at it when the medical professionals turn to people like DeVore when faced with this.

If we ignore people like DeVore, we should just adapt the "herd immunity" strategy and our wonderful heroic medical personnel can end up like those in Italy, Spain, and very soon, the UK and the US.

Don't get me wrong, the medical professionals are fantastic, I have nothing but praise and admiration for them, but they aren't superhuman as some seem to think, they make mistakes too as we well know in this country.

I think they are currently doing a fantastic job, but the Irish people are doing a fantastic job too. The vast majority (99.99+ %) are adhering to social distancing, at least where I live, which wouldn't be the richest part of Cork city by a long shot.

rubbish my wife is a medical professional and i didn't call the op poster dumb, however he is not a medical professional and there are a lot of key factors between the lines and not considered, the post is inaccurate at best

shesty

There are 2 axis on the graph.One is time, one is numbers (of cases).If you flatten the curve, you basically go further out on the X Axis...(the time axis) and therefore....you are extending the time period.

In doing so (and my thinking is still somewhat disjointed on this) you are buying yourself time.Essentially, many of the world's problem solvers will try to buy time in addressing a problem.It allows you to consider the problem further, see how solutions work, try different ones.Right now, we are buying time in order to fatten up our system, to be able to take more ICU patients.Be that taking over hotels, adding extra ICU beds, whatever.

The key thing to understand in all of this is that these things MIGHT be used.We are building contingency into the system, extra beds, buildings for isolation or whatever.I have seen posts where people have said things like oh god, we are building a temporary mortuary!!Oh god, we are putting in more ICU beds!!Oh god, we are all doomed!!

We are not doomed.This is risk planning, mitigation, contingency measures, whatever you want to call them. In other words, they are planning for the worst and hoping for the best.We do not want these things to have to be used...of course we don't ...but firstly, it is better to have them than be looking for them, and secondly...the fact that they are there doesn't mean that they WILL be used, or be used to capacity.

We need keep perspective.24 hour news coverage is very bad, and it skews everything way out of whack.Worse, because we have nothjng else to talk about these days.

Deleted User

Deleted User wrote: »

Is it? I think it's a lot less strange than some media articles that report some random celebrity's opinion on the whole thing.

By strange, I'm referring to the stay tuned until tomorrow where I'll explain more, that's after the be afraid be very afraid opener.
It's part one of a two part, I find that strange........ no need for it. Wait until you can post the entire thing.

sydthebeat

Muahahaha wrote: »

How many ICU beds does Ireland have per 100k population? Think I heard before we are lower than the UK who themselves are lower than some other European countries?

We are adding to that number very day, so any official number from a month ago will be void.

sydthebeat

sydthebeat wrote: »

We are adding to that number very day, so any official number from a month ago will be void.

This is true but at most we can double or maybe triple it. Not increase by a factor of 20 or more.

DeVore

RiseAbove4 wrote: »

So ...

We’re fúcked then?

All we’re really doing is slowing down the inevitable?



(Anyone else’s mental health in absolute bits more and more each day?)

Sweet.Science wrote: »

All very depressing . We are just slowing down Armageddon

No, we are averting it. If we do nothing, its not armeggeddon but it is very very ugly with many deaths.

If we slow it down, we buy ourselves and the health care givers, doctors, nurses, researchers time. Time to treat people. Time to find medicines which work, time to increase beds, time to rest and recuperate themselves (many are getting sick).

We just need time.

deathbomber

DeVore wrote: »

No, we are averting it. If we do nothing, its not armeggeddon but it is very very ugly with many deaths.

If we slow it down, we buy ourselves and the health care givers, doctors, nurses, researchers time. Time to treat people. Time to find medicines which work, time to increase beds, time to rest and recuperate themselves (many are getting sick).

We just need time.

and all of this has been known for weeks, your post is click bait and making anxious people more anxious

growleaves

Well its because of a report from the Imperial College London.

This ICL model is the one being followed by most governments around the world.

Dr. Neil Ferguson of Imperial College London also created the model which predicted up to 150,000 people could die from the human form of BSE ('mad cow diseases'). To date less than 200 people have died from it.

4. This is a model. Its a pretty good one but its still only a projection and a prediction. There are reasons why it might be wrong

..and why the models put forward by such fringe outfits as Oxford University might be right.

A Guardian article on the OU model said:

Models based on assumptions in the absence of data can be over-speculative and ‘open to gross over-interpretation’

Very true but also applicable to the worst-case-scenario models put forward by Fauci and Ferguson.

DeVore

Hogzy wrote: »

Am I correct in saying that the orange line above suggests that the UK will peak towards the end of 2020 if the current social measures remain in force? What is driving it to peak so late if all the social measures are adhered to between now and December 2020? I don't understand what is driving the December peak of the orange line in that graph.

The model presumes that social mitigation stops in Sept2020. As a result the virus just goes right back to doing what it was doing and spreads as it would if they did nothing.

This is not a very good part of the model. It should have modeled a more gradual return to "normality" which a general loosening and retightening of the restrictions over time in order to ease out of them. Other parts of the document DO talk about that.

Its instructive to see how just "going back to normal" with a big bang, simply un-pauses the virus and it goes back to spreading (which you would expect if nothing else changes in the meantime).

DeVore

GreeBo wrote: »

So the obvious question seems to be, how long to we need to maintain social distancing to keep the numbers at or below the red line?
i.e. how long is the flat curve?

Thats really not something I can answer, there are far too many variables in the mix to do much more than crystal-ball gaze. Its probably possible to give a "lowest bound" (ie: the very minimum we can expect) but even doing that I'm not comfortable opining on.

Doyler99

DeVore wrote: »

No, we are averting it. If we do nothing, its not armeggeddon but it is very very ugly with many deaths.

If we slow it down, we buy ourselves and the health care givers, doctors, nurses, researchers time. Time to treat people. Time to find medicines which work, time to increase beds, time to rest and recuperate themselves (many are getting sick).

We just need time.

Time for what exactly? Vaccines won't be available for another 12 months at least from what I'm reading. We are what 4 days into this 2 week "lockdown" with a very high chance it will be renewed on a rolling basis every 2 weeks to stop the population going bonkers - The whole situation is just so depressing.

DeVore

Earthhorse wrote: »

I don't understand the point you're trying to make. We need to flatten the curve to prevent huge over capacity on beds and also to give us time to add more capacity.

What am I missing?

Probably not much, but possibly. (You are not everyone tho )

1. The simple scale of the "ask".

2. The way that the most vulnerable will be predominantly pushed into "no beds, no vents" group (as per Italy and other places. We have similar intentions here, cf: https://www.gov.ie/en/publication/a02c5a-what-is-happening/#ethical-framework-for-decision-making-in-a-pandemic).
As a consequence, IF we end up exceeding the ICU limit, mortality rates suffer disproportionately.

Alf Veedersane

RiseAbove4 wrote: »

So ...

We’re fúcked then?

All we’re really doing is slowing down the inevitable?

No. We slow down the rate of increase in cases to a manageable number. In theory, the same number of cases but over a much longer time frame.

Take a small funnel. Pour a load of water into it quickly....the flow out the bottom is much smaller than what's going in and so lots of water overflows the top.

If you pour water in more slowly, the water goes out the bottom and water doesn't overflow the top.

But the same quantity of water has been through the funnel. In the first instance, where the water went in quickly and overflowed, that overflow is people in need of intensive care but there was no capacity left. The overflow is people dying.





That sounds like a rather bizarre analogy but I think it gives the idea. I think...

Ballso

What a bizarre thread

DeVore

Muahahaha wrote: »

How many ICU beds does Ireland have per 100k population? Think I heard before we are lower than the UK who themselves are lower than some other European countries?

Its hard to say, there are differences in ICU beds, Critical Care Beds, Ventilators etc.

According to this source: https://www.siliconrepublic.com/companies/medtronic-double-production-ventilators-galway-ireland
There are 30 Vents per 100k people here with another ~22 coming.

But critical care beds are something else and sources are poor for that.

DeVore

deathbomber wrote: »

rubbish my wife is a medical professional and i didn't call the op poster dumb, however he is not a medical professional and there are a lot of key factors between the lines and not considered, the post is inaccurate at best

I'm not making any appeals to authority OR medical prounoucements that arent backed by sources (which you can check for yourself).

I am a mathematician, and skilled in model building, and run a company of data scientists. We dont build models for the healthcare community but numbers are numbers.

If you want to challenge any assertions I've made, please, genuinely, feel free to do so.

My intent isnt to scare anyone, just to make people aware of the scale of the task ahead.

DeVore

Augeo wrote: »

By strange, I'm referring to the stay tuned until tomorrow where I'll explain more, that's after the be afraid be very afraid opener.
It's part one of a two part, I find that strange........ no need for it. Wait until you can post the entire thing.

Yeah sorry, I intend to do a post most days to try to bring some science to this discussion. Tomorrows ISNT a second part of todays but it IS more hopeful. I didnt intend to sound like it was a cliff hanger but I also have a company to run, staff to manage from home, a family packed with underlying conditions to tie to chairs and budgets to rip up and redo.

I opened this thread because I was curious. Then saw the Warning. I didn't read on but my heart is still beating harder than a few minutes ago. Have a bit of cop on and put your warning in the thread title.

DeVore

deathbomber wrote: »

and all of this has been known for weeks, your post is click bait and making anxious people more anxious

YOU may have known all this for weeks but in this very thread there are people going "WTF?!".

I'm genuinely trying to explain the scale to people who arent yet aware and think this is all going to be over by Easter. This is a counter point to the "sure why dont we just all go back to the pub and save the economy" crowd. The "flatten the curve" explanations that have been passed around are good but they really hide the breadth of this thing. At some stage we have to stop and face that because its not going away on its own.

DeVore

Deleted User wrote: »

I opened this thread because I was curious. Then saw the Warning. I didn't read on but my heart is still beating harder than a few minutes ago. Have a bit of cop on and put your warning in the thread title.

A. It wont fit. (edit: I made something fit...)

B. If you didnt read the rest of the post, why would the same warning in the title make you any less anxious?

C. As a fellow anxiety sufferer, sorry. That wasnt my intention but this stuff is important.

DeVore

DeVore wrote: »

A. It wont fit. (edit: I made something fit...)

B. If you didnt read the rest of the post, why would the same warning in the title make you any less anxious?

C. As a fellow anxiety sufferer, sorry. That wasnt my intention but this stuff is important.

Knowing there is a warning in the title tells me its something to stay away from. That's all.
Anxiety was never really a thing for me until all of this but now I'm working hard to keep my head. There are a lot of other people like me.