The maths of it all and what it means to Ireland

normanoffside

normanoffside wrote: »

That's the thing. Long term there are pros and cons to each approach

But if they develop a vaccine (or even a treatment) we should have a much lower death rate?

normanoffside

Deleted User wrote: »

But if they develop a vaccine (or even a treatment) we should have a much lower death rate?

Unless a vaccine comes about quite fast, effective herd immunity should be achieved before it (my opinion).

IAMAMORON

Deleted User wrote: »

But if they develop a vaccine (or even a treatment) we should have a much lower death rate?

normanoffside wrote: »

Unless a vaccine comes about quite fast, effective herd immunity should be achieved before it (my opinion).

If we get a vaccine by Christmas we will be laughing. You will be quicker growing spuds. Obviously a lot of resources will be focused on generating one. However there is the time factor which needs to be considered when designing vaccines. At some point human Guinea Pigs need to be introduced and then you also need to test for months after, not just to see if the vaccine is working, but also to investigate if there is any potential for nasty side effects.

As well as Antibody testing I hope they are also checking for mutations. This is vital information long term.

Jurgen Klopp

I fully believe if Oxford University has there's ready for September like they believe it will be waved through under emergency, just like swine flu , declared a pandemic in April and injections that November

Up to lads whether they'll risk it but I think so many are panicked they will the old and very vulrenable anways

Jurgen Klopp

normanoffside wrote: »

Another study in California suggests that the infection rate is at least 50 times higher than the official figures meaning the mortality rate is 0.2% at worst.


https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought

Just parking this here so one of us will keep an eye out for the results

Other large-scale sample studies are currently underway. The National Institute of Health is testing 10,000 people. UC Berkeley is going to test 5,000 healthy volunteers to see if they have, or have ever had, the coronavirus

IAMAMORON

Jurgen Klopp wrote: »

I fully believe if Oxford University has there's ready for September like they believe it will be waved through under emergency, just like swine flu , declared a pandemic in April and injections that November

Up to lads whether they'll risk it but I think so many are panicked they will the old and very vulrenable anways

Not altogether that simple. A pharmaceutical company is not going to risk contingent litigation based on selling a vaccine that is not suitable or indeed could endanger end patients. For example if a rushed up vaccine gives you an irreversible cancer next year it kind of defeats the point and is certainly not worth the risk. Drug production is profit orientated, pharma will not be releasing risky vaccines early, they will wait 6 months and release it then, they will still make the money anyway.

Hmmzis

I think in the short term the smart money is on one or some of the existing antivirals having a positive effect on outcomes.
If one of them reduces ICU admissions by half and does the same for mortality, then at least it's possible to have society back to some form of normality. That would give the vaccine developers the time needed to find one or few and make sure they're safe.

IAMAMORON

I agree. I think every day the world is learning new ways to deal with the virus. Overtime this will see a reduction in deaths and better treatments. Lives will be saved. This is also why current death rate percentages need to be scrutinised, they are based on a reactive approach to treating the virus. Doctors will be learning better techniques over time.

alwald

IAMAMORON wrote: »

I agree. I think every day the world is learning new ways to deal with the virus. Overtime this will see a reduction in deaths and better treatments. Lives will be saved. This is also why current death rate percentages need to be scrutinised, they are based on a reactive approach to treating the virus. Doctors will be learning better techniques over time.

Exactly, that was the point I was making a couple of pages back, current death rate based on confirmed cases is so important. I would like to understand why Germany has a 5% death rate on confirmed cases, meanwhile other hard hit countries in Europe have a far higher rate, like Spain with 21%, Italy with 34% and France with 35%.
What is/are the key(s) element(s) to these huge variations?

normanoffside

alwald wrote: »

Exactly, that was the point I was making a couple of pages back, current death rate based on confirmed cases is so important. I would like to understand why Germany has a 5% death rate on confirmed cases, meanwhile other hard hit countries in Europe have a far higher rate, like Spain with 21%, Italy with 34% and France with 35%.
What is/are the key(s) element(s) to these huge variations?

More testing/community testing.
Catching mild cases which don't need hospital treatment.

fr336

This is a useless post but just wanted to say thank you to all posters in here. Very interesting stuff and am I alone in being reassured (kind of) by numbers at a time like this? Cheers all.

alwald

normanoffside wrote: »

More testing/community testing.
Catching mild cases which don't need hospital treatment.

The testing per 1M done by Germany, Spain and Italy is literally the same and yet there are huge variations regarding the death % for confirmed cases.
On top of that Germany has more recoveries than Spain, Italy and France so there must be something else.
I am not buying that more testing is the key difference as it is a tool to reduce the spread and not a cure in itself.

ShineOn7

normanoffside wrote: »

Another study in California suggests that the infection rate is at least 50 times higher than the official figures meaning the mortality rate is 0.2% at worst.


https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought

How are the Guardian is terms of being a good source? They started off very strong and very good since all this began

I'm just thinking that they now post so much info about studies, trials and tests that maybe their own quality control has dropped?

I really hope it's true though. O.2% would definitely see a return to somewhat normality, with sporadic lockdowns implemented if there's a another surge, for example, this Winter

alex_cronin

IAMAMORON wrote: »

If you could elaborate on your core data here, the 4.9 m is fine ( republic population ) , but what probabilities are you basing the other percentages on?

I am a new member and so cannot post URLs for day days + 50 posts. But If you want to post them I can send them to you.

The .037% German number is only one hot spot in one country in the world over a finite 5 week period. Any extrapolations thereof are ignoring the propensity for scenarios deviation, this virus is not a constant, any historical data used to forecast future scenarios need to anticipate change.

The .037% does not appear to be peer reviewed and the original study is in German so I cannot read it. The lancet version appears to be more reliable. Numbers will vary based on age/genetics/preexisting conditions/age/wealth etc. of the populations. Changes can be predicted as up or down. Attitude has a lot to do with your actions performed in preparation.

Day 69 is not correct either. I have sunday 1st of March, which puts us currently on day 49. You're missing 20 days?

I made an error here you are correct.

ShineOn7

alex_cronin wrote: »

Without a vaccine we will be playing the long game based on the number below, I would welcome additional links to models and details on hospital beds, ICU beds, average lengths of patient stay. If someone is kind maybe they could PM me and I can send them some links to post related to below. Please let me know any errors.

So with a death rate of between
* 0.37% (German study - does not appear to be peer reviewed)
* 1.38% (lancet.com)
and a population of 4.9 million - central statistics office

And an R0 between 2.2 and 5.7 (worst case) and 70 to 82% to achieve heard immunity (US CDC)
We are at day 69 since our first case (RTE News) -*** should had said 49 days **

If we do not wait for a vaccine and we want the current level of patient care
* 55’200(4.9m*82%*1.38%) to 12’691 (4.9m *70%*0.37%) dead to achieve heard immunity and
* 160'720 (4.9m*82%*4%) to 137'200(4.9m*70%*4%) ICU beds assuming 4% goes through ICU
* 642'880 (4.9m*82%*16%) to 548'800(4.9m*70%*16%) non ICU beds assuming an additional 16% goes to hospital

Are you saying you believe that, over the next 12 months, that Covid will kill at least around 12,000 people?

normanoffside

alwald wrote: »

The testing per 1M done by Germany, Spain and Italy is literally the same and yet there are huge variations regarding the death % for confirmed cases.
On top of that Germany has more recoveries than Spain, Italy and France so there must be something else.
I am not buying that more testing is the key difference as it is a tool to reduce the spread and not a cure in itself.

Ok My Theory:
Spain and Italy have had more infections in a short period of time, therefore more people turning up to hospital to get tested. More people tested who are in a serious condition and the people who are not in a serious condition have still had it but stayed at home.
This is till Reactive testing despite the (relatively) high number of testing

Germany has a lower infection rate so the fact they are testing so many shows they are being proactive in their testing, catching people with mild symptoms who don't need hospitalisation. Contact tracing etc.

Also it should be pointed out that a negative test does not mean you did not have it, it just means that you don't have it at time of testing. That's why antibody tests to see how many people have had it is a lot more reliable when calculating infection rates.

alex_cronin

normanoffside wrote: »

Clearly the most important thing to do right now is to protect the vulnerable, especially those in nursing homes.

Everything else is under control.

The devil is in the detail. Being overly cautious in locking down children and healthy young adults may do more damage in terms of mental health and poverty in the long run. Providing more resources and better health protocols to protect nursing homes appears to be wise. Doing antibody testing so that we can see an accurate death and serious infection rate for Ireland looks like it will be done when there is a good test available. Continuing to invest more in ICU beds may be a good way to spend the money but more visibility on data would be needed, and having more beds would be a good idea if want to relax the lockdown and have people enjoy the same quality of care they are getting.

alex_cronin

ShineOn7 wrote: »

Are you saying you believe that, over the next 12 months, that Covid will kill at least around 12,000 people?

No I think that if we continued to do a slow release of the lock down and achieved heard immunity in the absence of a vaccine that this would be a low figure for the death toll (this was based on the unreliable German figures), 55’200 might be more accurate.

But we don't have the hospital beds to give all patients good care so I don't think we can commit to heard immunity for all before a vaccine. I think we may move toward herd immunity for the low risk (children and younger adults) and cocooning for the higher risk (old people, pre existing medical conditions) . Working out the numbers for this is pretty complicated. Lots more reading to do before I could comment on how this would be done.

ShineOn7

alex_cronin wrote: »

No I think that if we continued to do a slow release of the lock down and achieved heard immunity in the absence of a vaccine that this would be a low figure for the death toll (this was based on the unreliable German figures), 55’200 might be more accurate.

Wait. You believe that 55,000 Irish people will die of this within 12 months?

alex_cronin

normanoffside wrote: »

Ok My Theory:
Spain and Italy have had more infections in a short period of time, therefore more people turning up to hospital to get tested. More people tested who are in a serious condition and the people who are not in a serious condition have still had it but stayed at home.
This is till Reactive testing despite the (relatively) high number of testing

Germany has a lower infection rate so the fact they are testing so many shows they are being proactive in their testing, catching people with mild symptoms who don't need hospitalisation. Contact tracing etc.

Also it should be pointed out that a negative test does not mean you did not have it, it just means that you don't have it at time of testing. That's why antibody tests to see how many people have had it is a lot more reliable when calculating infection rates.

Your theory seems to make sense. Home antibody tests would be great as you would possibly want to test yourself every few weeks as you could be develop antibodies without every having symptoms.

alex_cronin

ShineOn7 wrote: »

Wait. You believe that 55,000 Irish people will die of this within 12 months?

No, I will try to explain in more detail

If we had unlimited ICU beds and hospital beds and staff and we just went for heard immunity with no social distancing, no lockdown and no vaccine I think this is what would happen.

We don't have unlimited beds, we don so we will continue social distancing, cocooning, less restrictive lockdowns awaiting a vaccine. The death will I expect be much lower.

We now appear to have an R0 between .7 and 1 (do a search for "professor nolan R0", I am not allowed to make url links yet) so we have a handle on the tap so we can turn the deaths up and down as we want.

There are lots of options where we go from here. Some options cost more, some less, some are complex, some the outcomes are unknown. As a nation I think we are quite happy to protect the vulnerably and wait for another nation who is further ahead in the curve to experiment. This does mean we will suffer more financially and mentally and it may have a worse public health outcome in the long run. But it is very complex to model and so in the end our attitude will play a big role in how we proceed.

ShineOn7

Some numbers, stats and more from the Reddit user who digests the daily government briefings into one handy read. I'm not sure why they're going back to Wednesday with some of these stats though?



This was posted by them today;



New Cases: 597 (Germany: 112) Total Cases: 13980
New Death: 44
Total Deaths: 530
Male: 25
Female: 19
Median Age: 84
Underlying conditions: 25
Of the 530 deaths
Hospitalised + died in hospital: 316
Died in ICU: 45
Underlying conditions: 430
Male: 308
Female: 222 Median age: 83
Mean age: 69
Range: 25-105
Of 296 in ICU

• Remain in hospital: 153
• Discharged: 98
• Died: 45
• Underlying conditions: 243 (82%)
• Median Age: 60

As of Wednesday 15th

• Cases: 13012
• In Hospital: 2082
• In ICU: 294
• Deaths: 521
• Clusters: 436
• Account for 2723 cases
• Median age infected: 48
• Healthcare workers: 26%

Clusters

• Residential Homes: 261 > 1628 - cases notified
• Nursing Homes: 166 > 1008 - cases notified

4 actions have been identified to help expand current information set we have relating to residential homes (nursing homes, mental health institutes, specialist disability services)

1. Survey of mortality in longterm residential settings - January to April - Covid and non Covid, whether in hospital or long term residential centre
2. Increase testing of staff at long term residential settings - starting with nursing homes, and is an action of scale. 30,000 staff work in nursing homes
3. HIQA going to make a Covid 19 document, looking at preparedness of residential and nursing homes
4. Urgent implementation of previously implemented actions. Want to continue to see implementation across the country.

• An action tracker implemented to see how actions are progressing

Questions

• Not recommending that people bring someone from a nursing home back to the family home. Standing up and enhancing quality care being provided to individuals. Working with HIQA to give independent reporting to give assurance that the right measures that are specific to protecting people living in these settings is being taken. Best, safest place is to stay in the nursing home facility.
• If you are worried about your relatives in a nursing home, ring up the nursing home and speak to the family members. This will be helpful to reassure people.
• Testing to be expanded to 100,000 tests a week, every week. Want this to kick in as soon as possible. Some of this is based on our hope of the disease following the pattern where the disease is dropping. Case definition may be re-defined by the end of next week, and larger testing implemented the week after. Know already that the HSE is already on the way to giving us that capacity, though might not necessarily be ready to provide that as of now. We want spare capacity to be used in the next week to 10 days to test more staff and patients.
• Backlog with 100,000 tests a week? We want to turn this around within a short period of time. Our intention is to have sampling and testing done on real time basis. If we are lifting restrictions, we need to be able to catch an increase in cases in community as quickly as possible, so we cannot be delaying with the kinds of delays we were dealing with heretofore.
• Aggressively test and pursue all suspected cases in nursing home settings - both residents and staff.
• Priority now is to tackle the disease in nursing homes
• Asked Tony Holohan about the Keelings 'controversy' - "Are you comfortable with companies chartering flights?" No. Didn't know about it until after it had happened. Says it isn't consistent with public health advice that we are currently giving. Advice has been clear and consistent. Doesn't want to be critical, as only knows whats being reported in media. The issue of travel is kept on the agenda, and what arrangements might need to be in place in airports/seaports if we were to lift restrictions
• Have NPHET any learnings from countries who have lifted restrictions? A bit early to tell yet. Particularly interested in those in Europe. Those changes have only happened recently so not enough information about disease control. Would need 2-3 weeks of data to review before being able to make decisions. These then will help make our own decisions
• Gown shortages - NHS told to work without them. Is this an issue? No, this was dire at the weekend, but multiple plane loads arrived with gowns today. All elements of PPE are hard fought for and secured. So we want right staff to have them. We have some concerns about some of the masks, but Kilmallock are able to provide us with masks. Demand however is unprecedented. Not at the stage where we would be asking for PPE to be reused. Demands is much higher, especially when you consider a Covid patient that needs to be turned often, as new PPE is required each time. Batch of reagent from China that the HSE said they would be taking a risk with, and testing would need to happen. Can we really on this? Yes, we can. There was no real concern, but it had not yet been reconciled within the lab. It was not a reagent, but a test kit instead.
• 44 deaths announced today - that doesn't mean all 44 of those happened overnight. When you plot notifications against days death occurred, the peak was on the 7th (39 deaths). Don't take this as a fall in deaths, as there is always a lag. Notifications of deaths have been increasing.
• Deaths notified on a certain date, are different from the dates they actually occurred.

Blut2

ShineOn7 wrote: »

Of the 530 deaths
Underlying conditions: 430
Median age: 83

Wow. A median age in the mid-80s, with 81% having a known underlying serious medical condition...

Any death is always a tragedy. But without wanting to sound too heartless, sooner or later the government is going to have reassess things based on this.

Given the very advanced age, and poor health, of the people dying from this sooner or later the economic shutdown is actually going to cost much more in terms of life years lost. The cancer patients in their 50s not currently getting treatment, the people with heart problems in their 60s not going to hospital, the young people in their 30s who's lives are being destroyed who commit suicide in every recession...etc.

IAMAMORON

Reading between the lines I think they are ramping up the PR and propaganda to ease restrictions at this stage. The virus has been political for weeks now, the press have been sniffing around for scandal but in fairness the government have been frustrating them somewhat.

The press got a pound of flesh with the nursing homes, a bit of dire mileage but plenty for the cranks to feed off. I mean given the median age of 81 no one can genuinely be surprised about the nursing home deaths. It is also genuinely difficult to finger point with any conviction. The press tried to ramp up the PPE issue, but all that did not gain any traction either.

The big golden egg they ( the press )are missing is the lack of a real meltdown at a rural hospital. They tried with Cavan General before Easter, I fully expected to see George Lee droning outside there on Easter Tuesday but that did not kick off either. As things stand both the HSE and the government seem to be making a good crack at it.

Say what you like but the WHO have not covered themselves in glory either. Not second guessing China will not go away for them.

Interestingly I noticed RTE focused on the WHO advising against widespread Antibody testing at yesterday's press conference. I found this kind of jaw dropping and I would love to see the whole conference to prove this piece of information. The reality is that the HSE would find it difficult to carry out widespread antibody testing. Speculate on that as you will but I found it convenient for both the WHO and the HSE to be saying it and RTE to be reporting it. I am not a crank either, I was just astonished to see RTE broadcasting this particular nugget from a large press conference, all things considered.

ShineOn7

Blut2 wrote: »

Wow. A median age in the mid-80s, with 81% having a known underlying serious medical condition...

Doesn't the high rate of Ireland's moralities occurring in nursing homes (60%) completely skew the median age?

normanoffside

ShineOn7 wrote: »

Doesn't the high rate of Ireland's moralities occurring in nursing homes (60%) completely skew the median age?

Exactly, since over half the deaths are in nursing homes then by definition the median age will be some of the younger of the nursing home fatalities.

I've been saying ti for a while but I think they should do separate reports/update on Nursing home deaths/ cases and those in the community.

Blut2

ShineOn7 wrote: »

Doesn't the high rate of Ireland's moralities occurring in nursing homes (60%) completely skew the median age?

The median age of death in every other European country is 80 or over too. Its just not killing young people in any numbers anywhere.

ShineOn7

Question for all the regulars in this thread:

Do you trust the Median or the Mean more in something like this?

Example; last I checked (it may have changed since) the Mean age of mortality of this in Ireland was somewhere around 70. Whereas the Median is around 80 years old. A big enough gap of 10 years

Blut2

ShineOn7 wrote: »

Question for all the regulars in this thread:

Do you trust the Median or the Mean more in something like this?

Example; last I checked (it may have changed since) the Mean age of mortality of this in Ireland was somewhere around 70. Whereas the Median is around 80 years old. A big enough gap of 10 years

The median figure almost always gives a more accurate picture in statistics. It removes the effect of rare, but extreme, outliers that otherwise play a huge role in the 'mean' figure.

https://www.diffen.com/difference/Mean_vs_Median

trapp

alex_cronin wrote: »

The devil is in the detail. Being overly cautious in locking down children and healthy young adults may do more damage in terms of mental health and poverty in the long run. Providing more resources and better health protocols to protect nursing homes appears to be wise. Doing antibody testing so that we can see an accurate death and serious infection rate for Ireland looks like it will be done when there is a good test available. Continuing to invest more in ICU beds may be a good way to spend the money but more visibility on data would be needed, and having more beds would be a good idea if want to relax the lockdown and have people enjoy the same quality of care they are getting.

This is where we need to be really careful.

Adults are adults but particularly for vulnerable children this could be a very damaging time.

Our children are the future of the country.

Simon Harris, despite his faults, seems very aware of this.