Coronavirus in the UK - news, lockdown and discussion

[elbows]

That's why there's always been wariness about using 'fatigue' as a symptom for testing like cough and temp are.

That stuff makes basic studies into the effects on adolescents especially tricky too, due to various forms of fatigue that are somewhat 'normal' during that stage of development.

I do find all this stuff hard to unpick. And I'm not actually as far along the gloomy doomy end of the pandemic spectrum as some think I am, so theres a whole bunch of possibilities that I havent spent a long time dwelling on here so far. Need better data and a lot of time for the full picture to emerge. There may well be some aspects which in future years will emerge more clearly and cause some to regret the way they thought about this disease in the first few years, but it wont be good for peoples mental health if I go on about those endlessly long before the scale of that picture and its its ramifications have really been ascertained properly. In my own mind I am reminded about some of the fears about mad cow disease and its future implications, there were years where it was hard to predict what the appropriate way to think about that risk and the scale and future of it really was.

 

[Cloo]

Got an email confriming by order or a lateral flow test kit made at 12.30am this morning. Was definitely asleep then and haven't ordered any since the weekend, which I got a confirmation email for at the time, so a bit worried about what my unconscious is doing if that's so....

 

[elbows]

There could be ordering system glitches which have manifested themselves as they attempt to clear any backlog.

 

[elbows]

Harries as UKHSA head is far more impressive than Harries was as a public communicator in the first months of the pandemic, in my opinion so far. I suppose this isnt too surprising, as all of the people in those roles suffered from having to operate under a government with dodgy priorities, and early pandemic mistakes were made across the full establishment and expert advisors. A lot of those people improved once the early errors of pandemic perception and timing were out of the way, although I cant say I really put Harries in the much improved camp at that stage.

The head of the UK Health Security Agency raised concerns about low-paid workers being disadvantaged by changes to the Covid testing regime in England, as they would still need a PCR test to access financial support for isolation, a leaked internal memo shows.

The memo from Dame Jenny Harries, the chief executive of the UKHSA, also highlighted a greater risk of false negatives for those on lower incomes forced to go to a testing centre to ensure they received the £500 Covid test-and-trace support payments.

England Covid testing changes could hit low-paid workers, leaked memo warns

Exclusive: Health Security Agency chief set out risks of PCR test requirement for £500 isolation payment in December

www.theguardian.com

 

[bluescreen]

The problem with all the studies cited is that they use self-reported symptoms and include no control group. Ideally control groups would include people who didn't have COVID but had some other virus e.g. a cold virus, and people who thought they had COVID but for whom in-study antibody testing reveals they didn't.

If you just ask people "do you sometimes experience fatigue", you can't conclude that everyone who says yes is suffering from long COVID.

The studies he cites don't all rely on self-reported symptoms like fatigue but measurable physiological symptoms*. Admittedly it's anyone's guess what these actual patients' functions were before catching the disease because they weren't being measured then, which is why Topol's article is interesting because it measures before and after.

*eg, The Yale study Ricksecker cited measured reduced aerobic capacity, oxygen extraction. and ventilatory efficiency in “mild” COVID patients even after recovery from their acute infection, compared with a control group.

DEFINE_ME

journal.chestnet.org

 

[zahir]

Independent Sage, back with their first briefing since before Christmas.

 

[platinumsage]

The studies he cites don't all rely on self-reported symptoms like fatigue but measurable physiological symptoms*. Admittedly it's anyone's guess what these actual patients' functions were before catching the disease because they weren't being measured then, which is why Topol's article is interesting because it measures before and after.

*eg, The Yale study Ricksecker cited measured reduced aerobic capacity, oxygen extraction. and ventilatory efficiency in “mild” COVID patients even after recovery from their acute infection, compared with a control group.

DEFINE_ME

journal.chestnet.org

None of the studies searching for long-COVID symptoms featured a control group: Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT, Long COVID in a prospective cohort of home-isolated patients - Nature Medicine, Sequelae in Adults at 6 Months After COVID-19 Infection

The Yale study is interesting but it compares a group of former COVID patients who were referred to specialists for unexplained exercise intolerance with a control group. This is very different from assessing a random sample of those who have had COVID.

 

[elbows]

The weekly data on 'for covid' and 'with covid' in hospital patients is out for England, leading to the usual press reporting that I dont think does the subject proper justice. Hospital infections as part of this picture still dont get much of a mention, and most of the focus ends up being on the politics instead.

I believe Sotland have published their version of this data for the first time too, which I havent looked at for myself yet but sounds like it shows a similar pattern.

My graphs using data from the Primary Diagnoses Supplement file at Statistics » COVID-19 Hospital Activity

Data goes up to 4th January despite what the date labels show. And this is number of patients in hospital beds, not daily admissions/diagnoses.

Also note this data covers acute hospitals, so I dont think its showing the picture in other sorts of community hospitals and mental health hospitals.

 

[elbows]

Mark Drakeford has accused Boris Johnson of failing to take the necessary action to protect people in England from Covid.

"The one country that stands up as not taking action to protect its population is England," said the first minister.

The comments come as Mr Drakeford announced Covid restrictions would not be relaxed in Wales.

He added that England was the "outlier" in the UK when it came to Covid. The UK government has been asked to comment.

Covid: Drakeford accuses Johnson of failing to protect England

Mark Drakeford calls the UK government "politically paralysed" as Covid rules remain in Wales.

www.bbc.co.uk

 

[elbows]

I am lacking time to do the England hospital data graphs I was going to do today.

I'll just have to do a quick description instead. I would describe the daily hospital admissions/diagnoses picture for England overall as a bumpy plateau, a description that is also a fair fit for most regions at the moment.

Thats much better news than continual steep rises, obviously, ad the intensive care data also continues to look promising. When zooming down to the individual trust level, even phrases involving the word decoupling which I have often criticised, seem more fair to use right now. This is probably a combination of Omicron leading to less severe illness, especially when coupled with booster jobs, and the fact that Omicron infections have displaced the more severe Delta infections.

It is possible to find a handful of hospital trusts where the number of admissions and covid patients in hospital beds are challenging or even exceeding the levels seen in the wave a year ago, but as discussed many times before this picture is partly sponsored by incidental positives and hospital acquired infections. Not that those are entirely implication-free either.

Manchester University NHS Foundation Trust is perhaps the most obvious example: https://coronavirus.data.gov.uk/det...me=Manchester University NHS Foundation Trust

 

[_Russ_]

Whilst Im not in agreement with everything Drakeford has done during the pandemic, at least he has tried and if you read transcripts of his interviews and compare them to the absolute nonsense that gobshite Boris spits out....

ETA nice to see his openness over a disagreement with an advisor rather than trying to hide it with waffle or lies, shows he has some principles which seems a rare attribute in politics

 

[elbows]

Meanwhile in terms of cautious messages from the UK government, a theme of rising cases in older age groups has continued since the last press conference. This is one of the reasons I really need to update some of my graphs, but the picture shown by age doesnt always tend to neatly follow the simplistic and gloomy expectations. Best case scenario is that any sustained rises in older age groups, continuing long after the main overall peaks, will have a more limited impact on healthcare systems than might be implied on the face of it. And we know that when the first two waves peaked, the government were keen not to change the mood music quickly, preferring to delay the sense that the worst was behind us. Which is fair enough considering the impact of behaviours and the problems that can still arise from slower, grinding pressure even after the explosive growth phase has ended.

 

[MBV]

Some hospital graphs here:

 

[Cloo]

There could be ordering system glitches which have manifested themselves as they attempt to clear any backlog.

That's my guess, I'm not expecting they will turn up!

 

[elbows]

The BBC put loads of daily admissions graphs for the regions and UK nations in this article, similar to the ones I do except I've been very slack about doing ones for the other UK nations.

Covid: Sajid Javid concern over admissions in older people

The NHS faces "a rocky few weeks", the health secretary says as staff absences grow and cases rise.

www.bbc.co.uk

Not sure I would pay much attention to the doubling time stuff they included though, the way they are doing it is laggy and smoothes out recent trends too much, or doesnt pick up on recent trends properly, and in the case of London describing that as 'flat across the last fortnight' would not be my choice of words at all. I mean its fair in some ways with the benefit of hindsight (ie with subsequent data after the very peak) but thats taking data smoothing a bit too far for me and exaggerates how long ago admissions stopped rising in the London region.

 

[Brainaddict]

The problem with all the studies cited is that they use self-reported symptoms and include no control group. Ideally control groups would include people who didn't have COVID but had some other virus e.g. a cold virus, and people who thought they had COVID but for whom in-study antibody testing reveals they didn't.

If you just ask people "do you sometimes experience fatigue", you can't conclude that everyone who says yes is suffering from long COVID.

Firstly I think we need to be clearer about a difference between 'lingering physical symptoms', which is all it is with those footballers, and proper post-viral fatigue, which is a poorly understood dysregulation of much of the body. If people are concerned about the rigor of asking people about their fatigue in post-viral fatigue cases I think the response should be to fund expensive studies in which objective measures are used - i.e. using activity monitors or other such devices. It is no longer the time to quibble about what people experience but measure it. I can promise you that those suffering with serious long covid are not worried about being excluded from diagnosis by objective measures.

 

[platinumsage]

Firstly I think we need to be clearer about a difference between 'lingering physical symptoms', which is all it is with those footballers, and proper post-viral fatigue, which is a poorly understood dysregulation of much of the body. If people are concerned about the rigor of asking people about their fatigue in post-viral fatigue cases I think the response should be to fund expensive studies in which objective measures are used - i.e. using activity monitors or other such devices. It is no longer the time to quibble about what people experience but measure it. I can promise you that those suffering with serious long covid are not worried about being excluded from diagnosis by objective measures.

Well exactly. To determine the prevalence of long COVID we’ll need much better studies than the ones that have been published.

 

[zahir]

Thread from Christina Pagel

 

[Mation]

The problem with all the studies cited is that they use self-reported symptoms and include no control group. Ideally control groups would include people who didn't have COVID but had some other virus e.g. a cold virus, and people who thought they had COVID but for whom in-study antibody testing reveals they didn't.

If you just ask people "do you sometimes experience fatigue", you can't conclude that everyone who says yes is suffering from long COVID.

Not so the studies cited in that thread that measured oxygen levels, lipids, brain atrophy, cardiovascular outcomes, testicular function etc. Did you just look at the first two or three? There are loads more.

 

[elbows]

The uptick in reported deaths has now gone on for long enough that its gone slightly beyond merely plugging the holiday season reporting gaps, and will start to be visible in deaths by date of death graphs too. But its still very modest at this stage, and may well remain that way, especially when contrasted with the very high daily death figures people got used to in the first two waves. It has also taken us past the 150,000 milestone for deaths within 28 days of a positive test, as someone was talking about the other day.

In regards hospital data, as I suggested this last week this data for England now continues to be published at weekends. Todays data doesnt add any new trend to the picture, with the overall description of 'flat' being fair. Although when it comes to daily hospital admissions/diagnoses in the London region, it is increasingly possible to fairly describe numbers as falling rather than flat.

 

[David Clapson]

So the vaccine only reduces transmission of Delta for 8 weeks. And for Omicron it's probably less. This is news to me. This nugget is within one of today's Covid news stories, a debate between Sajid Javid and an unvaccinated NHS consultant at Kings Unvaccinated NHS doctor challenges Sajid Javid over compulsory Covid jabs. I can't find it anywhere on urban. The short version of the story is:

An NHS doctor has challenged Sajid Javid over compulsory vaccines for healthcare workers...the government has decided that all NHS staff in England who have direct contact with patients must have had their first dose of a Covid vaccine by 3 February or risk losing their job at the end of March....While on a walkabout at King’s on Friday, Javid had asked doctors and nurses what they thought... Steve James, a consultant anaesthetist... told Javid: “I’ve had Covid at some point, I’ve got antibodies, and I’ve been working on Covid ITUs since the beginning; I have not had a vaccination, I do not want to have a vaccination. The vaccine is reducing transmission only for about eight weeks with Delta. With Omicron it’s probably less. And for that I would be dismissed if I don’t have a vaccine? ...the protection I’ve got is probably equivalent to someone who is vaccinated...if you want to provide protection with a booster you’d have to inject everybody every month. If the protection has worn off for transmission after two months then after a month you’ve still got a bit of protection. But if you want to maintain protection you’re going to need to boost all staff members every single month, which you’re not going to do.”

Wham. Suddenly I'm a bit of a vaccine sceptic. Rug pulled from under me. (FWIW I'm triple jabbed, hardly go out, always wear a mask when I do.)

 

[gentlegreen]

There has been sod all meaningful research to evaluate actual live transmission by vaccinated people.
And in any case that was never a reasonable aim of a vaccine.

Vaccines prevent serious illness and death and that's one thing we CAN reasonably infer to be working.
Paul Offit is a paediatrician as well as a virologist who advises the FDA and disapproved of "boosters" - but they were overridden by the CTC.

 

[David Clapson]

Vaccines prevent serious illness and death and that's one thing we CAN reasonably infer to be working.

Good stuff. It's a shame that message isn't winning. Or maybe it is? Maybe I'm just too much of a hermit?

 

[elbows]

There has been sod all meaningful research to evaluate actual live transmission by vaccinated people.
And in any case that was never a reasonable aim of a vaccine.

The whole reason that even the UK government got nervous about Omicron was that it further eroded the amount we could expect from the current vaccines in terms of protection from catching Covid as well as on paper possibilities leading to nerves about how much it would erode protection against hospitalisation and death too. And there has been some erosion on that severe end of the spectrum front, but boosters have compensated for a big chunk of that, especially in the short term.

The figures the doctor mentions are an oversimplification but there are some very fair points in there, at least when applied to the issue of how much good can come from mandatory vaccines for health care workers. The picture of protection afainst infection is now different enough that my own stance on mandatory vaccination for health and social care workers has now evolved, its quite a bit harder to make a proper case for such things, and easier to imagine the upsides being outweighed by downsides such as loads of essential workers losing their jobs.

Its hard to predict whether the government will stick to their guns on that front or will u-turn. Perhaps they may initially delay the cut-off date for vaccination of these workers. I would back off if I were them, and would only reignite the issue if we get a different class of vaccines that do far more to reduce infection and transmission at some future point.

 

[elbows]

Good stuff. It's a shame that message isn't winning. Or maybe it is? Maybe I'm just too much of a hermit?

Its in a lot of the news, the messaging about the importance of getting boosters, and the daily data covering the current wave and the previous wave.

If the vaccines were not very good at protecting against severe disease and death then we would not have been able to relax the rules so much this last summer. And we'd have ended up with something more akin to a full lockdown in both the Delta wave and the current Omicron wave, along with hospitalisation and death figures that would have been far more horrible than those we've actually ended up with.

There are still limits to this side of things too, a lot of the people who have died of the virus in this country from the second half of 2021 onwards have been vaccinated. But this was expected given that the vaccines dont offer 100% protection and that very many millions of infections have been allowed to occur. And its still a small amount of death compared to what we would otherwise have endured.

 

[elbows]

And I say all that as someone who does think that in this country people were encouraged to expect the vaccines to be able to carry more of the weight of this pandemic than was ever likely to really be the case. But they can still carry a tremendous amount of weight, and people should resist losing faith in them to too great an extent, just tweak your expectations, dont get defeatist about them, they are saving a shit load of lives as we speak.

 

[David Clapson]

The antivaxxers are capitalising hugely on the Steve James interview. It's a pity that Javid didn't have a useful response.

 

[teuchter]

The uptick in reported deaths has now gone on for long enough that its gone slightly beyond merely plugging the holiday season reporting gaps, and will start to be visible in deaths by date of death graphs too. But its still very modest at this stage, and may well remain that way, especially when contrasted with the very high daily death figures people got used to in the first two waves. It has also taken us past the 150,000 milestone for deaths within 28 days of a positive test, as someone was talking about the other day.

In regards hospital data, as I suggested this last week this data for England now continues to be published at weekends. Todays data doesnt add any new trend to the picture, with the overall description of 'flat' being fair. Although when it comes to daily hospital admissions/diagnoses in the London region, it is increasingly possible to fairly describe numbers as falling rather than flat.

I keep half an eye on the data from my local NHS trust, partly because it's my local one and partly because it's in the area of London that started seeing the first effects of Omicron in the UK. One thing I've noticed is that mechanical ventilation numbers for London as a whole don't really show much happening:



But there has been something of a rise in my local trust (King's).

 

[brogdale]

Another milestone

The respective populations of those other named countries being 331m, 213m, 1326M, 146m, 130m, & 33m.

#Worldbeating

 

[Brainaddict]

So the vaccine only reduces transmission of Delta for 8 weeks. And for Omicron it's probably less. This is news to me. This nugget is within one of today's Covid news stories, a debate between Sajid Javid and an unvaccinated NHS consultant at Kings Unvaccinated NHS doctor challenges Sajid Javid over compulsory Covid jabs. I can't find it anywhere on urban. The short version of the story is:



Wham. Suddenly I'm a bit of a vaccine sceptic. Rug pulled from under me. (FWIW I'm triple jabbed, hardly go out, always wear a mask when I do.)

Why would this make a you a vaccine sceptic? The main goal of vaccines is not to prevent transmission but to prevent hospitalisation and death. In the limited question of whether staff should be mandated to have the vaccine in order to reduce transmission in hospitals, these figures (if they are right) might mean something. But they're meaningless to whether or not vaccines work for their main goals in the majority of the population.