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Coronavirus in the UK - news, lockdown and discussion

elbows said:
Perhaps most striking of all is the attitude towards testing once you get towards the end of the article. This side of the establishment clearly isnt interested in taking lessons from the pandemic and using them to reduce deaths from various viruses in non-pandemic times. Rather we are encouraged to think that tests are pointless, and that decent data is bad for the rascal multitude. For sure there are anxiety traps that can be reinforced by paying the wrong sort of attention to data, but all the same, fuck the attitude towards tests and data that this article seeks to promote.
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What exactly is it you take issue with?

For example, do you think everyone should do a Covid (and flu?) test now, if they have cold-like symptoms?

The message to me seemed to be: if you have cold-like symptoms, be mindful of infecting others. If you decide you are going to stay away from other people as much as possible when you have a cold, then what is to be gained by taking a test?
 
farmerbarleymow said:
What was going on with flu in 2013/14? That's a hell of a drop from the figures in adjacent years
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It was probably a season with low amounts of the H3N2 strain, and lots of H1N1 strain.

The H1N1 in question was the swine flu version from the swine flu pandemic, a version of flu that tends to affect younger people more than older people. And since older people are at far greater risk of death, its the H3N2 years that tend to show up a large number of deaths. (H3N2 is the strain that arrived in a nasty pandemic in the late 1960s and has caused a lot of deaths ever since).
 
teuchter said:
What exactly is it you take issue with?

For example, do you think everyone should do a Covid (and flu?) test now, if they have cold-like symptoms?

The message to me seemed to be: if you have cold-like symptoms, be mindful of infecting others. If you decide you are going to stay away from other people as much as possible when you have a cold, then what is to be gained by taking a test?
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I wasnt happy with the pre-pandemic status quo, various attitudes, including those of the public and of the establishment in this country.

On the establishment side of things we had a really stupid attitude towards doing routine diagnostics testing in healthcare settings, care homes etc. An attitude that contributes greatly to nosocomial spread, and one that set the scene for our inability to scale up testing when needed in the pandemic. SIgns so far are that we arent quite going all the way back to the old ways on these fronts, they have to do more routine testing still because their old methods of guesswork and actually testing just a tiny fraction of cases in healthcare dont enable them to properly differentiate between covid and flu, but Im not complacent about exactly how far back to the old ways they will travel in the years ahead, its currently unclear.

When it comes to the wider public, unfortunately attitudes and behaviours are still in many cases shaped by peoples perceptions, and I will always prefer testing to guesswork...

Its certainly true that we are very far beyond the era when mass testing could give us a reasonable picture of the size, timing etc of epidemic waves. So I'm not going to claim that personal testing is a vital part of that, we have to rely on a variety of other things including wastewater testing, survey-based testing, testing people in specific health settings, doing testing during outbreaks in care homes etc.

But attitudes towards personal illness and resulting behaviour are affected by testing. Theres plenty of people that assume they have 'a cold' these days if they dont test, and some of them will not take as much care around other people as they would if they had done a covid test. Granted a big chunk of those people are unlikely to have required an article by Nick Triggle in order to stop bothering, but I'm still aware of the wider impact mood music and messaging can have over time, it tends to erode certain things, and can undermine the right behaviour in situations where stuff does still matter. For example, one of the people quoted does mention the benefits of testing if you are vulnerable with a lung condition (thats too narrow a definition of vulnerable in my book but anyway) so you can get antivirals, but consider how broader attitudes towards testing do have an impact on whether particular groups will bother. And I think we see less effort directed at advising those groups to take tests and seek treatment than we do towards broad 'plkerase go back to normal' messaging.

Listening to the testimony in the current covid inquiry module, its clear that groups such as those representing people with disabilities are not impressed with overall priorities and messaging even at the best of times, how its a world designed for an imagined ideal independent person and all that goes with that. That sort of thing is on my mind when I see these sorts of articles and their sense of priorities. Plus of course I will never forget what sort of messaging Nick Triggle was enthusiastically supporting in March 2020 and again around September 2020 when a second wave loomed.

I am not demanding that everyone routinely tests themselves these days ( and no, routine flu testing is not really a thing available to the masses) but I am pleased by the number of people who still take that responsibility seriously. And Im bound to speak up about this stuff even though the usual suspects with their shit priorities will tend to think I'm the extremist. Its not like I suffered fools with their 'its not proper flu unless you are bedridden' misconceptions gladly before this pandemic, you have to take into account that I cared about this stuff long before covid. We let loads of people die in every bad flu season because there is a form of half-arsed shit and cold priorities in this country, and the pandemic was an opportunity to modify some of that for the longterm. When we dont seize those opportunities, I moan. My auntie had a bunch of disabilities and was routinely infected in care and hospital situations all the bloody time. One of those finally killed her a little while before this pandemic began, but I'll never forget the wider lessons and the shit establishment attitudes.
 
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In terms of data holes, the thing that troubles me most about the huge reduction in certain forms of testing is the genomic surveillance. New vairant fears of the most extreme kind have turned out to be overblown so far, but that doesnt mean it will always be the case.

However you need PCR testing to get that data, so its not like massive amounts of public lateral flow testing would help to fill that hole.

We still have a surveillance programme on that front, via in-hospital etc testing on a smaller scale, but its a lot less complete and offers a less timely picture than it once did. But I cant blame Triggle or people with stupid attitudes towards general public testing for that, this is an area where I will acknowledge that it isnt very easy to balance costs and benefits beyond the acute phase of the pandemic. I'd still rather we have a more routine mass diagnostics setup for a large number of potential illnesses in this country, but then I'd also rather we spent a greater proportion of our GDP on health systems, public health, etc.
 
Heres another way of me trying to explain my rant:

What we have now is just the routine version of a question that became acute as the first wave arrived. "how can we shield the vulnerable while letting everyone else carry on with their lives?" was a question, and there was no useful answer, so we had to do a load of extreme stuff until vaccines could change the population immunity picture. Well, a milder version of this scenario and question exists the rest of the time too, especially in winter. The difference is that we can usually get away with ignoring it. And I dont think Im actually an extremist for not being happy with that. The measures required in the pre-vaccine phase of the pandemic were one sort of extreme, and business as usual is the other sort of extreme. I'd like to think we could do a bit better than that, that a better balance could be struck without wankers demanding nothing less thant he old normal at all times. Articles trying to get people all the way back to the old normal would be easier to stomach if we actually put the effort into retaining certain responsible behaviours, if there was actually a concerted effort to get people to do the right thing when they have symptoms etc. Combine that with the right amount of ongoing effort by authorities to reduce nosocomial spread of various things and we could actually make a difference to how much death is considered normal. But no, the cold calculations of the establishment judge such things to be too costly, too much of a pain in the arse to bother with, too likely to interfere with economic activity. This shows up in all sorts of ways, including the chasm between what we are invited to prevent is the attitude towards going to work when ill, and the actual reality of what people know is expected of them.

Plus a huge theme of the pandemic, which comes up time and time again in the inquiry, is how much more harm it caused to those who were already disadvantaged, a stark difference. That doesnt change just because we got beyond the acute phase of the pandemic, thus the sorts of messaging I am complaining about is likely to pose a greater threat to those most disadvantaged members of society.
 
Another thing that makes me moan about that article is that we dont exactly enjoy a regular analysis of data that gives us the picture from all sorts of angles.

And the likes of Triggle are only happy to show how much Covid was not seasonal in 2022, now that they can point to 2023 looking much better on that front. Bloody cheek.

For example, I dont find the ongoing death picture so horrific that I've felt the need to shout about it all the time. But it still makes me uncomfortable enough to mention it a few times a year, and I cant say it makes me comfortable that there is not much routine focus on this sort of thing in our media.

This graph shows registered weekly deaths from all causes for England and Wales, going back to the start of 2010. Despite what the labels say, the data cover the period up to 29th September. Covid is hardly the whole story here, but its still a part of it, directly and indirectly. And if it were no part of it, we might think people would be even keener to know what the story is behind its recent trends? The summer dips still arent what they were pre-pandemic.

Screenshot 2023-10-15 at 17.06.18.png
 
I had an interesting conversation with a customer this evening. He's a consultant on a hospital respiratory ward and he said that he hasn't seen a vaccinated non-immunocompromised patient on his ward with Covid for nearly two years now. The only people who are getting really seriously ill with it now are people who are undergoing chemo or the like. He said the vaccine seems to still be providing good protection against serious illness even for those who haven't had one in 18 months or so (because they aren't eligible for another booster). Which is quite comforting.
 
weepiper said:
I had an interesting conversation with a customer this evening. He's a consultant on a hospital respiratory ward and he said that he hasn't seen a vaccinated non-immunocompromised patient on his ward with Covid for nearly two years now. The only people who are getting really seriously ill with it now are people who are undergoing chemo or the like. He said the vaccine seems to still be providing good protection against serious illness even for those who haven't had one in 18 months or so (because they aren't eligible for another booster). Which is quite comforting.
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Thats a very real change to the picture that provides some guide as to a very important change in the vaccine era, with some effect also likely seen due to the evolution of the virus and peoples immunity also building via prior infections. Plus certain categories of susceptible people already having succumbed previously.

Without wishing to be a downer I still dont feel like I can avoid pointing out that its not the entire picture though....

Whats likely missing is a big chunk of the picture regarding the very elderly and any others where it often wouldnt be deemed appropriate to give them intensive respiratory care, or where their symptoms werent primarily respiratory in the first place. Covid deaths have always been hugely weighted towards older people, and beyond the sorts of younger severely immunocompromised cases you mention, a lot of those people wouldnt have been candidates for intensive care at any stage of the pandemic. They would have fitted into a few different sorts of pictures, including frail people who were finished off by the virus without intensive respiratory care being deemed appropriate. It also seemed like the nature of respiratory symptoms and severity of those symptoms changed as the virus itself evolved (eg from Omicron onwards), athough I'm still a little unclear as to the full extent of this.

So what you are describing is very real, it reflects the fact that the numbers of susceptible people with no immunity were in the pre-vaccine era still sufficient to cause bad scenes in intensive care wards. Even though older people were at far more risk at every stage, the overall picture back then meant that there even the smaller fraction of younger people at risk was enough to create bad scenes in intensive care. Both the virus and the population immunity picture changed, and so those scenes are much diminished, the scale is very different.

I'm guilty of neglecting to mention Scottish figures very often, but just to provide some sense of the scale of Covid death that remains in Scotland these days: Official data which counts deaths where Covid is mentioned as a contributing factor on death certificates in Scotland, has 1538 deaths in 2023 so far. Thats for deaths registered up to the week beginning 2nd October. Of those, 664 were aged 85 or higher, 481 were aged 75-84, 252 were aged 65-74, 129 were aged 45-64, and 12 were younger than that. Obviously this sort of data doesnt tell the whole story, and it doesnt tell me stories of individual vulnerabilities, vaccine status etc, but it might provide some vague sense of what other parts of the picture still remain, albeit at much diminished scale compared to the first waves and the non-vaccine and early vaccine eras.

Vaccines have saved huge numbers of lives and have enabled a huge chunk of the population to return to relative normality. But of the ongoing deaths, a large percentage occur in elderly people who have been vaccinated multiple times. This was always expected because the protection isnt 100%, and certainly isnt sufficient to completely eliminate the increased risk that comes from old age.

(death figures come from adding together columns from table 1 of a spreadsheet found at Deaths registered weekly in Scotland | National Records of Scotland )
 
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You're right of course elbows in that he will never get to see some of those older patients because they won't be seen as viable to treat. He did say also that the picture has changed a lot from a couple of years ago purely because they now have a much better idea of how to treat people with it, rather than the situation we had at first where noone knew what to do.
 
weepiper said:
You're right of course elbows in that he will never get to see some of those older patients because they won't be seen as viable to treat. He did say also that the picture has changed a lot from a couple of years ago purely because they now have a much better idea of how to treat people with it, rather than the situation we had at first where noone knew what to do.
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Yes thats a good point and a lot of treatment options havent been very visible to most of us compared to all the stuff that happened earlier when everyone had many terrible reasons to pay attention.

In some important clinical ways its not even appropriate to think about covid as a straightforward respiratory disease, but Im not the best person to try to describe what I mean by that in detail.

I should probably also say that although in the first years of the pandemic I was very careful to avoid giving the 'a load of those old people would have died anyway' wankers any ammunition, some of those realities of death at that stage of life are part of the ongoing covid death statistics. And I cant unpick the figures, I cant evaluate how many quality years of life are being lost that individuals would otherwise have enjoyed if they hadnt caught covid now. I can only say some, I cant put a figure on it. Some institutions and experts can attempt to estimate such things, but I dont know if any are these days. And on the other hand, reductions in testing and changing assumptions and attitudes would also be expected to have some impact on how many deaths where covid was actually involved actually end up officially recorded as such.

Without being complacent about the future or any possibility of any setbacks in future, eg any epidemic waves in future years that put obvious additional pressure on healthcare etc, we have long since reached a point where it should be more obvious how even if a virus itself doesnt change very much, our impressions of its impact have changed a lot. eg we can go from a picture where the impact on the population is dramatic, to one where it is possible for the implications of the virus to fade into the background to a greater extent, based mostly on the changing population immunity picture. That stuff is after all what makes a pandemic a pandemic in the first place, a immune-naive population that never had to deal with this virus before, and one way or another that picture doesnt last forever. I dont want to push that point too far though, eg H3N2 influenza A that arrived as a pandemic in the late 60's still causes plenty of death in bad epidemic years, just not horrific pandemic levels of death that turn the world upside down. Worst case scenarios where viral evolution bypasses a huge chunk of immunity still exist in theory, but theres not much point in the masses talking about these as though they are incredibly likely, never say never but no point anticipating such scenarios unless there actually ever comes a time when they show real signs of arriving. And those entities that do need to plan can plan for them in advance in general terms similar to if a brand new threat arrived anyway.

So although I was rude about a recent Nick Triggle article, it is understandable that over time more people come to see the virus as less of a big deal. All the viruses that get lumped together as 'the common cold' are not treated as a big deal by most people most of the time, but they still end up killing some people occasionally, or having other longer term consequences, but in ways that dont usually draw much attention, and often dont even get captured in data. Covids impact on human populations hasnt travelled all the way to that 'common cold' level yet, and I'm unclear whether it will ever reach that point or stick at a level more similar to attitudes towards, implications of, and the visibility of 'bad flu', but its there for everyone to see that we've travelled a fair way down that sort of road. Sadly not everyone can make that journey, those with particular vulnerabilities dont get to enjoy that sense of normality, they dont get to forget about this new, permanent additional risk. And for some others they may spend a long time being relatively untouched by covid but may still face moments where covid joins the ranks of traditional things like pneumonia that may contribute to the final story of a loved one, a potential cast member of that stage of the cycle of life and death.
 
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elbows said:
It was probably a season with low amounts of the H3N2 strain, and lots of H1N1 strain.

The H1N1 in question was the swine flu version from the swine flu pandemic, a version of flu that tends to affect younger people more than older people. And since older people are at far greater risk of death, its the H3N2 years that tend to show up a large number of deaths. (H3N2 is the strain that arrived in a nasty pandemic in the late 1960s and has caused a lot of deaths ever since).
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www.bbc.co.uk

Swine flu: UK detects first human case of new strain

Patient had mild illness and is fully recovered from a strain of H1N2 normally seen in pigs.
www.bbc.co.uk
Swine flu H1N2 in North Yorkshire.

www.nature.com

Why has swine flu emerged in a person in the UK — and what’s next?

Scientists are closely monitoring a virus that has been detected for the first time in a UK individual.
www.nature.com www.nature.com
When viruses breed

However, influenza viruses are unusual in that they are able to breed, meaning that different viruses can combine their genes during replication. This helps the virus to adapt from one species to another.

“If you get two different viruses infecting the same cell at the same time, the virus can come out which has some genes from one parent virus, and some genes from the other parent virus,” Hutchinson says. This is called reassortment.
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The process is especially concerning when it leads to a virus that has a lot of human-adapted genes and so is adept at replicating in humans, and has proteins on its outside — which are what human antibodies use to recognize and destroy viruses — that are from a new non-human source.

The virus that caused the 2009 swine flu pandemic was a mixture of different viruses: a swine flu, human flu and a bird flu all exchanged genes, Hutchinson says. “And then another swine flu mixed with that one, to produce a virus which was able to jump into humans, and so that was an unusually complex mixing and matching version,” Hutchinson says.

Over the coming days scientists will be working to understand more about the genetics of the strain that infected the person in the UK, using known data from large sets of virus information to see if it is related to other viruses.
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Edit: already posted here Bird flu: humans infected with H5N8 strain for first time in Russia
 
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yield said:
Swine flu H1N2 in North Yorkshire.
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Enhanced surveillance has failed to find any other H1N2 cases as of the last update from December 11th.

Here is the technical report about it. It does sound like a couple of the cases contacts might have caught it, but they didnt manage to test them while symptomatic so no confirmation of that and no further spread detected. An example of a situation where backwards contact tracing was actually attempted in this country, though not timely enough to catch all possible cases in time, still useful though especially if it had spread further.

www.gov.uk

Influenza A(H1N2)v: rapid technical assessment

www.gov.uk www.gov.uk

1. To determine the source of infection, backwards contact tracing and assessment of potential locations for animal to human spillover in the vicinity of the case were undertaken. Although the case lives in an area of the country which contains pig farms and in proximity to sites containing animals (including a veterinary facility and a live auction market) no direct link or chain of transmission could be identified between the case and any animal. Environmental sampling is ongoing.

2. To identify any potential human to human transmission: contact tracing, polymerase chain reaction (PCR) testing and serology are being used. One household contact and one other contact were symptomatic but their symptoms had already resolved by the time they were identified, and therefore they were not tested whilst unwell. At the time of testing, one of these contacts had a non-influenza respiratory pathogen detected although its significance is unclear given timing with respect to symptoms. To date, no further cases have been detected through the investigations including follow-up of contacts (including precautionary follow up of the contacts of symptomatic contacts). Serological assessment is ongoing.

3. To rule out any local community transmission, enhanced surveillance is being conducted (community and hospital). Following the index case, no further cases have been detected to date through enhanced surveillance through local GP practices (Table 1) and hospital trusts, but this will continue for a further 4 weeks.
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Anyone else getting colds more often since the pandemic? I seem to get one, not severe, lasts about a week then reappears a month or so later. Been like that since Covid. Before Covid used to get them twice a year maybe. Now it’s seems more like six a year!?
 
I eat well and exercise fairly hard throughout the week. Wouldn’t say I was normally “unhealthy” in the lifestyle sense
 
And the colds themselves are very unusual, more just like a runny nose with no other symptoms. But still. Weird. Def a new pattern since Covid for me
 
BigMoaner said:
Anyone else getting colds more often since the pandemic? I seem to get one, not severe, lasts about a week then reappears a month or so later. Been like that since Covid. Before Covid used to get them twice a year maybe. Now it’s seems more like six a year!?
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Mrs Numbers has had one bug after the other since November, she’s had more time off work in the last few weeks than her entire career/working life combined.
 
BigMoaner said:
And the colds themselves are very unusual, more just like a runny nose with no other symptoms. But still. Weird. Def a new pattern since Covid for me
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Same. And my middle son. I think it's probably something like allergic rhinitis rather than a cold.
 
BigMoaner said:
Anyone else getting colds more often since the pandemic? I seem to get one, not severe, lasts about a week then reappears a month or so later. Been like that since Covid. Before Covid used to get them twice a year maybe. Now it’s seems more like six a year!?
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I've had a few bouts of low level crud since autumn, then something that started in early december (sneezing, coughing, general all-over crappy feeling) that i haven't quite finished with yet. i've just about managed to keep on working with it.

BigMoaner said:
And the colds themselves are very unusual, more just like a runny nose with no other symptoms. But still. Weird. Def a new pattern since Covid for me
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hmm. that suggests a possible allergy to something more than a bug, but not sure what.
 
My daughter sent this a couple of hours ago:
“Down with flu, had headache and sore throat from Thurs, chills and fever and aches today. Had a steaming hot bath and was shivering”
She’s just tested positive for Covid and is hoping that if her partner and toddlers get it, they wait until she feels better. She’s 100 miles away but her partner’s family are nearby.
 
Are the covid test thingys picking up new variants?

I ask because as I mentioned Mrs Numbers has had a few bugs and always tests negative on the covid tests - so just curious.
 
The SARS-CoV-2 rapid antigen (RAT) tests (the at home cassette tests) still work. They look for protein sequences (the antigens) from the surface (nucleocapsid) of SARS-CoV-2. This has hardly varied since the early type virus, unlike the spike (where all the variant action literally is).

However, testing could prove to be less sensitive because (of any combination of):
  • You stockpiled RAT tests and they are now expired/nearing end of shelf life.
  • The RAT tests haven't been stored in near-ideal conditions (particularly the correct, stable temperature).
  • Significant reduction of the window of detection due to vaccination and subsequently acquired immunity.
  • Failure to be as thorough in collecting the sample as one might have been motivated to do so in the past.
 
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elbows said:
I also saw the other day that an investigation has been launched into bias in diagnostics equipment that may have been tuned to only work appropriately for some ethnicities, failing others in a bad way. eg the disgraceful situation with pulse oximeters, a subject that I do not remember gaining traction here when it first came out.
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I see it reported:

www.bbc.co.uk

Medical device bias needs immediate action - review

The review focuses on devices frequently used in the NHS, like pulse oximeters and skin cancer apps.
www.bbc.co.uk
 
The Anti-Vaxers were out in force this afternoon at Clapham Common near the underground station.
There are not going back to masks according to their placards - and more worryingly they claim that Covid injections are causing "Turbo Cancer"
This Reutters article had five experts denying these claims, although it did say that a reduction in medical screening during Covid may have led to late detection of some cancer cases.
 
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