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Let's talk about China

We dont do a very good job of counting flu deaths properly due to lack of routine testing. In normal times the authorities and experts have to resort to trying to figure it out using estimates, things written on death certificates, broader categories of death, overall death rates and excess death amounts measured over each winter. And there is a lot of variation in what estimates different people come up with, some doctors like to believe the numbers are relatively modest but that sort of view isnt actually supported by the broadest forms of death data. But just to give some vague numbers, in 2018 authorities listed 29,516 'influenza and pneumonia' deaths and in 2019 they listed 26,398 (figures are for England & Wales since thats what the ONS covers). I wont bore on at great length about how many there actually are in bad flu years, but if we study a season like 1999-2000 when there was a really bad flu wave, the official figure was 'only' 19,000 compared to 48,000 excess deaths that winter. This range of numbers is likely where Vallance plucked his '20,000 would be a good result' from early in this pandemic, never mind that flu is a poor guide to covid. Increased vaccination campaigns against flu in recent decades has certainly changed the overall death picture compared to last century, so there are some broader clues there, flu can be quite nasty, especially the H3N2 version of it.

Certainly in recent years we havent had the normal quantity of flu deaths, lockdowns and behavioural changes stopped the normal flu waves from happening at anything like their usual scale, flu was largely absent (though not completely gone in reality). This winter it is expected that we will get a flu wave more like those seen before the pandemic, and indeed one has already begun. And such waves vary each year in terms of how much death they cause. And we tend to get a large proportion of those deaths in a relatively short space of time over winter, whereas this years Covid deaths that I mentioned have happened over about 4 waves throughout the year. About half of them happened by mid April, so it was worse earlier this year than later. Some of those earlier deaths were from Delta rather than Omicron. The extent to which we are undercounting isnt so easy to ascertain, but if we include deaths recorded as 'involving' covid then the figure is more like 30,000 than 20,000. If we look at deaths from all causes, 2022 so far for England & Wales has seen about 11,000 less deaths than there were in the same period of 2021, which isnt an amazing result given how large a covid death wave (and lockdown) we had in early 2021, and that 2021 featured pre-Omicron strains and the vaccine rollout took time to take maximum effect back then.
There's also a bird flu pandemic affecting only birds for the time being atm, there's been huge die offs of sea birds discussed among birders:( which might er...complicate the picture at some point if it starts to spread to humans :(
 
In regards zero covid, the 'zero covid until vaccine uptake reaches a certain level' was adopted in some other countries too, we arent stuck with only Chinas version of zero covid (featuring zero workable exit strategy so far) as a real world example. New Zealand and Australia are examples where they came to terms with an exit strategy that involved a certain amount of death later on.

As for lockdowns, theres not much new that would make a discussion about this any deeper now than it would have been a number of years ago.

And it wasnt just a question of needing lockdowns early on, they were needed for subsequent waves pre-vaccine too. UK attempts to dodge this reality without a sufficient replacement only led to a longer winter lockdown in the end.

Ways to avoid lockdowns and other restrictive responses, roughly in sequential order:

Stop the new virus getting into humans in the first place, by reducing the risks from animal-human interfaces and also to cover all bases things should be done to reduce the risk of lab accidents.

If you fail to do that, then at least have systems that offer a better chance of detecting the outbreak early, and limiting the human to human spread at or near ground zero. If that fails too, then at least have systems to stop it spreading rapidly around the entire country, and then around the entire globe.

If all those lines of defence fail then at least do stuff that slows down the spread and buys more time. Including having the ability to test way more people from an earlier stage. Put pressure on authorities not to get stuck behind the curve at every single step during the crucial early period.

If all of that fails then you still dont end up with lockdowns in every single pandemic, that level of response has tended to be the exception not the rule. Because the strength of response required depends on properties of the virus including its transmissibility, uniqueness of symptoms, what rate of hospitalisation and death it causes, age-risk profile, whether any treatments and vaccines are available, and what sort of hospital capacity a particular country has. Then depending on how all those things balance out, there might be plenty of room to deal with the issue via standard health responses, pharmaceutical methods etc. Work is being done on a broad influenza vaccine that it is hoped will offer protection against a bunch of strains that have future pandemic potential, to give one pharmaceutical example of something that can change the equations in some scenarios without people having to resort to lockdowns.

If things are still considered a close thing, with margins that are too tight to call with high confidence, then you do all you can to buy time every step of the way, increasing the chances of success, and give the masses the right information and the right impression of the situation so that they can voluntarily make some changes to behaviour early on rather than falling for inappropriate reassurances from the authorities. Ultimately there are a whole range of non-pharmaceutical interventions, lockdowns and closures of things are at one end of the spectrum of these non-pharmaceutical interventions and if the numbers add up better then you wont find authorities feeling the need to go as far as closures and lockdowns. And if authorities get too far out of step with basic reality, a fair chunk of the population will take matters into their own hands.

This virus was a bad one and many mistakes were made. If a virus with similar potential to cause severe illness etc came along in future, and authorities made the same sort of mistakes, and we didnt have treatments or vaccines or a wonderful new quantity of spare healthcare capacity or a big difference to the underlying health of our populations, then we would end up in a similar position and very strong responses would be required again. We could fiddle with some of the detail of restrictions and decent timing of a strong response could help, eg act early to reduce size of outbreak in the first place thus making periods of lockdown shorter, but the basic hospitalisations numbers game would still be where the action was, would still lead to trigger points where tough shit was required if certain levels were breached. There are a whole bunch of factors which affect quite how much wiggle room particular countries end up with, and quite how far they have to go with restrictions. When we get into this level of detail and variations between nation, the blanket term lockdown may be too simplistic to do the detail justice. And there can be infinite quibbling to suit some peoples preferences for avoiding certain actions, for choosing to believe what they feel like in regards how much good masks and lockdowns etc do, but that sort of discussion doesnt usually lead to useful alternative choices that UK authorities could actually rely on if we faced a similar virus threat in future.

People learning the obvious via the experience of this pandemic, that lockdowns were not much fun and have downsides really does not change the fundamentals. Not unless people are proposing that we develop new lower standards in regards peoples expectations of being able to receive healthcare at all during a pandemic of this sort, as opposed to being overtly sacrificed. And even when such cold calculations are made use of, the UK demonstrated that there are still limits to how far such a thing can be pushed, they still ended up having to go much further with restrictions than they originally had the appetite for. Even with their heavy handed use of rather cold calculations in the early months they still couldnt make the numbers add up. Because this particular virus sucks too much and we were starting from almost nothing in terms of pharmaceutical options, and because they resisted doing various tough but sensible things at the earliest opportunities, compounding our plight.

Being able to reduce spread of the virus in care homes, reduce the spread in hospitals, and being able to genuinely shield the most vulnerable can affect the equations and buy more wiggle room that could alter the balance to the extent that you then dont have to go so far with measures in other settings and other aspects of peoples lives. These things are tricky to achieve though, and likely require us and authorities to adopt a different sense of priorities as a nation during normal times, and there appears to be a lack of appetite to bother.


elbows ... That's fucking poetry!

That's really fucking poetry of the highest order.

Thank you.

:)


Woof
 
There's also a bird flu pandemic affecting only birds for the time being atm, there's been huge die offs of sea birds discussed among birders:( which might er...complicate the picture at some point if it starts to spread to humans :(

A particular form of bird flu is why I first started to learn about pandemics, many years ago now. Very hard to guess if and when one will gain the potential to spread effectively in humans and then go on to cause a pandemic.

This sort of thing is one of the reasons the news about a new type of flu vaccine was potentially important: Universal flu vaccine could counter future pandemic
 
They had already started changing the rules in recent months, but it is certainly true that this appears to be a new chapter in terms of how quickly they are changing the rules and a very large change to the rhetoric.

BBC version of the story:




In reality is is unlikely that there have been recent changes to the pathogenicity of the virus or to vaccination levels that match the timing of the change of rhetoric.

But there is a difference between what has actually changed with the virus recently, and what the authorities and Chinese media are suddenly ready to reveal to their people. And sure enough, look what I just found, an article with todays date on it:








The article then goes on to mention previous Omicron research in some other countries.

"Omicron is mild' was a sentiment that was very useful in many countries, speeded up a change in attitudes towards the virus in populations all over the place. So not too surprising that China is now making heavy use of it. A more nuanced version of the claim is probably a better fit with reality, eg Omicron is certainly mild compared to Delta and it does seem to affect certain parts of the body less even compared to the original strain. The amount of death it can still cause means I cannot call it mild overall, but risk is judged in a relative way compared to what we've experienced before, so I do understand the sentiment. And Delta was a real shit of a strain, so the contrast between Delta and Omicron is not so subtle, as shown in intensive care figures all over the place. Levels of population immunity are part of the picture too though, some of what people attribute to Omicron reflects other changes to the situation, changes to us rather than the virus.


Omicron is as nasty as Delta.

The only difference in the West is that, by the time Omicron came along, the vast majority of the population was already protected against severe illness or death by high levels of vaccination and/or previous infection, which wasn't the case with Delta.

In a sero-negative population, with very low protection through prior infection by previous variants and insufficient vaccination among the elderly, the case fatality rate in Hong Kong's unvaccinated 80+ year olds was over 16% - and we had a lot of un-vaccinated elderly. By the time Omicron came around, the UK was already well protected.

Our per capita Covid death rate in Hong Kong is the highest in the world for 2022, about 98% of which was down to Omicron and happenned largely over a two month peak in Feb/Mar 2022. Entirely due to the catastrophic failure of the Govt. to adequately vaccinate the most vulnerable when it was eminently doable.

:)

Woof
 
Yes I havent been very keen on the 'Omicron is mild' narrative since it first emerged around a year ago. I dont dismiss it from absolutely every angle these days because there are some specific areas where studies suggest it isnt as bad as Delta, but then Delta was especially nasty. And people need to be aware that the intrinsic deadliness of a particular strain isnt the only factor that determines how many deaths will result from it - if it spreads more easily and thus infects more people, then any other advantage stemming from its other properties can easily be lost.
 
Yes and although its pretty tedious that I feel the need to point out we've had over 20,000 Covid deaths in England & Wales so far this year, I cant help it. Partly because this sort of figure also offers clues about why lockdowns were needed in the pre-vaccine era. If we still end up with over 20,000 deaths when well into the vaccination era, and when dealing with the Omicron strain, and in a population with a significant amount of prior exposure, then it shouldnt be too hard to contemplate what earlier phases of the pandemic would have been like if everyone carried on as normal instead of making large changes to behaviour.

I wont have a great idea about what to make of Chinas official statistics for the next period with their changed approach, I dont know how much of the picture they will try to suppress.
Nah bad example....flu deaths (for which we've had a vaccine program for ages) deaths 10k-25k per annum usually in England and Wales

The early forms though were though, substantially more deadly and cos they were still working out what they were doing, nearly overwhelmed the health service
 
There's also a bird flu pandemic affecting only birds for the time being atm, there's been huge die offs of sea birds discussed among birders:( which might er...complicate the picture at some point if it starts to spread to humans :(

When we were on holiday on Islay in August, Mrs Sas and her sister came home from a walk in tears. The Big Strand, the beach alongside the airport was absolutely littered with dead birds. It was the gannets that got to Mrs Sas, never having seen one of those beautiful birds, her first sight was dozens dead along the shoreline.
 
When we were on holiday on Islay in August, Mrs Sas and her sister came home from a walk in tears. The Big Strand, the beach alongside the airport was absolutely littered with dead birds. It was the gannets that got to Mrs Sas, never having seen one of those beautiful birds, her first sight was dozens dead along the shoreline.

We're seeing things like that too:


 
I'm in a Telegram group to support the local protests (anyone walking past the memorial site can scan a QR code and join the chat) and there was a message in the group saying that posters in town had been taken down and replaced with a poster of Xi Jinping :eek: :(
 
Nah bad example....flu deaths (for which we've had a vaccine program for ages) deaths 10k-25k per annum usually in England and Wales

Well I already provided a bit more detail about difficulties with counting flu deaths in a subsequent post. And when it comes to undercounting, its hard to say how undercounting of flu deaths compares to undercounting of covid deaths. And flu deaths vary per year. And the difficulties of making comparisons extends well beyond deaths. Its not as trivial as it should be to get a accurate sense of how covid hospitalisations compare to pre-pandemic influenza hospitalisation figures, due to differences in testing/lack of testing, the way such data is collected, estimated and presented. Although I may find it easier to make a hospitalisations comparison this season, assuming our flu wave continues to grow, because at least one weekly report is covering both diseases and reporting on hospitalisations using the same metric (albeit formal testing for flu still remains an issue). So far, and especially in the older population, hospitalisation rates per 100,000 for flu remain very much lower for flu than covid, even at points in the wave cycle where our covid admissions have hit their lowest point. Things might be much closer when it comes to intensive care admissions this season, may well be easy for flu to beat covid in that respect for a time this season, but still too early to make strong claims about that. I will post more about this elsewhere later in the season when there is more data and once we've seen how big the flu wave gets.

Its also important to understand that there are differences with the vaccination picture between these two diseases as well. There are difference with uptake rates in different age groups, and differences with how often some people are asked to get vaccinated. But there are also differences in terms of how well the vaccines work. For example there were some years where the flu vaccines on offer at the time appeared to have offered no protection in older people at all, and that surely contributed to the high number of flu deaths those years. This is surely a reason to be cautious when being tempted to reach reassuring conclusions when comparing number of covid deaths this year with number of flu deaths in a bad year. eg if our covid vaccines worked as badly at protecting older people against severe disease or death as the flu vaccines did some years, the covid death numbers would be higher than what we've actually seen this year. The situation with the flu vaccine in older people when faced with H3N2 waves of flu was so bad that some years ago they started to offer a different flu vaccine to older people, one that should offer better protection. But I dont think there have been enough normal flu years since that change for me to get a full sense of how many flu deaths will be considered normal in future under this new vaccination regime.

People trying to make these comparisons is understandable when people are trying to put current covid risk levels into a broader context. But in practical terms as far as the authorities are concerned, the concern is more along the lines of having to live with both of these diseases at the same time, and the extent to which their combined weight puts pressure on health systems during winters. As well as winter concerns, a big factor in how well governemnts manage to stick with their 'learning to live with covid' agendas will be whether covid settles down in future in terms of the size and frequency of waves it causes. Asking our NHS to cope with a large wave in winter is one challenge, and asking it to cope with 4 covid waves a year is another sort of severe challenge that has implications if it continues next year with a similar scale of wave peaks as seen this year.

Since China is at a different stage of its pandemic journey to us, some of these longer term pressure concerns will pale in significance compared to concerns about what their first wave under more relaxed measures will look like. Given the timing they may still have to contend with the overlapping covid wave and flu wave issue, but will have to wait much longer to see what the longer term version of 'living with covid' actually means, how sustainable it is, the extent of its permanent implications with subsequent waves that come later than the anticipated initial 'big one'.
 
Some indications of the level of concern and crackdown online:

Leaked directives issued to online Chinese platforms, first published by a Twitter account devoted to sharing protest-related information, have revealed authorities’ specific concerns about the growing interest among citizens in circumventing China’s so-called “Great Firewall”. The demonstrations have been strictly censored, but protesters and other citizens have this week used VPNs to access non-Chinese news and social media apps that are banned in China.

The directives, also published and translated by the China Digital Times, a US-based news site focused on Chinese censorship, came from China’s cyberspace administration, and announced a “Level I Internet Emergency Response, the highest level of content management”.

It ordered managers to take a “hands-on approach” and strengthen content management to rapidly identify, deal with and report information about what it termed “offline disturbances” and “recent high-profile events in various provinces”.

“The incident on November 24 triggered expressions of various grievances,” it said, according to CDT’s translation and in reference to the Urumqi building fire which killed 10 people.

“Pernicious political slogans appeared in Shanghai; college and university students held conspicuous political gatherings; smears by foreign media increased; and various websites have strengthened their content management.”

It noted upcoming dates during which managers should take particular care, including the one-week anniversary of the fire, World Human Rights Day, and International Anti-Corruption Day. They also ordered e-commerce platforms to “clean-up” the availability of products and apps and “harmful content” designed to circumvent internet restrictions, such as VPNs and firewall-circumventing routers.

 
That same article also vaguely hints at the sort of opposite concerns that I mentioned in connection with the earlier Foxxcon incident:

However, the haphazard relaxation of restrictions appears to have fuelled some confusion and concern, with residents suddenly feeling more exposed to a virus that, until this week, authorities were describing as deadly.

And a bit more on the changed messaging:

Commentaries in the official state news outlet, Xinhua, on Friday urged greater individual responsibility around mask-wearing, hand washing, ventilation, and reduced gatherings. They also emphasised the need to protect vulnerable groups, and for local authorities to be faster at re-opening targeted lockdowns.

“Given that risks can be managed, what should be managed must be managed well, and there should also be relaxation when appropriate,” it said according to a translation by the China analyst Bill Bishop.
 
I probably should have pointed out in previous posts that if I use deaths within 28 days of a positive test rather than death certificates, then the number for England & Wales in 2022 so far is 44,065.

This also further illustrates the difficulties of coming up with a single number that use, there are uncertainties, and so we end up with a rather broad range instead. And there is no way for me to offer an equivalent figure for flu due to a lack of testing.

And the issue is even worse when it comes to China. Most countries end up underreporting deaths for a number of reasons. The suspicion is that China does this to an even greater extent, but then again when western media report on this, the level of underreporting that is considered plausible is also affected by assumptions, some of which will be accurate but some of which may also be influenced by our own biases and the extent to which it is 'politically acceptable' to make certain assumptions about the extent of underreporting in our own countries as opposed to China. So for example some reports came up with figures of 7%, 17% or 30% underreporting of Covid deaths in the USA. But one of those also concluded that China was underreporting by 17000% which implies over 1.7 million Covid deaths in China already. I plucked those numbers from articles like this one Part 1: Beijing Is Intentionally Underreporting China’s Covid Death Rate It is not possible for me to reach a safe conclusion about the true scale of underreporting in China up to this point, let alone how distorted their figures will be in the next phase with less restrictions.
 
This seems to be a good article on how not to read the protests in China:

[W]hile the Chinese protesters are demonstrating against the authoritarian pandemic governance they have been subjected to, it would be a profound misreading of the protests to conclude that they are demanding the nihilistic necropolitics of the United States and other Western countries. To put it as unequivocally as possible: the protesters in China and the anti-mask/anti-vaxx protesters in the United States, Canada, and Europe are not the same. Western protests against masks and vaccines are a rejection of our ‘shared interdependence’, as political theorist Elisabeth Anker puts it. According to Anker, ‘[t]he COVID warriors practice a freedom to expose others to death, and indeed to be free from them’), with ‘them’ representing basically anyone outside of their private bubble. The assertion of individual freedom as the right to expose others to harm, and protect a fantasy of invulnerability and indifference to strangers, is neither a universal nor desirable definition of freedom. Chinese protesters’ calls for ‘freedom’ (自由) are both polyvocal and symbolically overdetermined by the context of their inscription. Also it is worth pointing out here that student protesters (as they did in 1989) have been singing The Internationale, illustrating that socialist values are not the monopoly of nominally socialist regimes.

Biopolitical Binaries (or How Not to Read the Chinese Protests)
 
Well I already provided a bit more detail about difficulties with counting flu deaths in a subsequent post. And when it comes to undercounting, its hard to say how undercounting of flu deaths compares to undercounting of covid deaths. And flu deaths vary per year. And the difficulties of making comparisons extends well beyond deaths. Its not as trivial as it should be to get a accurate sense of how covid hospitalisations compare to pre-pandemic influenza hospitalisation figures, due to differences in testing/lack of testing, the way such data is collected, estimated and presented. Although I may find it easier to make a hospitalisations comparison this season, assuming our flu wave continues to grow, because at least one weekly report is covering both diseases and reporting on hospitalisations using the same metric (albeit formal testing for flu still remains an issue). So far, and especially in the older population, hospitalisation rates per 100,000 for flu remain very much lower for flu than covid, even at points in the wave cycle where our covid admissions have hit their lowest point. Things might be much closer when it comes to intensive care admissions this season, may well be easy for flu to beat covid in that respect for a time this season, but still too early to make strong claims about that. I will post more about this elsewhere later in the season when there is more data and once we've seen how big the flu wave gets.

Its also important to understand that there are differences with the vaccination picture between these two diseases as well. There are difference with uptake rates in different age groups, and differences with how often some people are asked to get vaccinated. But there are also differences in terms of how well the vaccines work. For example there were some years where the flu vaccines on offer at the time appeared to have offered no protection in older people at all, and that surely contributed to the high number of flu deaths those years. This is surely a reason to be cautious when being tempted to reach reassuring conclusions when comparing number of covid deaths this year with number of flu deaths in a bad year. eg if our covid vaccines worked as badly at protecting older people against severe disease or death as the flu vaccines did some years, the covid death numbers would be higher than what we've actually seen this year. The situation with the flu vaccine in older people when faced with H3N2 waves of flu was so bad that some years ago they started to offer a different flu vaccine to older people, one that should offer better protection. But I dont think there have been enough normal flu years since that change for me to get a full sense of how many flu deaths will be considered normal in future under this new vaccination regime.

People trying to make these comparisons is understandable when people are trying to put current covid risk levels into a broader context. But in practical terms as far as the authorities are concerned, the concern is more along the lines of having to live with both of these diseases at the same time, and the extent to which their combined weight puts pressure on health systems during winters. As well as winter concerns, a big factor in how well governemnts manage to stick with their 'learning to live with covid' agendas will be whether covid settles down in future in terms of the size and frequency of waves it causes. Asking our NHS to cope with a large wave in winter is one challenge, and asking it to cope with 4 covid waves a year is another sort of severe challenge that has implications if it continues next year with a similar scale of wave peaks as seen this year.

Since China is at a different stage of its pandemic journey to us, some of these longer term pressure concerns will pale in significance compared to concerns about what their first wave under more relaxed measures will look like. Given the timing they may still have to contend with the overlapping covid wave and flu wave issue, but will have to wait much longer to see what the longer term version of 'living with covid' actually means, how sustainable it is, the extent of its permanent implications with subsequent waves that come later than the anticipated initial 'big one'.


Now this, my friends, is a perfect example of OCD at its very, very finest. A pinnacle!

And I should know. I should know. I should know. I should know. I should know.

It's pure fucking poetry. A complex and rhythmic dance. Beautiful.

Thank you, elbows, for your attempts at clarity. It's clear to me.

Poetry. More power to your elbow, elbows. More power!

Relax. Take your time. We're listening. Or trying to.

Keep thinking peeps and be nice to each other.

Come Bells.


Woof
 
This is from Wilfred Chan, an NYC based journalist who used to be based in Hong Kong.

Rose Tang is a Tianamen Square protest veteran who now live in de facto exile and remains an activist.

“We wanted the Communist party to introduce democracy, but we didn’t want the Communist party to leave China,” Tang says. So today’s protests, which have called for the removal of the CCP and its leader, are “really the first time we’ve seen such a demand in public on such a large scale”.

Zhou Fengsuo is a 55-year-old former Tiananmen student leader now living in New Jersey.

[He] tells me he wept when he saw videos of the protests spreading across multiple cities. “Freedom in China is precious,” he says, “and it’s been postponed for so long.”

‘Freedom in China is precious’: Tiananmen Square protest veteran salutes new generation
 
Apologies.

I didn't mean to accuse any others of that of which I am guilty. My bad.

It's something I'm learning to take seriously and struggle with.

Apologies again. My shame is palpable.

:(


Woof
 
In Beijing, people prepared to go into shopping malls or on public transport without a recent negative test. Elsewhere, they were allowed to enter parks and supermarkets without checks, or told they could quarantine at home – rather than a government facility – if they had come into contact with a case.

eta: It isn't really clear to me from this whether zero covid policies are being abandoned or just relaxed.
 
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eta: It isn't really clear to me from this whether zero covid policies are being abandoned or just relaxed.

Well abandoning zero covid doesnt mean abandoning every single covid mitigation.

It could also be judged not in terms of the strength and nature of any remaining measures at all, but rather by intent described in rhetoric. If you stop claiming that the aim is to totally suppress the disease and its spread, then you have abandoned the rhetoric of zero covid. You could still use rhetoric and measures that aim to somewhat reduce the amount of spread, because thats not zero covid.

jesus christ the policies were fucking hardcore up until now and the new policies are still harsher than anything in europe since 2020

What sort of measures are you referring to? Measures used in Europe in 2020 were still used there for a portion of 2021 too. And things like the legal requirement to self-isolate didnt end in England until February of this year.
 
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