Coronavirus 19

30th March 2020

Over the past 18 editions of this series of mini-blogs I have stressed the uncertainties. Here I try to constrain the uncertainty based on what we surely know.

The UK has now seen 1228 deaths.  (Update 31st March:  1789) (update 1st April: 2352)
The numbers are rising about every three days.
It takes, typically, almost three weeks from infection till death.
Most of the people who die over the coming three weeks have already been infected.
It is reasonable to assume that the infection rate has been doubling every 3 days, at least until recently when stricter stay at home measures were announced and adhered to.
Therefore the deaths over the coming days are already baked in.
15 days, five doublings, we see almost 40,000 deaths.
Three weeks, seven doublings, we pass 150,000.

If the current measures on lockdown are effective we should see the inflection in the logistic curve in a couple of weeks time, with the increase in deaths then falling off.

The Government is not telling us numbers like these. Is the Government telling us the truth? The whole truth?

anon.

And here is a message from Rupert Read, a philosopher.

Coronavirus 18

Saturday 28th March

13/03/2020	11
14/03/2020	21
15/03/2020	35
16/03/2020	55
17/03/2020	71
18/03/2020	104
19/03/2020	144
20/03/2020	177
21/03/2020	233
22/03/2020	281
23/03/2020	335
24/03/2020	422
25/03/2020	465
26/03/2020	578
27/03/2020	759
28/03/2020	1019

29/03/2020

1228

UK deaths are almost doubling every three days. If such an exponential growth continues there will be a million deaths by the end of April and everyone will be dead before May ends.

Of course that won't happen. Even if we do nothing, the virus will not be able to find new victims so the death rate will slow. There will be an inflection in the logistic curve.

And we are doing a lot, by staying at home and being very careful. Some have been irresponsibly careless, including the Prime Minister and Health Secretary by not applying their own rules on social distancing to themselves.
The Financial Times is displaying global data in a useful (and free) way.

There is still almost as much uncertainty about key factors as there was when I started writing this series in early February. We don't know how many cases there are, we don't know the R0 number, we don't know the case fatality rate.

What we can be certain about is that for the last decade and more government has not applied the Precautionary Principle, has left the health service woefully under resourced and has ignored a wealth of scientific advice and recommendations. It has all been compounded by a litany of bad decision making since January.

London has become one of the global hot-spots for Covid-19 infection yet Heathrow is still receiving and sending out flights from and to every corner of the world. Flight numbers may have reduced by over 80% but these international airports are still ensuring that the global pandemic is maintained.
You can watch it happening minute by minute at FlightRadar.

****************
With extraordinary prescience, Professor Tim Lang's Book,  Feeding Britain : Our Food Problems and How to Fix Them, was published this week. Written just before SARS-CoV-2 was a thing, it tells us what we really need to know about the UK's food system.

Buy the book, and read the book when you've done work in the veg plot.

Coronavirus 17

24th March 2020

At last, far too late, the government is doing what it should have done weeks ago.

This is 17th in my Covid-19 series of little blogs. The first one, posted on the 7th of February, started with these words:

When it was first suggested that UK nationals should be flown out Wuhan, I remarked that it might be better if all international flights were grounded, reducing both the speed of infection spread and our carbon emissions.

In the old story, Cassandra did not fare well at the time but it was the leader, Apollo, who was condemned by history.

One day, when he hear the mother of all inquiries, we will revisit advice given, yet ignored, by government. There will be pile upon pile of it.

Here is one small sample out of the many, the Global Preparedness Monitoring report 'A World at Risk' dated September 2019.

********************************

Today, however, while we sit at home, our minds should turn to how we rebuild a better society. The unfairness must go. Today we have some people sitting at home and being paid £2500 per month from public funds to do nothing, more than many in the NHS have ever earned, while millions in the self-employed gig-economy have been promised nothing but a vague recommendation to enter the Byzantine world of the benefits system with its dysfunctional Universal Credit.

And we must also turn our minds to global heating . Let's treat Covid-19 as a drill. The Climate Emergency is not a drill. 

The lesson from Cassandra must not have to be learned twice over.

Source

Coronavirus 16

21st March 2020

13/03/2020	11
14/03/2020	21
14/03/2020	35
16/03/2020	55
17/03/2020	71
18/03/2020	104
19/03/2020	144
20/03/2020	177

21/03/2020

233

22/03/2020  281

23/03/2020  335

If the UK death count continues to double every 3 days then we pass a million before end April. If we do the right things it might not.

I'll keep it brief because I want you to read two lengthy articles:

The first is science. It's the second on the subject from Tomas Pueyo et al.

This is a tremendously important article. Quite long, already more than a day old in this fast-moving world, but absolutely necessary that everybody understands the message contained.
Coronavirus: The Hammer and the Dance

The second is politics. It concerns how we in the UK got to where we are right now. We don't yet know whether Mr Johnson and his government will be responsible, by their bad decision making and inaction, for thousands or millions of avoidable deaths. We will only see that in the rear-view mirror. But right now we have to understand the history of the past fortnight. It is outlined by Alex Wickham and the good folk at BuzzFeed.
10 days that changed Britain

Please read these two articles, pass them on to as many people as you can, and act thereon.

Right, I'm off to the veg plot because this year I aim to grow a surplus. Just in case others don't.

And here's a short film, horrifying, yet beautiful.

Coronavirus 15

19th March 2020

The UK death count appears to be doubling in about two days.

13/03/2020 11
14/03/2020 21
15/03/2020 35
16/03/2020 55
17/03/2020 71
18/03/2020 104
19/03/2020 144

With exponential growth, the trick is to act before it looks like you need to.

We've been saying for quite a while that the UK is about a fortnight behind Italy and that we should have used that opportunity to do everything now being done two weeks ago.
14 days ago Italy was on 107. Italy now has just under 3000 deaths.

I notice that in the Second World War there were a total of 450,900 UK deaths. This was 0.94% of the 1939 population. If the fatality rate of Covid-19 is only 0.9% we should feel we got away with the optimistic end of the predicted uncertainty range.

The UK Government is now taking actions, albeit late in the day, and still not going far or fast enough. Perhaps it is not the moment for recriminations, but if only for the benefit of future historians, it is important to record where culpabilities lie.

Here is an article published in the Guardian on the 10th of December 2019, before we heard of this virus. Written by a hospital doctor, Andrew Meverson, it starkly explains just how close the NHS is teetering on the edge of collapse, with blame firmly laid on the current Prime Minister and the past decade of government policy.

"You and your party have had nearly a decade to leave the health service in a better state than when you found it. On every objective metric, the Conservative party has failed in that, and we see this in our NHS hospitals every single day. ...Prime Minister, the NHS is not safe in your hands. Your negligence and that of your party over the past decade has contributed to the deaths of nearly 5,500 patients, and if you were a junior doctor like me, your licence would now be revoked, and you would be sent to prison."

The vital policy imperative when faced with an exponentially spreading pandemic is to act before it looks obvious to the lay observer that the time is right. The Government should have been preparing for a novel viral pandemic for years and should have built a health service with enough slack in the system to cope with shocks. The Government should have sprung into action into action in January and by early February (when I started writing this series of blogs) every citizen in the land should have been aware of the dangers, should have changed their behaviour and should have been planning for the worst.

Then the worst would not not come about.

While not wishing to compare apples with pears, we now have to accept that the situation has the possibility of being more dangerous to lives in the UK than the Second World War.

And yet. We are getting positive news from China. Suppression of the outbreak appears to be working. Will we now learn form the Chinese experience and take the actions today to suppress the virus here, and clutch victory from the jaws of defeat?

Nudge

Coronavirus 14

17th March 2020

Not so long ago the UK Prime Minister was cheerfully dismissing the notion of social distancing, telling us how he had been shaking hands with "everyone" in a hospital.

Yesterday we got a significant policy change, prompted, it has emerged, by the actual scientific advice, particularly this report from Imperial College:

Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand - 16th March 2020

The government is still not telling the whole truth. Prof. Chris Witty, in the prime minister's briefing yesterday, spoke of keeping fatalities below 1%. There were two things wrong with that:

1. He did not point out that 1% translates to around a quarter of a million deaths.
2. He did not point out that 1% assumes that the health services do not breakdown and can provide intensive care to those who need it.  It will break down, unable to treat many. Just what the fatality rate becomes is a deep uncertainty.

It is hard to visualise numbers such as 1,000,000. The Grenfell Tower disaster killed 72. It would take a disaster like that every day for the next 38 years to reach a million.

********************************

Now let's get on with the job of building a better world.

Last night saw the launch of the film, The Sequel, based on the  work of my late friend David Fleming. I was planning to attend the launch (see yesterday's blog) but last night we watched it on line and then the discussion between Shaun Chamberlin, Caroline Lucas, Kate Raworth and Rob Hopkins.

I cannot recommend highly enough that people take these dreadful times to look forward with a measure of optimism, learning how to survive the future and build a better society. That was David Fleming's message.

Start the conversation here:

The Fleming Policy Centre

Coronavirus 13

16th March 2020

We can do a lot whilst waiting for our government to get its act together.

1. Assume that we have Covid-19. (It might be the case.)
2. Behave in a way that slows its spread to other, perhaps more vulnerable, people.
3. Maximise personal hygiene. (Soap*) 
4. Meet as few people as we can.
5. Remember we are doing this to minimise peak demand on NHS so that deaths in the UK can be counted in hundreds of thousands not millions.

*That soap thing, it really does work. The virus is essentially a piece of RNA, the genetic bit that allows replication, and some proteins and enzymes that do the damage, all held together with a lipid or fatty material. Here's the vulnerability. If soap touches, it all falls apart. End of virus. So the advice to wash thoroughly with soap is good. Very good. 

Of course a lot of us will need to interact closely with others to keep society functioning. The above five points still apply and should be kept in mind all the time. Even when we are necessarily with others.

But we all need to do whatever we can. Today I was planning to travel from Lincolnshire to London for the launch of the film, The Sequel, based on the life and works of my late friend David Fleming. It was to be a lovely evening, celebrating David Fleming's vision for the future with the best of people, Caroline Lucas, Kate Raworth, Rob Hopkins and Shaun Chamberlin. It isn't going to happen. 

Still, there will be an opportunity to share in this no-longer-a-real-event tonight online.
More information of how you can join us at The Sequel.

And more still on Shaun's blog at Dark Optimism.

Stay safe, keep others safe, and we'll build a better world on the other side. Meanwhile this is a good moment to read David Fleming's works, Lean Logic and Surviving the Future.

Coronavirus 12

15th March 2020

The UK government's action, or lack of action, has come under unprecedented criticism.

Harry Stevens, in the Washington Post, provides a helpful visualisation of how an infection can spread and how that spread can be slowed, giving the health care system invaluable time to cope. Watch it here

A letter from Richard Horton, editor of The Lancet, and many other well know figures (and me) was sent to the government, calling for more urgent action. Read it here

Most importantly, 282 scientists from British universities and a further 33 distinguished international scientists, have signed this letter.

It concludes, "We consider the social distancing measures taken as of today as insufficient, and we believe that additional and more restrictive measures should be taken immediately, as it is already happening in other countries across the world."

The UK Government has never before faced such a serious criticism from the scientific community on an issue that is life-critical for a couple of million people.

Read the rest here

Postscript.
Arne Akbar, Professor of Immunology University College London, President of the British Society for Immunology, is about as top a top expert as one can find. He has written this open letter to the Government.

Coronavirus 11

14th March 2020

If you haven't, look at previous posts linked to on the right.

We need to talk about the numbers.

The UK Government says 80% of the population may catch Covid-19 and 20% might be infected at the same time.
Let's make the arithmetic easy enough to check in our heads. Call it 50 million people infected (That's optimism bordering on magic.) 20% of that is 10 million. 5% of them are acute cases needing intensive care treatment to stop them dying. That's 500,000. Compared to that number, the actual number of ICU beds is approximately zero. That means most of those 500,000 people will die, in a short space of time.

That's our elderly relatives and our friends who are imuno-compromised or have 'underlying health problems'  or are just unlucky.

More numbers:

In countries and parts of China away from Wuhan, where draconian measures have been put in place and the health services have been prepared, case fatality has been kept be low 1%.  Let's pretend it's only 0.5%
If that were the situation in the UK (It isn't, this is not Fairyland) then 250,000 people will die.

A more realistic figure if we take drastic action now, i.e. lock-down of everything and everybody to smooth the peak in demand on health services and add a good deal of optimism, is that we get a case fatality rate of 1%. That means 1,000,000 people die.

The current UK Government policy as announced by the Prime Minster a couple of days ago leads to something in the region of 5% case fatality. That means 2,500,000 die.

When faced with governance failure the population has to do the right thing despite the government.

We all need to stay at home as much as we possibly can. Don't go to meetings and entertainment. If you are an event organiser, cancel it.

In this diagram the red area represents the UK, the blue area shows Fairyland.

Coronavirus 10

13th March 2020
[If you are new to this blog, it might be worth your while glancing at previous parts, linked to on the right.]

There is general agreement that any delay in the now inevitable spread of Covid-19 reduces the intensity of peak demand on the health services. In the UK the NHS has little slack at the best of times and now the worst of times brings the threat of overwhelming demand in which people will die because there is a lack of physical space, equipment and staff.

There has been little mention in the news media or from government statements of the importance of smoothing the peak in terms of potential casualties numbers. Estimates, still with a deal of uncertainty, of case fatality rates under different local circumstances vary from under 1% to around 5%. The essential factor seems to be the ability of the health services to cope with the small proportion of victims with acute symptoms. And that is where smoothing the peak of demand is vital.

For the UK smoothing the peak is all about shifting the fatality rate from the 5% region to below 1%. What was missing from yesterday's government statements was how this translated into actual numbers, the shift from over 2 million deaths to under half a million deaths was not emphasised.

What we got instead was the argument about the importance of timing. This seemed to be based on some notion that the public would not accept drastic social distancing for very long, that we would somehow get tired of making the effort and give up. That is a political judgement.

The government makes much of its policy being based on the science and the Prime Minister makes statements while flanked by his medical and scientific advisers. But remember these are political appointments, people on the government payroll, and subject to political restraint in everything they say. (Recall the sacking of David Nutt by the then Home Secretary, Alan Johnson, or the way David King has become much more vocal on the climate emergency since retiring.)

The current government position on social distancing, amounting to little more than "wash your hands" is a political decision, not scientifically supported. It is a decision that will determine, along with the past decade of NHS funding policy, whether the ultimate death toll from Covid-19 in the UK will be about half a million or a couple of million.

The stakes are high. We have not seen a peace-time situation before where government could be responsible for two million avoidable deaths. At least, not since the Irish potato famine.

Coronavirus 9

You might think, having listened to the Budget Speech, that the UK Government is now doing the right thing.

They are not.

I'll not waste your time explaining why as Tomas Pueyo does it so well.

Read this and share it widely and quickly.

Social Distancing will save lives. It's up to each of us to act now, even before government tells us to.

And if you don't want to take Tomas Pueyo's word for it, other similar work is available, as reported in today's Guardian.

Coronavirus 8

Readers of this little series of bloglets (for #1-7 see panel to right) will know that I have tried to emphasise the uncertainty around the Covid-19 pandemic, hoping for the best whilst being aware of the worst.

We can still hope for the best, that the virus will spontaneously mutate into a less harmful form and that the outbreak will peter out. There is, however, no evidence of that yet. So let us plan for the worst.

It is important to understand the underlying nature of how an epidemic can spread and the best account I've seen so far is this video from 3blue1brown . It's a bit of a maths lesson but it is quite okay to let the mathematical notation wash past you; the essential message will stick. I do urge all my readers to watch it. The eight minutes will not be wasted.

Lives depend on delaying and spreading out the peak in demand for health services. Tragically, our political leaders, and even some of their scientific advisers, seem to be acting like frightened rabbits caught in the headlights. In the UK we are some 10 to 14 days ahead of the situation in Italy but instead of grabbing the chance to get ahead of the curve by implementing drastic measures our government has announced they are going to wait and see.

This may turn out to be the most egregious failure of leadership in our lifetime.

Governments may fail but that just places a greater responsibility on each of us. It is high time we assume that other people are potentially infectious and that we do everything we can to avoid becoming infected ourselves. It is time we assume that we ourselves are infected and that we do everything we can to avoid infecting others.

For my part, as curator of an art exhibition planned for this coming April (see Faces of Climate) I have today written to the venue organisers to explore possible dates for a postponement.

Life as planned will be disrupted in the coming weeks. For some it may be disrupted permanently, but we all have our part to play to minimise that.

Coronavirus 7

This is the seventh in my series of bloglets on Covid-19. (Click on links in panel to right for earlier episodes.) Over the last month I've tried to emphasise the uncertainties while making clear the possibilities of bad outcomes. With each day that passes the probability of good outcomes has faded and the probability distribution has looked more skewed to the bad end.

Earlier to day I tweeted a few figures from the UK:

Big caveat: we don't really know how well the reported cases reflect the actual cases. That said...
03/03/2020 51
04/03/2020 87
05/03/2020 116
06/03/2020 164
07/03/2020 209
08/03/2020 273

What is the doubling time?

It takes about 26 doublings to go from one to 67 million.

The doubling time question was rhetorical. There is such unreliability in the figures, particularly in as much as we don't know how many mild cases of infection are going unrecorded, that there is little point in trying to derive a precise number, but suffice it to say it looks like a few days rather than a few weeks of months.

Our politicians (remember the Prime Minister was happy to declare he had been shaking hands with everyone in the hospital) have been woefully slow to move from 'containment' to 'delay'.
The news coming from Italy is not encouraging. The infection there seems to be running at about a fortnight ahead of the UK. 

That gives us an opportunity. Government might be wise to act now on the basis of data that we can expect to see in a fortnight's time, rather than to wait until that data arrives.  Significant delay is going to be best achieved by acting ahead of the curve, rather than in response to the curve.

Delay is important as it spreads the workload of the NHS. That is life-critical.

Coronavirus 6

March 2nd 2020

A quick update in this mini-series of mini blogs on Covid-19. (See previous episodes here.)

The window of opportunity for containment and prevention of pandemic seems now to have slipped away. We still don't have firm data on the reproduction number, RO, how many people on average get infected from an ill person. Nor do we have a sound figure for the mortality rate, though the evidence so far points to an order of magnitude of 1%.

What has become clearer is that containment is unlikely and the probability that the virus spreads throughout the global population has increased.  1% of a large proportion of the human population is a large number.

The UK government is still trying to assure people that #Covid-19 is containable. The truth is that it probably is not. The sooner we accept that there is a pandemic the more likely we will adopt appropriate measures.

The objective of government policy and personal behaviour should be to slow the spread of the virus, in the hope that a sudden spike of illness across the population that overwhelms the health service may be avoided.

Short term economic costs must not be allowed to trump a longer term human and economic catastrophe.

Here I re-post a message from a GP, Dr Peter Weeks @DrPeterWeeks1 that he posted on twitter.