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The UK’s public health response to Covid-19

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Re: The UK’s public health response to Covid-19

#61

I'm all for criticism and investigation. But it seems so early to make these kinds of definite proclamations. There is so much about the virus and how it's transmitted that we still don't understand. The UK government had no idea what they were doing, but really neither does anyone else. And until we are a little further along in successfully containing this epidemic, it's not going to be clear what the best course o…

These are some very good points.

I'm glad the Nightingale hospitals were not used, as they were set up if we had to scale response massively.

But I think we really need to look at the deaths and where they occurred. I have a feeling in some areas they've pushed people out of hospital to keep the hospitals ready for the worse cases. A neighbour works in a hospice and she said her place and the local hospital do not have patients. So we need to look at the balance of avoiding sending people to hospital which could make it worse vs being in hospital with the virus. - Has this made the death rate worse than it could have been? - Has this made the care home issues worse as well? - How has this affected the accuracy of the reporting of deaths

Testing, to me appears to be an absolute joke, I think they are defining tests as having taken the swabs and not processed it. (as the 40k of tests were home tests that had been sent out) I saw my nearest test station (Portsmouth) last Sunday, the only cars there were the people that worked there. I'm wondering what the hell the government has done to increase the actual capacity from taking the test to processing it. I feel this is being avoided in the media, we just hear we're doing X tests a day.

Now I can understand if people are showing the common symptoms of covid-19, then testing isn't much help unless you want to know the strain etc. But if we're talking about people with mild symptoms that aren't on the government symptom list, then that's could be a big issue for the R value. The government only just updated that list yesterday. I had a slight cough and had breathlessness, my peak flow was around 650, doctor doesn't think it's asthma or covid, but then went on to talk about how his colleagues had mild symptoms and didn't feel right. The right thing would be to just test. Without testing we could be missing out on a lot of information that could shape how we respond to covid-19 in the following years.

Personally I think it will be quite some time before we get a better understanding of the deaths. People will be needing to go through the death and medical records to understand why patient X died. My mum has a friend who father died out of the blue and it classed as covid, despite no symptoms.

As for PPE, the government has failed, we've seen the interviews with suppliers who have been ignored by the government. It wouldn't be that hard to get someone to inspect items initially, then have it sent to some location for further distribution. Seeing hospitals wearing home made masks and 3d printed face shields isn't right, the NHS/government purchasing/logistics has failed here. The government should have taken a larger interest in the production and distribution of PPE early on, even having control over the export. I'm all for free market but we need some centralisation to know what we have and capacity to produce so we know it's going to the right areas.

Re: The UK’s public health response to Covid-19

#63
post #58

I'm all for criticism and investigation. But it seems so early to make these kinds of definite proclamations. There is so much about the virus and how it's transmitted that we still don't understand. The UK government had no idea what they were doing, but really neither does anyone else. And until we are a little further along in successfully containing this epidemic, it's not going to be clear what the best course o…

> As of today, there have been 23,953 deaths in England. No. 1) The actual number is 34,796 https://coronavirus.data.gov.uk/ 2) That only includes people who were tested positive for covid-19. That's only tests carried out by government labs, not private tests. We've only just started to include deaths that happened outside hospital. > Why weren't the Nightingale Hospitals (field hospitals) needed? Because we didn't…

> Because we didn't have enough ICU nurses to staff Nightingale:London.

I guess the idea was that military medical services would have moved in to run the Nightingale hospitals if things got really bad?

Re: The UK’s public health response to Covid-19

#64
post #50

Earlier quoted context omitted.

You're looking at the total number of deaths, not the death rate per capita. Every country has a different population size which means the total number of deaths needs to be normalised in order to be comparable. Belgium has the highest death rate per million population in Europe - 79.25 The UK is 4th in Europe behind Belgium, Spain and then Italy. https://coronavirus.jhu.edu/data/mortality The fact we're 4th does war…

Your link is talking about "confirmed cases". Belgium is high in that list because they do a lot of testing inside and outside hospital, and so many of the people who die of covid-19 have had a test to confirm that, and because Belgium is including deaths that happen outside hospital. The UK however has only just started testing people outside hospital, and has only just started including deaths outside hospital in i…

If you look at excess death rates, Belgium is still 1rst in europe (and UK second), both with over 60% a week ago.

Within a small area with a >40% IR, the excess death rate reached 270% (in France), so it could be worse, but it still bad.

Re: The UK’s public health response to Covid-19

#65
post #58

I'm all for criticism and investigation. But it seems so early to make these kinds of definite proclamations. There is so much about the virus and how it's transmitted that we still don't understand. The UK government had no idea what they were doing, but really neither does anyone else. And until we are a little further along in successfully containing this epidemic, it's not going to be clear what the best course o…

> As of today, there have been 23,953 deaths in England. No. 1) The actual number is 34,796 https://coronavirus.data.gov.uk/ 2) That only includes people who were tested positive for covid-19. That's only tests carried out by government labs, not private tests. We've only just started to include deaths that happened outside hospital. > Why weren't the Nightingale Hospitals (field hospitals) needed? Because we didn't…

You've confused England with the UK (England, Wales, Scotland and Northern Ireland).

Re: The UK’s public health response to Covid-19

#66
post #45
post #22

Earlier quoted context omitted.

Not only they tested early, they have the capacity to test ten if not hundreds of thousands of people a day and have laboratories spread across the country working with the government, rather than against it [0] Sure the UK was slow at testing but there are still ways of getting a private testing kit for yourself in the UK. Thus, it's very easy to blame the UK government for the high death rates and slow response whe…

UK has a public health service, why would people pay for a private test?

> why would people pay for a private test?

The NHS already has its inefficiencies whilst being a public health service and is already slow enough to get an appointment given its long waiting times to see the GP which is why some go to private healthcare to bypass this.

Re: The UK’s public health response to Covid-19

#67
post #62

Infographic in the link article is worth a click: https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg It is timeline graphic of the growth of the virus per country and actions taken by each country.

Anyone know what is causing the humps in the graphs of “confirmed cases” ?

Looked at this before, at first I thought it was weekends being under reported, then people going out on weekends, etc. — but now starting to think it might be the R0 (reproduction number) is very high and the virus burns itself out among a social network.

Any ideas what is the source of those humps?

Re: The UK’s public health response to Covid-19

#68
post #2

>If the government failed in its duty to protect the public, it also failed to protect staff in the NHS and social care by not delivering sufficient amounts of personal protective equipment (PPE) of the right specification, again deviating from WHO advice The government is currently telling anyone who will listen that hospitals have all the PPE they need. However, local nurses and doctors are co-ordinating with volun…

Is there any evidence that there has been excess deaths for NHS staff and that this has been caused by a lack of PPE?

There is this study (https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-cov...) that suggests deaths are amongst NHS staff are not over-represented.

There is also a remarkable correlation between the cumulative UK deaths from covid-19 in the UK population and among health and social care workers. Accepting a lag of one to two days, the ratio is very close to 1:200 so the deaths among health and social care workers are approximately 0.5 per cent of all deaths, suggesting they are not overrepresented.

That is the only study I could find that tried to look at excess deaths for NHS staff. I think their suggestion that deaths are not overrepresented is not backed by their data because it doesn't look like they are adjusting for difference in base mortality rates between NHS workers and the general population. However, considering how people are claiming lack of PPE is killing NHS staff you would think someone would have checked by now whether NHS staff are actually dying at a higher rate!

When NHS deaths were around ~80 I ran my own model adjusting by age and found 10 excess deaths. However, the way I interpolated the deaths in the population to NHS age bands was very dirty and I didn't adjust for sex and race. The NHS has BAME groups overrepresented in their work force and these groups have higher mortality rates.

Re: The UK’s public health response to Covid-19

#69
post #2

>If the government failed in its duty to protect the public, it also failed to protect staff in the NHS and social care by not delivering sufficient amounts of personal protective equipment (PPE) of the right specification, again deviating from WHO advice The government is currently telling anyone who will listen that hospitals have all the PPE they need. However, local nurses and doctors are co-ordinating with volun…

> If the government failed in its duty to protect the public

Most governments failed when they didn't start to tax the sh*t out of unhealthy food and ingredients.

"Preliminary evidence suggests that the severity of symptoms associated with Covid-19 and the eventual outcome of being infected with this virus are associated with the health status of individuals prior to infection. Among the factors linked to an increased risk of hospitalization and mortality are overweight/obesity, insulin resistance and diabetes: these lifestyle-related diseases [...]" https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.22849

Re: The UK’s public health response to Covid-19

#70
post #60

Earlier quoted context omitted.

I disagree. The UK strategy was to not pull the trigger on lock down too early, and then to flatten the curve in a way that fills our front line health service's capacity without overstretching it. All while increasing numbers of beds, ventilators and distributing PPE as widely as possible. That's broadly what's happened.

https://twitter.com/BBCMarkEaston/status/1237694665824047111 "There's going to be a point, assuming the epidemic flows and grows as we think it probably will do, where you'll want to cocoon -protect- those at-risk groups so that basically they don't catch the disease, and by the time they come out of their cocooning herd immunity has been achieved in the rest of the population". It's clear from this that the policy w…

that's a pretty cynical interpretation that confuses the practical and biological inevitability (herd immunity) with one of the many method(s) by which we get there (shielding vulnerable groups)

a great many things have gone wrong -- but I don't think the overarching UK strategy, or even the timing of executing it -- has necessarily been one, based on existing data

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