[petejh]

Another musing..
Anybody else think that this has the potential (if not already there) to turn into THE moral dilemma that will be studied and dissected for the next hundred years?

i.e.

Situation:
An infection to which humanity has no immunity and no vaccine is rapidly spreading throughout the world. It kills a tiny fraction of people in good health under 50, and an order of magnitude greater fraction of people in poor health over 60.
The only way to prevent mass infection is total isolation.
No health service can cope with the ill-health with mass infection which will result from unimpeded spread of the virus.
No economy can cope with the only way to prevent mass infection.

Do you:
a. voluntarily kill the global economy temporarily, to try to protect the at-risk group from infection?
b. protect the livelihoods of current and future generations, but accept that the at-risk group will die in huge numbers from infection?

Is that about right? Big envelope required.

I consider this a category error - the decision has already been made as a) and always will be.

Human lives are real and cannot be valued in economic terms. Conversely the economy is entirely a product of our imaginations and has no unbreakable link to reality. It won't go away because modern society is dependent on trade. But the current position is no more concrete than a game of monopoly, there are just more players.

I was thinking about this yesterday. I'm not sure it's as simple as this. Imagine if the risk to age demographics was reversed. Children especially vulnerable and the older you get the less risk you're at. We'd have had martial law at the outset.

Yep I think that's probably right about age - if it was the very young and up to, say age 40, who were looking at a 15% case fatality rate then the public sentiment would look very different to how things look currently. Lots of dead may change sentiment but it will be a bit late.

There seems an inevitable logic about this situation because in the absence of effective anti-virals or a vaccine a virus will infect and kill the % its designed to kill. It doesn't care what you believe, what you earn, what your plans are or who you know. The only variables that alter the probability of the different outcomes of infection are your underlying health status and your age - chronological age being a proxy for immune system status.

I think people consciously or not have baked-in the likelihood of their own demise of this virus into the more ancient instinctive parts of their brains.
 
Seems fairly simple to understand. But difficult/near impossible to educate those in low-risk groups who can't wrap their imaginations around that they're supposed to act in awkward ways to try to slow the exponential rise of an invisible microbe that gives most people a mild cold but kills a smallish fraction of a gigantic number of people who they don't know, many of who seem just as unconcerned by it as them anyway.

 

[petejh]

I agree that we value young life above old. I'm not convinced that means the lower value placed on old life is anywhere close to the much lower value place on money. In desperate times people say things like 'it's only money, we'll get through it'. They don't say 'ah well it's only death'.

It's clear that lots of people, perhaps even a majority, are just blithely ignoring the facts and will do until the bodies are being trucked out. At which point they'll complain that nobody warned them.

They do, just not in those terms. It's wired into us in the way we're more accepting of old people dying than children or young adults dying. One is mostly natural, one is mostly tragic and unnatural.

Something like this makes far starker and difficult to square the calculation of relative value between money/younger people living their lives, and protecting older/sicker people.

I agree with the second bit.

[Murph]

This is probably a bit off message but I cant see that it's worth the cost. The hope is that by closing the economy down and making millions unemployed can save 300k 500k (?) lives at a cost of £hundreds of billions. So a million quid a life easily.

When was the last time lives were worth a million quid on average? Especially old/sick ones. The NHS cost effectiveness threshold is something like £20k per QALY. Cant see how the covid cost isn't quite handsomely north of that.

I fear that the current policy - of sort of half putting out the fire - is going to cost a fortune and deliver little benefit. I dont think it will extinguish it and so long as it rages around the world this wont change unless Britain or whatever country is semi permanently cut off. We are not talking about wuhan locking down within China where it is a few % of the population.

As things are at the moment school closes today - mine are already out - but we have a rearranged birthday party invite for monday to respectfully decline. What is the point?

So a million people lost their jobs and (small sacrifice but ukb related!) I'm not supposed to go bouldering any more but old people - the people that absofuckinglutely should be on lockdown are out and about having a nice time. For some people not dependent on working to earn this really cant have been any sort of inconvenience yet.

So I just dont think it will work and we will get 80% of the cost of a proper lockdown with 20% of the benefit (figures calculated with SCIENCE). Surely its debatable whether the sort of epidemic stopping lockdown is even possible now/here.

Sorry long rambly rant there but this feels like it could be the biggest big deal for 100 years and I'm struggling to process it. Hope I'm wrong of course.

[Paul B]

When was the last time lives were worth a million quid on average? Especially old/sick ones. The NHS cost effectiveness threshold is something like £20k per QALY. Cant see how the covid cost isn't quite handsomely north of that.

Guidance in my industry allows for you to essentially put a price on loss of life when comparing it to the cost of remedial works. That figure is considerably in excess of £20k and it's far nearer the million quid.

Imagine for instance you've done a load of works to make something safe in 2018 to current best practice as the loss of life as a result of failure is likely. You spend £Xm. In 2020 if that guidance is updated and the difference between the 2018 condition and the current isn't 'that much' (in terms of loss of life) but will cost £££ to improve to the modern standard it's considered disproportionate. However, as above, those figures aren't ~£20k/head.

[jshaw]

skills to volunteer to help with testing as the hospital lab. is very stretched

I work in the School of Biological Sciences at Uni of Manchester. I know of a number of PhD's with good molecular biology lab skills but with little to do since all the research building have closed until further notice.

It'd probably be the same at the nearest University to wherever you're based...

[duncan]

When was the last time lives were worth a million quid on average? Especially old/sick ones. The NHS cost effectiveness threshold is something like £20k per QALY. Cant see how the covid cost isn't quite handsomely north of that.

Guidance in my industry allows for you to essentially put a price on loss of life when comparing it to the cost of remedial works. That figure is considerably in excess of £20k and it's far nearer the million quid.

Back of an envelope Department of Heath Economics here:

A QALY is one year in ideal health (or two years in 50% compared-to-ideal health, etc.). A 25 year-old living to 85 might be thought to have roughly 50 QALYs ahead of them, perhaps made up of 35 years ideal health, 20 years not-bad health and 5 years mediocre health. If a QALY is valued at £20k (likely now £30k) then a young adult life is roughly worth £1 million.

[Murph]

Beat me to it Duncan. Thanks.

If saving a healthy 25 year old from sudden death is worth a million, then saving an unhealthy 85 year old is not. Not under the QALY framework anyway.

[petejh]

That's what's being wrestled with isn't it. Either by those who can see the figures and make the calcs, or in more of an instinctive inaccurate estimation by people who can't, but who still realise there's a calculation at play.

You can mess around with the figures such as infection rate 80% or 60% or 40% of 65,000,000

Then a fatality rate of 1% or 2% or 3% of the total.

Plus the probable % breakdown of that total by age.


The expected death total ends being massive in scale.
Given the scale of economic damage inflicted by choosing full lock-down, for it to be a rational choice the lessening effect on the death toll must also be massive. Unless you take a different view on the worth of money versus life as per JB's point.

Seems to maybe make sense to give full lock-down a shot in the short term and hope for a miracle anti-viral or vaccine. In the long term, it doesn't unless you alter the value of things.

[Ru]

Duncan, where does the £20k (or £30k) come from? And is a similar sort of estimation used to calculate what sort of other medical treatments are offered that just improve quality of life?

[tomtom]

No been through the thread since this morning - but Amazon’s Audible audio book service is now free for all children’s books 👏👏👏

[duncan]

Duncan, where does the £20k (or £30k) come from? And is a similar sort of estimation used to calculate what sort of other medical treatments are offered that just improve quality of life?

This is the NICE cost-effectiveness threshold: the value per QALY gain that NICE use to judge the cost-effectiveness of a new health interventions. A new intervention (hip replacement, cancer drug, form of psychotherapy) results in gains of a certain number of QALYs compared to the usual care. The new intervention generally has more associated costs than usual care so there is a cost per QALY gain. Above this threshold the intervention is judged not cost-effective: the money would be better spent elsewhere

QALYs are a crude measure but they encompass both quality (of life) and quantity (years) so allow for comparison between very different treatments in people with wildly different conditions. The £20k threshold is much debated but it is interesting, in a macabre kind of way, that it can be tortured to give a roughly similar number to the £1 million often quoted by Engineers.  Note that this threshold does not apply to expensive new end-of-life treatments for no reason other - that I can see - than avoiding Daily Mail headlines.

[cheque]

No been through the thread since this morning - but Amazon’s Audible audio book service is now free for all children’s books 👏👏👏

Got to plug public library services here- we (I work for one) have loads of free online resources- ebooks, e-audiobooks, emagazines and, certainly in the case of my authority, all of us who don’t work on the frontline are still working full time so these online services are very much fully operational and supported even though we’ve closed our branches temporarily. 

[Oldmanmatt]

First two deaths in Torbay hospital today.

Judging from the social media response to the announcement, it had more effect than Bojo’s news conference.

[teestub]

These Kurzgesagt vids are always great at getting the science across in a palatable manner.

[Oldmanmatt]

Drip.
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Drip
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Drip drip
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Drip drip drip drip
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Drip drip drip drip drip drip drip drip

https://uk.reuters.com/article/us-health-coronavirus-britain-hospital-idUKKBN2172QM?utm_campaign=trueAnthem%3A+Trending+Content&utm_medium=trueAnthem&utm_source=facebook

[BrutusTheBear]

Don’t think this has been shared but a very good paper, explains why we need all need to isolate, now..

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

[mark20]

I handed my notice in at work a few weeks ago and it's supposed to be my last day next Thursday. The plan was to spend Spring working on my loft conversion, bathroom and re-wire before renting it out and move to Cornwall this summer with my missus who has a new job lined up down there. I can't see any reason the UK won't be shutdown like France,Spain,Italy etc this time next week, which will make it almost impossible to go out and get the stuff I need to do the work, and for others to put up scaffold, etc. I don't want to be sat at home all summer with no income and making no progress on the house, so I'm going to have to ask to rescind my resignation and hopefully I can carry on working (frontline water industry 'key worker'). Either way it throws the whole Cornwall move in the air now- I don't think we'll be able to go and view houses down there anytime soon. All a bit uncertain for us at the moment. Sorry to whinge, we have our health and that's the main thing. Good to get that off my chest! Stay safe out there

[galpinos]

Good article in Guardian showing the impact on other health provision and explaining my wife's current life:

https://www.theguardian.com/society/2020/mar/19/cancer-patients-coronavirus-outbreak-difficult-decisions

whilst stressing about getting infected and passing it on to our daughter.

[Wood FT]

I handed my notice in at work a few weeks ago and it's supposed to be my last day next Thursday. The plan was to spend Spring working on my loft conversion, bathroom and re-wire before renting it out and move to Cornwall this summer with my missus who has a new job lined up down there. I can't see any reason the UK won't be shutdown like France,Spain,Italy etc this time next week, which will make it almost impossible to go out and get the stuff I need to do the work, and for others to put up scaffold, etc. I don't want to be sat at home all summer with no income and making no progress on the house, so I'm going to have to ask to rescind my resignation and hopefully I can carry on working (frontline water industry 'key worker'). Either way it throws the whole Cornwall move in the air now- I don't think we'll be able to go and view houses down there anytime soon. All a bit uncertain for us at the moment. Sorry to whinge, we have our health and that's the main thing. Good to get that off my chest! Stay safe out there

I feel for you and V, they’ll be time for all this later. Just remember to keep perspective.

[Offwidth]

More farce

https://www.bbc.co.uk/news/51980731

[mikester]

So how long does Cov-19 stick around on different surfaces...

https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Unfortunately, they didn't test rock types.

[Muenchener]

frontline water industry 'key worker'

Bavarian state government where I live have mentioned the possibility of quarantining essential services workers *at work*. They aren't doing it yet, but apparently under state of emergency powers they can & might.

[mark20]

frontline water industry 'key worker'

Bavarian state government where I live have mentioned the possibility of quarantining essential services workers *at work*. They aren't doing it yet, but apparently under state of emergency powers they can & might.

Interesting. A friend at a power station said the operators there are doing this already.
But I can’t see it affecting me as I’m a mobile worker covering lots of sites across the county with no defined ‘place of work’ to be quarantined at.

[tomtom]

So how long does Cov-19 stick around on different surfaces...

https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Unfortunately, they didn't test rock types.

My take home from this is that it’s not quite the same as the SARS virus it’s compared to. This is important as many people assume it is similar/same. If anything it seems hardier on some surfaces

[Duma]

frontline water industry 'key worker'

Bavarian state government where I live have mentioned the possibility of quarantining essential services workers *at work*. They aren't doing it yet, but apparently under state of emergency powers they can & might.

Interesting. A friend at a power station said the operators there are doing this already.
But I can’t see it affecting me as I’m a mobile worker covering lots of sites across the county with no defined ‘place of work’ to be quarantined at.

I'm a key worker in electricity generation - there's already a plan in place for teams of us to live in the office if really hits the fan.