[Ru]

This is why I'm confused about the gov strategy - if that's the strategy, it's a shit one. Much better to lockdown way harder, whatever estimates you make for the numbers. If it's not the strategy, then what is? Unfortunately nothing the gov says on this seems to shed any light. I don't really get why the media aren't pushing harder on the "isn't your strategy kind of muddled bollocks?" question.

The strategy has evolved as time has gone on.

1: Let's do nothing, it will probably all go away.
2: It's not gone away, but it's not that bad, no-one will tolerate a lockdown, so let's just let everyone get it. Probably all a bit late now anyway.
3: It's actually quite bad and we don't think people will put up with thousands of deaths. Let's lock down.
4: We've been locked down for a while now, the economy is a bit fucked, people are getting shirty, but virus death numbers are dropping a bit. Let's carry on locking down a bit longer with a plan to stop in a few weeks and then see what happens.

[mrjonathanr]

5: In summary:
Minister 1: I have no idea
Minister 2: This is scary, me neither
Both: Let's obfuscate and pretend we do, till Boris takes responsibility, he can't dodge it forever.

Stone, you almost seem to suggest there that the speed of response in a pandemic of exponential growth impacts the outcome...

[tomtom]

I think we will now see herd immunity via the back door. Bear with me....

Herd immunity via natural immunity (if this actually happens - its not certain) or via vaccination is ultimately the only way this virus will be overcome/worked around.

But, politically the herd immunity fell flat on its face. Herd? Eh? are we a load of cattle (cue Piers Morgans eyes popping out of his head etc..). Further, the public were (understandably) not happy that granny would be left to die in order to help the general population. So - about face and try and do something better - but it was obviously too late.

So keeping R close to 1 is basically about managing case load on the NHS... Keeping the number of cases managable - whilst allowing enough of the economy to function without everything tanking - or our debt becoming totally unweildy.

I'll be a cynical f*cker here and say track and trace is really a political tool to sweeten the pill of the next year or two of shitness. The virus is so widespread we would require a very effective stasi to keep on top of it (and even Singapore couldn't) and as Stone calculates the number of cases would take months to come down to being managable. Tech - apps - nice try - but only a certain percentage of the population have smartphones (with the appropriate bluetooth technology) and mass data gathering of our mobile phone movements, ANPR data, facial recognition etc.. aside from being difficult to iplement would bust all sorts of data protection/privacy rules.

Problem is - 50-100k people will die in total. I doubt the numbers with our shonky lock down will get much below 100 people a day - for 300 days... 30k...

[abarro81]

I wonder if SAGE is really just someone in the background shouting "push on" and "fuck it, just do it", a bit like Loskott from Dosage 2?

[petejh]

Fair enough, I'll re-phrase that to: I'll believe that it was worth the public hysteria caused by all the implications by the media that supplies of PPE are responsible for excess mortality among healthcare workers, when we see the evidence of excess mortality among various sectors plus the general population by age group.

I imagine most hospital workers aren't too keen to just wait and see how many of them die compared to the general population before they kick up a fuss about PPE.

Exactly. Jesus fucking Christ, get some empathy.

No I don't think they 'should wait to see how many die'. From spider's and ali's responses clearly it's a subject that can't be talked about with any rationality or you're accused of lacking empathy. There isn't clear evidence that 1. there is excess mortality in healthcare compared to other sectors. 2. Lack of PPE has led to deaths of healthcare workers. 3. There has actually been large-scale instances of PPE actually running out and staff in high risk areas working unprotected - valid concern over supplies running out is different to running out and not having PPE. If evidence emerges I'll change my mind. I'm not saying people shouldn't have concerns. Nor that those concerns shouldn't be made public, course they should. But there's making concerns public, and there's media whipping up moral panic - they're good at that. I know what I meant, I'll leave it at that.

[stone]

I was crossing my fingers and hoping that they were going to spring a surprise with serology testing such that it would transpire that 60% of us had already had it without realising and we consequently already had herd immunity or something like that. The announcements of that sort though so far seem so flaky and yet lots of serology testing is being done seriously by others apparently. The fact that there hasn't been any reputable fanfare of that sort is making my hopes fade right away.

I was wondering whether the death rate of some ultra exposed group might give some indication of a lower bound for how bad it would be for the "non-vulnerable" to all get COVID19. Twenty London bus drivers have died of it but there are 25k in total which perhaps makes it seem OK-ish. Is there any other cohort of well/ working age (ie would not be shielded under current current COVID rules) people anywhere in the world with a much higher death rate yet?

[ali k]

There isn't clear evidence that 1. there is excess mortality in healthcare compared to other sectors. 2. Lack of PPE has led to deaths of healthcare workers. 3. There has actually been large-scale instances of PPE actually running out and staff in high risk areas working unprotected

Of course there isn’t. That will only come out in the inevitable public enquiry, or at the very least once the data is complete and available - potentially years down the line.

If evidence emerges I'll change my mind.
...there's making concerns public, and there's media whipping up moral panic - they're good at that.

So in the absence of the above data your default position is to assume that the media (and by extension the individuals, organisations and unions sounding the alarm bells) are “whipping up moral panic”. Fuck me.

[stone]

I don't see how there can be any ambiguity about whether or not UK medical staff had adequate PPE. They didn't and they caught COVID as a result (well the two COVID ward doctors I know personally both did). https://www.theguardian.com/world/2020/apr/06/nhs-doctors-lacking-ppe-bullied-into-treating-covid-19-patients

NHS staff weren't even asking for kit like that in South Korea (where no health care workers have died of COVID). All that was that being asked for was for the previously stated UK standards for PPE to be met.

[tomtom]

Guardian had a memo from late 2019 presented to cabinet (I think) about the impacts of a mild pandemic on the UK. Prescient.

• A pandemic would play out in up to “three waves”, with each wave expected to last 15 weeks … “with the peak weeks occurring at weeks 6 and 7 in each wave”.

• 50% of the population would be infected and experience symptoms of pandemic influenza during the one or more waves. The actual number of people infected would be higher than this, as there would be a number of asymptomatic cases.

• A pandemic of moderate virulence could lead to 65,600 deaths.

• The potential cost to the UK could be £2.35tn.

• Even after the end of the pandemic, it is likely that it would take months or even years for health and social care services to recover.

• There would be significant public outrage over any perceived poor handling of the government’s preparations and response to the emergency.

https://www.theguardian.com/world/2020/apr/24/revealed-uk-ministers-were-warned-last-year-of-risks-of-coronavirus-pandemic?CMP=Share_iOSApp_Other

[petejh]

There isn't clear evidence that 1. there is excess mortality in healthcare compared to other sectors. 2. Lack of PPE has led to deaths of healthcare workers. 3. There has actually been large-scale instances of PPE actually running out and staff in high risk areas working unprotected

Of course there isn’t. That will only come out in the inevitable public enquiry, or at the very least once the data is complete and available - potentially years down the line.

If evidence emerges I'll change my mind.
...there's making concerns public, and there's media whipping up moral panic - they're good at that.

So in the absence of the above data your default position is to assume that the media (and by extension the individuals, organisations and unions sounding the alarm bells) are “whipping up moral panic”. Fuck me.

No, and I wish people could consider things without putting words in other people's mouths. My default position is that the truth of what actual impact the PPE situation had on outcomes probably lies somewhere between the picture portrayed in the media and by staff; and the picture portrayed by the government.

[spidermonkey09]

I always find what you write interesting Pete, but I think you're miles off the mark here. Raising questions about whether PPE is as important as the NHS/media say it is isn't commendable "free thinking", it just comes across as bellendry (to use that word again). I find it quite distasteful to be honest as someone with a partner and numerous friends in the healthcare system. DanMs comment about forums distorting people's true views in bad ways may be relevant here, but that's my take.

[mrjonathanr]

I think it is good that you post questioning received ideas Pete. We should be interrogating our assumptions, no question. So I had a think about the stats.

1,227,375 full time equivalent healthcare workers in NHS  2018, from ONS stats
Covid19 deaths In NHS currently = 119
=0.0097%

Going off the ONS data, updated 10 April, deaths in hospital aged under 65 = 13% of total
65 seems a reasonable proxy for working age.
So approximating numbers, 13% of 20K current hospital deaths = 260 or so under 65.

So the comparator would be therefore 260 as a percentage of 66.5 million, vs 119 as a percentage 1.25 million.
= 0.00039%

The NHS staff rate of death is about 24 times higher than that of similar demographic in the general population, who don’t have PPE and are likely to be statistically in poorer health than NHS staff.

Whilst the data isn’t available, and the ethics of having a study to compare NHS workers with PPE vs a group completely without would be questionable, I’d want PPE if I worked in hospital. Those numbers look grim.

[ali k]

I wish people could consider things without putting words in other people's mouths. My default position is that the truth of what actual impact the PPE situation had on outcomes probably lies somewhere between the picture portrayed in the media and by staff; and the picture portrayed by the government.

Ah I see. Three clarifications of your original “media hysteria” position later and we discover that’s not what you meant after all 

[IanP]

I think it is good that you post questioning received ideas Pete. We should be interrogating our assumptions, no question. So I had a think about the stats.

1,227,375 full time equivalent healthcare workers in NHS  2018, from ONS stats
Covid19 deaths In NHS currently = 119
=0.0097%

Going off the ONS data, updated 10 April, deaths in hospital aged under 65 = 13% of total
65 seems a reasonable proxy for working age.
So approximating numbers, 13% of 20K current hospital deaths = 260 or so under 65

Unfortunately you've made a factor of 10 error on your percentage calculation.  There's a couple of sources that actually back up the evidence that NHS deaths are very similar to deaths in the general community , More or Less ( radio 4) did a decent back of the envelope calculation and was also pretty good on the caveats around any such calculations.

Below also covers this looks in more details at the BAME figures which do look strange.

https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

[mrjonathanr]

Well spotted, shouldn’t cook and calculate at same time... still looks like 2.4 to me which, whilst less dramatic, doesn’t seem encouraging, especially considering it’s despite PPE use etc

I’ll have a look at the link.

[petejh]

JonR,

Yes, looking at the stats is where I'm coming from. The more or less programme from yesterday that went through the numbers.

First, if you're comparing NHS population with general population then your general population should be of working age: population should be 42 million not 66 million.

Second, you've under-calculated your deaths in the general population by an order of magnitude. The ONS stats (for when more or less programme was recorded) were 2,145 deaths in general population of working age (65 and under).

Now do your same calcs.

2,145 covid deaths in the general population of working age, divided by 42 million general population of working age, gives you a death rate of 0.0051%

Covid19 deaths In NHS currently = 0.0097%


That this was based on deaths at 16,500 - when the more or less programme was recorded. Today it's in the low 20-thousands.

Do the calcs with the updated figures:
2,500 deaths in working age / 42,000 = 0.0059%

So, back of fag packet calcs show the death rate among NHS staff IS higher than the death rate in the general population of working age. Possibly double, it depends how the numbers increase over time. And then factor in that the whole NHS don't work in high risk areas. So the death rate will be higher again.

But. The death rate for London transport workers is also VASTLY higher than average - 29 workers out of 26,000 total workforce (again, not all working in high risk areas).
29/26,000 = 0.112%

Which makes me think other workers in other sectors also must also be facing similar risk as the NHS, going off the back of a fag packet stats. The construction sector for e.g. is full of over-40s and 50s in poor health. Little social distancing going on.

It also makes me think the huge amount of noise focused around PPE might be more emotional than rational and perhaps doesn't correlate with the spectrum of risks encountered by different parts of the population.

I'm just interested in the truth, not what the media or people with their own agendas want to believe. If the evidence shows that the risk of death for NHS staff is massive compared to other sectors, and that risk has been massively increased by a lack of PPE, then I'll accept that.

[mrjonathanr]

From Ian’s link:

BAME individuals account for 63 per (of all staff), 64 per cent (of nursing staff) and 95 per cent of (medical staff) deaths in the same staff groups

[mrjonathanr]

Pete, thanks for that, it looks around double to me. That, if PPE is meant to be any barrier at all, must be a massive concern. Precautionary principle applies.

Transport workers- well there’s another scandal in train there.

I agree again about not blindly following the drumbeat of the news outlets. I don’t generally, although I do sub the Guardian because I think they are trying to do some genuine journalism, starting from a liberal POV. Your last comment does sound a bit ‘fake news’ ish though.

[teestub]

I think looking at actual figures is a separate issue to the provision of PPE. There seems to be consensus in general about what PPE is required to work in the various parts of the hospitals. If the government are failing to provide this,  then that is an issue, even if that lack of provision does not result in a single extra death.

As everyone in government is fond of a military metaphor: failing to provide adequate equipment to our soldiers in Afghanistan may not have resulted in any additional deaths, but that does not make it less of an issue.

[ali k]

It also makes me think the huge amount of noise focused around PPE might be more emotional than rational and perhaps doesn't correlate with the spectrum of risks encountered by different parts of the population.

The media focus on PPE supply to healthcare workers is presumably front and centre because as a country we’re being told to maintain 2m distance from every human outside your household and ideally to stay inside 23hrs a day. But at the same time these frontline staff have to come into direct contact and perform procedures on people expelling huge amounts of the virus for 12hr shifts on a regular basis, so it’s easy for the public to see why having the government recommended PPE in the right quantities is important. A story about construction workers catching the virus would rightly focus more on why the hell they’re still at work instead of ‘can they be supplied with enough PPE’. Bus drivers are somewhere in between, as that’s arguably an essential service for medical staff. The death rates across different sectors will be long picked over and make for interesting reading.

I admire your search for the truth Pete. I just don’t think a desire to put pressure on the government to supply PPE to these workers can or should be described as “hysteria”. Supplying sufficient quantities of PPE to NHS workers should be an absolute bare minimum, and that just hasn’t happened.

[petejh]

Actually JonR,

NHS figure on more or less is quoted as 1,470,000 staff of working age (this is 98% of the total staff of 1.5 million)

And, this review analyses NHS staff deaths from covid.  119 but 13 were excluded:
''Thirteen cases were excluded — in four cases multiple attempts to confirm information over several days were unsuccessful, in six cases the individual had retired and was not working, and in three the individual was not an active healthcare worker.''

So that leaves 106. It gives 94 NHS staff, 10 social care, 2 dental.

So 94 NHS staff / 1,470,000 = 0.006%

Remember my previous post gave the average death rate in general population of working age = 0.0059%


The jury - at least my jury - is out on the impact of PPE to the risk of NHS staff dying from covid. I'm completely open to changing my opinion based on the evidence changing.

But what this suggests to me that there are bad things happening which aren't being looked at, because people love focusing on an emotionally resonate juicy story with political baggage.


Ali, I agree with much of that. But I'd say if you look back over the typical tone of this forum's opinion on the PPE situation it could fairly be described as bordering on implying the government is culpable for huge excess mortality among NHS staff. Again, I agree it may actually come to that, but it doesn't seem to have to me.

[Offwidth]

The problem with that calculation is the proportion who died who work in places with a high risk of covid exposure is massively more than your number as.by far the majority of NHS staff don't work in those situations. It's so obbious I suspect you of trolling. I hope any NHS staff reading that have a forgiving nature.

[Ru]

NHS figure on more or less is quoted as 1,470,000 staff of working age (this is 98% of the total staff of 1.5 million)

So that leaves 106. It gives 94 NHS staff, 10 social care, 2 dental.

So 94 NHS staff / 1,470,000 = 0.006%

Not a fair comparison. You should only be counting front line NHS staff that are exposed to covid patients. They're who the concern re: PPE is about. The vast majority of the staff you are including will never go near a covid patient, so of course the risk to them is low or close to that of the general population. As an example, less than a 1/3 of NHS staff are doctors and nurses. As far as I am aware the hospitals are also split into "dirty" (covid) and "clean" (non covid) wards to prevent spread so not even all the clinical staff have the same exposure.

[petejh]

The problem with that calculation is the proportion who died who work in places with a high risk of covid exposure is massively more than your number as.by far the majority of NHS staff don't work in those situations. It's so obbious I suspect you of trolling. I hope any NHS staff reading that have a forgiving nature.

The expected bellendry from you Offwidth. It isn't my opinion - it's an analysis of the facts published by HSJ 2 days ago.
And my point is not to make light of anything - but to try to understand what's really going on behind the media reports, and what it might imply for others who don't work in the NHS and hence don't have the focus shone on their risk of being at work.

Why not just read the analysis? If you think the report authors are trolling then why don't you send them an email to tell them you don't like what their report says? Hopefully they'll forgive you your bellendry.

Ru,
They note absence of intensive care staff:

''the absence of certain workforce groups among those who have died, while welcome, is also notable. Anaesthetists, intensive care doctors and by association nurses and physiotherapists who work in similar settings are believed to be among the highest risk groups of all healthcare workers. It is therefore notable that all of these groups are completely absent from the data set.''

They estimate number of patient-facing staff:

''However, the NHS is estimated to employ approximately 1.2-1.5 million staff, including more than 120,000 doctors, approximately 300,000 nurses and a similar number of healthcare support workers. A modest estimate of the patient-facing NHS workforce might be 600,000-800,000,''

So if all deaths are among just the patient-facing staff then the rate would be 94/700,000 = 0.013% or roughly twice the average for the general population. Or the same fatality rate as that for the whole staff of Transport for London.
However the subgroup of TfL drivers would have a massively higher death rate than patient-facing NHS staff. Which as I say above and elsewhere could suggest serious implications for other workers' risk profiles as we all begin to return to work next month.

On one hand it helps put some context to the amount of furious hot air expelled on the subject of PPE.
On the other hand the figures could actually suggest we need *more* stringent PPE guidance for ALL public-facing workers if you pursue that particular line of logic in the figures.
Or it could suggest anything less than a visor AND a mask is ineffective defence against covid - because the people wearing both of those items aren't in the stats but the people wearing just FFP3 are. Or any number of other lines of logic could follow from the figures.


Some quotes from the study (my emphasis added):
....

Conversely, the absence of certain workforce groups among those who have died, while welcome, is also notable. Anaesthetists, intensive care doctors and by association nurses and physiotherapists who work in similar settings are believed to be among the highest risk groups of all healthcare workers.

This is because both caring for the sickest patients with covid-19 and undertaking airway management (so-called aerosol generating procedures) are associated with high risk of viral exposure and transmission. It is therefore notable that all of these groups are completely absent from the data set.

Again, the reason for this is not known and data on infections and serious illnesses are important to consider as well as fatalities, but these data also are currently lacking. What is likely is that these groups of healthcare staff are rigorous about use of personal protective equipment and the associated practices known to reduce risk.

It may be that this rigour is protecting staff better than some fear and the results can be considered cautiously reassuring. However, this finding is not a reason to slacken off on the appropriately rigorous use of PPE, but rather to wonder why others, who are likely involved in what are generally considered to be lower risk activities, are becoming infected and consider whether wider use of rigorous PPE is indicated.

....

However, the NHS is estimated to employ approximately 1.2-1.5 million staff, including more than 120,000 doctors, approximately 300,000 nurses and a similar number of healthcare support workers. A modest estimate of the patient-facing NHS workforce might be 600,000-800,000, which is more than 1 per cent of the UK population and more than 2 per cent of the employed population.

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.

Although there are caveats to this estimate — explained below — and every death is one to be mourned, the data does not clearly show that healthcare workers are dying at rates proportionately higher than other employed individuals or even the population as a whole. Again, this is cautiously reassuring.

....

The distribution of deaths by occupation among nurses, healthcare support workers and doctors is broadly consistent with employment ratios. Distribution of deaths by geographical region correlates well with known regional distribution of cases.

....

Our report shows that a significant number of health and social care workers are dying during this pandemic. Overall the rate of deaths appears to be largely consistent with the number of healthcare workers in the population and the distributions by occupation and geography are largely as expected. However, individuals of black and minority ethnicity are notably over-represented in the data and conversely those working in the high risk specialties of anaesthesia and intensive care appear to be under-represented, most likely through good practice.

[IanP]

Not a fair comparison. You should only be counting front line NHS staff that are exposed to covid patients. They're who the concern re: PPE is about. The vast majority of the staff you are including will never go near a covid patient, so of course the risk to them is low or close to that of the general population. As an example, less than a 1/3 of NHS staff are doctors and nurses. As far as I am aware the hospitals are also split into "dirty" (covid) and "clean" (non covid) wards to prevent spread so not even all the clinical staff have the same exposure.

Probably worth reading the analysis I linked to earlier, this actually seems to  show that if anything that 'frontline covid' staff are less impacted than other NHS staff:

'Conversely, the absence of certain workforce groups among those who have died, while welcome, is also notable. Anaesthetists, intensive care doctors and by association nurses and physiotherapists who work in similar settings are believed to be among the highest risk groups of all healthcare workers.

This is because both caring for the sickest patients with covid-19 and undertaking airway management (so-called aerosol generating procedures) are associated with high risk of viral exposure and transmission. It is therefore notable that all of these groups are completely absent from the data set.

Again, the reason for this is not known and data on infections and serious illnesses are important to consider as well as fatalities, but these data also are currently lacking. What is likely is that these groups of healthcare staff are rigorous about use of personal protective equipment and the associated practices known to reduce risk.'

I haven't got any sort of axe to grind here  - I think the performance of the current government  is not great and worry that it's getting worse.  However I think we need to be careful to properly analyse the data available, understand it's limitations and not jump to conclusions which aren't supported by that data.