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London will be overwhelmed by Covid in a fortnight says leaked NHS briefing

271 points by biomene 6y ago

stupidcar 6y ago
This article is confusing. It starts off by saying this is an analysis of "best" and "worst" case scenarios for continued growth in cases, but later it says: > HSJ understands that the briefing was part of an attempt to get senior clinical leaders to focus on what they would have to do, if current growth trends were not surpressed by the tighter lockdown. So, er, what if the growth trends are suppressed by the tighter lockdown, as seems likely? Will things then be better than the "best" case scenario? It sounds like there's a bit of misreporting going on here. The leaked document forecasts demand based on pre-lockdown trends, to highlight the significant risks. But the article is reporting it as if running of beds is totally guaranteed in all circumstances, which doesn't appear to be the case, if the lockdown works.
- regularfry 6y ago
  The hospitalisation curve for the next fortnight is largely locked in by what was happening before lockdown started. If lockdown has a positive effect, it'll be visible in the hospitalisation stats after 12 days or so.
- flukus 6y ago
  > So, er, what if the growth trends are suppressed by the tighter lockdown, as seems likely? Will things then be better than the "best" case scenario? There's two lag factors to consider. The first is the lag between restrictions and cases dropping, this takes a couple of weeks and cases and the growth isn't likely to even slow for 1 week. The second is the lag between infections and people getting seriously sick and needing hospitalization, that takes 3-4 weeks. There's also the serious possibility that the restrictions arn't strict enough to make a big difference. This scenario is basically baked in, avoiding it required action weeks earlier.
  - andy_ppp 6y ago
    Or because of the incompetence of those in charge people just don’t take the lockdown seriously...
    - Blahah 6y ago
      Nobody is in charge of people's perspectives. The UK has really gone all in on psychosocial nudge tactics in this pandemic, and it has massively failed so far. Arguably, they've done so because they knew the population were so belligerent and arrogantly ignorant that a more direct approach would definitely fail. They have leveraged the 'new variant' to implement at the last moment the measures that were being recommended for months by all their expert committees. People here don't want to be told what to do and there are very well organised efforts to encourage people to feel empowered in their ignorance and irresponsibility. The 'people in charge' aren't the only ones to blame for that.
- simonh 6y ago
  I would expect that if growth trends are suppressed by the tighter lockdown, that would be the best case scenario. That’s not the most likely scenario though, and you need to prepare for the worst case scenario. So that’s what clinical leaders need to focus on, right?
- rossdavidh 6y ago
  I agree that the "best case" scenario should probably involve some impact from the lockdown (after a delay), but given the experience in California (which was that the lockdown didn't slow things down much, if at all), it seems at least plausible to look at what happens if the same is true in the U.K.
  - toyg 6y ago
    Big lockdowns last year definitely made an impact in England and Italy. I expect it will be the same now. What failed here in UK was the regional approach, the continuous attempts at unfounded optimism, and the attitude that covid-related rules were just another game to play and cheat at (like a minster saying that a scotch egg is “a substantial meal” which can justify going to the pub...). The population doesn’t take the message seriously unless the gravity of the situation is stressed and the necessary plans are clear, simple, consistent throughout, and ruthlessly enforced. When most of that happened, lockdowns worked.
    - Taurenking 6y ago
      They made so much of an impact that we're still battling with the virus 8 months later
      - toyg 6y ago
        The critical issue is to ensure the health system is not overwhelmed, and that was achieved. Prolonging the agony is actually a result of unwillingness to extend hard lockdowns for 4+ straight months over whole countries - we keep lowering restrictions as soon as possible. But sure, things might have definitely been faster if only we just let more people die.
      - ben_w 6y ago
        I’m not an epidemiologist, so I’m going out on a limb with this, but: Looking at the infection rate curve, I think the lockdown was working right up until the more-infectious strain took over. (“People tested positive” graph: https://coronavirus.data.gov.uk/ https://coronavirus.data.gov.uk/)
- tomatocracy 6y ago
  It's not immediately obvious from any reporting but the "rules" in London haven't actually changed significantly since the 20th December (schools did not reopen as planned but they'd been closed since before then anyway for the Christmas break). The only meaningful change in the past couple of days is the "takeaway pint" ban (which is unlikely to make any difference and is purely symbolic).
pjc50 6y ago
I believe certain hospitals are already at the stage of queuing ambulances outside and are breaching the four hour wait times. This is a consequence of loosening the lockdown for Christmas.
- mfDjB 6y ago
  The lockdown was tightened for Christmas. [1] 1: https://nypost.com/2020/12/20/londons-covid-19-christmas-lockdown-leads-mass-exodus/ https://nypost.com/2020/12/20/londons-covid-19-christmas-loc... EDIT: It's weird that people don't believe me. Here is a BBC article talking about the Tier 4 lockdown that occurred right before Christmas: https://www.bbc.co.uk/news/uk-england-london-55380644 https://www.bbc.co.uk/news/uk-england-london-55380644 From the article: "Millions of people across England have been banned from meeting friends and family indoors over the festive season as they enter a new tier-four level of Covid restrictions, while indoor mixing has been restricted to Christmas Day alone for the rest of the country." Perhaps someone in the comments could show me evidence that London was "loosening the lockdown for Christmas"? Also I live in London (and did during Christmas, where I cancelled my plans because of said lockdown), and am British.
  - robtaylor 6y ago
    Nope. It was wide open for Christmas Day. Source: Being in UK.
    - barnacled 6y ago
      Not for much of the country, including London. Source: living in (what was at the time) a tier 4 area The issue is the new strain, clearly. Cases were growing even during the November lockdown.
      - simonbarker87 6y ago
        Growing in the southeast from memory but the rest of the country saw pretty strong decreases I think. Wasn’t Kent the first place things started to really kick off and take a turn in mid Nov?
jiggawatts 6y ago
If a mutant strain of COVID-19 becomes twice as deadly, this "merely" doubles the pressure on hospitals. A constant factor like this can be dealt with. However, an increased rate of spread (R factor) is a change in the parameter of the exponential curve, and cannot be dealt with by any sub-exponential response. The only thing that could possibly work is to change the factor. Rapid vaccination or lockdown. It's impossible to vaccinate the population of London in two weeks, which means a full lockdown is the only option now. YC News is mostly a forum for software developers, which means that these notions ought to be familiar to most people here. When talking about software algorithms, we all learned about big-O notation. We all learned that Exponential time algorithms are (nearly) the worst case, and will always be worse for large data sets than a linear-time or quadratic algorithm, irrespective of the constant factor. Essentially the new mutant strain changes the "R" term in Θ(a×exp(R×𝑡)), whereas increasing the lethality is a change in the "a" term. People are concerned about the lethality getting worse, but they shouldn't be. This change in the infection rate is more scary.
- laqq3 6y ago
  Good analysis but small nitpick: the use of "Θ" in Θ(a×exp(R×𝑡)) is slightly inaccurate (or is it the use of "a"?) because the set of functions Θ(a×exp(R×𝑡)) is the same for all positive a.
  - deleted 6y ago
    [deleted]
  - s_gourichon 6y ago
    Well, yes, of course: isn't "a doesn't matter" the core of the point of the parent comment?
- mikepurvis 6y ago
  I agree, but I think there is now a non-trivial group who are either a) in total denial about the virus or believe it's a conspiracy, b) overwhelmed by news of it and unable/unwilling to process anything new, or c) believe in herd immunity and might even welcome a faster spread on that basis. Arguments about exponentials mean nothing to anyone in any of these buckets— they'll be flaunting a lockdown up until and perhaps beyond the point where it is administered by force. I don't know how to deal with this reality, but it feels like the greatest threat at this point.
yread 6y ago
Even bigger news is that as of yesterday there were just 46 free ICU beds (out of 1300+) in the whole London
- simonbarker87 6y ago
  What’s the status of nightingale? In use or not?
  - notretarded 6y ago
    They got shut down, the one at Excel had like 4 patients in it and a handful of nurses.
  - callamdelaney 6y ago
    Doesn't exist anymore :)
    - mtmail 6y ago
      The article says it will be opened and used again.
      - callamdelaney 6y ago
        When?
        Nursie 6y ago
        It's been quietly resupplied with everything except staff, from what I can tell from a civil servant friend. Which makes it of limited use.
  - mtmail 6y ago
    From the article "These would be complemented by 1,000 “step down beds”, some of the supplied by the opening of the capital’s Nightingale hospital," so sounds like it's not in use yet.
mike00632 6y ago
3478 people died from COVID in the US yesterday. https://covidtracking.com/data/charts/us-daily-deaths https://covidtracking.com/data/charts/us-daily-deaths
- deleted 6y ago
  [deleted]
- jonhohle 6y ago
  s/from/with https://covidtracking.com/about-data/data-definitions https://covidtracking.com/about-data/data-definitions
- core-questions 6y ago
  ~1700 people per day die of heart disease in America and have done so for decades. I think we should shut down the economy until we can get everyone's heart healthy.
  - d4mi3n 6y ago
    That'd make more sense if heart disease had a significant chance of killing people breathing the same air as you.
    - matz1 6y ago
      Good thing that the chance of being killed by covid infected people breathing the same air as me is very very low.
      - sojournerc 6y ago
        How can someone downvote this? 99.9% is low odds...
        gnusty_gnurc 6y ago
        Anxiety disorder pervading society. Habituation to an unimaginably high safety standard in modern society.
callamdelaney 6y ago
>The NHS England presentation, seen by HSJ (see slides below story), showed that even if the number of covid patients grew at the lowest rate considered likely Covid rates have consistently grown at the lowest rate considered likely.
- Closi 6y ago
  Well even at the most conservative readings of recent statistics the growth rate has been 3.5% daily, so you might have 2 and a half weeks if you are really lucky.
WaitWaitWha 6y ago
When did we switch the emphasis from tracking deaths, to tracking infections?
- dragonwriter 6y ago
  > When did we switch the emphasis from tracking deaths, to tracking infections? Never, infections have always been a foucs of tracking because infections lead hospitalizations lead deaths (and hospitalizations have second-order impacts on mortality from other causes when they reach a critical level, even beyond direct COVID deaths.) If you only focus on deaths, you are weeks behind the curve in reacting.
- n4r9 6y ago
  There's still a focus on deaths, but greatly increased testing capacity means that infection estimates are becoming more accurate.
  - WaitWaitWha 6y ago
    Thank you. From a non-medical, "just following the news" perspective, there was a pronounced shift. A few simple google news search will show this.
    - midasuni 6y ago
      Back in April we weren’t able to test anyone outside of hospitals. In march we were likely up in the 100k infections a day just before lockdown, around what we are now come to think of it. That’s based on taking the IFR and working backwards from reported deaths at different ages.
- skybrian 6y ago
  Not sure what you mean since tracking infections, hospitalizations, and deaths are all useful. However, there are reporting delays for infections and deaths during weekends and holidays. Infections happen earlier than hospitalizations and deaths but the count depends on people getting tested.
jpxw 6y ago
And yet we still have idiots here in the UK saying things ranging from: * coronavirus is invented as a government power grab * the government locking down is a deliberate ploy to kill small businesses * the government should just let this run its course, it’s Just A Flu TM * hospitals are actually empty (the “proof” being people recording empty waiting rooms in outpatient departments on bank holiday weekends) * coronavirus doesn’t exist (!) Maybe this will be a bit of a wakeup call.
- pjc50 6y ago
  It's not a wake-up call until protestors storm the government buildings. Apparently.
  - backWardz00 6y ago
    Brains, amirite? With the masses sedate at their screens, the bureaucracy has no cognitive experience or expectations for anything different. Decades of headlines being fed to Main Street going on about growing inequality did not really motivate Main Street to do much but shuffle back into the office. Relativity pervades all experience. Reading about history in books is not exactly experiencing history.
- labster 6y ago
  Or maybe these people will keep believing the lie, even after they die from COVID, like the Calormen at the end of CS Lewis’ The Last Battle. Everyone else will be in Heaven, and they’ll be all like, “Let me out of the hospital, corona is a lie!”
  - fsdfgsfsdfsdfsd 6y ago
    People die from all sorts of diseases. Someone dying from Corona doesn't prove that he died from a pandemic level disease. (I'm not saying it is not a pandemic, just that that kind of logic is bullshit). Even the nurse reports about "patients being in disbelief about dying". I would imagine lots of people who are about to die are in disbelief. A friend of my mother died from the flu. He called her shortly before that. I think he probably also was in disbelief. Do you expect to die from the flu?
anonunivgrad 6y ago
In Florida, bars and restaurants are just about fully open and everything is just fine.
- markdown 6y ago
  If you ignore the dead and dying, yes, everything is just fine.
  - WaitWaitWha 6y ago
    https://covidtracking.com/data/charts/currently-hospitalized-by-state https://covidtracking.com/data/charts/currently-hospitalized... hospitalization by state: 342 per million FL 569 per million CA 444 per million PA 442 per million NY Can anyone point me to similar chart for death per million, by state, over time?
    - AareyBaba 6y ago
      http://91-divoc.com/pages/covid-visualization/?chart=states-normalized&highlight=California&show=midwest&y=both&scale=linear&data=deaths&data-source=jhu&xaxis=right#states-normalized http://91-divoc.com/pages/covid-visualization/?chart=states-...
      - WaitWaitWha 6y ago
        Excellent! Thank you!
    - markdown 6y ago
      22k dead in Florida. I guess if nobody in your family is included in that figure, it's all peachy.
      - war1025 6y ago
        Funny, I didn't see anyone calling to shutter the economy when my dad was dying of cancer. Similarly, I didn't see any great outrage this summer when my uncle died of a heart attack. Death is tragic, but it's also a fact of life. A lot of people have fallen into the trap of making fear a virtue this year.
noncoml 6y ago
Because on one hand the government thinks it's OK for people to die alone in ICU and bury them without their friends of family[1]. But on the other hand said that it's OK to meet people to celebrate Xmas with[2]. Sources: [1]https://www.bbc.com/news/uk-england-london-52312653 https://www.bbc.com/news/uk-england-london-52312653 [2]https://www.bbc.com/news/explainers-55056375 https://www.bbc.com/news/explainers-55056375 Edit: Downvoted? It's not even my opinion. It's facts. Damn. Or do you think that's not the reason? Timing-wise it matches pretty well.
- jiggawatts 6y ago
  Meanwhile in Australia the "cricket has to go ahead", crowds and all, despite Sydney being on the knife-edge of heading towards a second wave. All because the politicians involved are huge cricket fans and even server on the boards of cricketing organizations. I've never understood why politicians are allowed to have such blatant conflicts of interest, but they get to write the rules, not us...
  - asdff 6y ago
    NFL and college football have been dealing with outbreaks all season. The people demand their spectacles.
lrossi 6y ago
Here is a video filmed in London this Christmas: https://youtu.be/Yz7wJZln6Kw https://youtu.be/Yz7wJZln6Kw Plenty of people outside. In fact, I would call it lightly crowded, although less than other years. Many people don’t wear masks. It’s not a surprise that transmission has increased. Nevertheless, London looked absolutely beautiful. Not sure if this was worth the risks though.
- drudu 6y ago
  What makes you unsure of the risk was worth it?
  - lrossi 6y ago
    Just the fact that it’s not my city and not my risk, so not for me to decide.
- alkonaut 6y ago
  The people in the video seem to just walk around outdoors and not very close to other people. That many people obviously will mean a risk that some of them go into stores, but if there is a reasonably safe thing to do outdoors (like a particularly nice street) it’s natural that this becomes extra popular when people want to find something to do outdoors.
  - LeoNatan25 6y ago
    Outdoors, especially in a humid night, is not a magical place where the virus is inactivated right at the mouth of the shedding individual. People being so close, people walking into air that someone recently exhaled—these are big opportunities for infection.
    - tasuki 6y ago
      Can you quantify that? I've been under the impression that outdoors transmission was extremely rare and the vast majority of transmission was indoors. I've been meeting with people outdoors for walks thinking that was mostly safe. I've no sources unfortunately.
racl101 6y ago
So scary man. Scary times.
mrfusion 6y ago
I feel like I’ve heard this before.
ppod 6y ago
People who are making claims about hospital capacity should compare them to the same times in previous years. The data is all available online: https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/critical-care-bed-capacity-and-urgent-operations-cancelled-2018-19-data/ https://www.england.nhs.uk/statistics/statistical-work-areas...
- simonh 6y ago
  The link you provided is for last year, and that site doesn’t have any data after February 2020 anyway. I think this is the best source: https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospital-activity/ https://www.england.nhs.uk/statistics/statistical-work-areas...
- lol768 6y ago
  So, January 2019 in London Commissioning Region hospitals: 1033 open adult critical care beds; 882 in use. 85% utilisation. Best-case forecast Jan 2021: 2078 critical care beds required, 1,661 available (increase of ~600). Forecasted 125% utilistation.
  - yt-sdb 6y ago
    Beat me to it. And according to this report, London currently has 46 free ICU beds.
  - cptskippy 6y ago
    I took the term open to mean unoccupied which put them at 46% utilization. The columns in the spreadsheet are "Sum of Number of adult critical care beds open" and "Sum of Number of adult critical care beds occupied".
  - Aeolun 6y ago
    I don’t think beds really work in a way that allows 125% utilization.
    - asdff 6y ago
dfsegoat 6y ago
Ignorant US Guy here: I had to google to learn a 'Fortnight' is 14-days / 2 weeks.
- madeofpalk 6y ago
  ??? Is this not an extremely common phrase? I'm not from the UK (or the US) but... I've never considered this phrase is not known in America?
  - polka_haunts_us 6y ago
    I am American, I know what it means, I expect a majority of people in the US don't. It's not a word in common usage in American English.
  - garmaine 6y ago
    It's not a term used in America, outside of some extremely old black-and-white movies. Still I'd be surprised if someone born and educated here didn't know what it meant, since it must have been encountered in books or film or something.
  - kortilla 6y ago
    Not in the US. It’s mainly thought of as an “old English” word. It hardly ever appears so you usually learn the length some time in school and then subsequently forget it.
- eznzt 6y ago
  Well, thanks for your comment! I am not native and I had assumed a fortnight ends the next morning.
- lordnacho 6y ago
  Happened to me a couple of years ago: Kid: Dad, what's Fortnite? Me: Fourteen days Kid: What? That makes no sense Me: It's an old word that means two weeks Kid: Okay I want to play it Me: What? That makes no sense Kid: I want to play it, what does it mean? Me: It means two weeks. What do you mean you want to play it? Kid: I want to play it. What does it mean? etc, etc. Weird drive home until I went online.
LatteLazy 6y ago
Work places remain open. People continue not to wear masks with impunity. Closing schools will help a bit. But I doubt it will reverse the spread, it wasn't enough for the old covid 19, let alone the new strain.
- qznc 6y ago
  Closing schools did help a lot last spring: https://science.sciencemag.org/content/early/2020/12/15/science.abd9338 https://science.sciencemag.org/content/early/2020/12/15/scie...
  - LatteLazy 6y ago
    I'm probably going to get the maths wrong here, please correct me kind stranger! So closing schools and universities reduces R values by 38% (16%-54%) per your excellent link. England R value is about 1.3 at last count. 1.3*(1-38%) = 0.806 So hopefully that's enough. I'm a cynic and pessimistic so I worry that: London is likely higher (more workers, denser, people use public transport). Keeping nurseries open and some pupils in schools will reduce the 38%. The spike from christmas/new year will ruin things. I guess the optimist would say: 1.3m people vaccinated (especially in high risk groups) means the hospitalisation rate should go down.
renewiltord 6y ago
So now we get to see if we hit that hockey stick. There's a natural experiment at work here to see if everyone starts dying en masse. Sucks for people in the UK, and for folks like my cousins and aunt who work in the NHS, but doomsday is almost here so we get to see what doom is like. We should play close attention from afar so we can learn.
tin7in 6y ago
Although lockdown measures in the UK look very similar to measures in other European countries I can tell that there is very little police control, probably due to lack of resources. For example I don't know anyone who arrived from abroad being checked if they are self isolating at home as they declared.
- tomatocracy 6y ago
  Anecdotally compliance has actually been pretty high. And I think it's wrong to say there haven't been checks - I have a couple of friends have received visits or calls from the police to check they were in compliance with travel quarantine requirements.
andred14 6y ago
Time to stop lying unless you want to go to jail. Your scam has been revealed: https://www.reddit.com/r/NoNewNormal/comments/kl15z4/italian_scientists_test_a_kiwi_fruit_for/ https://www.reddit.com/r/NoNewNormal/comments/kl15z4/italian...
sjg007 6y ago
It’s pretty obvious that this is the fate of the US and Europe too in the next 6 months. Unless we lock down hard. People are still in total denial though.
oxfordmale 6y ago
Looking at COVID models, the hospital admission peak is around the 10th of January UK wide. Cases have already started to level in London. Lockdown has been implemented too late to make any significant difference to that. Not the most reliable source, but confirmed by other sources which are unfortunately behind a paywall. https://www.dailymail.co.uk/news/article-9115357/amp/Coronavirus-UK-Government-shows-data-suggesting-cases-new-coronavirus-variant-falling.html&ved=2ahUKEwja-pmmyIjuAhWSqHEKHWfzA18QFjAGegQIGBAB&usg=AOvVaw061D_IEpuxkSv14mCBn0Nc&ampcf=1 https://www.dailymail.co.uk/news/article-9115357/amp/Coronav...
- alimw 6y ago
  > Cases have already started to level in London. Lockdown has been implemented too late to make any significant difference to that. This is a common claim and I have seen it made about various periods of lockdown in various countries. "Look, rate of increase started to slow within a week of lockdown, but it should take two weeks to see the effect, so it can't be that lockdown has made any difference." There is usually far too much noise in the figures to make such a claim about small differences in time scale. Also if you were expecting a sudden drop after two weeks then you were bound to be disappointed. The amount of time it takes for an infection to become a recorded case of Covid will be random according to some distribution (possibly with a mean of one or two weeks) so the transition will be smooth.
  - oxfordmale 6y ago
    I am not suggesting lockdowns do not work. Hospital peak was predicted to be around the 10th of January well before lockdown was announced and that has not shifted. Lockdown is undoubtedly going to change the shape of the curve after the peak has passed, but it didn't move the actual peak.
    - deleted 6y ago
      [deleted]
  - okl 6y ago
    Add to that additional delays because of the holidays.
throwaway23242 6y ago
covidiots
olivermarks 6y ago
What happened to the Nightingale hospital? Can it be re erected? https://www.theguardian.com/world/2020/may/04/london-nhs-nightingale-hospital-placed-on-standby https://www.theguardian.com/world/2020/may/04/london-nhs-nig...
- asadhaider 6y ago
  I believe it's back on standby as is the one in my city, Nightingale Hospital North West, in Manchester. The issue is staff though, there simply isn't enough qualified staff to work it alongside their hospitals. I've been working as a volunteer nursing assistant in hospital A&E departments through St John Ambulance it's honestly just insane. I don't know what the plan is for Nightingale but we're focusing on getting mass vaccination centres setup currently and delivering the vaccines.
mikesabbagh 6y ago
PLEASE WEAR MASKS
fsdfgsfsdfsdfsd 6y ago
Remind me in two weeks.
akmarinov 6y ago
Maybe start by looking at limiting international travel? The UK are the only countries that have a stay at home lockdown but no international flight ban and testing at arrival.
- Closi 6y ago
  It’s a good idea and should be done, although there is too much transmission in the community at the moment for it to make any significant difference unfortunately. It would have probably made a difference if it was done earlier.
74d-fe6-2c6 6y ago
In Germany we have a couple of politicians and scientists who every fortnight predict mayhem in a fortnight. No mayhem ever materialized though. We didn't have any actual Triages, ICUs are not overwhelmed. And this seems to be true for almost anywhere except for extreme shit shows like in Italy early 2020. So ... my emprical conclusion is that Corona is bad but not as dangerous as our governments want us to believe to justify their powergrabbing moves. And gathering outside is probably completely irrelevant anyway.
- koonsolo 6y ago
  Go talk to someone in the ICU. The sister of one of my best friends works in ICU in Belgium. Recently with the 2nd peak, they had to pick between 2 patients because they were overwelmed in some timeframe. They let one patient die to save the other. Don't expect these things to reach the news. In the news we always stayed well below our max capacity. But it's not because you have 1000 free beds that you can handle 1000 patients on average, because things peak in regions and time.
- apexalpha 6y ago
  When I was a little kid I asked my father once why there were large trucks driving around covering the streets with salt. "It's to keep the roads ice free." he said. 'But dad, there's never ice one the roads here!', I responded. To which my dad says: "mhh, I guess we might as well stop with the salt then." ---- Just because the mayhem in Germany was prevented doesn't mean it wouldn't have happened if no measures were taken. I live in the Netherlands, and we just went into full lockdown again because we're running out of hospital capacity. Some cancer treatments and other non-Covid care have already been postponed / cancelled. Believe me when I tell you your politicians are right; it would be mayhem if nothing was done.

271 points by biomene 6y ago

This article is confusing. It starts off by saying this is an analysis of "best" and "worst" case scenarios for continued growth in cases, but later it says: > HSJ understands that the briefing was part of an attempt to get senior clinical leaders to focus on what they would have to do, if current growth trends were not surpressed by the tighter lockdown. So, er, what if the growth trends are suppressed by the tighter lockdown, as seems likely? Will things then be better than the "best" case scenario? It sounds like there's a bit of misreporting going on here. The leaked document forecasts demand based on pre-lockdown trends, to highlight the significant risks. But the article is reporting it as if running of beds is totally guaranteed in all circumstances, which doesn't appear to be the case, if the lockdown works.

regularfry 6y ago
The hospitalisation curve for the next fortnight is largely locked in by what was happening before lockdown started. If lockdown has a positive effect, it'll be visible in the hospitalisation stats after 12 days or so.
flukus 6y ago
> So, er, what if the growth trends are suppressed by the tighter lockdown, as seems likely? Will things then be better than the "best" case scenario? There's two lag factors to consider. The first is the lag between restrictions and cases dropping, this takes a couple of weeks and cases and the growth isn't likely to even slow for 1 week. The second is the lag between infections and people getting seriously sick and needing hospitalization, that takes 3-4 weeks. There's also the serious possibility that the restrictions arn't strict enough to make a big difference. This scenario is basically baked in, avoiding it required action weeks earlier.
- andy_ppp 6y ago
  Or because of the incompetence of those in charge people just don’t take the lockdown seriously...
  - Blahah 6y ago
    Nobody is in charge of people's perspectives. The UK has really gone all in on psychosocial nudge tactics in this pandemic, and it has massively failed so far. Arguably, they've done so because they knew the population were so belligerent and arrogantly ignorant that a more direct approach would definitely fail. They have leveraged the 'new variant' to implement at the last moment the measures that were being recommended for months by all their expert committees. People here don't want to be told what to do and there are very well organised efforts to encourage people to feel empowered in their ignorance and irresponsibility. The 'people in charge' aren't the only ones to blame for that.
simonh 6y ago
I would expect that if growth trends are suppressed by the tighter lockdown, that would be the best case scenario. That’s not the most likely scenario though, and you need to prepare for the worst case scenario. So that’s what clinical leaders need to focus on, right?
rossdavidh 6y ago
I agree that the "best case" scenario should probably involve some impact from the lockdown (after a delay), but given the experience in California (which was that the lockdown didn't slow things down much, if at all), it seems at least plausible to look at what happens if the same is true in the U.K.
- toyg 6y ago
  Big lockdowns last year definitely made an impact in England and Italy. I expect it will be the same now. What failed here in UK was the regional approach, the continuous attempts at unfounded optimism, and the attitude that covid-related rules were just another game to play and cheat at (like a minster saying that a scotch egg is “a substantial meal” which can justify going to the pub...). The population doesn’t take the message seriously unless the gravity of the situation is stressed and the necessary plans are clear, simple, consistent throughout, and ruthlessly enforced. When most of that happened, lockdowns worked.
  - Taurenking 6y ago
    They made so much of an impact that we're still battling with the virus 8 months later
    - toyg 6y ago
      The critical issue is to ensure the health system is not overwhelmed, and that was achieved. Prolonging the agony is actually a result of unwillingness to extend hard lockdowns for 4+ straight months over whole countries - we keep lowering restrictions as soon as possible. But sure, things might have definitely been faster if only we just let more people die.
    - ben_w 6y ago
      I’m not an epidemiologist, so I’m going out on a limb with this, but: Looking at the infection rate curve, I think the lockdown was working right up until the more-infectious strain took over. (“People tested positive” graph: https://coronavirus.data.gov.uk/ https://coronavirus.data.gov.uk/)
tomatocracy 6y ago
It's not immediately obvious from any reporting but the "rules" in London haven't actually changed significantly since the 20th December (schools did not reopen as planned but they'd been closed since before then anyway for the Christmas break). The only meaningful change in the past couple of days is the "takeaway pint" ban (which is unlikely to make any difference and is purely symbolic).

pjc50 6y ago

I believe certain hospitals are already at the stage of queuing ambulances outside and are breaching the four hour wait times. This is a consequence of loosening the lockdown for Christmas.

mfDjB 6y ago
The lockdown was tightened for Christmas. [1] 1: https://nypost.com/2020/12/20/londons-covid-19-christmas-lockdown-leads-mass-exodus/ https://nypost.com/2020/12/20/londons-covid-19-christmas-loc... EDIT: It's weird that people don't believe me. Here is a BBC article talking about the Tier 4 lockdown that occurred right before Christmas: https://www.bbc.co.uk/news/uk-england-london-55380644 https://www.bbc.co.uk/news/uk-england-london-55380644 From the article: "Millions of people across England have been banned from meeting friends and family indoors over the festive season as they enter a new tier-four level of Covid restrictions, while indoor mixing has been restricted to Christmas Day alone for the rest of the country." Perhaps someone in the comments could show me evidence that London was "loosening the lockdown for Christmas"? Also I live in London (and did during Christmas, where I cancelled my plans because of said lockdown), and am British.
- robtaylor 6y ago
  Nope. It was wide open for Christmas Day. Source: Being in UK.
  - barnacled 6y ago
    Not for much of the country, including London. Source: living in (what was at the time) a tier 4 area The issue is the new strain, clearly. Cases were growing even during the November lockdown.
    - simonbarker87 6y ago
      Growing in the southeast from memory but the rest of the country saw pretty strong decreases I think. Wasn’t Kent the first place things started to really kick off and take a turn in mid Nov?

jiggawatts 6y ago

If a mutant strain of COVID-19 becomes twice as deadly, this "merely" doubles the pressure on hospitals. A constant factor like this can be dealt with. However, an increased rate of spread (R factor) is a change in the parameter of the exponential curve, and cannot be dealt with by any sub-exponential response. The only thing that could possibly work is to change the factor. Rapid vaccination or lockdown. It's impossible to vaccinate the population of London in two weeks, which means a full lockdown is the only option now. YC News is mostly a forum for software developers, which means that these notions ought to be familiar to most people here. When talking about software algorithms, we all learned about big-O notation. We all learned that Exponential time algorithms are (nearly) the worst case, and will always be worse for large data sets than a linear-time or quadratic algorithm, irrespective of the constant factor. Essentially the new mutant strain changes the "R" term in Θ(a×exp(R×𝑡)), whereas increasing the lethality is a change in the "a" term. People are concerned about the lethality getting worse, but they shouldn't be. This change in the infection rate is more scary.

laqq3 6y ago
Good analysis but small nitpick: the use of "Θ" in Θ(a×exp(R×𝑡)) is slightly inaccurate (or is it the use of "a"?) because the set of functions Θ(a×exp(R×𝑡)) is the same for all positive a.
- deleted 6y ago
  [deleted]
- s_gourichon 6y ago
  Well, yes, of course: isn't "a doesn't matter" the core of the point of the parent comment?
mikepurvis 6y ago
I agree, but I think there is now a non-trivial group who are either a) in total denial about the virus or believe it's a conspiracy, b) overwhelmed by news of it and unable/unwilling to process anything new, or c) believe in herd immunity and might even welcome a faster spread on that basis. Arguments about exponentials mean nothing to anyone in any of these buckets— they'll be flaunting a lockdown up until and perhaps beyond the point where it is administered by force. I don't know how to deal with this reality, but it feels like the greatest threat at this point.

yread 6y ago

Even bigger news is that as of yesterday there were just 46 free ICU beds (out of 1300+) in the whole London

simonbarker87 6y ago
What’s the status of nightingale? In use or not?
- notretarded 6y ago
  They got shut down, the one at Excel had like 4 patients in it and a handful of nurses.
- callamdelaney 6y ago
  Doesn't exist anymore :)
  - mtmail 6y ago
    The article says it will be opened and used again.
    - callamdelaney 6y ago
      When?
      - Nursie 6y ago
        It's been quietly resupplied with everything except staff, from what I can tell from a civil servant friend. Which makes it of limited use.
- mtmail 6y ago
  From the article "These would be complemented by 1,000 “step down beds”, some of the supplied by the opening of the capital’s Nightingale hospital," so sounds like it's not in use yet.

mike00632 6y ago

3478 people died from COVID in the US yesterday. https://covidtracking.com/data/charts/us-daily-deaths https://covidtracking.com/data/charts/us-daily-deaths

deleted 6y ago
[deleted]
jonhohle 6y ago
s/from/with https://covidtracking.com/about-data/data-definitions https://covidtracking.com/about-data/data-definitions
core-questions 6y ago
~1700 people per day die of heart disease in America and have done so for decades. I think we should shut down the economy until we can get everyone's heart healthy.
- d4mi3n 6y ago
  That'd make more sense if heart disease had a significant chance of killing people breathing the same air as you.
  - matz1 6y ago
    Good thing that the chance of being killed by covid infected people breathing the same air as me is very very low.
    - sojournerc 6y ago
      How can someone downvote this? 99.9% is low odds...
      - gnusty_gnurc 6y ago
        Anxiety disorder pervading society. Habituation to an unimaginably high safety standard in modern society.

callamdelaney 6y ago

>The NHS England presentation, seen by HSJ (see slides below story), showed that even if the number of covid patients grew at the lowest rate considered likely Covid rates have consistently grown at the lowest rate considered likely.

Closi 6y ago
Well even at the most conservative readings of recent statistics the growth rate has been 3.5% daily, so you might have 2 and a half weeks if you are really lucky.

WaitWaitWha 6y ago

When did we switch the emphasis from tracking deaths, to tracking infections?

dragonwriter 6y ago
> When did we switch the emphasis from tracking deaths, to tracking infections? Never, infections have always been a foucs of tracking because infections lead hospitalizations lead deaths (and hospitalizations have second-order impacts on mortality from other causes when they reach a critical level, even beyond direct COVID deaths.) If you only focus on deaths, you are weeks behind the curve in reacting.
n4r9 6y ago
There's still a focus on deaths, but greatly increased testing capacity means that infection estimates are becoming more accurate.
- WaitWaitWha 6y ago
  Thank you. From a non-medical, "just following the news" perspective, there was a pronounced shift. A few simple google news search will show this.
  - midasuni 6y ago
    Back in April we weren’t able to test anyone outside of hospitals. In march we were likely up in the 100k infections a day just before lockdown, around what we are now come to think of it. That’s based on taking the IFR and working backwards from reported deaths at different ages.
skybrian 6y ago
Not sure what you mean since tracking infections, hospitalizations, and deaths are all useful. However, there are reporting delays for infections and deaths during weekends and holidays. Infections happen earlier than hospitalizations and deaths but the count depends on people getting tested.

jpxw 6y ago

And yet we still have idiots here in the UK saying things ranging from: * coronavirus is invented as a government power grab * the government locking down is a deliberate ploy to kill small businesses * the government should just let this run its course, it’s Just A Flu TM * hospitals are actually empty (the “proof” being people recording empty waiting rooms in outpatient departments on bank holiday weekends) * coronavirus doesn’t exist (!) Maybe this will be a bit of a wakeup call.

pjc50 6y ago
It's not a wake-up call until protestors storm the government buildings. Apparently.
- backWardz00 6y ago
  Brains, amirite? With the masses sedate at their screens, the bureaucracy has no cognitive experience or expectations for anything different. Decades of headlines being fed to Main Street going on about growing inequality did not really motivate Main Street to do much but shuffle back into the office. Relativity pervades all experience. Reading about history in books is not exactly experiencing history.
labster 6y ago
Or maybe these people will keep believing the lie, even after they die from COVID, like the Calormen at the end of CS Lewis’ The Last Battle. Everyone else will be in Heaven, and they’ll be all like, “Let me out of the hospital, corona is a lie!”
- fsdfgsfsdfsdfsd 6y ago
  People die from all sorts of diseases. Someone dying from Corona doesn't prove that he died from a pandemic level disease. (I'm not saying it is not a pandemic, just that that kind of logic is bullshit). Even the nurse reports about "patients being in disbelief about dying". I would imagine lots of people who are about to die are in disbelief. A friend of my mother died from the flu. He called her shortly before that. I think he probably also was in disbelief. Do you expect to die from the flu?

anonunivgrad 6y ago

In Florida, bars and restaurants are just about fully open and everything is just fine.

markdown 6y ago
If you ignore the dead and dying, yes, everything is just fine.
- WaitWaitWha 6y ago
  https://covidtracking.com/data/charts/currently-hospitalized-by-state https://covidtracking.com/data/charts/currently-hospitalized... hospitalization by state: 342 per million FL 569 per million CA 444 per million PA 442 per million NY Can anyone point me to similar chart for death per million, by state, over time?
  - AareyBaba 6y ago
    http://91-divoc.com/pages/covid-visualization/?chart=states-normalized&highlight=California&show=midwest&y=both&scale=linear&data=deaths&data-source=jhu&xaxis=right#states-normalized http://91-divoc.com/pages/covid-visualization/?chart=states-...
    - WaitWaitWha 6y ago
      Excellent! Thank you!
  - markdown 6y ago
    22k dead in Florida. I guess if nobody in your family is included in that figure, it's all peachy.
    - war1025 6y ago
      Funny, I didn't see anyone calling to shutter the economy when my dad was dying of cancer. Similarly, I didn't see any great outrage this summer when my uncle died of a heart attack. Death is tragic, but it's also a fact of life. A lot of people have fallen into the trap of making fear a virtue this year.

noncoml 6y ago

Because on one hand the government thinks it's OK for people to die alone in ICU and bury them without their friends of family[1]. But on the other hand said that it's OK to meet people to celebrate Xmas with[2]. Sources: [1]https://www.bbc.com/news/uk-england-london-52312653 https://www.bbc.com/news/uk-england-london-52312653 [2]https://www.bbc.com/news/explainers-55056375 https://www.bbc.com/news/explainers-55056375 Edit: Downvoted? It's not even my opinion. It's facts. Damn. Or do you think that's not the reason? Timing-wise it matches pretty well.

jiggawatts 6y ago
Meanwhile in Australia the "cricket has to go ahead", crowds and all, despite Sydney being on the knife-edge of heading towards a second wave. All because the politicians involved are huge cricket fans and even server on the boards of cricketing organizations. I've never understood why politicians are allowed to have such blatant conflicts of interest, but they get to write the rules, not us...
- asdff 6y ago
  NFL and college football have been dealing with outbreaks all season. The people demand their spectacles.

lrossi 6y ago

Here is a video filmed in London this Christmas: https://youtu.be/Yz7wJZln6Kw https://youtu.be/Yz7wJZln6Kw Plenty of people outside. In fact, I would call it lightly crowded, although less than other years. Many people don’t wear masks. It’s not a surprise that transmission has increased. Nevertheless, London looked absolutely beautiful. Not sure if this was worth the risks though.

drudu 6y ago
What makes you unsure of the risk was worth it?
- lrossi 6y ago
  Just the fact that it’s not my city and not my risk, so not for me to decide.
alkonaut 6y ago
The people in the video seem to just walk around outdoors and not very close to other people. That many people obviously will mean a risk that some of them go into stores, but if there is a reasonably safe thing to do outdoors (like a particularly nice street) it’s natural that this becomes extra popular when people want to find something to do outdoors.
- LeoNatan25 6y ago
  Outdoors, especially in a humid night, is not a magical place where the virus is inactivated right at the mouth of the shedding individual. People being so close, people walking into air that someone recently exhaled—these are big opportunities for infection.
  - tasuki 6y ago
    Can you quantify that? I've been under the impression that outdoors transmission was extremely rare and the vast majority of transmission was indoors. I've been meeting with people outdoors for walks thinking that was mostly safe. I've no sources unfortunately.

racl101 6y ago

So scary man. Scary times.

mrfusion 6y ago

I feel like I’ve heard this before.

ppod 6y ago

People who are making claims about hospital capacity should compare them to the same times in previous years. The data is all available online: https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/critical-care-bed-capacity-and-urgent-operations-cancelled-2018-19-data/ https://www.england.nhs.uk/statistics/statistical-work-areas...

simonh 6y ago
The link you provided is for last year, and that site doesn’t have any data after February 2020 anyway. I think this is the best source: https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospital-activity/ https://www.england.nhs.uk/statistics/statistical-work-areas...
lol768 6y ago
So, January 2019 in London Commissioning Region hospitals: 1033 open adult critical care beds; 882 in use. 85% utilisation. Best-case forecast Jan 2021: 2078 critical care beds required, 1,661 available (increase of ~600). Forecasted 125% utilistation.
- yt-sdb 6y ago
  Beat me to it. And according to this report, London currently has 46 free ICU beds.
- cptskippy 6y ago
  I took the term open to mean unoccupied which put them at 46% utilization. The columns in the spreadsheet are "Sum of Number of adult critical care beds open" and "Sum of Number of adult critical care beds occupied".
- Aeolun 6y ago
  I don’t think beds really work in a way that allows 125% utilization.
  - asdff 6y ago

dfsegoat 6y ago

Ignorant US Guy here: I had to google to learn a 'Fortnight' is 14-days / 2 weeks.

madeofpalk 6y ago
??? Is this not an extremely common phrase? I'm not from the UK (or the US) but... I've never considered this phrase is not known in America?
- polka_haunts_us 6y ago
  I am American, I know what it means, I expect a majority of people in the US don't. It's not a word in common usage in American English.
- garmaine 6y ago
  It's not a term used in America, outside of some extremely old black-and-white movies. Still I'd be surprised if someone born and educated here didn't know what it meant, since it must have been encountered in books or film or something.
- kortilla 6y ago
  Not in the US. It’s mainly thought of as an “old English” word. It hardly ever appears so you usually learn the length some time in school and then subsequently forget it.
eznzt 6y ago
Well, thanks for your comment! I am not native and I had assumed a fortnight ends the next morning.
lordnacho 6y ago
Happened to me a couple of years ago: Kid: Dad, what's Fortnite? Me: Fourteen days Kid: What? That makes no sense Me: It's an old word that means two weeks Kid: Okay I want to play it Me: What? That makes no sense Kid: I want to play it, what does it mean? Me: It means two weeks. What do you mean you want to play it? Kid: I want to play it. What does it mean? etc, etc. Weird drive home until I went online.

LatteLazy 6y ago

Work places remain open. People continue not to wear masks with impunity. Closing schools will help a bit. But I doubt it will reverse the spread, it wasn't enough for the old covid 19, let alone the new strain.

qznc 6y ago
Closing schools did help a lot last spring: https://science.sciencemag.org/content/early/2020/12/15/science.abd9338 https://science.sciencemag.org/content/early/2020/12/15/scie...
- LatteLazy 6y ago
  I'm probably going to get the maths wrong here, please correct me kind stranger! So closing schools and universities reduces R values by 38% (16%-54%) per your excellent link. England R value is about 1.3 at last count. 1.3*(1-38%) = 0.806 So hopefully that's enough. I'm a cynic and pessimistic so I worry that: London is likely higher (more workers, denser, people use public transport). Keeping nurseries open and some pupils in schools will reduce the 38%. The spike from christmas/new year will ruin things. I guess the optimist would say: 1.3m people vaccinated (especially in high risk groups) means the hospitalisation rate should go down.

renewiltord 6y ago

So now we get to see if we hit that hockey stick. There's a natural experiment at work here to see if everyone starts dying en masse. Sucks for people in the UK, and for folks like my cousins and aunt who work in the NHS, but doomsday is almost here so we get to see what doom is like. We should play close attention from afar so we can learn.

tin7in 6y ago

Although lockdown measures in the UK look very similar to measures in other European countries I can tell that there is very little police control, probably due to lack of resources. For example I don't know anyone who arrived from abroad being checked if they are self isolating at home as they declared.

tomatocracy 6y ago
Anecdotally compliance has actually been pretty high. And I think it's wrong to say there haven't been checks - I have a couple of friends have received visits or calls from the police to check they were in compliance with travel quarantine requirements.

andred14 6y ago

Time to stop lying unless you want to go to jail. Your scam has been revealed: https://www.reddit.com/r/NoNewNormal/comments/kl15z4/italian_scientists_test_a_kiwi_fruit_for/ https://www.reddit.com/r/NoNewNormal/comments/kl15z4/italian...

sjg007 6y ago

It’s pretty obvious that this is the fate of the US and Europe too in the next 6 months. Unless we lock down hard. People are still in total denial though.

oxfordmale 6y ago

Looking at COVID models, the hospital admission peak is around the 10th of January UK wide. Cases have already started to level in London. Lockdown has been implemented too late to make any significant difference to that. Not the most reliable source, but confirmed by other sources which are unfortunately behind a paywall. https://www.dailymail.co.uk/news/article-9115357/amp/Coronavirus-UK-Government-shows-data-suggesting-cases-new-coronavirus-variant-falling.html&ved=2ahUKEwja-pmmyIjuAhWSqHEKHWfzA18QFjAGegQIGBAB&usg=AOvVaw061D_IEpuxkSv14mCBn0Nc&ampcf=1 https://www.dailymail.co.uk/news/article-9115357/amp/Coronav...

alimw 6y ago
> Cases have already started to level in London. Lockdown has been implemented too late to make any significant difference to that. This is a common claim and I have seen it made about various periods of lockdown in various countries. "Look, rate of increase started to slow within a week of lockdown, but it should take two weeks to see the effect, so it can't be that lockdown has made any difference." There is usually far too much noise in the figures to make such a claim about small differences in time scale. Also if you were expecting a sudden drop after two weeks then you were bound to be disappointed. The amount of time it takes for an infection to become a recorded case of Covid will be random according to some distribution (possibly with a mean of one or two weeks) so the transition will be smooth.
- oxfordmale 6y ago
  I am not suggesting lockdowns do not work. Hospital peak was predicted to be around the 10th of January well before lockdown was announced and that has not shifted. Lockdown is undoubtedly going to change the shape of the curve after the peak has passed, but it didn't move the actual peak.
  - deleted 6y ago
    [deleted]
- okl 6y ago
  Add to that additional delays because of the holidays.

throwaway23242 6y ago

covidiots

olivermarks 6y ago

What happened to the Nightingale hospital? Can it be re erected? https://www.theguardian.com/world/2020/may/04/london-nhs-nightingale-hospital-placed-on-standby https://www.theguardian.com/world/2020/may/04/london-nhs-nig...

asadhaider 6y ago
I believe it's back on standby as is the one in my city, Nightingale Hospital North West, in Manchester. The issue is staff though, there simply isn't enough qualified staff to work it alongside their hospitals. I've been working as a volunteer nursing assistant in hospital A&E departments through St John Ambulance it's honestly just insane. I don't know what the plan is for Nightingale but we're focusing on getting mass vaccination centres setup currently and delivering the vaccines.

mikesabbagh 6y ago

PLEASE WEAR MASKS

fsdfgsfsdfsdfsd 6y ago

Remind me in two weeks.

akmarinov 6y ago

Maybe start by looking at limiting international travel? The UK are the only countries that have a stay at home lockdown but no international flight ban and testing at arrival.

Closi 6y ago
It’s a good idea and should be done, although there is too much transmission in the community at the moment for it to make any significant difference unfortunately. It would have probably made a difference if it was done earlier.

74d-fe6-2c6 6y ago

In Germany we have a couple of politicians and scientists who every fortnight predict mayhem in a fortnight. No mayhem ever materialized though. We didn't have any actual Triages, ICUs are not overwhelmed. And this seems to be true for almost anywhere except for extreme shit shows like in Italy early 2020. So ... my emprical conclusion is that Corona is bad but not as dangerous as our governments want us to believe to justify their powergrabbing moves. And gathering outside is probably completely irrelevant anyway.

koonsolo 6y ago
Go talk to someone in the ICU. The sister of one of my best friends works in ICU in Belgium. Recently with the 2nd peak, they had to pick between 2 patients because they were overwelmed in some timeframe. They let one patient die to save the other. Don't expect these things to reach the news. In the news we always stayed well below our max capacity. But it's not because you have 1000 free beds that you can handle 1000 patients on average, because things peak in regions and time.
apexalpha 6y ago
When I was a little kid I asked my father once why there were large trucks driving around covering the streets with salt. "It's to keep the roads ice free." he said. 'But dad, there's never ice one the roads here!', I responded. To which my dad says: "mhh, I guess we might as well stop with the salt then." ---- Just because the mayhem in Germany was prevented doesn't mean it wouldn't have happened if no measures were taken. I live in the Netherlands, and we just went into full lockdown again because we're running out of hospital capacity. Some cancer treatments and other non-Covid care have already been postponed / cancelled. Believe me when I tell you your politicians are right; it would be mayhem if nothing was done.