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Coronavirus

scaramanga said:
My mistake
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FaintingDog-7a23.gif


The forum seems to have gone wrong.
 
scaramanga said:
My mistake - I must have misread your previous posts as I thought you were in PH now and had been an MD. In which case I'd have expected you to work closely with people like Ferguson.

I'm not saying his analysis is wrong - I couldn't without taking the same steps he has, probably taking longer than he did and needing a team to do so. My concern is that the govt is reacting to advice from someone who I have heard of for three papers - two of which were overly alarmist in their predictions, costing time and money that wasn't required. The stakes are now significantly higher than in either of those two cases - I would prefer the govt to be using someone else's work.
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No worries. I am a frontline doctor now who has worked previously in things to do with PH and have some experience with infectious diseases as well.

I am by no means a PH doctor now though and am certainly not a statistician. I have previously worked (and studied) alongside people like Ferguson but have not done so for a long time now.

The government is reacting to advice from him and his team, a world leading expert, as well as others who are experts in the field. This is pretty much the same approach as will have been taken in almost every other country in the world currently, who have all undergone some degree of social distancing, lockdown, tracking etc, all with their own epi experts.

I'm going to stick my arrogant cap on for a second and say I know more about this than the average person, from both a medical and PH perspective (and the average doctor for that matter) but that I still would never say I know what the solution is. It is a uniquely difficult situation, one in which eventually the cure will be worse than the disease, where the tipping point is reached and morbidity and mortality from the poverty caused by the lockdown is worse than the morbidity and mortality caused by the virus itself. Again, it is difficult to know exactly where this is. We need to model and make our best estimates and react accordingly. We need to model to know when fatigue sets in from these methods and people start ignoring the measures. My colleague from HK says this is already starting to happen to some extent there.

Ferguson and his equivalents all around the world are not pretending they know the answer. They are using the best possible models we have at our disposal to make predictions and try to alleviate the strain this virus will place. If other epidemiologists or experts feel they have come to a different conclusion, they are free to present their evidence to their respective governments and attempt to persuade them.

Some countries will get it right. Some will get it wrong. Life will probably never be the same again. But we have to do something and, in the absence of hard empirical evidence (which nobody has), all we can go on are these models.
 
Hootnow said:
It is a uniquely difficult situation, one in which eventually the cure will be worse than the disease, where the tipping point is reached and morbidity and mortality from the poverty caused by the lockdown is worse than the morbidity and mortality caused by the virus itself. Again, it is difficult to know exactly where this is
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Without speaking for Scara but I think thats part of why he champions not locking down because the rates will be similar locked down and not but the lockdown brings about more long term pain, especially economically.
 
Hootnow said:
Its unclear at the moment. Bit early in the UK's curve but there's some stuff coming out of China of 3-10% of recovered patients later testing positive. They seem to be asymptomatic though and unclear if they're still transmitting the disease.

I haven't personally read the papers though so can't be too sure.
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Do you think a bit like TB it could be dormant. Stays there in the background for some.


Sitting on my porcelain throne using glory-glory.co.uk mobile app
 
Grays_1890 said:
Without speaking for Scara but I think thats part of why he champions not locking down because the rates will be similar locked down and not but the lockdown brings about more long term pain, especially economically.
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The rates will not be similar of locked down vs not. That is one of the few confirmed facts from this.

We've already cancelled pretty much all elective work in the NHS currently. Operations are not happening. A lot of semi emergency work is not happening. Yet many of our hospitals, especially in London, are already overwhelmed. The hospital in my trust which deals with neurosurgery for instance has closed down its neurosurgery ward (bad time to get a head injury in West London....) and turned it into another ICU and this is already filling up. Our ICUs are almost exclusively Covid-19 patients.

This is despite us having enacted some measures which we do know to work in reducing transmission. Letting it go would have led to the ICUs getting even more overwhelmed.

At some point however (and pretty much everybody agrees with this), the long term economic damage from lockdown, unemployment will cause a more significant M&M than the virus itself will. That particular point will be very difficult to estimate.

What is clear that at the moment, pretty much every single country in the world, regardless of political system, regardless of wealth, robustness of the HC system, general characteristics of its population, pandemic preparedness, have enacted some measures which will have some impacts on the economy.

I feel like even if people think I'm just some random tool on the internet or Ferguson is an idiot, that should speak for something.
 
Grays_1890 said:
Sorry I read your message wrong then, I thought that was what you was saying.
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Sorry, was trying to say that at some point (could be a week, a month, year, we may have already passed it), the health impacts of the poverty caused by lockdown will be worse than the health impacts from the virus itself.

As to when that tipping point arrives for each country, it is difficult to know. It will be a very difficult decision to make if we don't get on top of things soon.
 
Hootnow said:
Sorry, was trying to say that at some point (could be a week, a month, year, we may have already passed it), the health impacts of the poverty caused by lockdown will be worse than the health impacts from the virus itself.

As to when that tipping point arrives for each country, it is difficult to know. It will be a very difficult decision to make if we don't get on top of things soon.
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Hopefully the decision will be helped by other interventions coming along.

All we have at the moment is a lockdown fader. Crank it up...transmissions, hospitalisations reduce
Fade it down...the reverse happens.

Of course this is worthwhile, primarily to keep you medical guys sane, and the moral of frontline staff off the floor

Second to that, it buys time for the background effort to establish the other landscape changing interventions. Anti viral drugs, oxygen delivery options, quality testing, vaccine development. Only these open up new management pathways as they provide new data and hopefully more survivals that will in turn dial down the fear that grips people.

The testing, if reliable, should be the quickest of these to appear? And if proven, that we develop decent immunity, people can be 'released' back into the community to help others or just return to work.

If treatment becomes better and hospitalisation isn't feared as a death sentence, it may be quicker to look at the natural herd immunity route as I'm guessing that that will be quicker than development of a vaccine?.
 
ricky2tricky4city said:
Hopefully the decision will be helped by other interventions coming along.

All we have at the moment is a lockdown fader. Crank it up...transmissions, hospitalisations reduce
Fade it down...the reverse happens.

Of course this is worthwhile, primarily to keep you medical guys sane, and the moral of frontline staff off the floor

Second to that, it buys time for the background effort to establish the other landscape changing interventions. Anti viral drugs, oxygen delivery options, quality testing, vaccine development. Only these open up new management pathways as they provide new data and hopefully more survivals that will in turn dial down the fear that grips people.

The testing, if reliable, should be the quickest of these to appear? And if proven, that we develop decent immunity, people can be 'released' back into the community to help others or just return to work.

If treatment becomes better and hospitalisation isn't feared as a death sentence, it may be quicker to look at the natural herd immunity route as I'm guessing that that will be quicker than development of a vaccine?.
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I think that most forecasts suggest that this would take longer than a vaccine being developed, if we want to avoid overwhelming the NHS and having a very high death toll. We also do not know yet whether it would provide anything more than short term immunity.
 
Hootnow said:
No worries. I am a frontline doctor now who has worked previously in things to do with PH and have some experience with infectious diseases as well.

I am by no means a PH doctor now though and am certainly not a statistician. I have previously worked (and studied) alongside people like Ferguson but have not done so for a long time now.

The government is reacting to advice from him and his team, a world leading expert, as well as others who are experts in the field. This is pretty much the same approach as will have been taken in almost every other country in the world currently, who have all undergone some degree of social distancing, lockdown, tracking etc, all with their own epi experts.

I'm going to stick my arrogant cap on for a second and say I know more about this than the average person, from both a medical and PH perspective (and the average doctor for that matter) but that I still would never say I know what the solution is. It is a uniquely difficult situation, one in which eventually the cure will be worse than the disease, where the tipping point is reached and morbidity and mortality from the poverty caused by the lockdown is worse than the morbidity and mortality caused by the virus itself. Again, it is difficult to know exactly where this is. We need to model and make our best estimates and react accordingly. We need to model to know when fatigue sets in from these methods and people start ignoring the measures. My colleague from HK says this is already starting to happen to some extent there.

Ferguson and his equivalents all around the world are not pretending they know the answer. They are using the best possible models we have at our disposal to make predictions and try to alleviate the strain this virus will place. If other epidemiologists or experts feel they have come to a different conclusion, they are free to present their evidence to their respective governments and attempt to persuade them.

Some countries will get it right. Some will get it wrong. Life will probably never be the same again. But we have to do something and, in the absence of hard empirical evidence (which nobody has), all we can go on are these models.
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I'm glad the govt are following expert advice, I wouldn't want them to do otherwise.

Given your comments on the fine balancing act between economic survival and short term life saving, aren't you at all concerned that the author's two other high profile papers ended up in a very expensive, overly cautious approach?
 
milo said:
The article is covers a lock/release approach. It suggests that behavioural scientists are questioning the public response to loosening and tightening restrictions. You could see that compliance might drop off with each lockdown and that prompting a more authoritarian response from the government. If we do see a relaxation in the next few months, then I think that July and August would be the second lockdown.
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I believe that if there is a re-phasing/relaxing if current conditions, it will happen in August and we would see a second lockdown in Oct/Nov where "winters" are about to take root. Of course, the only real parameter would surely have to be systems being able to accommodate the sick. If we could get to a stage where enough ventilators exist to deal with the potential demand, that would likely be the single biggest factor in all this other than a vaccine or anti-body shot.
 
Hootnow said:
Sorry, was trying to say that at some point (could be a week, a month, year, we may have already passed it), the health impacts of the poverty caused by lockdown will be worse than the health impacts from the virus itself.

As to when that tipping point arrives for each country, it is difficult to know. It will be a very difficult decision to make if we don't get on top of things soon.
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First of all, thank you for your interesting and expert views from the frontline. Greatly appreciated. I think the bold-faced line above is a key matter and a relative "white elephant" in the room. I am of the belief that mental health is very important when it comes to maintaining physical health, that the two dovetail deeply. If mental health collapses, my feeling is that physical health follows and immune systems, etc, get compromised badly. It is a really key area for sure. Stress from increasing poverty likewise will compromise the mental and thus physical health of those who endure it. What a time to be alive.
 
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