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Arnold Weinstock, a British industrialist, once said “I’ve forgotten what the 7 wonders of the world are, but the 8th must be compound interest”. Under his cautious guidance General Electric became a great UK company. Under his successors it went bust. Some problems compound and need to be nipped in the bud.

A respect for compound interest is not new. The origin of the story may even pre-date 1256, where it is presented as the request that payment be made in the form of a single grain of wheat being placed on the first square of a chessboard, and doubling thereafter. The answer is 18 big ones, quintillions. 10 to the power 18.

These answers are counter-intuitive. Most people prefer a million dollars right now rather than a penny doubling every day for a month. Exponential growth comes as a surprise. Another example, given in various forms, is the lily in a pond which doubles every day. If the pond is full on the 60th day, on what day will it be one-quarter covered?

Most people tend to think in linear terms. Perhaps this is because payments by the hour or week or month tend to be linear, and that is how most people have to judge these matters. Handling investments is usually only done by a minority.

The spread of an infectious disease follows the same exponential pattern, hence the deep interest in the doubling rate of coronavirus infections, used as a shorthand for the growth in number of cases.

Imperial College has been running simulations, and also running into criticism for them. The code is written in thousands of lines of C and is undocumented, the lead researcher explains, in a short break from running more simulations and recovering from the infection himself. “Tut tut”, say the critics.

This is silly. If people had been interested in this problem years ago, they could have done the work themselves, documenting and publishing their code. There must be lots of programs out there against which the Imperial College simulations could be compared. However, there is certainly an odd assumption that intensive care beds are the key variable to be managed, unless one knows the success rate of such facilities with respiratory problems in mostly old aged patients. As the triage guidance gently puts it, one must consider if the outcomes are ones that patients would be happy to live with. Survival rates may not be very much improved among the severely sick elderly. Some estimates are that ventilators saved only 3% of such cases.

Now, there is indeed a simulation from the University of Oxford Medical School, against which the Imperial College predictions can be compared.

https://www.dropbox.com/s/oxmu2rwsnhi9j9c/Draft-COVID-19-Model%20%2813%29.pdf?dl=0

Commenter Philip Owen says:

This is far less apocalyptic than Imperial College. To be fair it is recent and models SARS2/Covid-19. It suggests that as high a proportion as two thirds of the UK population has already been infected! The core suggestion is, that many of those testing negative have in fact already had the disease in an exremely mild form. Young and socially active got it first? In Italy, they speculate that as many as 80% of the population already have been infected.

The inference is that SARS-CoV2 infection will be largely over in 3 months from the initial cases coming to attention. This is far less dramatic than the Imperial College model (based on flu). It is much more consistent with the cruise ship data except that the people testing negative for the virus, in large part, had already had an asymptotic infection that had been cleared by the body before testing.

I need more time with this, but it would be good if modellers all followed the same protocol in the summary of their methods, so that we could compare their assumptions in a common format. They make many disclaimers about the error terms in many of the figures, and call for antibody testing to see who once had the virus and may now be immune, for a while at least.

We need more competing simulations, and more debate about underlying assumptions.

Incidentally, this crisis may change health services for the better, by ensuring that all consultations are online initially, which should be more efficient, and less conducive to cross-infection. Add in some good quality video and remote health monitoring and there could be a more effective delivery of medical care, with face to face interventions being focussed on key cases, while the worried well are directed to other, less expensive, resources.

This will not happen seamlessly. Currently pharmacies are struggling to meet demand, likewise companies delivering medicines direct to patients at home. Pharmacists have turned down people calling to collect prescriptions on the ground that they had already ordered them to be delivered. The companies themselves deliver very late, so patients short of medication are in a Catch 22.

Also, quarantine is stressing delivery services, which require two hour waits, and politely restrict those endless additions to an order which were possible Before Corona. However, money is pouring into these services, and some shoppers may decide to give up old style food shopping and get back to home delivery, a middle class habit in early 20th Century Britain.

After Corona, before we ever board a plane again, security checks could also include basic health checks, and anyone with a high temperature, or even with a cold, could be denied access. Might help us all in a big way.

Currently, an exhibition centre in East London is being converted into a 4000-bed overflow hospital for London. It has very high ceilings, and will certainly be spacious. They may even have sufficient toilets, and kitchen space. Unless they have excellent staff and equipment, many may prefer to take their chances at home.

 
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  1. dearieme says:

    There should also be a grand reform of the architecture of hospitals. It’s bonkers that we direct highly infectious people into a general hospital packed with people who are already ill, some of them seriously. Staff milling around will spread the infection widely and thereby kill people needlessly. (There’s already a suggestion that this phenomenon might explain the high death rates in Lombardy. https://wattsupwiththat.com/2020/03/24/the-italian-connection/)

    So it’s good news that a 4,000 bed overflow hospital will be available in London, but they need to decide whether it’s to be for COVID-19 sufferers or whether it will exclude them.

    There used to be separate hospitals/sanatoriums for TB sufferers, didn’t there? Relearn that lesson.

    • Replies: @James Thompson
    , @Sean
    , @Cortes
  2. dearieme says:

    Well, well, well. So it’s not a head-banger.

    “Status of COVID-19
    As of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious diseases (HCID) in the UK.

    The 4 nations public health HCID group made an interim recommendation in January 2020 to classify COVID-19 as an HCID. This was based on consideration of the UK HCID criteria about the virus and the disease with information available during the early stages of the outbreak. Now that more is known about COVID-19, the public health bodies in the UK have reviewed the most up to date information about COVID-19 against the UK HCID criteria. They have determined that several features have now changed; in particular, more information is available about mortality rates (low overall), and there is now greater clinical awareness and a specific and sensitive laboratory test, the availability of which continues to increase.

    The Advisory Committee on Dangerous Pathogens (ACDP) is also of the opinion that COVID-19 should no longer be classified as an HCID.”

    • Replies: @YetAnotherAnon
  3. Svevlad says:

    Thank god the Clinical Center of Serbia was designed with overkill in mind – a whopping 3000 hospital beds. I guess it was supposed to cover all of Yugoslavia

  4. Thank you for quoting me. Very gracious as I don’t always agree with you.

    The Diamond Princess and the Costa Luminosa Cruise ships are whole population experiments in infection in which we can still find lessons, particularly after antibody tests are available. After at least 3 weeks exposure in each case, 4/5 of the population did not test positive for infection. (Did they never have it or had they already recovered? We don’t know).

    So the incubation period becomes important. There are American researchers favourable to the Imperial Model arguing for 5.6 days. Early Wuhan figures were at least two weeks (which would favour the Oxford model). In the UK, we have had a natural experiment to show us the answer fairly definitively.

    #Benneton, a North Italian Rugby team, played #Gwent Dragons in #Newport on 6 March. At this point the Aneurin Bevan University Health Board (Gwent) had low numbers of #infections, comparable to the rest of #Wales. On 19 March the infection rate suddenly increased and now ABUHB has by far the largest number of #covid19UK infection rates in #Wales, only London has a similar rate of infection in the UK. Today 50/100,000 at ABUHB. In Cwm Taf University Health Board where I live, the rate is 8/100,000. They are very similar places. So we deduce a minimum incubation period of 13 days. The 8% who tested positive for the virus but showed no symptoms were held for 3 weeks before release. If the disease manifests in these people the incubation period will be sometimes weeks or months. This is an imponderable at the moment.

    Both cruise liners were at sea three weeks before tests could begin. So the disease had at least 21 days but not a lot more to incubate, manifest and disappear. With a 13 day incubation period, this seems ambitious to me. My conclusion is that neither the Imperial College model assuming SFAIK a flu like 5 days nor the Oxford model (which would need a disease cycle of less than 21 days to apply to the cruise ships) yet have the right picture. The 4/5 uninfected in exposed populations need more investigation.

    Iceland is testing everyone who volunteers. They are finding the 1/1 Covid-19/asymptotic ratio among those who carry the SARS-CoV-2 virus as was found on the cruise ships. I am still thinking about this. Rate of infection issue? Really a low grade infection? Is there a virus load issue etc etc.

    The Imperial College Apocalypse is unlikely in my opinion but the eventual outcome is still not clear. 80% herd immunit should aleady be blocking a virus with a short infectious period. If the infectious period is two weeks, will herd immunity ever work?

    18 months to a vaccine is discussed but we still have no vaccine for SARS. Real vaccines take the best part of ten years to develop.

    The UK need a separate reserve system of isolation hospitals as we once had for TB (they were sold off in the Blair era usually for property development. The cottage hospitals where people conavalesced too). Single patient partitions. Beds rolled out onto the patio in any dry weather however cold.

    I need to resurrect my blog and put my thoughts there.

  5. @Philip Owen

    Not quite enough thought I fear. In 13 days the rugby fans needed to to incubate, develop symptoms and get tested. They were a population alert to danger so maybe 10 days of incubation. So there would be enough time for the uninfected on the cruise ships to have experienced an asymptotic infection. This does allow the Oxford model to be correct.

  6. dearieme says:
    @Philip Owen

    I need to resurrect my blog and put my thoughts there.

    Be sure to give us all a link.

    The Imperial College Apocalypse

    I knew a fellow who taught there for years. “What’s it like?” I asked. “Ferrets in a sack” said he.

  7. Just a guess. What seems mostly neglected is to compare overall mortality rates per period of time with the overalls for the periods that can be defined and have numbers for Coronavirus mortality. Italy must have mortality numbers from over the last few years with reasonable detailing possible. If Covid-19 is exponential, it would show soon enough as excess numbers, maybe already of yet.

    By the way, a thousand lines of code often means concatenating a thousand lines of code out of working and existing libraries, patches with some adjustments to glue a whole for the occasion. Could be done at Github as well as in the confines of a proprietary university realm. Copy paste is the usual. Then what can be done in C probably can be done in some other languages, scripting, on different systems. Run simulations might not be the problem, bringing in the data to operate on, in the case of Covid-19 might be the core of the problem.

    Could turn out Covid-19 is the first global hoax of human history. Tulips of Amsterdam times over. This time around not so much as to the insipid power hunger of global elites, but because a failed IQ test of the local power elites, copy-pasting their colleagues of other exotic places on the globe. This phenomenon might be over indeed in less then six weeks. Artificially kept alive, abused, taken advantage of as to the surplus populations.

  8. LondonBob says:
    @Philip Owen

    It is interesting, it does appear to be highly infectious, in which case we have to ask where are the dead bodies and why are some so easily infected and others untouched?

    • Replies: @Philip Owen
  9. After Corona, before we ever board a plane again, security checks could also include basic health checks, and anyone with a high temperature, or even with a cold, could be denied access. Might help us all in a big way.

    We can dream. I expect that, if Covid-19 is vanquished, we will return to our old ways in less than 24 hours.

  10. Sean says:

    Oxford tend to assume they are the world authorities, and pique at Imperial College going over the top of them may be clouding their judgement. Imperial supplied the necessary by giving a projection that made the public’s flesh creep, and Johnson needed that fear. As Trump said, fear is power. The median age in Britain is 40 years old, so as far as I can see it is is very, very unlikely that anything like two thirds of the UK population has been exposed to SARS-CoV-2. My energetic fifty-something cousin in Watford was in bed for a week with Covid-19. And it might be worth remembering that the median age in Oxford is 29.

    Currently, an exhibition centre in East London is being converted into a 4000-bed overflow hospital for London. It has very high ceilings, and will certainly be spacious. They may even have sufficient toilets, and kitchen space. Unless they have excellent staff and equipment, many may prefer to take their chances at home.

    The psychological effect of being in a bed in the middle of an Zeppelin hanger size building can be imagined. I once saw the poor performance of the WW2 Italian army explained by their very low ratio of NCOs to ordinary soldiers. Abundant nurses, nice hospitals, and empathetic staff must give the patient a far better chance. According to an English consultant I saw quoted a few days ago, it takes a month to die of Covid-19.

  11. @LondonBob

    As well as the usual risk of prior risk factors (Cancer immuno suppresants, undiagnosed/untreated AIDS, diabetes, heart disease, high blood pressure, smoking & today anorexia) I think TB deserves consideration. Older people everywhere had it. An 80 year old now was born in 1940. China, Italy and Spain were poor. The UK was rich but not that focussed on public health. Germany had by far the world’s best public health measures. For example, compulsory fitness training or a fine. They had TB under better control than any others even before antibiotics. Also male cardio vascular health seems to depend at least a little on the health of the mother (this was noted in research on the Dutch hunger winter). Germany had the healthiest mothers until, say 1944. Russian men born during the war died like flies in the 1990’s.

    There was a Chinese paper discussing a small sample in Wuhan where all the Covi-19 dead had dormant TB and the living very little.

  12. The code is written in thousands of lines of C and is undocumented

    Whoever developed it should be stripped of their research grant and fired.

    For what’s being done, ‘thousands’ of lines of C sounds like terrible code bloat, too. Maybe they wrote their own functions – or worse, did everything on-the-fly (I’ve seen some terrible code like that – where almost-exactly-the-same thing is written ‘inline’ ten times at different points in the code, instead of being defined as a function once).

    .

    This is a much much bigger problem than people generally understand: until relatively recently (the last 5 years or so), enterprises and governments got a lot of their code development done externally.

    Worse, they got their output pre-compiled (i.e., they didn’t get the raw code), and ‘documentation’ was largely restricted to with manuals on how to use the end-product.

    This is a very different thing from documentation detailing how the code works, how to maintain it, how to extend it, how to test it, and so forth.

    In other words, nominally ‘bespoke’ software came in approximately the same format as their operating systems and proprietary software (like Office).

    And over and above that, there is the problem that most enterprises don’t employ developers.

    The world’s entire back-end is fragile, poorly-documented, badly-maintained and of largely-unknown code quality.

    • Agree: PetrOldSack
    • Replies: @obwandiyag
  13. Survival rates may not be very much improved among the severely sick elderly. Some estimates are that ventilators saved only 3% of such cases.

    The idea that ventilation wouldn’t work, was discussed briefly on Unz a day or so ago. I was trying to understand this emphasis on ventilators as some important front-line therapy: it strikes me as counter-intuitive to force oxygenated air into lungs before you drain them of excess fluid. Another commenter had thought the same thing.

    I also thought it counter-intuitive that there was no discussion of the administration of expectorants (e.g., guaiphenesin) or that ‘whack them on the back’ thing that is used as a ‘percussive’ adjunct to postural drainage in cystic fibrosis and COPD management.

    A thing being counter-intuitive doesn’t make it wrong, but it makes it interesting to find out why it’s used (i.e., the reason it’s not wrong).

    So I’ve spent parts of each subsequent day trying to work out if thoracentesis or some other method of aspiration, is part of the normal protocol. Same for guaiphenesin (to liquefy excretions and make them easier to clear), and for percussive and postural draining.

    From what I have seen from 50 different places outlining treatment for ‘flu and pneumonia, it appears not – not a single one of them.

    I’m becoming increasingly curious about this – because guaiphenesin plus that ‘whack them on the back‘ thing worked an absolute treat when I got a genuinely horrible (bacterial) chest infection about a decade ago.

    It worked so well that I never even had to go to the doctor (I am very averse to antibiotics), although it did take me more than three weeks to totally shake it. It also improved The Lovely‘s bashing technique.

    This NYT story about a guy who had 20 litres of fluid removed (over time) shows that people can have massive pleural effusion and be treated successfully.

    Do US hospitals use ventilators because it’s easier and machine-centric?

    The ‘drainage first’ route seems much more personnel-intensive, but given the 3% success rate for ventilators, it must stand at least as good a chance of working.

    • Replies: @botazefa
  14. LondonBob says:
    @Philip Owen

    Explanations are needed for both the high number of deaths in Spain, Italy and China(Wuhan). Air pollution, smoking, large number of elderly, family patterns explain some, but it seems there needs to be more explanation, so perhaps TB, related to the poverty of these nations when the elderly were young. Others have suggested vaccinations etc.

    The other issue I mention is why when it seems to transmit so easily, do some seem to not get infected at all, asymptomatic doesn’t seem to be that high in number, does the virus come and go so quickly it is not picked up or do large numbers never even get it despite exposure?

    Living in London I just think this has been around awhile, as the Oxford team suggest, but we don’t really have many deaths. A number of people have had it and have simply recovered at home and not been recorded. Others have to have been either asymptomatic or simply they have been so little affected they have shrugged it off or not even been infected at all.

  15. @dearieme

    That’s not unreasonable. The HCID diseases are

    acute infectious disease

    typically has a high case-fatality rate

    may not have effective prophylaxis or treatment

    often difficult to recognise and detect rapidly

    ability to spread in the community and within healthcare settings

    requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely

    Lots of serious and notifiable ailments don’t fall into this category, but it doesn’t mean they’re not dangerous.

    https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid

    • Replies: @dearieme
  16. @Philip Owen

    I was amazed when I heard the Benetton Treviso team were coming and playing, at a time when cases were increasing fast in Northern Italy. I love rugby, but not at any cost*.

    “The UK need a separate reserve system of isolation hospitals as we once had for TB (they were sold off in the Blair era usually for property development.”

    A relative spent nearly a year with TB in Garn Goch Hospital (recovered, saved by an antibiotic combination drug called Pasinah), on the moors outside Gorseinon. It’s actually still there, as an NHS hospital.

    * is there anywhere in the world free of Covid-19, where soccer and/or rugby is still played? They could make a fortune selling TV coverage. At the moment I’d watch two amateur teams play, if they were evenly matched.

    • Replies: @YetAnotherAnon
  17. Sean says:

    The Oxford study gave a range of scenarios. In the one that is causing all the fuss, the two key assumptions Oxford made are that the accrual of ‘compound interest’ continued for one week longer, and only one in a thousand people infected with SARS-CoV-2 will require hospitalisation. It is ostensibly an extreme hypothetical, but why would they include it?

    The power of compound interest is indeed salient in this scenario, but I do not think it is very enlightening about the actual situation. As already mentioned my 53 year old cousin was in bed for a seven days with Covid-19 and half the UK population are over the threshold for getting troubled by symptoms if infected by SARS-CoV-2.

    https://www.wired.co.uk/article/coronavirus-infections-oxford-study-immunity
    “It’s a little concerning that they’ve taken it straight to the media,” says Tim Colbourn, an epidemiologist at University College London’s Institute for Global Health. “It has not been properly sense-checked against any data.” The authors of the Oxford study did not respond to WIRED’s request for comment in time for publication.

    The study, led by Sunetra Gupta and José Lourenço at the University of Oxford’s Department of Zoology, puts forward several hypothetical scenarios about the spread of coronavirus in the UK. In the most extreme scenario they estimate that if the virus had started being transmitted 38 days before the first confirmed death then 68 per cent of the UK population would have been infected by March 19.

    Again, according to an English consultant I saw quoted a few days ago, it takes a month to die of Covid-19. The other estimates I have seen are lower by a week (3 weeks to death).

    “I am surprised that there has been such unqualified acceptance of the Imperial model,” the study’s supervisor, Sunetra Gupta, told the Financial Times. But in an evidence session before the Science and Technology Committee the lead author of the Imperial study, Niall Ferguson, said that the current data did not support the scenarios in the Oxford paper. “We don’t think [the model] is consistent with the observed data,” he says. The Imperial model took into account studies in some Italian villages where every single resident was tested,

    The Oxford foreign legion are aware Niall Ferguson was not debilitated by his SARS-CoV-2 infection, and could not put that out their mind. Who was it that said in academia the rivalries are bitter because the stakes are so low?

    • Replies: @Philip Owen
  18. LondonBob says:
    @Philip Owen

    There was a Chinese paper discussing a small sample in Wuhan where all the Covi-19 dead had dormant TB and the living very little.

    That would be significant and needs exploring.

    • Replies: @for-the-record
  19. botazefa says:
    @Kratoklastes

    The fluid you are talking about is in different locations. The whack the back technique is for fluid in the airways – thick mucus typically. If it was thin the patient could easily cough it out.

    hr NTY story about pleural effusion liquid is in the pleural space, not airways. Whack the back would not help.

    The covid-19 is causing diffuse interstitial pneumonias, not a fluid problem in the the lungs per se. Whack the back might help, but probably at best not much. Positive pressure ventilation is often employed at this stage. This is the covid-19 pathway to the ventilator according to what I’ve read.

    • Replies: @gfhÄndel
  20. @dearieme

    Do no harm. Extremely interesting. I was advised that we should avoid hospitals at all costs, and have turned down proffered hospital appointments, though the consultant orthos in fact changed the consultation to telephone only.

  21. dearieme says:
    @Philip Owen

    “compulsory fitness training or a fine”: OK but that’s not much of a public health measure, properly so called. It’s mainly a private health measure imposed on members of the public, a plain different thing.

    This is a distinction that Public Health England seems to miss too. It’s obviously more fun having a bunch of under-educated twerps bullying us about sugar than employing people to worry constructively about epidemics.

  22. dearieme says:
    @YetAnotherAnon

    Thank you: I had already read that. I didn’t say it wasn’t dangerous, I said it wasn’t a “head-banger”. That’s interesting because they first classified it as a head-banger, presumably out of caution until more was known. Maybe they were wise to do so: I have no reason to think otherwise.

  23. Sean says:
    @dearieme

    The hospital that Mattia the marathoner went to ignored emergency regulations already then in place about people with his symptoms and sent him away, then admitted him without testing him for 36 hours. It is not impossible that the Italian strain has become more virulent due being able to spread in a hospital (which meant the virus did not have to worry about keeping the infected person up and about to spread it). Prisons, especially Uyghurs detention centres in China are a worry on this count.

    The pathogen of TB is very long lasting, weeks and months, which is why there had to be separate facilities for it and why it is so lethal (ditto smallpox).

  24. Cortes says:
    @dearieme

    Infectious disease hospitals were the “low hanging fruit” in the first wave of Thatcherite disposals of NHS “excess capacity” in the 1980s.

    In most cases they were conveniently located in dormitory villages ideally set for conversion to suburbs within a 30-minutes drive of city centres. In one case on the southern side of Glasgow the conversion was to a hi-tech business park.

    • Replies: @dearieme
  25. gfhÄndel says:
    @botazefa

    Further to your points, botazefa:
    COVID19 is killing chiefly by acute respiratory distress syndrome [ARDS].
    Radiologically, this appears as diffuse ground glass opacities on pulmonary CT (also seen in the interstitial lung diseases such as idiopathic pulmonary fibrosis, perhaps a radiologist could chip in if there are subtle ways of distinguishing ARDS and other pneumonitides).
    Histopathologically (the diagnostic gold standard), ARDS is characterized by so-called hyaline membranes. These membranes, which comprise pus-like material formed from components of the acute inflammatory response, line the alveoli (the basic gas exchange unit of the lung).
    Mechanical ventilation allows optimized gas exchange, essentially buying time for resolution of the ARDS (mopping up of membranes by the immune system restoring normal gas exchange across the alveolar wall), but it does little to address the underlying pathology.
    In extreme cases, the only other option is ECMO (essentially lung bypass). Again this is really just buying time for the immune system to correct the ARDS.
    Immunosuppressive agents will dampen things down, but the mechanisms of ARDS (thought to be an exaggerated and counterproductive immune response) are poorly understood and there is no specific therapeutic agent for it (the antimalarials such as chloroquine are acting along the same lines).
    Antibiotics can be used as prophylaxis for the risk of bacterial superinfection.
    Antivirals appear to have a place as well. I am not in position to comment on this with any authority.
    Fluid within the alveolus (pulmonary edema) is managed with positive pressure ventilation (possible without intubation and mechanical ventilation in less severe cases) as well as diuresis.
    Some “sucking out” of the smaller airways is possible eg. bronchiolar-alveolar lavage but in the setting of ARDS this is principally a diagnostic endeavor not a therapeutic one.
    The “sucking/whacking out” is really only for mucus obstruction in the largest branches of the bronchial tree.
    Thoracocentesis is for drainage of pleural effusions (which may accompany any severe lung pathology) which when sufficiently large impair the mechanics of respiration. Effusions can accompany ARDS or other major lung pathology.

  26. dearieme says:
    @Cortes

    Thank you. Someone else has explained to me on the web that it was all done by Blair. You two should hunt each other out and have a cheery chat about it.

    P.S. I have no idea whether an old TB sanatorium would be any use for this new disease – I am making a point about infectious diseases in general. Putting the carriers into an everyday hospital seems mad to me.

    • Replies: @Philip Owen
  27. @Sean

    Does one see the colleges of the University of London closing ranks against Oxford? Where do Cambridge and Manchester (The Victoria version including Liverpool Tropical Medicine) stand on these. Certainly not in support of the first two. (Sorry US readers. This is British class war).

  28. @dearieme

    It was me. Blair certainly finished the job. I remember one of my clients, a manufacturing company installing itself into the beautiful grounds of a former TB, then a mental hospital near Wells in Somerset.

    • Replies: @dearieme
  29. dearieme says:
    @Philip Owen

    Thanks, Philip. My nursery school was in a former TB sanatorium so it must have been repurposed a million years before Maggie or Toni.

    Nice little spot, mind, up a pleasant slope with a view of the sea. Plenty of reflected sunlight, I’d think, and exposed to the breeze. Given that I can remember almost nothing from that age it’s odd that its location should have stuck. I don’t even remember its name, if ever I knew it.

    It was the only school that I was driven to, rather than walking or cycling. I imagine that’s because no one would have been so foolish as to build an infectious diseases hospital within a town.

    • Replies: @Cortes
  30. Anonymous[278] • Disclaimer says:

    In Italy, they speculate that as many as 80% of the population already have been infected.

    That makes no sense. Are they suggesting that the country has already achieved considerable herd immunity? Are they pretending that lockdowns only have a minor effect?

    If that were the case the northern regions would have been fairly safe long ago and most deaths would be coming from densely populated clusters in the south. As a matter of fact, the national chart showing the spread of the virus would show a markedly different activity and distribution. The same can be said for the 66% UK theory.

    If the pond is full on the 60th day, on what day will it be one-quarter covered?

    58th

    • Replies: @James Thompson
  31. Cortes says:
    @dearieme

    “I imagine that’s because no one would have been so foolish as to build an infectious diseases hospital within a town.”

    https://en.m.wikipedia.org/wiki/Ruchill_Hospital

    There were others – Belvedere, mentioned in the linked article was, like Ruchill, located adjacent to areas of overcrowded labourers’ housing.

    • Replies: @dearieme
  32. @Kratoklastes

    Documentation? What’s that?

  33. @LondonBob

    In case you haven’t seen it, here is what I presume to be the study in question:

    https://www.medrxiv.org/content/10.1101/2020.03.10.20033795v1.full.pdf

    A key result:

    Our data also show that MTB infection is associated with more rapid development of symptoms (Figure 1C-D); MTB coinfected COVID-19 cases developed symptoms on average 3.3 days earlier than their non-MTB-infected counterparts. Development of critical symptoms is reported to occur on average 9 days after initial symptom onset4. The 7 MTB-infected severe/critical COVID-19 cases here, however, were categorized as severe/critical 3.4 days after initial symptom development. While the number of cases here is not sufficient to draw a solid conclusion, it would appear that COVID-19 disease progresses more rapidly in the presence of MTB coinfection.

    • Replies: @Philip Owen
  34. botazefa says:

    Being in the US, I’m finding this Covid dashboard really useful:

    http://ncov.bii.virginia.edu/dashboard/

    It allows access to the underlying data. It breaks-out US data summaries in a nice banner, regularly updated.

    To Dr. Thompson’s point, covid19-attributed deaths in the US are just under 1500. Doubling time is a bit more than 2 days over the last week.

  35. dearieme says:
    @Cortes

    Fair point, but note the detail (N.B. I don’t know Glasgow so correct me if I’m wrong).

    53 acres (21 ha) of land there for a public park, golf course and 36 acres (15 ha) for the city’s second fever hospital Do I guess correctly that the hospital is separated from residential areas by the park and golf course?

    initial capacity of 440 beds, spread across sixteen isolated Nightingale ward pavilions, twelve of which were large, each containing beds for 30 patients, and four smaller ones accommodating 20 patients each That’s the sort of intelligent architecture I was advocating.

    After the opening of the Brownlee Centre for Infectious and Communicable Diseases at Gartnavel General Hospital, Ruchill Hospital closed in 1998. And that’s what I was a arguing against. Bloody silly (unless surrounded by green acres and in a separate set of pavilions).

    The site was sold to Scottish Enterprise in July 1999. So Toni not Maggie.

    • Replies: @Cortes
  36. Cortes says:
    @dearieme

    It wasn’t part of the “low hanging fruit” since it was retained as a working hospital. Moreover, the transfer date is not the same as the zoning or change of use date for large public sector sites. My original response refers to hospitals in dormitory villages, not places like Ruchill or Belvedere within the city boundaries.

  37. LondonBob says:
    @James Thompson

    Their model allowed to a top range of infected in Italy to be 80%. I wonder if Northern Italy is close to herd immunity, presumably a large number have been infected, and a fair number of the most vulnerable have been died already. I suspect that the virus is close to the upper limit there.

    https://www.spectator.co.uk/article/how-to-understand-and-report-figures-for-covid-19-deaths-

    A good article on the data problems at this stage as well as how deaths are recorded here in Britain.

  38. dearieme says:

    I saw an interesting point this morning. In some countries the estimated flu deaths for the last two winters were rather lower than usual. Therefore, said the writer, there was a backlog of frail oldsters waiting for a respiratory virus to come along and kill them.

    Could be. Anyway, a reminder that much cannot be clear for some time, and some things will not be clear even then.

    • Replies: @Sean
  39. LondonBob says:

    I wonder if there is something more to the healthy, no TB, upbringing of most people in Northern Europe as against the rest of the world. As mentioned I have seen it suggested a quarter of British deaths are Muslims?

    • Replies: @dearieme
  40. @YetAnotherAnon

    “is there anywhere in the world free of Covid-19, where soccer and/or rugby is still played? They could make a fortune selling TV coverage”

    Belarus has CV19, but are taking the President’s advice to ward it off with vodka.

    https://www.theguardian.com/football/2020/mar/29/belarus-football-continues-coronavirus-premier-league

    “With professional football at a virtual standstill around the globe, fans in need of their weekly fix are turning to the Belarusian Premier League to fill the void as it carries on with matches despite the coronavirus outbreak.

    The league, one of Europe’s least glamorous competitions whose teams rarely reach the Champions League group stage, is drawing foreign fans’ attention and a string of new broadcast deals.

    It has said it has no intention of postponing matches or cancelling the season it began earlier this month. While most of its teams, perhaps with the exception of Bate Borisov and Dinamo Minsk, are unknown to the majority of soccer fans, the league is making the most of stoppages to the world’s top competitions.

    The decision to carry on and allow fans into stadiums has helped the Belarus Football Federation get broadcasting deals with sports networks in 10 countries, including Russia, Israel and India, where fans have been left with nothing to watch. “

  41. dearieme says:
    @LondonBob

    I’ve seen some suggestion that the death rate among Orthodox Jews might be atypically high.

    I wonder how many such stories flourish because everyone knows that our governments will censor and lie about any racial aspect to any social phenomenon?

    The moslem one is interesting. Presumably if it were real then you might expect different responses among moslems from different parts of the world. Unless it’s just lack of bacon and beer in the diet, which doesn’t seem very likely.

    Is dressing your women so that they get very little exposure to the sun going to leave them with low levels of vitamin D and therefore weakened immune systems? In other words, is there any sign that among moslems women might be relatively more vulnerable than female followers of other religions?

    • Replies: @LondonBob
  42. Sean says:
    @dearieme

    The lockdown is not just stopping deaths from COVID-19, but also preventing those that would have otherwise occurred from endemic influenza. People have been warning about a flu epidemic for decades because they seem to come very roughly about every 25 years and one is long overdue. The exit from the lockdown will be an extremely difficult political problem because there are going to be a vast number of deaths, and not necessarily from COVID-19.

    Are more people dying than would have died without COVID-19 existing? I do not think that is at all obvious. The lockdown and distancing is certainly going to preserve the lives of many people who would otherwise have died from endemic influenza, which is very often what finishes the elderly off. This means a lot of dry tinder on the forest floor which will increasingly accumulate the longer the lockdown goes on.

    Even if COVID-19 is completely eradicated, those who would have died of endemic influenza, but didn’t because of the COVID-19 lockdown, will constitute a vulnerable substrate for an influenza epidemic whenever the lockdown is ended.

  43. LondonBob says:
    @dearieme

    Of course there is the Italian angle.

    A 1921 investigation into Spanish Flu, in The American Journal of Hygiene, reported ethnic differences in mortality from the virus, commenting that, in comparison to other immigrants, the death rate was “enormously high among Italians” but “lower than would be expected among persons of Irish, English and German stock,” presumably based on the mortality rate that poverty would predict [Influenza: An Epidemiologic Study, by Warren Taylor Vaughan, American Journal of Hygiene, 1921].

    The pandemic scythed through urban America’s Little Italies, and Italian-Americans had one of the very highest mortality rates in the entire country [America’s Forgotten Pandemic: The Influenza of 1918, by Alfred Crosby, 2003, pp.227-228].

    • Replies: @dearieme
    , @res
  44. dearieme says:
    @LondonBob

    Ashkenazi Jews are, by descent, about 50% Italian, 50% “middle eastern” apparently. So if either Italians or middle easterners are particularly vulnerable …

    Though maybe a further 1000 years of evolution in northern and eastern Europe might change things for them. Anyway, it’s conceivable that atypical rates are something to do with culture rather than genetics. Though it’s my guess that very few things are entirely free of genetic influence. Who knows?

    At least on this topic there’s one thing we can be confident of: strenuous efforts to hush the facts up. The Grauniad headlines write themselves.

  45. res says:
    @LondonBob

    It would be very interesting to see an analysis of how much of that was genetic (e.g. mortality rates for different HLA variants compared to distributions for different populations) vs. environmental.

    Of course we are unlikely to ever see such an analysis. Because, racist!

  46. I make the following observation. The major centres are almost all steel making industrial cities.

    Wuhan – originally a major steel town.
    Lombardy – major steel producing region
    Madrid/Toledo – steel producing region
    Lorraine (Frances biggest centre of infection) – major steel producing region
    Gwent, Wales – (UK’s highest rate per 100,000) – until recently a major steel producing region

    On this basis, I predict Pittsburgh and the Donbass will have problems. It might be poverty induced TB from 80 years ago? All these places had an exceptionally hard time.

    The Ruhr becomes an exception to be explained. The Nazis were exceptionally keen on public health and physical fitness.

    • LOL: utu
    • Replies: @dearieme
  47. dearieme says:
    @Philip Owen

    Why no exceptional problems around Redcar, then, or Ravenscraig, or Sheffield?

    • Replies: @Philip Owen
  48. @dearieme

    I have moved on from this after many comparisons and tests.

    Qom in Iran can be added to the list. It is a steel town where a Chinese built rod mill is nearing completion. There is a Chinese owned steel mill in Newport, Gwent.

    TB and pollution can be removed. I now think the common trigger is a visit by a person or persons from the Wuhan steel industry complex at sometime up to Mid February.

    Wuhan is not the only steel making region is China. Manchuria makes a lot. However, Wuhan operates at a somewhat higher technical level.

    • Replies: @dearieme
  49. dearieme says:
    @Philip Owen

    On your first hand, Philip, this morning’s Tel declared that Sheffield has become another hot-spot. Maybe they too had a Chinese visitor.

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