UK fact of the day

#COVID19 mortality in UK hospital patients has been falling steadily from >6% in March to ~1% now, with similar trends elsewhere. The reasons behind this pattern remain unclear, but #COVID19 Infection Fatality Rates will likely have to be revised downward. tinyurl.com/ybnlmkdz

That is from Francis Balloux.  And again here is the source link.  And please do not conclude the virus is becoming less dangerous, that is not a necessary implication of the above!  Alternative explanations are given at the latter link.  Most broadly, I will say it again: if your model does not have long-run elasticities as much greater than short-run elasticities, it is likely to be off in some significant ways.

Comments

Certainly within our network we have gotten better at treating Covid. We started using steroids fairly early as well as proning. We also got aggressive about using Hi flo O2 and BiPAP. We saw our mortality rate drop by about 30% from when we first started treating pts. There is also data suggesting that if you operate on Covid positive pts they have worse outcomes so we test surgical pts and delay their surgery if positive. Suspect the UK does the same. I also wouldn't be surprised if their idea about pts already in hospital getting infected has some merit. Would be interesting to see their fatality rate for hospitalized pts and how that has varied.

Steve

+3

And your network geared up, achieved the proper economy of scale.

The added bonus is that fewer deaths means fewer cases get to the extreme stress level that causes long term damage.

All of this supports the decision to lock down, at least temporarily.

Whether in Leicester or Gutersloh or Beijing.

Why?

It gave us time to figure out the procedures to get the death rate way down. Of course, the logical corollary is that there is much less need for lock downs at this point.

1.) treatment has rapidly improved.
2.) people are wearing masks, distancing profits otherwise getting smaller initial doses of the virus.
3.) the warmer dry weather stunts the virus somehow.
4.) the virus is mutating in favorable, less fatal direction.
5.) what else? Some combination of all the above?

My guy says treatments are already improving (thank you medical scientists, doctors, nurses and whoever) but that’s just gut. At this point, we just have a stylized fact to work with.

"My guy says"

Thank you for your deeply moving scientific anecdote.

Oops... gut haha. Which is even worse, but we haven’t much to go on anyways.

Vitamin D vitamin D vitamin D

I don't know why I believe this is the primary factor, but I really do.

Please Tyler, titling a post "UK fact of the day" when it's about England helps perpetuate this fallacy many well meaning but ignorant people have that UK=England.

For the record, England posted something like 150 deaths yesterday while Scotland had its fifth consecutive day without a death. There's been talk from the First Minister of closing the border.

-1, if he had posted a US fact of the day and it was about Texas, nobody would have gotten confused. You are being too sensitive about the subject.

Informed people know that England is just a region of the UK, and the un-informed don't care.

Isn't summer air typically more moist than winter in much of the US? Am I just mixing up absolute versus relative humidity?

The Most logical alternate explanation? It was never very dangerous to begin with. It's basically only "dangerous" if you spit on people in a nursing home.

Well, nursing homes pay low wages and provide no health care benefits to workers to get the best and healthiest workers.

Clearly the way to save residents in nursing homes is to dump in the street any residents who get infected and cut costs by getting rid of all workers.

I still dont understand why only dying is considered a bad outcome or dangerous. If you end up in the hospital and on a vent for 10 days but live that is still a pretty bad result from contracting Covid. Even if you have just 4 or 5 days in hospital on lots of O2 and having trouble breathing that isn't anything one would want to experience. Also, we still dont have a handle on long term outcomes. We know that a number of pulmonary issues result in major long term morbidity.

Steve

You know what's a bad outcome? When 10% of the work force is unemployed because we're "locking down" to "flatten the curve" when it's already flat enough for the hospitals to deal with it.

Not having 3-5% of your population permanently disabled is more important than even a 30% spike in unemployment.

I love how the goalposts changed from flattening the curve to preventing a complete and utter unknown, that being the slim possibility of long term effects of the virus.

When that turns out to be a null argument, what will the next boogeyman be?

It's not a "slim possibility".
At this point >1% of those infected being so disabled that they will never be able to work again is an absolute certainty.
And there will be several % on top of that of people able to work but still disabled.

Care to share the source of your delusions?

You can easily extrapolate from tim spector's app data and the rate of recovery seen in SARS-1 patients.
Don't worry, you will get the first peer-reviewed publications in the autumn and then even morons like you will be in pain to deny it - though I'm sure you will find a way.

Can you link to this data? I can’t find it with a quick google search

Covid symptom study:
https://covid.joinzoe.com/post/covid-long-term

SARS-1 sequlae:
Lung:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758905/
Chronic fatigue:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071317/

Who is actually Slavic (but not Russian, no way, no how), and whose job includes visiting here, apparently on a tighter schedule.

He is hilarious, and clearly a sign of civilizational collapse. Run for the hills!

"At this point >1% of those infected being so disabled that they will never be able to work again is an absolute certainty."

Frankly, there's no way of knowing it because the disease has only been around 6 months. Your comments are speculative.

It's not speculative. When the most closely related virus that has infected humans before did this to a third of survivors while having ~10 times the death rate, 1% severe disability is a certainty. Especially since the reports 3 months in so far point to a far larger % of those infected unable to return to baseline.

" 1% severe disability is a certainty."

Well if God told you so, then it must be true. But I'll wait at least a couple of years and see what the data actually says.

By this logic I can remove the chair upon which I sit, because the chair I have is presently sufficient to reduce my downward acceleration to zero.

That's a bad analogy, the chair isn't harming you.

A better analogy: "We can stop the chemotherapy now, because the Cancer is in remission".

And if most of the unemployment is from people delaying/foregoing consumption and investment, (there were firms open for business that would have transacted with them if the consumer or investor had chosen to engage in the transaction) how it that the result of"lockdown?" This is a massive fail of the Fed, again, just like 2008-09.

"was never very dangerous to begin with." If your explanation is correct then why was the rate higher at the beginning?

Because no one realized how many asymptomatic cases there were

https://news.psu.edu/story/623797/2020/06/22/research/initial-covid-19-infection-rate-may-be-80-times-greater-originally

Yes, and while being not dangerous, it managed to kill 0.25% of the entire population of NYC.
We are reaching unbelievable levels of stupidity here.

Andrew Cuomo, the Angel of Death.

I love how in the same thread we have two wingnuts arguing opposite directions: one is arguing the disease was harmless, the other that it was deadly.

Completely without self-awareness.

If you die at home,
or in the Nursing Home,
That does not count.

Hospital facility rate
Is not the same as
Case fatality rate.

It's not hospital mortality, it's identified deaths with infections, which got pretty close in the UK to excess mortality at least as far as I can see up to the point where there stopped being any excess mortality (after initially not being so). Balloux says this in the Twitter. Thus, your haiku is invalid...

The UK government publishes the following data:

The daily number of people who have died in hospital in England with a diagnosis of COVID-19;
The daily number of people admitted to hospital in England who are diagnosed with COVID-19.

The number of people dying with COVID-19 in hospitals in England each day has fallen from a peak of 899 on the 8th April to 50 on the 15 June.

The number of people In hospital with COVID has fallen from a peak of 15,702 on the 10th of April to 2,891 on the 19th of June.

The link...,

Well said.

Cuomo should have sent all the covid patients to nursing homes to reduce the number of covid patients dying in hospitals.

M cannot dispute the table and the specific titles in the link.

Thank you Link for
Confirming that
Haiku valid.

It's clear that it's hospital deaths.

But if the hospitalization rate is not decreasing pain and suffering per positive case are not really decreasing? In this country very high medical bills would also not be decreasing.

In related news, Arizona is forced to deny treatment to some, to save others:

https://twitter.com/NicoleSGrigg/status/1277772261265530880?s=19

As Fauchi talks about 100k new cases per day:

https://twitter.com/tackettdc/status/1277996974650908672?s=19

That's gotta impact the system, and that death/hospitalization ratio.

-10, Reading comprehension fail

In related news, Arizona is forced to deny treatment to some, to save others

This is absolutely not true. Re-read your own link.

Next, that NPR story. She was charged for going to the Emergency Room. She was not charged for any Covid test, those are free. She decided not to get a test since she “felt fine 7 days later and returned to work”

If you’re not in an emergency in any way, walking into a non network hospital ER is going to be very expensive

Stupid pedantry, and in no way contributing to a higher trust society.

Dude is more concerned with my word choice than the hash reality.

Going to the emergency room for a non-emergency is a waste of resources and should be penalized. She should absolutely cover her own cost for that. Choosing not to even get a test in the end? Come on.

I think you have to be pretty far into the idiocy of our system in order to think that is the correct response.

Once I was driving the Alcan, and I got a tummy ache. I stopped at a Canadian health center and had them check me out. They apologized because it would be free for a Canadian, but they had to charge me.

I was like "no no, that's okay just let me know what it is .."

(Gets out credit card)

And they said "we are very sorry .. it is $10."

(Puts back credit card, pays $10)

Well, that's no good at all. Why should Canadians have to pay for your dumb ass to use their healthcare facilities?

Right, it's more important that doctors make $500k, and half the town residents are afraid to go.

Not to mention that in a pandemic, you are trying to "teach" people not to get tests.

Can I get a WTF?

My understanding is that at some point, emergency room was the only way in

It's utterly fraudulent to say that "Arizona is forced to deny treatment to some." Your own links show that that's false. No one has been denied treatment.

You can't take fraud away from Dem voters. It's all they have.

What is even wrong with you people?

"Arizona hospitals want more power to decide who gets care as COVID-19 overwhelms facilities, staff"

You are mad at me because I say now, rather than in a couple days?

BFD

And you believe some headline in some media?

Stupidity as ideology.

"It's utterly fraudulent to say that"

Making shit up isn't unique to anonymous, but he's one of a kind at posting Links that contradict his own point.

One thing I am confident of is that a graph which shows a data set where both ends on on one side of the trend line, and the middle in on the other is not well-represented by that line. The fact that TC claims the rate is "falling steadily" is clear indication of a failure to understand this. Of course, perhaps the graph is not of (all of) the relevant data. I'd flunk a sophomore undergrad who reported that data and claimed a linear relationship without noting the obvious fact that either it is higher order or is actually two (or more) different (straight) lines.

We see hospitalizations now at 20.8% of their peak value in April but deaths at 6.45% of their peak, so the death rate has been improved by 2/3 vs the hospitalization rate.
Close to 90% of the deaths are in the over 65 range and this has been fairly stable since the beginning of the epidemic.
So the reduction in deaths by this much must probably come from the reduction over time of the infected in this age group due to the increased protection of the vulnerable.
It’s hard to find this age demographics of cases over time for the UK online, but this lowering of infection age over time seems to be true in US states.
Better treatment protocols with respect to oxygenation no doubt play a part also. The use of Dexamathasone on severely ill patients ( 33% death decrease claim with patients on ventilators) is helpful but I am not clear how much it contributed as its use hasn't been widespread yet.

How does it possibly make sense to quote national numbers for hospital utilization?

This is a disease spreading on a heterogeneous 2d map, with crises experienced locally and in waves.

Arizona has the experience it does today because Arizona specifically could not control spread, and Arizona specifically did not have resources for uncontrolled spread.

i don't get your concern. These are graphs about national statistics ( England). We can't talk about aggregate data ? what is Worldometer publishing every day ?
Not clear why you're bringing AZ into this

Think a bit more about maps and waves.

What's happening in AZ is not germane to this discussion. We're talking about national statistics and falling hospitalizations and falling death rates in the aggregate in England. Surely it means something and is worth trying to explain.
Somehow you want to reframe this to make it about some crisis in Maricopa County/AZ ?

Okay, try it like this:

Completely disregard map lines, state and national boundaries.

As a potential pandemic strikes somewhere in the world, it ignites in sparks, and usually dies out. Those that we notice, like SARS or Ebola, burn brighter and bigger. We try to combat them through containment. That usually works.

For the first time in a hundred years though, we have a breakout pandemic. It spreads across the globe in wavefronts, aided by big jumps in air travel.

At any point of that progression, the top line numbers (using world or national boundaries) are driven by conditions *within* the wavefront.

But those all change as the wavefront moves, and new places (like Arizona) are more fully exposed.

And so national (and world) numbers on hospital utilization have no meaning, at least until a nation (or world) is fully and equally exposed.

*that is something we don't want to happen anyway*

Until the disease is wrestled into submission, or until it defeats us, everything is local.

Arizona is the kind of battle ground that defines the war.

What a drama queen. And idiot.

Fauci: 100k new cases per day

https://www.cnbc.com/2020/06/30/fauci-says-us-coronavirus-outbreak-is-going-to-be-very-disturbing-could-top-100000-cases-a-day.html

-1, you are just throwing tangential crap at the post instead of attempting to make a point.

This may provide some background about the role it played in the UK, which involved saving somewhere around 600 lives before June 8 - In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.

On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit.

A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

Was dexamethasone only given to the 2104 patients ( as part of the trial) or more widely ?

The number was 2104 until June 8th - after that, the trial was over, and the therapy was used in all applicable cases.

A slight dose of the elixir in an inhaler, maybe. Inhale once a week during covid season.

Thank you for omitting the racial stereotyping from your argument this time. Your racial caricatures were tasteless when you posted this same idea in the "World Gone Mad" thread today.

If it was not you who posted the same idea in the other thread, my apologies. You can't identify posters here because of the pseudonymous author names.

I do not use pseudonymous author names.

Such as the current pharma patent regime. "The drug has been watched eagerly for the last five months, said Hill, yet there was no mechanism to ensure a supply outside the US. “Imagine this was a vaccine,” he said. “That would be a firestorm. But perhaps this is a taste of things to come.”

Remdesivir would get people out of hospital more quickly, reducing the burden on the NHS, and might improve survival, said Hill, although that has not yet been shown in trials, as it has with the other successful treatment, the steroid dexamethasone. There has been no attempt to buy up the world’s stocks of dexamethasone because there is no need – the drug is 60 years old, cheap and easily available everywhere.

Hill said there was a way for the UK to secure supplies of this and other drugs during the pandemic, through what is known as a compulsory licence, which overrides the intellectual property rights of the company. That would allow the UK government to buy from generic companies in Bangladesh or India, where Gilead’s patent is not recognised.

The UK has always upheld patents, backing the argument of pharma companies that they need their 20-year monopoly to recoup the money they put into research and development. But other countries have shown an interest in compulsory licensing. “It is a question of what countries are prepared to do if this becomes a problem,” said Hill."

New cases are way down. Therefore, hospitalized cases are on average older. Longer periods of survival so far in a hospital (which are higher on average)l favor lower rates of eventual death. Also, less taxed hospitals can care better for those in the hospital with less cross-infection risk and more treatment expertise. And less crowded hospitals triage in less acute cases than taxed ones do.

Pardon my ignorance, but what does "..if your model does not have long-run elasticities as much greater than short-run elasticities" mean?

(happy to take pointer if explanation lengthy)

He's basically saying that predicting tomorrow is easier than predicting next week, and if you're trying to predict next week, your model better have big error bars.

Thank you Tom, I now get the gist. Be well.

That over a longer period more things can change, so that assumptions about what can or will change in the short term differ from those about the long term. Example: Short term almost no one got a test, long term everyone gets a test.

Thank you Ken, this additional color is helpful. Much appreciated.

Tyler, have a look at this paper. It estimates the daily hazard rates. You can then understand the dynamics. https://www.medrxiv.org/content/10.1101/2020.05.14.20101378v1

One explanation for decreasing fatality rate is initially the virus kills a lot of vulnerable people and then because there are less vulnerable people the fatality rate decreases. Virus can’t kill you twice.

They called it American bacteria then courtesy Sartre et al.
https://books.openedition.org/iheid/6657

Shh! My wife's brother-in-law is in the French police.

Haha, responding to Joel of the West coast spitting US dollars!

François not Francis - Neither donkey nor horse !

Celebrating more than a decade & few years of friendship with Alex & Tyler !

We can call it two decades.

After all these nationalities don't count. With one, one can be the other. So much for the 'older' nation states !

Poorness lab - turned American, second marriage French. Who cares about the other passport - always ready to help though - mercenaries have a long history - Claude Martin.

Of course, passports only came later. Otherwise we were all swimming in the Bay of Bengal. But I was anointed by AK Sen much before my work.

Long live Idi Amine.

> Most broadly, I will say it again: if your model does not have long-run elasticities as much greater than short-run elasticities, it is likely to be off in some significant ways.

Anyone modeling that level of complexity on something so novel way overestimates their modeling ability. For all intents and purposes, until you understand a system, it is indistinguishable from a purely random event. More knobs doesn't make up for poorly understood models.

Additionally, once you realize your system depends on human behavior, then all bets are off. Humans will change behavior in ways a modeler could never anticipate: News stories, market changes, pressure from family/friends, etc.

And if you believe you could model anything that depends on human behavior, then you are wasting your time on epidemics. If you are good, you'll make a lot more money in the market.

So, if someone cannot make boatloads of money predicting a system such as the stock market, which is highly dependent on human behavior (just as the Ro of a virus is) why on earth should we trust them to model spread of a virus?

I think Deputy Prime Minister is doing a great job. His correct leadership is helping Vietnam to forge ahead on the road for greater development and freedom.

Yes, Murthy's son-in-law is doing a job (good?) but temples in Champa are certainly languishing.

But who's the deputy here ?

One thing is for sure, when the next novel pandemic comes around, and the media asks professional epidemiologists for some early forecasts, what you'll hear is crickets.

Fortunately, there's plenty of experts on Twitter and MR.

Why would pros dare forecast? They just end up in jail when they are wrong:
https://www.sciencemag.org/news/2016/10/seven-year-legal-saga-ends-italian-official-cleared-manslaughter-earthquake-trial

The sound of the crickets.

The primary (not sole) reason has to be increased testing, right? Early on, mostly only the people who were sick enough to be hospitalized were eligible to be tested.

Tyler could easily have found a similar graph about declining US deaths, but hey, we'll be grateful that he's willing to admit that things are getting better..... at all.

If the ratio of Covid deaths/all hospitalised is falling, isn't that consistent with fewer active covid cases across the population? Ie; this isn't a measure of how fatal the disease is, it's just a measure of how serious the outbreak is at any point in time.

And I thought that there were fewer cases across the population due to the implementation of social distancing measures (though this might change in the coming months).

So as far as I'm concerned, no change to the working theory.

"If the ratio of Covid deaths/all hospitalised... "

I don't think this is what's being shown. It wasn't clear, and the heading of the graph certainly reads that way, but when you look at the source link for the data you see that the two data sets being compared are:

1: "The daily number of people who have died in hospital in England with a diagnosis of COVID-19;"
And 2: "The daily number of people admitted to hospital in England who are diagnosed with COVID-19."

Maybe it's already been mentioned, but one thing that came to mind was from MR's Monday's assorted links:

"4. Miami fact of the day (NYT): “One-third of all patients admitted to the city’s main public hospital over the past two weeks after going to the emergency room for car-crash injuries and other urgent problems have tested positive for the coronavirus.”"

If something similar is happening in the UK then that would account for a drop in the ratio of Covid-19 deaths to people in the hospital who test positive for SARS-CoV2.

In other words, if originally only severely ill people going to the hospital were getting tested, but now people going to the hospital with a broken leg, or some other unrelated illness/injury are also getting tested, then you would expect to see an increasing proportion of non-severe cases in the hospital (assuming the background spread of low-level minor or asymptomatic cases is high enough which looks likely in Florida, but not so clear in the UK).

Well, that solves that.

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