Doctoroncall

If anyone is interested in a bit of antibody news... https://www.fiercebiotech.com/biotech/astrazeneca-targets-summer-start-for-covid-19-antibody-trial

i hope they don’t find out Huawei are already part of the 4G network. Absolute cretins.

My weekend rides I’ve reduced down to a couple of hours although fitness level may drop, trying to spread exercise throughout the week - little and often between work. Besides it’s not the same when in a group. As I live in the countryside I don’t get to see many folks anyway.

The Belarus season has kicked off for anyone wanting their football fix!

Philip Green.

It will probably even out by the end of the pandemic. Unless Germans are good at following orders! But it’s not a simple explanation but a list of factors. Germany has done four times the testing we have in the UK. Have been able to clear the hospitals in preparation. Had a younger demographic that caught the virus first. Unlike in Italy, there is currently no widespread postmortem testing for the novel coronavirus in Germany. The RKI (German HA) says those who were not tested for Covid-19 in their lifetime but are suspected to have been infected with the virus “can” be tested after death, but in Germany’s decentralised health system this is not yet a routine practice. This will not amount to that many as the testing and hospitalisation is in place. The RKI’s official mortality figures include both people who have died of the virus as well as those infected and with underlying health problems, where the precise cause of death could not be determined.

Mortality rates for those in ICU: https://www.icnarc.org/DataServices/Attachments/Download/b5f59585-5870-ea11-9124-00505601089b

Basically the US screwed us over the money, atomic bomb and the aviation advantage we had. They played it well.

Combination of things, primarily the demand outstripping supply from older population and increase in population. Also where there were life threatening diseases, medicines have prolonged life. Cost of specialist equipment, increase in types of treatments available, cost of medicines, obesity, diabetes, lawsuits, not regularly modernising, etc etc However, the NHS, is still high up in the efficiency score compared to other nations as far as I know. It comes down to what worth is the NHS to the nation.

As soon as the stadium is separated from the club, it’s another hurdle to overcome. There are a number of EFL clubs that have had this done by the owners, initially to help (ummh) but then turns bad. See Walsall as an example.

Dan Patrick has a different point of view in the US to keep things going (not specifically the Olympics). Really feel for the health workers around the world.

https://www.lbc.co.uk/radio/presenters/tom-swarbrick/doctor-nhs-cant-cope-with-coronavirus-stay-home/

Some reporter from PBS asked a number of days ago. He said that was a nasty question and turned on her. Saying it wasn’t him. Surprised you missed it.

It’s been stated by Sir Patrick Vallance that worse case scenario of 80% infected has been used in modelling. Germans have used 70%. Generally, herd immunity is achieved at 60%.

Hoodoo / voodoo medicine man - Aerosmith Die for you - Alice Cooper Saint Etienne - You're in a bad way Haim - all right now. The Who - Boris (the spider)

http://Www.gov.uk/government/statistics/annual-flu-reports

The problem/issue isn’t the following of scientific advice but the execution of the plan. Why was Hunt questioning the current policy? He is closer than most to the source of information. It creates confusion. Why is Matt Hancock saying different things (not following herd immunity) in his latest media communications than the PM and advisors? It creates confusion. Why is the head of the BMA stating we don’t have enough medical equipment and not prepared now? We had a lead time of two months. Why are head teachers questioning what is happening as teachers will be on the front line? What safeguards will be place for them. Important stakeholders who are needed to help execute the plan if it is to succeed surely. Better to have them onside/ clear on the plan than causing confusion.

It’s a shame the thread has been reduced to point scoring. It hasn’t been confirmed. It can take 1-3 weeks to form antibodies. No one knows if immunity is short term only. More studies are needed. It’s must likely those infected can have a relapse. The virus has been found in swabs from throats four weeks later.

I wouldn’t say that. It’s the not knowing which causes most concern. We are at war, people need to be mobilised to do the right thing and there is always going to be risks in any strategy/policy. This from a Aussie critical care director which puts it in perspective of the knock on effect this virus will have: In Australia, Dr Adam Visser, the director of critical care at Toowoomba hospital in regional Queensland, has posted an impassioned plea for the Australian community to take individual action to help “flatten the curve” and keep intensive care units from being overwhelmed by Covid-19 cases. I’m an intensive care specialist in a small city. Coronavirus isn’t just like the flu, but it’s only really very dangerous to the elderly or the already unwell. Quite a lot of people in their 80s will die, but most of the rest of us will probably be OK. If you’re in your 70s and you get Coronavirus, you’ve got a really good chance of survival. If I’ve got a bed for you. If you’re in your 60s and you have a heart attack, you’ve got a really good chance of survival. If I’ve got a bed for you. If you’re in your 50s and need bowel cancer surgery, you’ve got a really good chance of survival. If I’ve got a bed for you. If you’re in your 40s and have a bad car accident, you’ve got a really good chance of survival. If I’ve got a bed for you. If you’re in your 30s and have terrible pre-eclampsia as a complication of pregnancy, you’ve got a really good chance of survival. If I’ve got a bed for you. If you’re in your 20s and have a bad reaction to a party drug, you’ve got a really good chance of survival. If I’ve got a bed for you. I have 7 beds equipped with life support machines. We have a plan to increase to about 25. Getting more isn’t a matter or more equipment or more money, that bit is easy. There are not enough skilled staff, even if we all work double shifts every day for six months (and we probably will). If 50% of my city gets infected, that’s 75,000 people. If 5% of them need life support (which is the estimate), that’s 3750 people. For 25 beds. And then I might not have a bed for you. So it’s up to you to flatten the curve. Wash your hands. Stay home. It’s important to remember that the 3750 projected cases will not happen at the same time but it illustrates the risks to people with other medical conditions and the importance to flatten the curve considering the resources available.

It’s not all about science but executing a plan of action with many stakeholders. The biggest of which are the people. There are many others from supermarkets, schools, HCPs, local authorities, labs, medical kit manufacturers, etc etc. It seems not many know what to do hence you are seeing businesses and organisations dictating policy to protect their workers (and hence their business).

Hundreds of members of the scientific community have sent two open letters to the British government, voicing their concerns about the government’s response to the coronavirus outbreak. One comes from 198 academics in the field of maths and science , calling for urgent measures of social distancing across the UK. It says: “Going for “herd immunity” at this point does not seem a viable option, as this will put NHS at an even stronger level of stress, risking many more lives than necessary.” Another letter has been signed by 164 behavioural scientists. It raises concerns about the idea of ‘behavioural fatigue’ - the idea that if the public are instructed to take preventative measures too early, they’ll eventually revert back to prior behaviour. The letter suggests that this has been a cornerstone of British government policy on coronavirus and sheds doubt on the evidence behind this. “While we fully support an evidence-based approach to policy that draws on behavioural science, we are not convinced that enough is known about “behavioural fatigue” or to what extent these insights apply to the current exceptional circumstances,” it says. “If “behavioural fatigue” truly represents a key factor in the government’s decision to delay high-visibility interventions, we urge the government to share an adequate evidence base in support of that decision. If one is lacking, we urge the government to reconsider these decisions,” it ends.

Ideally, yes it would be great to be able to monitor the infections however practically this is very difficult to do on a continuous basis in this phase (test kits availability and resource to obtain results) so the priority are for hospitals, vulnerable and HCPs so immediate response can be initiated. It is a risk and they are probably relying on the modelling and forecasts to help predict if other measures need to be introduced. Hopefully there will soon be kits available to test for antibodies. The antibodies typically appear in the blood one to three weeks after infection. China may already have them and they will be a big help.

If only they showed another graph to indicate what they are trying to do, it would be easier to understand although a bit macabre in pursuing a solution to creating infections (but also immunity) in the community. As currently there is very little immunity in the community and a vaccine is at least a year away the best practice is to lessen the gradient of the curve so NHS can cope better and society can still function as best it can. Where it has gone out of control like northern Italy where infections have ran out of control there is too much strain on HCPs and services. The other aspect to avoid is a second wave. It’s all very well for a country to have a lockdown as an immediate reaction but if it gets to the stage where there is little immunity in the community - how do you return to normal activities, trade, tourism etc? The lock down will have to last until there is a vaccine or the infection could be back so it is better to manage the rate of infections from the beginning until there is the natural immunity in the community and the focus can be on the care of the vulnerable and HCPs.

Median incubation period is five days. The time from exposure to onset of infectiousness may be shorter than the incubation period. An analysis of infections in Singapore and Tianjin in China revealed that two-thirds and three-quarters of people respectively appear to have caught it from others who were incubating the virus but still symptom-free.

Taiwan suffered badly with SARS and learnt from it. Have implemented an aggressive lock down plan at the start of latest Coronavirus outbreak, and have been successful in combating the spread and containing the virus. Could the UK succeed with the same plan? - it needs 100% cooperation and compliance to work.