Month: October 2020

A review of where we are with UK Covid restrictions. With apologies to Nandos.

It wasn’t meant to be like this. Remember the Alert Levels (the ‘Nandos chart’)? The whole idea of that was to set some sort of policy – a roadmap if you will – of how we get out of a national lockdown. Introducing… Covid Alert Levels. 12 May 2020.

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And remember this? The gentle ski slope of calm. ‘R less than 1 caseload decreasing’ Ah, simpler times.

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This was about the same time as the ‘science bit’.

We’ve also had the shiny new:
– Joint Biosecurity Centre
– National Institute for Health Protection
– The Contain framework
and lots of other things that seem to have been good ideas at the time.

That Contain framework was a good one. Basically if you get to 50 cases per 100,000 your local authority gets on to a watchlist and restrictions come in. Leicester took the brunt of this one.

Each week, a watchlist was created of the local authorities that were nearing the 50-or-so cases per 100,000 threshold, and they were placed on a list. New restrictions came into force. Trafford was Mentioned in Dispatches with only 32 cases per 100,000

Of course, experts have been banging on about the reckless way that restrictions were lifted – with no basis in science. 10pm closure times for pubs, that sort of thing. Of course, SAGE has experts coming out of its ears, who could have advised on this sort of thing

Of course, they *did* advise on this sort of thing. Here’s the warning to the Government from ‘The Science’ on 14 July (worth a read).

Despite warnings from the Deputy Chief Medical Officer that releasing restrictions too early will backfire spectacularly, the Government pressed on relasing things. We were happy, we ate out to help out. We spread the virus.

Turns out that focus groups and popular policies aren’t necessarily the best way of doing strategy. (I wrote about this in the Financial Times in March).

So, the Government came up with a new shiny Tier Level thing. A new Nandos chart, with extra mild and mild removed. Like the Nandos chart, we start with ‘medium’. Sounds lovely. That’s most of the country.

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Problem is that *every single local authority in the country’ has a higher than Trafford that managed to get itself on the Contain watchlist.

So, we now have High and Very High Tier levels. Problem is, of course, that all this procrastination means that the virus is still doubling. If the growth rate is 5%, that means doubling every two weeks.

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So, we’re seeing
– patients admitted to hospital increasing 30% week on week
– deaths increasing 50% week on week

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And of course, Test and Trace has failed completely.

We’re now back to another mess of Very High Tier 3 restrictions, not uniform at all as per the plan, but different depending on where you are.

And… we’re back to where we started – uncontrolled virus spread with a mess of differing local restrictions. Maybe we could do some Powerpoints and Blue Sky Thinking and re-invent the Nandos scale and call it the Scoville scale. Because things are getting extra hot out there.

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Media Roundup week ending 12 October 2020

Letter in the Financial Times

The failure of the government’s testing strategy (Report, September 22) is a lesson in confusing resources with capabilities. Commercial NHS test and trace has resources but not capabilities. NHS labs and local authority directors of public health supported by Public Health England have capabilities but not resources.

In order to resolve this conundrum, we should provide the experts who are custodians of those capabilities with the resources they need to do their job.

Duncan Robertson School of Business and Economics, Loughborough University Leicestershire, UK

Long Interview on BBC Five Live debating against a herd immunity strategy

Interview on LBC (Nick Ferrari) and LBC (Iain Dale)

Interview on Sky News

Background to The Daily Mail, The Guardian

Heatmap of Cases & Deaths in the over-80s

Here is the heatmap of cases for PHE week 41 using week 40 data.

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Studies in Spain, France, and the US have all shown that although the second wave may start in young people, it will inevitably move to older people.

The remarkable thing about this disease is that the death rate increases massively with age.

Students are unlikely to die of Covid-19, although some may, and we are still unsure about the long-term health consequences from catching the disease.

The heatmap of cases shows how the disease has travelled through the age groups.  As you go from left to right through the weeks, you can see a gradual rise upwards through the population.

These figures should be seen as a minimum.  Lack of testing capacity has meant that not everyone can get a test.  For example, we do not know whether delays in testing may be concentrated in certain groups such as care home residents.

The latest figures (which will be revised upwards as new cases are recorded) show a very worrying number of cases in the over-80s.

A case rate of 53 per 100,000 over-80s is very concerning.  The Department of Health and Social Care have this week stopped publishing the COVID-19 surveillance report which broke down numbers of people with the disease.  However, we can estimate that over 1,000 over-80s tested positive last week.   Given the very high fatality rate in over-80s, we can confidently predict that over 100 over-80s will die of infections caught in the last week.

This is one of many reasons why interventions are so critical – by not clamping down hard on the disease now, we will sleep walk into a situation as bad or worse than the first wave.   The mid-July Academy of Medical Sciences report commissioned by the Chief Scientific Adviser set out a reasonable worst case scenario of 119,000 deaths in this second wave excluding those in care homes.  We have a choice as to whether we as a nation repeat the mistakes of the past.

We May Be Systematically Underestimating R by Excluding Students in Halls of Residence

We know that data on the Government Coronavirus dashboard is unreliable (see this Twitter thread).

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We also know that we are not doing enough testing as the positivity rate is so high (7% overall for Pillar 2 tests and up to 15% in some areas such as Liverpool) (see this thread)

So, how do we go about estimating R? Here’s a post I wrote in January explaining R in relation to Covid-19 (which then didn’t have an official name) in relation to Covid-19 (which then didn’t have an official name)

To estimate R, we carry out surveys – which means you pick a representative group of people, either households or individuals, and test them repeatedly. There are two main surveys: ONS and REACT

ONS excludes student halls of residence, as ‘only private residential households, otherwise known as the target population in this bulletin, are included in the sample. People in hospitals, care homes and other institutional settings are not included’. This is confirmed here.

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The REACT survey uses GP lists to generate its sample of people who are tested. But of course, new students are only just registering with their GPs, and it is unclear when the GP lists were pulled for the latest study (Round 5 of REACT-1, 18-26 Sep)

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We know that halls of residence are a significant driver of transmission. We may be systematically under-sampling from halls of residence and therefore systematically underestimating R.

We Are Still Not Doing Enough Testing: A Case Study of New York and Liverpool Schools

The Wall Street Journal is reporting that “New York City on Wednesday will close public schools and nonessential businesses in parts of Brooklyn and Queens that have registered a week-long spike in coronavirus cases”

Let’s look at New York and then compare to a UK city, Liverpool.

Cases are high in some New York boroughs. Up to 216 cases per 100,000 per week. But school closures are also being implemented in areas with 89 cases per 100,000 (source: New York Times)

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Source: New York Times
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Source: New York Times

Let’s compare with Liverpool. Here is the latest @PHE_uk report. Liverpool has cases of 238 cases per 100,000 in a week. Which is slightly higher than the highest rate ZIP code in NYC.

But remember, Liverpool’s figures are for the whole local authority.

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Source: PHE Week 40 Report


Let’s dig a little deeper into Liverpool. Here’s the map. We can see some areas with incidence in excess of 1200 cases per 100,000. That’s very high. And don’t forget this is detected cases. The number of cases will be much higher.

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Source: PHE Week 40

But how do we know that there hasn’t been enough testing? We look at positivity. Positivity is the number of people who test positive divided by the number of people tested. And this is what NYC uses to determine whether schools should be closed.

If an area of NYC has positivity greater than 3% – three in every 100 tests being positive – then schools close. What does positivity tell us? Whether enough tests are being performed.

“the World Health Organization recommended in May that the percent positive remain below 5% for at least two weeks before governments consider reopening.” (Johns Hopkins University)

So, given that positivity is set at a threshold of 3% for school closures in NYC and WHO suggest 5% before reopening, this begs the question – What is the positivity in Liverpool?

Just under 15%, according to the latest published data (PHE week 40 reporting). Which means that around 15% of all tests in Liverpool come back positive. That’s *very high*. And means not enough testing is being carried out. And this is a problem.

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Source: PHE Week 40

This is just an example of a city with large positivity. Extra testing capacity has been sent to Liverpool presumably due to students returning to universities there. This is not a Liverpool problem – it’s a national problem.