The Swedish approach

[Alvez_48]

Your verbal gymnastics on this issue are certainly impressive - Nadia Comaneci has got nothing on you!

For the past few weeks you've been claiming that Covid-19 deaths are being over-reported, despite being presented with evidence to the contrary, as doctors have been advised to use their clinical judgement when certifying deaths in the absence of a test result. Now you appear to have perfomed a volte-face and are claiming that the very same evidence you were informed about is, in fact, proof that the lockdown is causing significant excess deaths from other causes.

The simple fact is that we don't know. Unless the ONS changes its timetable, we won't see the data for causes of death until next year. Only then will we be able to determine whether there has been a spike in, say, heart attacks (which could possibly be lockdown related) or whether there's been a significant increase in other lower respiratory illnesses (which may be more suggestive of under-reporting of Covid-19).

Incidentally, I'm not advocating eternal lockdown, as clearly we can't simply cocoon ourselves until there is an effective vaccine (which may or may not happen). But the lockdown was necessary to buy us some time, in order that the NHS could cope with numbers and that we can try and put a properly resourced contact tracing and mass testing system in place, which is the only realistic way to try and manage this epidemic for the foreseeable future and what the government should have concentrated on in the first place.

I'm not volte facing anything those 2 things aren't mutually exclusive.

See below image might explain it more clearly.

 

[Billy Horner]

I'm not volte facing anything those 2 things aren't mutually exclusive.

See below image might explain it more clearly.

Many thanks for that illuminating explanation. If you'd care to reread the following replies that I made to you last week, you may recall that I actually pointed this out to you.

Except that all of the evidence suggests the exact opposite. There were 6,000 more deaths in week ending 3rd April than is the average. Of those, just under 3,500 had Covid-19 mentioned on their death certificates, meaning that there were more than 2,500 unexplained excess deaths in that one week alone.

The only possible explanations could be that Covid-related deaths are being under-reported or that there has been a sudden spike in other causes of death. C4 News had a whisteblower GP tonight who told them that they knew of colleagues who, when they suspected Covid-19 as a cause of death, were writing pneumonia on death certificates instead, because of the additional scrutiny and evidence that coroners were requesting if they put Covid-19.

It’s statistically reasonable to say both/either actually. You are correct in saying that Covid-19 accounted for 33% of all deaths registered in week 15.

However, as we are examining excess deaths compared with the average and Covid-19 is a new cause of death, it’s also reasonable to examine the extent to which Covid-19 can explain excess deaths. In that regard, it accounts for 6,213 (78%) of excess deaths, meaning that 1,783 (22%) were caused by something else (or Covid-19 was under-reported).

And I reiterate, we cannot draw any conclusions on the reasons for this spike in excess deaths until the ONS publishes data on causes of death next year. One plausable hypothesis is that Covid-19 deaths are being under-reported.

 

[Alvez_48]

Many thanks for that illuminating explanation. If you'd care to reread the following replies that I made to you last week, you may recall that I actually pointed this out to you.





And I reiterate, we cannot draw any conclusions on the reasons for this spike in excess deaths until the ONS publishes data on causes of death next year. One plausable hypothesis is that Covid-19 deaths are being under-reported.

Or maybe Billy just maybe... Essentially turning off all other healthcare functions within the NHS, scaring people all day, telling them to stay away from hospital, massive added stress and lockdown could be having an impact?

You know since if there's any chance that covid was involved it will be on the death certificate as has been explained many times by many posters.

Also don't be condescending to me you're not smarter than me, we just have different opinions but at least I'm respectful.

 

[borolad259]

It's emotive stuff. Please do all keep it civil. Thanks.

 

[Baggins]

The norwegians are already thinking of opening up I believe. Certainly the Finns are. They've realised that they are simply putting things off rather than dealing with them. It is easier for them to do this, of course, because of the geography. They also have much smaller care homes for the elderly, so protecting them is easier.

The Danes will be first reopening, the Norwegians usually follow.

Cafes, restaurants etc are beginning to reopen here and some never shut. Most shops stayed open and things like tattoo parlours and hairdressers are reopening too.

There wasn't the same kind of lockdown here that they had in the UK, you could move around relatively freely. The thing Norwegians felt keenest was the ban on travels to cabins.

Most of the elderly that I know self isolated, but you still see them out and about, a lot of families had one half of the grandparent unit isolating and the other taking care of the kids.

 

[dooderooni]

The world is 4, maybe 5 months into a global pandemic which has been handled in many different ways by many different governments. We can't say one way or another if one approach is better, but for us in the UK we have to deal with the approach which we've chosen.

There is one undeniable fact though, if you catch this virus then there is a chance that it will kill you. Of course there are factors that increase that risk and some are known and some are unknown simply because we are still learning about this virus and its interaction with human physiology.
As we eliminate the unknowns then the best defence against it is to not catch it and so minimise the risk.

I am sick of saying that the public health and economy are intrinsically linked and that you need to strike a balance between them with any actions that you take.
Sweden have done this as have we in a different way, but if it turns out that you can catch the virus more than once or that you can be infectious for longer time periods then all approaches will have to be rethought.

Paulo Dybala, the Juventus player, has tested positive for the fourth time in six weeks according to the club. Think about that when you ask for people to go back to work in the absence of testing. If someone can carry the virus for that long how many infection vectors would that open up? Yes it is one person, but it is one person that is being tested by an organisation with a vested interest in getting back to business.

 

[Billy Horner]

Or maybe Billy just maybe... Essentially turning off all other healthcare functions within the NHS, scaring people all day, telling them to stay away from hospital, massive added stress and lockdown could be having an impact?

You know since if there's any chance that covid was involved it will be on the death certificate as has been explained many times by many posters.

Also don't be condescending to me you're not smarter than me, we just have different opinions but at least I'm respectful.

Apologies. I just thought it a bit rich to try and support your argument by pointing me in the direction of some information which I had already pointed out to you. However, as I say, I apologise if that came across as condescending.

Yes, it is possible that some of the excess deaths have been caused by people not attending hospital when they have a medical emergency. In fact, it’s probably the case that some have been.

However, the point I was trying to get across was that it’s impossible to say which explanation is the correct one (or the extent to which they are correct), until we see the data for causes of death. Until then, we are simply hypothesising so shouldn’t really be claiming that we know.

I do have to take issue, again, however with your claim that if there’s any chance covid-19 was involved it will definitely be in the death certificate. There are now multiple sources stating that GPs have been putting other causes of death on death certificates in order to avoid time consuming enquiries from coroners. This is supported by the fact that the CQC figures on covid-19 deaths in care homes are higher than the registered deaths from covid-19 in care homes for the same period.

 

[Alvez_48]

Apologies. I just thought it a bit rich to try and support your argument by pointing me in the direction of some information which I had already pointed out to you. However, as I say, I apologise if that came across as condescending.

Yes, it is possible that some of the excess deaths have been caused by people not attending hospital when they have a medical emergency. In fact, it’s probably the case that some have been.

However, the point I was trying to get across was that it’s impossible to say which explanation is the correct one (or the extent to which they are correct), until we see the data for causes of death. Until then, we are simply hypothesising so shouldn’t really be claiming that we know.

I do have to take issue, again, however with your claim that if there’s any chance covid-19 was involved it will definitely be in the death certificate. There are now multiple sources stating that GPs have been putting other causes of death on death certificates in order to avoid time consuming enquiries from coroners. This is supported by the fact that the CQC figures on covid-19 deaths in care homes are higher than the registered deaths from covid-19 in care homes for the same period.

No worries you didn't cause any offence, I appreciate we're just on opposing ends of an argument.
Because we disagree does not mean I dislike you.
On your final point regarding GPs this contradicts with what I have read:-

'
Further, any possible mistakes will never be noticed or rectified, thanks to recent changes to the law.
Usually, any death attributed to a “notifiable disease” had to be referred to a coroner for a jury hearing.
Under UK law Covid19 is a “notifiable disease”, but the new Coronavirus Bill alters the Coroners and Justice Act 2009, to specifically exempt alleged Covid19 deaths from jury inquests.
Further, according to the office of the Chief Coroner, the Coronavirus Bill means that these deaths don’t have to be referred to a coroner at all, and that medical practitioners can sign off a cause of death for a body they have never even seen

'

 

[Billy Horner]

No worries you didn't cause any offence, I appreciate we're just on opposing ends of an argument.
Because we disagree does not mean I dislike you.
On your final point regarding GPs this contradicts with what I have read:-

'
Further, any possible mistakes will never be noticed or rectified, thanks to recent changes to the law.
Usually, any death attributed to a “notifiable disease” had to be referred to a coroner for a jury hearing.
Under UK law Covid19 is a “notifiable disease”, but the new Coronavirus Bill alters the Coroners and Justice Act 2009, to specifically exempt alleged Covid19 deaths from jury inquests.
Further, according to the office of the Chief Coroner, the Coronavirus Bill means that these deaths don’t have to be referred to a coroner at all, and that medical practitioners can sign off a cause of death for a body they have never even seen

'

Extract from BMA guidance to doctors regarding issuing of a Medical Certificate of Cause of Death (MCCD) during the Coronavirus crisis:

The rules surrounding the completion of the MCCD have changed following the Coronavirus Act 2020. In order for a doctor to complete a MCCD without referral to the coroner any doctor must have seen (including via video link) the patient in the 28 days before death. If these conditions are met, then a doctor may complete a MCCD which is sent to the registrar who will record the death and complete the paperwork to allow burial or cremation.

If these conditions are not met but the doctor is satisfied regarding the likely cause of death, then a MCCD may still be issued but should be clearly marked to indicate that the person was seen not seen in the 28 days before death. In such circumstances the case must be referred to the coroner. The process for this referral is defined at a local level by each coroner, but the doctor will be required to explain the medical history and circumstances of the death to help the coroner reach a determination.

EDIT - the Medical Defence Union (legal indemnity organisation for doctors) has also issued advice to its members:

https://www.themdu.com/guidance-and...ce/certifying-deaths-during-covid-19-outbreak

Pertinent extract:

The Act also allows an MCCD to be completed if a patient was not seen by any medical practitioner during their last illness. If that happens, a doctor would need to state to the best of their knowledge and belief the cause of death. Guidance from NHS England and NHS Improvement states that a doctor intending to complete the MCCD should obtain agreement from the coroner that they can do so. It remains the case that if there is no doctor at all who can give a cause of death then the death will still need to be referred to the coroner in the usual way.

 

[borolad259]

Well this is cheery.

 

[Alvez_48]

Ok so the article I read goes on to state what you've posted. It doesn't contradict the original statement I made but it does place a time limit on it as noted to 28days.

Which leaves everything clear as mud and drifting far off topic. So I will bow out.

 

[borolad259]

One for you Stattos, Sweden have initiated dual testing on a sample of 4000 people, for current infection and also for antibodies. They will be periodically re-testing the same sample (2 weeks I think). First results due in May.

 

[bear66]

One for you Stattos, Sweden have initiated dual testing on a sample of 4000 people, for current infection and also for antibodies. They will be periodically re-testing the same sample (2 weeks I think). First results due in May.

Aren't we doing the same with 10000 people, rising to 25000, with first results in about two weeks? Thought Whitty mentioned it last week.

 

[borolad259]

Dunno, I hope so. It would be good to have a better idea of just how widely the virus has spread. I was reading about a small community in Swedish Lapland yesterday. The local school had some teacher absences, so they tested them all. 25% of the 80 or so teachers tested positive for current infection. I suppose an equivalent would be some small town on the west coast of Scotland .... say Ullapool. If the virus has made it up there and into the community that quickly, you have to think that places with esier metropolitan connections would have even higher rates. I know you can't judge from one small sample, but I was really surprised.

 

[Billy Horner]

Aren't we doing the same with 10000 people, rising to 25000, with first results in about two weeks? Thought Whitty mentioned it last week.

There appear to be two elements to it. Firstly they will randomly select 100,000 people to receive antigen testing. This will provide data on levels of current infection within the general population.

The second strand is designed to test the efficacy of antibody testing, to see if it can determine the likely proportion of people who have already had the virus in the general population. This aspect of the research will be built up gradually, to ensure confidence in the results, but again the intention is to roll out to 100,000 people selected at random.

Of course, the unanswered questions at this point remain whether having had the virus and developing antibodies actually provides any protection from reinfection and, if so, how much and for how long?

Government info below:

https://www.gov.uk/government/news/...ll-track-levels-of-infection-in-the-community

 

[bear66]

There appear to be two elements to it. Firstly they will randomly select 100,000 people to receive antigen testing. This will provide data on levels of current infection within the general population.

The second strand is designed to test the efficacy of antibody testing, to see if it can determine the likely proportion of people who have already had the virus in the general population. This aspect of the research will be built up gradually, to ensure confidence in the results, but again the intention is to roll out to 100,000 people selected at random.

Of course, the unanswered questions at this point remain whether having had the virus and developing antibodies actually provides any protection from reinfection and, if so, how much and for how long?

Government info below:

https://www.gov.uk/government/news/...ll-track-levels-of-infection-in-the-community

Thanks. That's quite a protracted scale up of testing testing!

 

[Jonny_Rondos_Disco_pants]

The world is 4, maybe 5 months into a global pandemic which has been handled in many different ways by many different governments. We can't say one way or another if one approach is better, but for us in the UK we have to deal with the approach which we've chosen.

There is one undeniable fact though, if you catch this virus then there is a chance that it will kill you. Of course there are factors that increase that risk and some are known and some are unknown simply because we are still learning about this virus and its interaction with human physiology.
As we eliminate the unknowns then the best defence against it is to not catch it and so minimise the risk.

I am sick of saying that the public health and economy are intrinsically linked and that you need to strike a balance between them with any actions that you take.
Sweden have done this as have we in a different way, but if it turns out that you can catch the virus more than once or that you can be infectious for longer time periods then all approaches will have to be rethought.

Paulo Dybala, the Juventus player, has tested positive for the fourth time in six weeks according to the club. Think about that when you ask for people to go back to work in the absence of testing. If someone can carry the virus for that long how many infection vectors would that open up? Yes it is one person, but it is one person that is being tested by an organisation with a vested interest in getting back to business.

so, I was in hospital for 37 days before testing clear, 8 days earlier I had my first symptom, incubation period of 2-14 days...........so possibly 59 days from catching it to getting the two clear swabs to be released.
Worth reading up on South Korea where about 270 have tested positive again.

 

[SmallTown]

Anyone still defending lockdown...

More 'excess' (horrible term) people are dying due to non covid related death than covid undeniably now.
The economy is in tatters and it's not even helping stop the spread.
That's before we even look at the impending big brother creep across the western world.

I mean it is helping stop the spread...

 

[Billy Horner]

Thanks. That's quite a protracted scale up of testing testing!

Indeed! I think it’s demonstrative of the low level of confidence that there is in the efficacy of the antibody testing.

On a separate but related note, the distance left to travel in order to get to a properly resourced contact tracing and mass testing system appears to be enormous. Numerous scientists are saying that each new infection would generate around 100 contacts who would need tracing and testing.

We’re currently reporting 4-5000 positive tests per day. To test each of their previous contacts would involve scaling that up by a factor of 100.

On top of that, apparently the tests need to be administered twice within 3 days of each other, due to the high number of false negatives. That takes us to a testing requirement of 800,000 to one million per day! And that’s assuming that we remain at the 4-5000 positives per day, which would be highly unlikely.

 

[dooderooni]

so, I was in hospital for 37 days before testing clear, 8 days earlier I had my first symptom, incubation period of 2-14 days...........so possibly 59 days from catching it to getting the two clear swabs to be released.
Worth reading up on South Korea where about 270 have tested positive again.

I think that you're the best data we have Jonny.
Two months is a lifetime in this pandemic so you should be our cautionary tale.