Archive for April, 2020

Huge variations in estimates mean that we are 25% of the way through this to 2% of the way through this. All of this underscores the desperate need to start wide-scale antibody testing so that we can make evidence-based decisions on how we fight coronavirus.

The number of people likely to die depends on two factors: how likely you are to die when you get it (IFR) and how many people you will spread it to (R₀). Below, I’ll explain both of these and run the numbers based on current estimates.

How many people you will spread it to

R₀ represents how many people an infectious person will give it to. With seasonal flu, this is typically around 1.3. With highly infectious disease, such as measles, this can be as high as 9. Anything below 1 is great because it means the disease will slowly disappear as anything less than 1 means you are not even passing it on to one other person.

The Lancet has given an early estimate that COVID-19 at 2.35. But other studies have suggested it could be as high as 5.7.

The amount of people you infect is also dependent on the percentage of the population that are vulnerable. If half the population is immune because they have already had it or because they have been vaccinated, you can divide R0 by two. The number of people you infect is actually R₀ * percentage of the population that is vulnerable (R₀S).

R₀ is important for two reasons. First, the higher it is, the faster it will spread. We can artificially suppress the number to be lower by using things like social distancing and lockdowns. If we can get it down to 1 we can control the situation. This is easier to do at 2.35 than it is at 5.7. The problem with social distancing is that it only artificially suppresses the outcome. Once you end the social distancing, the number jumps back up and the whole process starts again.

Second, it defines the number of the population that need to be infected or vaccinated before the disease will start to disappear. At 2.35, we need around 60% of the population to be immune before the number drops below 1. At 5.7, that means 80% of the population.

How many people die from it

The second factor is how deadly the disease is. If you haven’t followed the coverage too deeply, you might think the death rate is anywhere up to 3.4%. But this is not the case. What you’re looking at here is the case fatality rate (CFR), which is the percentage of people who test positive and then die.

This is quite high in some countries that are not bothering to test anyone and quite low in countries that are widely testing. But nobody is pretending it is the infection fatality rate (IFR), which tells you of the people who get it (tested or not), how many of them die. This we can only poorly estimate because we haven’t tested enough people.

In the UK, we know we are missing a lot of people because we are only testing those admitted to hospital (plus Prince Charles), and the results from testing in Iceland suggest that 10-50% of people are asymptomatic.

Estimates on the IFR vary. In an article in The Lancet, Imperial put it as high as 0.66%. Oxford University, however, put the figure much lower, estimating it to be somewhere between 0.1% and 0.36%.

Combining the variables

Here is the data modelled at for both an R₀ of roughly 2.36 (60% of the population required to develop immunity) and for 5.7 (80% of population).

A few things should be noted: first, this only calculates the point at which the disease starts to disappear. It won’t disappear overnight. Even if we get R₀S down to 0.8, that still means that if 10 people get it, they will infect another 8. It’s on it’s way out but it is still throwing a few punches.

Second, if you want to be an optimist, you could say the IFR could be even lower. In the early days of swine flu, we were talking about high death rates (1-2%) and, in the end, it turned out to be 0.02%. This makes sense from a psychological point-of-view. Much better for a researcher to overestimate and say “sorry, it wasn’t that deadly after all” than to fail to raise the alarm, let everyone die and say “sorry, turned out it was super dangerous and it’s my fault everyone is dead”.

Other exit strategies

There are two other ways this could end. One is that it magically goes away over summer. Trump is still hoping for this option, I think, but even if this did happen, it may well just come back next winter.

The other exit option is a vaccine. Experts have said this is still 18 months away (12 if everything went perfect). But, importantly, this is just to deliver the vaccine. There is a difference between developing the thing and embarking on a nationwide or worldwide immunisation campaign. We have PPE equipment and COVID-19 tests now, for example, but getting them to the people who need them is still a logistical nightmare taking months.

So, we’re probably looking at two years until we’re immunised. For this to save lives, we would have to artificially suppress R₀S to less than 1 for that entire time, which means two years of varying degrees of lockdowns and social distancing.

Whether this can work depends on how easy it is to suppress the virus. If South Korea continues to limit their deaths to a handful per day, they could keep the total number down to 2,000. New Zealand seem to be doing even better. How well this will work in the long-term is unclear; China is now battling a second wave of foreign infections, for example, and normal life is far from resumed in any of these countries.

Conclusion

Somewhere between 40,000 and 400,000 people in the UK are likely to die with COVID-19.

At the best-case scenario, we could be in for another three weeks of grim death counts before the virus starts to disappear forever.

In a worst-case scenario, we’re 2% into this, which will either see us go through a full year of this many deaths per day or a two-year-long lockdown while we hideout waiting for a vaccine. Neither of these options is appealing because it involves a lot of death, or in option B, two years of social isolation, mental health problems, suicides, drug and alcohol abuse, lack of a healthcare system, missed cancer screenings, job losses, domestic abuse, children not getting their education and the many other social costs.

All of this underscores the need to start large-scale antibody testing to confirm what the IFR is. Once we know that, we can start making evidence-based decisions about what the plan should be.

With the triathlon season looking increasingly grim, World Triathlon Corporation has announced a series of virtual challenges, starting with Ironman VR1. This was a middle-distance format with a 5km run, 90km bike and 21km run.

You could complete them in any order starting from 6pm GMT on Friday and finishing at midnight on Sunday. They also had pro challenges with women racing on Saturday and men racing on Sunday. This only included the bike course, done inside on a turbo, via Rouvy.

I put in my 5km on Friday evening. A nice change to use my Nike Next%. Sub-24 minutes without having to push too hard. Then I got up super-early on Saturday morning (8am, things have been slack since the lockdown) and headed out for a loop of Rothwell, Tadcaster, Harewood and home on the bike. There are few cars about and I was able to get down on the aero bars for most of it.

Finally, a long, slow plod on Sunday afternoon for the 21km. I went back to my trusty Brooks Revenna and finished in just over two hours.

It would have been nice to have more than 48 hours notice this was taking place! And, in typical World Triathlon Corporation style, the technology is terrible: my login did not work, I got my confirmation email three times and it keeps saying “register for this event” long after I have completed it.

I didn’t win. I came 3,396 out of 5,320, with a total time of:

5:55:25

My splits were 23:37 for the 5km run, 3:29:47 for the 90km bike and 2:02:01 for the 21km run. Those figures are not accurate, though. First, I cycled 91.66km and ran 21.1km, and it takes the total time. But it also does not factor in elapsed time. I had auto-pause on on my Garmin, which would have pushed me over six hours if not.

Sunday Assembly Leeds has been on hiatus since last summer. However, given the current crisis, we decided to stage a virtual assembly.

The theme was “how do I stay positive?” during the current crisis. We had talks, songs from The Assembly Line (in the form of videos of our previous gigs), a moment of reflection and a section called positive news in which we looked at the good things coming out of the current situation.

I’ve been playing around with the setup. The camera on my iPhone is much better than the one in my Mac, so I got a phone adapter for my tripod and used my phone as the main camera. I used my Aftershokz has headphones slash microphone. This freed up my laptop to control the webinar. The final thing you need to sort out is lighting, and angling myself between the window and a studio light seemed to work well.

I’ve seen a lot of confusion about what we can and cannot do, exercise-wise, during COVID-19. That’s not surprising because what the law says, what the government guidelines say, and what Michael Gove has suggested are all different. In this blog post, I’ll break it down.

You can read Coronavirus Act on Parliament’s website. Which you probably should do, because I have no legal training and am in no way providing any kind of indemnified legal advice.

Can I go outside to exercise?

Yes. In order to leave your home, you need a reasonable excuse. The law (in England) then lists these reasons and includes “to take exercise either alone or with other members of their household”.

Can I go outside to exercise with other people?

Not unless you live with them, as the law says you can only go either alone or with members of your household.

Can I go out more than once per day?

Yes, you can. The law does not prohibit this.

However, where possible, you should avoid this. The government guidelines (which are guidelines, not laws) ask us to keep it to once per day and while it is not illegal to go out more, it makes sense for us to follow the guidelines.

Note that this specifically applies to England: in Wales, you are legally limited to going out once per day for exercise.

Is there a limit as to how far I can go?

No. You can go as far as you want. Neither the law nor the government guidelines, place any restrictions on distance.

That said, it makes sense to stick to your usual routine. If you try a 200-mile ride for the first time and end up exploding and needing someone to come pick you up, that is someone else having to travel.

Do I have to keep it to a maximum of one hour?

No, neither the law nor the government guidelines specify any kind of limit.

I think this may have come from a press briefing where Michael Gove said he expected people would be running for 30 minutes to an hour and encouraged people to stick to their regular routine.

Sticking to your regular routine makes sense, as explained above, so if you don’t usually exercise for more than an hour, I wouldn’t start now. But if you usually do long runs and rides, you are free to continue doing so.

Can I travel somewhere to start my exercise?

Some people have been travelling to national parks to exercise in the middle of nowhere. Can you do this? Probably, but you probably shouldn’t.

The law says you can go out to exercise, and the government guidelines don’t explicitly ban driving to a park either, but the government has said that you should avoid doing this during press briefings.

The concern is that more cars on the road, means more potential collisions, taking up hospital resources. Therefore, unless there is a specific reason you cannot exercise from your home, you should start from your front door.

Patrick Vallance previous said he thought the UK would need around 60% infection rates in order for a country to develop natural immunity. As discussed in today’s government press briefing, he’s also quoted as saying 1 death represents 1,000 cases, confirmed or not. This is just a rule of thumb as we do not have enough data to know for sure.

Based on those numbers, we would be looking at around 36,000 deaths in Italy, 28,000 in Spain and 41,000 in the UK. It should be noted that, as previously discussed on the blog, we don’t really know what the death rates are, but some people have placed it higher. Anyway, that disclaimer over…

If we assume the midpoint will line up with the peak (and I don’t know if that is the case), there is some good news on the horizon. Based on current death rates, both Italy and Spain would reach their peak in 5 days (which is from yesterday, because it’s yesterday’s WHO data, so 7 April).

The UK is more difficult to predict. Based on the current death rates, we wouldn’t hit the peak for another 40 days. But, that death rate is likely to continue to increase further as it has been doing all week. If it doubled, that would half the time to 20 days (still a pretty grim prospect).

There is a bunch of stuff that could throw this off. Valance’s numbers could be incorrect. The peak may not lead up with the midpoint. And the social distancing may slow down the whole process, or even move us back to a containment phase if things went spectacularly well.