I wrote a very lengthy and detailed reply, referenced with stats, but realized there's little point in it if it's unlikely to be read so I've deleted it and here's a shorter version (!). Some thoughts on @Dovefromabove@steveTu@amancalledgeorge posts. I hope this is helpful; if not, apologies for fouling the discussion.
In summary, if reading this is understandably not of interest: face coverings give no benefit at best, and increase risk at worst. The current lockdown strategy will fail, because there is only one hard way out of a modern pandemic: population immunity through acquired immunity, a vaccine, or an effective treatment (remember that flu kills tens of thousands in the UK every year, and we accept this).
We are looking at those SAGE graphs and asking the wrong question: not "how do we stop or reduce the peak", but "how do we get to the subsequent level off as quickly as possible whilst minimizing the trade off in deaths". We need to see the science behind those graphs, and understand the conditions that produce the level exit in all of them, which is a tacit acknowledgement that it is possible.
First up, @amancalledgeorge I hope this science gives you comfort that your bus journey isn't as risky as you perceive due to those not wearing coverings.
The article you linked wrongly conflates masks with coverings and the relevant research. It correctly identifies ventilation as a key control. Both punkdoc (an ICU doctor) and myself (a random internet lunatic) have previously explained why coverings are ineffective for the general public. This study is interesting: https://www.nature.com/articles/s41598-020-72798-7
In plain English: wearing a mask is worse than not wearing one. I'll quote a piece of the conclusion:
Our results clearly indicate that wearing surgical masks or unvented KN95 [..makes a big difference..], compared to wearing no mask. However, for the homemade cotton masks, the measured particle emission rate either remained unchanged (DL-T) or increased by as much as 492% (SL-T) compared to no mask
So, whilst it is perfectly possible that future studies and different methodology will produce different results, I am comfortable that face coverings at best have no value, and at worst increase risk.
Of course the law says we have to wear them, which creates a conundrum.
To the "pot" question and the statistics linked by @steveTu.
First, those stats don't show a virus related admission. They show an admission where the virus was identified in the 14 days prior or any time after admission, which is a critical distinction. I could be asymptomatic, admitted for an unrelated issue, and a test will put me into those stats even though the virus is not the root cause of my NHS resource consumption.
This is a very important causation distinction: an admission or death where the virus was at least one of the causes, versus a case where the virus was present but not a comorbidity. It is even more relevant with this virus, which presents a high level of asymptomatic infection.
The reality is that the 18-64 group (a 46 year span) is more likely to be admitted in non virus impact scenarios (asymptomatic etc) or where the virus is incidental to the admission, compared to the 65-84 group (19 year span) who are significantly more at risk of serious harm directly due to the virus.
With regard to the "pot", the issue is wider than the virus. I've previously posted about how a QALY is used to help allocate resources, and how medical ethics is a complex area (here's the BMA statement on ethics for the virus including what to do when resources run out: https://www.bma.org.uk/media/2360/bma-covid-19-ethics-guidance-april-2020.pdf )
It's an unfortunate fact of life that not everyone can be saved from any illness, even though the ability to save them may exist. Treatment may be too costly, difficult, risky, or unavailable because it's already allocated elsewhere. For example, there are only a handful of ECMO machines in the UK and the decision to use one is risky in itself, with about a 40% mortality rate. Logic must prevail over emotion.
However the difference now is the impact of the relentless focus on the virus. I've posted previously on how cancer care and similar life saving care, screening etc is being reduced and deferred, so I won't recap that other than to say Boris's point about "the nhs won't be there for us" is already true in some scenarios.
I've also posted about how the virus is not a leading cause of death, but this post is already far too long to recap that.
So I'll cover a couple of items. First, as I said before, pandemics are a fact of human existence. The only way out is through. The ethical framework to manage an excess of demand on the NHS already exists, but there is an understandable reticence to employ it. The "medical and moral disaster" Boris speaks of is simply an emotive non-sequitur. We already make those decisions, for example when NICE and other bodies deny funding (for example, paracetamol is available on prescription but premature babies cannot get the medically required nutrient milk, different to "regular" baby milk, on prescription, due to cost?).
The continued stop start of lock downs don't eradicate the virus. They temporarily reduce the spread, which resurges once restrictions are lifted. They kick the can down the road without a strategy. We cannot rely on a vaccine to eradicate the problem, and continuing the current approach will just extend and delay the inevitable. If we believe SAGE, immunity is short lived, so every time we lock down we reduce the opportunity to robustly break the chain.
SAGE unfortunately are not being honest with us. The only way out of a modern (global economy) pandemic is population immunity. There is no vaccine that gives immunity to the existing coronaviruses. I would be delighted if the vaccines under development are magic bullets, but it's highly unlikely. Therefore there is only one way forward - shielding the most at risk, and everyone else continuing on until we hit the 60% population immunity or have an effective treatment - or we will be in lockdown perpetually, to no effect. This leads to...
...Second, the NHS is paid for by tax. A weak economy, and poverty, also leads to poor health outcomes. Unless we return to a semblance of normality, the immediate impact and deaths from covid-19 will pale in comparison to the long term impact. The monetary and societal debt created by the current approach will be paid by the next generations, which is a problem because...
....Third, the young are least at risk but the most impacted. 16 to 24 year olds are one of the lowest risk groups, but the highest impact in terms of employment loss. Vast numbers of children are out of school, and very young children are at risk of developmental impact due to lack of socialization etc. Suicide and mental health issue prevalence amongst under 40s are increasing. These issues are the rock rolling down the hill, hitting us in 5, 10, 15 years.
So unfortunately the strategic macro view is different to the tactical NHS-specific view. Might the NHS become "overwhelmed" (whatever that means)? Possibly. There are already contingencies in place for this. But myopically addressing that issue today will leave us significantly worse off tomorrow with issues we cannot fix. Although coldly logical, the resource pot must be considered in macroeconomic and societal terms and long term strategy for the country as a whole.
I'm not intending to enter into a debate on any of this emotive stuff though, so please accept my apologies if you disagree or query and I don't reply.
I'm not sure the lockdown will fail - as to fail you have to define what it means to succeed. In this case if keeping the NHS working over winter is the criteria for success, then I'm not sure I see any other option. If you class success as being the eradication of Covid - then lockdown is doomed to utter failure. Local lockdowns appeared to have some effect, but they were leaving a large infected base (the numbers weren't reducing fast enough) - and any flare up again then expands from a larger base
As for how the hospitalisation stats are collected and what they show - I'm not sure it matters. That sounds insane - but we are all aware how the NHS is under stress normally during winter. With Covid the stress will be more - and it matters not whether the people hospitalised are aged 0-5, 6-10 or 11-100 or whether they have Covid on entry, on exit or at any other point. It's not the age group of the hospitalised group, but how many get hospitalised and how long they then use that resource isn't it?. All that is really required is how many hospital spaces have we got, and how many are being used and what the projection for use is. Much like the excess deaths gives a good indication of what the effect of Covid on deaths has been in general, hospital bed use would be a good measure of the effect of Covid on hospital usage in general - BUT the problem there is that you can't wait for hospitalisations in this case before you react. We already knew we had a problem with hospital resource - we do virtually every winter.
You seem to just favour the herd immunity route - fine. That would be ok, although I think difficult for a gov to sell to the public, even if the virus was a one-off. What if Covid-19 variants reappears each year like flu? What if it hits a different age group next? What if the age group that dies is the group the makes the economy tick? And given the world being a large village - to get herd immunity you'd need the world to do the same - or else, with a short term immunity (if that is the case), the virus will just go round the globe again and hit you 'n' months later - again and again.
I don’t wear a mask because I am exempt but many people really hate wearing them and I know from friends and family that shopping and eating out were much less pleasant experiences when wearing masks. I would suggest that unless they have proven benefits they should be optional
I agree with large amounts of what @strelitzia32 says, BUT I don't think herd immunity for this virus is achievable, certainly without too many dying, whilst trying to achieve it.
Sweden has tried it and ended up with higher mortality rates than its neighbours.
We would need well over 80% of the population to get it, in order to achieve herd immunity, and this would risk far too many deaths.
Immunity from this virus may well be very short, 4 months is being touted by some experts, which of course means that herd immunity is unachievable, even with a vaccine.
@debs64, I am sorry if this offends you, but, I don't like wearing a mask, but it is a damn site better than dying , or spreading the virus to someone else, who then dies.
How can you lie there and think of England When you don't even know who's in the team
@punkdoc I have a lot of respect for your opinion and I am not at all offended but I have honestly lost count of the number of people I see every day wearing masks incorrectly and then getting very close to others as” I am wearing a mask so I am safe”
@B3 a less pleasant experience means less shopping which has a very negative impact on retail and the economy. There definitely seems to be enough evidence that masks don’t work to make them optional.That’s just my opinion and if it offends you I am sorry.
Posts
James O'Brien on BBC today😂,
Best one since Trotters' Independent Traders
In summary, if reading this is understandably not of interest: face coverings give no benefit at best, and increase risk at worst. The current lockdown strategy will fail, because there is only one hard way out of a modern pandemic: population immunity through acquired immunity, a vaccine, or an effective treatment (remember that flu kills tens of thousands in the UK every year, and we accept this).
We are looking at those SAGE graphs and asking the wrong question: not "how do we stop or reduce the peak", but "how do we get to the subsequent level off as quickly as possible whilst minimizing the trade off in deaths". We need to see the science behind those graphs, and understand the conditions that produce the level exit in all of them, which is a tacit acknowledgement that it is possible.
First up, @amancalledgeorge I hope this science gives you comfort that your bus journey isn't as risky as you perceive due to those not wearing coverings.
The article you linked wrongly conflates masks with coverings and the relevant research. It correctly identifies ventilation as a key control. Both punkdoc (an ICU doctor) and myself (a random internet lunatic) have previously explained why coverings are ineffective for the general public. This study is interesting: https://www.nature.com/articles/s41598-020-72798-7
In plain English: wearing a mask is worse than not wearing one. I'll quote a piece of the conclusion:
Of course the law says we have to wear them, which creates a conundrum.
To the "pot" question and the statistics linked by @steveTu.
First, those stats don't show a virus related admission. They show an admission where the virus was identified in the 14 days prior or any time after admission, which is a critical distinction. I could be asymptomatic, admitted for an unrelated issue, and a test will put me into those stats even though the virus is not the root cause of my NHS resource consumption.
This is a very important causation distinction: an admission or death where the virus was at least one of the causes, versus a case where the virus was present but not a comorbidity. It is even more relevant with this virus, which presents a high level of asymptomatic infection.
The reality is that the 18-64 group (a 46 year span) is more likely to be admitted in non virus impact scenarios (asymptomatic etc) or where the virus is incidental to the admission, compared to the 65-84 group (19 year span) who are significantly more at risk of serious harm directly due to the virus.
With regard to the "pot", the issue is wider than the virus. I've previously posted about how a QALY is used to help allocate resources, and how medical ethics is a complex area (here's the BMA statement on ethics for the virus including what to do when resources run out: https://www.bma.org.uk/media/2360/bma-covid-19-ethics-guidance-april-2020.pdf )
It's an unfortunate fact of life that not everyone can be saved from any illness, even though the ability to save them may exist. Treatment may be too costly, difficult, risky, or unavailable because it's already allocated elsewhere. For example, there are only a handful of ECMO machines in the UK and the decision to use one is risky in itself, with about a 40% mortality rate. Logic must prevail over emotion.
However the difference now is the impact of the relentless focus on the virus. I've posted previously on how cancer care and similar life saving care, screening etc is being reduced and deferred, so I won't recap that other than to say Boris's point about "the nhs won't be there for us" is already true in some scenarios.
I've also posted about how the virus is not a leading cause of death, but this post is already far too long to recap that.
So I'll cover a couple of items. First, as I said before, pandemics are a fact of human existence. The only way out is through. The ethical framework to manage an excess of demand on the NHS already exists, but there is an understandable reticence to employ it. The "medical and moral disaster" Boris speaks of is simply an emotive non-sequitur. We already make those decisions, for example when NICE and other bodies deny funding (for example, paracetamol is available on prescription but premature babies cannot get the medically required nutrient milk, different to "regular" baby milk, on prescription, due to cost?).
The continued stop start of lock downs don't eradicate the virus. They temporarily reduce the spread, which resurges once restrictions are lifted. They kick the can down the road without a strategy. We cannot rely on a vaccine to eradicate the problem, and continuing the current approach will just extend and delay the inevitable. If we believe SAGE, immunity is short lived, so every time we lock down we reduce the opportunity to robustly break the chain.
SAGE unfortunately are not being honest with us. The only way out of a modern (global economy) pandemic is population immunity. There is no vaccine that gives immunity to the existing coronaviruses. I would be delighted if the vaccines under development are magic bullets, but it's highly unlikely. Therefore there is only one way forward - shielding the most at risk, and everyone else continuing on until we hit the 60% population immunity or have an effective treatment - or we will be in lockdown perpetually, to no effect. This leads to...
...Second, the NHS is paid for by tax. A weak economy, and poverty, also leads to poor health outcomes. Unless we return to a semblance of normality, the immediate impact and deaths from covid-19 will pale in comparison to the long term impact. The monetary and societal debt created by the current approach will be paid by the next generations, which is a problem because...
....Third, the young are least at risk but the most impacted. 16 to 24 year olds are one of the lowest risk groups, but the highest impact in terms of employment loss. Vast numbers of children are out of school, and very young children are at risk of developmental impact due to lack of socialization etc. Suicide and mental health issue prevalence amongst under 40s are increasing. These issues are the rock rolling down the hill, hitting us in 5, 10, 15 years.
So unfortunately the strategic macro view is different to the tactical NHS-specific view. Might the NHS become "overwhelmed" (whatever that means)? Possibly. There are already contingencies in place for this. But myopically addressing that issue today will leave us significantly worse off tomorrow with issues we cannot fix. Although coldly logical, the resource pot must be considered in macroeconomic and societal terms and long term strategy for the country as a whole.
I'm not intending to enter into a debate on any of this emotive stuff though, so please accept my apologies if you disagree or query and I don't reply.
Some people can't wear a mask for health reasons but a less pleasant shopping experience - polite words fail me.
Sweden has tried it and ended up with higher mortality rates than its neighbours.
We would need well over 80% of the population to get it, in order to achieve herd immunity, and this would risk far too many deaths.
Immunity from this virus may well be very short, 4 months is being touted by some experts, which of course means that herd immunity is unachievable, even with a vaccine.
@debs64, I am sorry if this offends you, but, I don't like wearing a mask, but it is a damn site better than dying , or spreading the virus to someone else, who then dies.
When you don't even know who's in the team
S.Yorkshire/Derbyshire border
There definitely seems to be enough evidence that masks don’t work to make them optional.That’s just my opinion and if it offends you I am sorry.