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Too soon… April 9, 2020

Posted by WorldbyStorm in Uncategorized.
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It’s beginning to irritate me, the muted calls for things to ‘return to normal’ or for ‘some sort of hope’. Because it displays a misunderstanding of what is actually taking place. Take for example this from the IT yesterday morning…

This is our lead story this morning. I’m afraid it is bad news for those who expect the Government to lift the restrictions as was planned on Easter Sunday.
https://www.irishtimes.com/news/health/coronavirus-restrictions-set-to-be-extended-as-citizens-warned-against-social-sabotage-at-easter-1.4223853

Or more seriously again:

Fianna Fáil leader Micheál Martin has told a party meeting that the public may need to be told when the restrictions introduced to deal with the coronavirus crisis will be lifted.
Mr Martin made the comments during a conference call with his senators and MEPs on Wednesday morning, which discussed the Covid-19 crisis and government formation.
Senator Pat Casey told the meeting that the public needed to be given hope about when restrictions will be lifted, alongside the warnings given recently and the extra powers of enforcement given to An Garda Síochána.

Does Martin not understand that any such public statement would be impossible to make at this sage of the pandemic. There’s a basic truth. It is impossible to accurately predict the manner in which these matters will go at this point, other than to say the number of infections and deaths will increase.
Moreover the situation has arrived at this point:

The intensive care unit (ICU) in Dublin’s Mater Hospital is full, with some patients being moved to the high dependency unit, a senior doctor there has said. The hospital’s Director of Critical Care Medicine, Dr Cormac O’Loughlin, said most of those in the ICU beds are Covid-19 patients adding that the biggest challenge in the treatment of them will be staffing problems.

That latter reality is soberly conveyed in the following, also from the IT:

Dr Jack Lambert, a consultant in infectious diseases at Mater hospital has described data published by the Institute for Health Metrics and Evaluation (IHME), at the University of Washington in the US as “misinformation provided by outsides based on inaccurate numbers and data.”

According to the IHME data Ireland has passed its peak of Covid-19 infections but can expect a total death toll of more than 400 virus-related fatalities by next month.

That modelling is based on inaccurate numbers and data, Dr Lambert told the Pat Kenny show on Newstalk. “I don’t think we’ve reached the peak yet. That is misinformation provided by outsiders. We haven’t reached our peak and we may have a second peak.
“We have to wait day by day, the accurate numbers are deaths and ICU admissions and they continue to rise.”

For all the good weather, for all the chafing, the actual danger from the virus facing this state and this island continues as before. Nothing has changed in that regard even if the figures are lower than those projected earlier in the crisis. Paul Cullen in the IT who (ironically) trailed the IHME report far too prominently, at least gets it right in the following:

It is abundantly clear from international evidence at this stage that social distancing works as a mechanism for slowing the spread of this virus.
Equally, it is clear that the widespread adherence to the social distancing measures implemented in Ireland has worked to curb the spread of disease here.
We have seen the rate of growth of new cases fall from 33 per cent a day to under 10 per cent since the restrictions were introduced…

Though oddly wrong in the next part…

Another way of measuring our progress is counting deaths. These hit 22 last Friday, but totals for the last three days have been lower. While it is hard with such small numbers to start mapping a curve there is no sign as yet of an exponential rise in deaths, and this despite the problems in nursing homes where the oldest and most exposed population are at risk.

Actually Tuesday saw the largest number of fatalities from the virus. This is a long haul, not a short one.

Comments»

1. alanmyler - April 9, 2020

Just about the biggest challenge being staffing problems, as I’ve mentioned before the eldest daughter is a nurse in James’s, on a surgical / non-covid ward. Unfortunately one of her patients has now tested positive and as a result she’s now on a week’s isolation at home and unable to go into work. She was wearing PPE but there are grades of PPE apparently and because the ward was non-covid up to that point the staff weren’t wearing the required grade of PPE for covid protection. So you can see how staff limitations begin to kick in when something like this happens.

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WorldbyStorm - April 9, 2020

That must be very stressful for her and for all of you. I hope she’s okay. There’s a heartlessness about so many online in regard to this which is quite disgusting. But it’s also a heartlessness intertwined with ignorance as to the actual outcomes as you outline above… staff limitations alone due to potential issues must impact and possibly very greatly further down the line. Anyhow hope she’s back up and running asap.

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2. NFB - April 9, 2020

Martin sounds like like an opposition figure with those comments, not a Taoiseach-elect. He wants the caretaker government to name a date,and then be able to hammer them when it comes and goes. Another reason why he isn’t fit to be a public rep, let alone leader of the country.

The sense now is that people are starting to take the restrictions less seriously. A few weeks was all they could bear, and if they aren’t dealing with the virus directly through someone they know, then it might as well not exist. I was telling people this would start happening after a few days and I was wrong, but only on the length of time. Where I am the canal walkway has always had a good few people strolling, cycling, jogging at all times of the day, and I’d place a confident bet that the number will hit a high come the weekend. Saw the Garda patrol brake up a picnic happening on that same path two days ago. Could do with a tropical storm now!

I’d be going all out at this stage: checkpoints on motorways, door-to-door in holiday home hubs, encouraging local businesses in such areas to refuse to serve people without permanent addresses nearby and make publicised arrests. Hell, if the law allowed it I’d have Garda clamping cars found at occupied holiday homes.

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WorldbyStorm - April 9, 2020

That’s my feeling NFB about his comments precisely. Just totally inappropriate for the moment we’re in.

I see much the same in the Fairview Park. It’s not broken down, and there’s a squad car in and out on a regular basis but I’d wonder how easy they will manage it across the weekend.

I’m with McConkey, I think we shut the whole kit and caboodle down for two weeks, bar utilities and food/pharmacies and then very cautiously see how and where we stand after that.

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3. Ned Corcaigh - April 9, 2020

The best measure of how countries have been affected is probably the deaths per 1 million of population (cases don’t really give a full picture because different countries have tested at different rates.)
So deaths per 1 million.
Spain 316.
Italy 292.
Belgium 218.
France 167.
Holland 130.
UK 105.
Switzerland 103.
Sweden 68.
Ireland 48.
USA 45.
Denmark 38.
Austria 33.
Germany 28.
Norway 19.
Czech Republic 10.
Greece 8.
Finland 7
Croatia 5.
Poland 4 (But major questions about these stats.)

I suppose what sticks out is the performance of Germany, a densely populated country which had the virus early. The difference is probably because they have more ICU beds than anyone else in Europe. The comparative lack of those beds here means that any laxness here will be severely punished. Norway also doing very well because they had a lot of cases early on. Seeing the small number of cases in the more peripheral parts of Europe you might wonder if we should be doing a bit better given our island status. The amount of cases within nursing homes and among health workers seems like something which could perhaps have been mitigated to some extent.
Agree with the statements on Martin. His statement is the political equivalent of asking, “Are we there yet?”
Also suspect this weekend will lead to an upsurge in a week or so. But I suppose Fiachra and Victoria can’t be expected to stay away from the beach when the weather is fine.
One of the joys of the CLR is that no-one will pop up here to explain that you don’t have to be well off to own a holiday home. Instead, like paying for your children’s private schooling, you do it by working hard and saving your money rather than spending it on drink, tattoos and following League of Ireland football.
How can they be in the wrong when they’re nice middle class people? It’s not like they’re a bunch of plebs in football jerseys.

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alanmyler - April 9, 2020

Just about holiday homes, and full disclaimer here, I don’t own one, but of the few people I know that do own such things they’re mobile homes in Wexford or Mayo and the people who own them aren’t SUV-driving D4-residents by any means. There are holiday homes and there are holiday homes.

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Ned Corcaigh - April 9, 2020

I take your point. Different down here where there’s villages of the things for the well heeled.
Though if people are travelling to those mobile homes in Wexford or Mayo, maybe I’m entirely wrong about the class basis to this. Maybe irresponsibility and fecklessness cuts across all boundaries.

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Ned Corcaigh - April 9, 2020

Maybe in other words this isn’t a CLR type issue at all but one about individual behaviour.

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Ned Corcaigh - April 9, 2020

And maybe the different reactions of various countries to lockdowns etc. have more to do with national character than political ideology.

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sonofstan - April 9, 2020

Thanks for that table above NC – was trying to compile something similar earlier but gave up.

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Aonrud ⚘ - April 9, 2020

I think there are better ones out there since, but I was looking for a comparison with population a couple of weeks back and couldn’t find one, so combined a population data source with the John Hopkins data on Covid19.

It might interest some here:

https://aonrud.gitlab.io/c19/cov19.html?countries=Ireland%2CUS%2CUnited%20Kingdom&mode=deaths&numMode=pop&alignDates=false&range=1#

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4. Joe - April 9, 2020

Just on those death rates above.
Several caveats: We’re in the middle of the outbreak, it hit different countries at different times. So those figures will change as the thing progresses. Whenever it’s all over, the experts can look at figures and try to relate them to actions taken by governments and when they took them etc.
I stand to be corrected on this but I understand that the UK figures (or maybe the English ones) relate to deaths the occurred in acute hospital settings i.e. doesn’t include people who died at home or people who died in nursing homes or other places. Whether I’m right or wrong in that, the point is that countries may be counting in different ways so again, we need to be careful about any conclusions we draw.

On the general issue of ‘Too Soon’. I’ve been very impatient with people, often online, who from the start have been shouting ‘we should do this, we should do that, why aren’t they doing this, that or the other’. I work in the health service and I’ve taken the line from the start that the team of medics and other experts (Tony Holohan is the main public face of this), that the government has been following the advice of that team and that’s what we all need to do. That team is best informed and best placed to make decisions about when we should take whatever action.
But I also understand people’s frustration about this and the desire to ‘do something’.

Now … some cognitive dissonance (I think… I’m not as clear as Roddy and the rest of yis as to what that actually is 🙂 ).
The debate about the difference between the government approach in the RoI and the approach in NI. There have been different approaches, different steps taken at different times – the RoI’s steps taken on the expert advice of that team I mentioned above; the NI’s steps taken on the expert advice of their team and mainly following the line of the UK government.
And it’s early days but am I right in saying that death rates in the RoI and NI aren’t wildly different. And is that a better comparison than e.g. RoI vs UK. SoS made the point that this disease hits hardest in urban areas. Roddy said that he always felt that more rural societies wouldn’t be hit as hard. It makes absolute sense. On this island, the greater Dublin region has had what, about half the total cases.
So my slightly cognitively dissonantic point (counterintuitive even, must look that up) is this: Ultimately, it may not matter an awful lot what expert human advice we take and follow – this virus is going to do what it’s going to do. And ultimate differences in death rates may be more about things such as population density than about the steps different governments took and when and based on whatever expert advice they were following or chose to listen to.

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Aonrud ⚘ - April 9, 2020

I think the meaningful comparison is the rate of increase – if a country is 10 days since its first reported deaths and the rate of increase is a much higher % than others at that stage, that’s a useful warning. But you’re right, comparison as of now doesn’t necessarily say much, since the outbreak hit at different times.

I think the UK did revise its figures to include non-hospital deaths, but can’t find a reference to that now… Certainly, cases in the UK has been a meaningless metric since the outset, because of completely different testing criteria.

As you say, population density is probably useful. For example, comparing US figures with a European country can’t tell us much, I assume. Looking at New York alone shows a very different picture. It’s hard to know what scale of comparison works though – certainly comparing small populations with large ones produces odd results.

But on your last point, surely when the major cities locked down and how early they did it will be a huge factor?

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Ned Corcaigh - April 9, 2020

Good point by Joe re Ni and Republic probably being a better point of comparison than UK and Republic. It seems to be an article of faith among quite a few people that things are much worse in the NI because of government policy etc. yet the figures don’t seem to bear that out at all. Bit of wish fulfilment going on there.
I do think this weekend’s exodus does give the lie to the idea that this country is a paragon of collective effort and social responsibility. We tend to be a bit prone to the idea that in all kinds of fields we are a shining example for everywhere else to follow and the envy of the world. It’s an insular thing probably.
Kind of agree with Joe too that in the end there’s only a limited amount which can be done anyway. And also with his point that Holohan et al probably know a bit more about what to do than the horde of virologists arrayed on Twitter.
Yachties are very annoying though. Perhaps even a virus in their own right.

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Alibaba - April 9, 2020

Somewhat like Joe, I would look to the medical experts first and would tend to take their advice, but then I would listen to healthcare workers for their takes because they know their stuff about what’s going on currently and where pitfalls must be addressed.

Regarding figures, interesting to see twice as many deaths per head of population in the UK compared to Ireland. More generally, I would like to see figures that show the ratio between virus cases and deaths internationally and how this relates to the onset of ‘cities locked down’.

As for getting back to ‘normal’, the Wuhan lockdown ended after 76 days, and restrictions within the city still remain in place. The lockdown happened in a very controlled manner in a centrally planned economy and in a way that is very different from the lockdown activities going on elsewhere.
 
My guess is that it will take much longer to ‘return to normal’ here. Harris expects virus restrictions for a ‘period of weeks’. Nicely ambiguous that, although in fairness it would be socially irresponsible and politically lunatic to set a deadline.

And it all depends on how we define ‘normal’. There will far reaching consequences for those whose medical treatment of non-Covid illnesses has been deferred, for clearing the backlogs and all this is just for the starters.

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sonofstan - April 9, 2020

“It’s an insular thing probably”
A small island thing really: bigger countries are actually far more insular. We Irish care deeply what the world thinks of us, whereas here in Britain no one really cares what the rest of the world thinks all that much. It’s pretty aggravating when you try and point it out, but it get’s you nowhere.

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Ned Corcaigh - April 9, 2020

Monster queues outside the local shops here this afternoon. No real difference in holiday home arrival numbers from a normal Easter weekend apparently. Heard that a quite few of them did arrive down in the early hours of the morning.
Make of it what you will.
You’re right though SoS, I used ‘insular’ in the wrong sense. Bugger.

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Ned Corcaigh - April 9, 2020

I am mildly surprised at the lack of public spirit. But I’m sure the rationalisations will arrive before too long.

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WorldbyStorm - April 9, 2020

+1 Alibaba re how do we define ‘normal’. It surely aint’ going to be what it used to be.

I think that’s a key point Aonrud, clearly the timing of lockdowns has been key. Look at NZ, and to an extent Australia. Again, there was no excuse for some of the messing around in NI, individual schools not closing when actual cases of the virus had been found in them. Though I do think that’s a valid point re the comparison between NI and the ROI being useful or more useful than necessarily with other places.

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5. CL - April 9, 2020
6. makedoanmend - April 9, 2020

Good scientific practice, and more so in medicine/health, is guided by the fundamental principle that you should always err on the side of caution; especially when many variables and subsequent conditions are unknown. In medicine the guiding principle is to save life above all else, but that is oft times easier said than done.

The scientific study of pandemics is not new or an emerging discipline. Pandemic disease is a well studied area of biological science and health, and there is abundant literature regarding the various issues in the public domain. There have been extensive studies carried out on SARS, Elboa and HIV in recent history to name but a few. We are also privy to additional information about how foot-and-mouth occurs, for example, and how we’ve had to deal with it on a national and international basis. This disease does not kill all animals and many could recover, but science and health officials know that it is very hard to eradicate the disease without strict quarantines and culling. Still the disease seems to pop randomly again and again.

Most well capitalised countries have competent scientific and health advisors at their disposal just for these types of eventualities, and we have international organisation like the WHO. (Although I see President Trump is threatening to stop the USA’s contribution because he seems to want WHO officials to blame China for the outbreak. Pretty petty stuff but not uncommon in certain political circles these days.)

Nor did Western European countries lack information regarding the Covid-19. WHO made information public about from at least January. It appears most Western countries seemed caught in the headlights initially as it appears political leaders across the world were more fearful of the economic impact rather than focusing on the ramifications of disease spread and the possible death toll. There seems to have been a distinct gap in communicating the data and ramifications between health officials and most governments.

The Germans took a view that without an immediate vaccine that testing would be key and then adopted the social distancing information provided by WHO. This policy seems the best one available, but the German response may have as much to do with luck or just some tendency inherent in the German medicine and national ethos – or both.

Just yesterday WBS posted up an article that dealt with a study carried out in the USA that suggested that the pandemic was peaking in Ireland, but the Irish medical advisory establishment was up to the task by refuting the study’s conclusions. In fact, the Irish health advisory panel has been pretty good so far. They certainly seems to be a cautious bunch. But our govt made a mistakes in delaying closure of vectors.

But the fact remains, as initially mooted, the much MSM publicly hearlded so-called policy of herd immunity was flawed both in its conception and at the most basic level of understanding of the term and how it came into usage in medicine. (The entire exercise smacks of D. Cummings need to be a “radical and innovate” capitalist.)

So, no, the UK’s initial response was less than satisfactory, and was in fact flawed. But it’s not that big of a deal. Most, if not all, countries made initial “mistakes” and unfortunately there is room for plenty more to be made. The UK made a u-turn and made adjustments later than most other European countries as was evident by the failure close a major vector in the case of schools.

The problem is compounded for us on the island in that the response in the six counties could impact on the entire polity of this island. A subsection of the political establishment in the six counties felt the need to emphasis their allegiance to their team rather than to well-being of their entire community, and probably with little or no interest of the impacts in the Republic. So,once again, no, the reaction of the political establishment wasn’t acceptable by basic tenets of pandemic advice. If something similar or worse occurs in the future and the same political line is again adopted, should the Irish govt immediately set up a border to stop all movement? Much new thinking is going to have to be contemplated.

At this jucture tyring to do some simple on the back-of-envelopes tabulating isn’t going to be very clarifying. It will take a much broader study with organised comparisons between different medical organisation and between different countries to draw up actionable policies for the future. A good study and policy formulation would be one that is tailored to specific countries or regions.

Anyway, the virus has quite some ways to go in terms of its evolution and much more data, especially at local levels, needs to be collected.

But the main tenet of pandemics will always remain the same. Err on the side of caution. You deal with pandemics with a view to limiting their impacts on the population, and you need seek international cooperation as a basic condition. The UK initially, like all European countries, took an individualistic approach, focusing on their own interests. With regard to pandemics, the EU now needs to focus on a wider policy to coordinate a continent wide response.

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WorldbyStorm - April 9, 2020

That’s very much my thinking too on this. Strange political decisions were made in the UK and in NI that were exacerbated by the very specific view of capitalism extant in the UK’s political governance elite. And because we’re on an island that has an impact and a potential for much worse. And I think that’s a very good point re the lack of all-island accord in regard to the border. Of course the real irony is how during foot and mouth the DUP were arguing precisely the opposite, that the animals on the island were all as one in being Irish and hence an all-island approach was necessary. But then that was economy, economy, economy.

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