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Rough calculations… May 21, 2020

Posted by WorldbyStorm in Uncategorized.
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A stray bit of news this last week has significant implications:

A study led by the Pasteur Institute has found that just 4.4% of the  French population – or 2.8 million people – have been infected by the novel coronavirus, much higher than the official count of cases but too low to achieve so-called “herd immunity”.

“As of a consequence, our results show that, without a vaccine, the herd immunity alone will not be enough to avoid a second wave at the end of the lockdown. Efficient control measures must thus be upheld after May 11”, researchers say.

A Spanish study also published yesterday showed similar results, saying about 5% of the country’s population had contracted the disease and that there was no herd immunity in Spain.

But why control the situation? Because to let matters run uncontrolled runs, apart from the lethality of the virus, into two further problems.

Did a bit of number crunching on foot of figures released from NPHET at the weekend.

Over-85s account for 10.2 per cent of all cases, and 45.6 per cent of deaths, according to a breakdown of older age groups provided for the first time.
Out of a total of 22,915 cases, there were 771 among 65-69 year-olds, 910 among 70-74 year-olds, 974 among 75-79 year-olds, 1,241 among 80-84 year-olds and 2,329 among over 85-year-olds.
Out of 1,429 deaths, 69 occurred among 65-69 year-olds, 128 among 70-74 year-olds, 180 among 75-79 year-olds, 304 among 80-84 year-olds and 652 among over 85-year-olds.

1,429 deaths, 1333 aged 65 and over which leaves 96 aged below 65.

It’s back of the envelope stuff. But add a 0 to each figure below and rapidly those numbers ramp up. So, for example…

As of now we have…

22,915 cases
96 deaths below 65
1,333 deaths above 65
2,915 Hospital admissions
373 ICU admissions

Add a 0 as the virus spreads tenfold.

229,150 cases
960 deaths below 65
13,330 deaths above 65
29,150 Hospital admissions (NB there were 14,000 hospital beds in the ROI in 2017)
3,730 ICU admissions (NB Ireland currently has a total of 537 critical care beds)

Add another 0 – this would be approaching though not quite at half the population of the state. Still not enough though for ‘herd immunity’ in any meaning of the term.

2,291,500 cases
9,600 deaths below 65
133,300 deaths above 65
291,500 Hospital admissions
37,300 ICU admissions

Double that to bring the figures closer to the population of the state c20,000 deaths below the age of 65 and 266,600 deaths above the age of 65 A staggering near 583,000 people in hospital or thereabouts and 74,600 ICU admissions.

Would that happen? It would under the logic of those who have supported ‘herd immunity’. Could it happen in reality? Well, I think not for reasons articulated below. And there could and likely would be mitigating factors. Perhaps those who are hospitalised skews towards the elderly (though notably near enough 60% of those who died according to the figures released three days before the above figures were in a non-hospital environment).

As the virus goes through the population perhaps that would see that pool diminishing – which is a glib way of saying people would die in very very large numbers. That said the population of the state in 2016 over the age of 65 was 637,567 (in 2011 the number over 80 was around 130,598). That’s a lot of people and the first tenfold jump in the virus would easily be accommodated by that number – a jump that would have implications for the health service which are addressed below. Perhaps those with underlying conditions would be fewer as the virus worked its way through the population, perhaps some cocktail of treatments would be developed, though how would a health service under such pressure of numbers be able to use these treatments?

But cut it whatever way one wants once numbers ramp up we are talking appalling numbers of deaths, massive surges of people who have been infected, and consequent waves of those having to go to hospital and some on to ICU.

And keep in mind for the proponents of herd immunity those numbers don’t just have to ramp up, they have to keep going. They need to get to the point where everyone who can be infected is infected – despite there being no evidence as of yet that catching the coronavirus offers anything other than short term immunity from reinfection (as has been noted ad nauseam there’s no long term immunity against colds or flu). Kingston Mills in the IT pushed back hard against that particular concept of so-called “herd immunity” while noting that ‘A very optimistic figure of 60 per cent has been suggested as being the threshold for herd immunity against Covid-19, but this is not backed up by reproducible research findings’. So it would have to be more than 60%, though Mills argues for herd immunity through vaccination (or elimination or containment of the virus). But if the virus only reached 4-5% of the population in this initial outbreak(s) in Spain and France and we see the accompanying misery and death and attrition of resources in health and so on… what would it take to get to 60% plus?

And how would ICU deal with those numbers. Well ICU’s couldn’t, of course (George Lee does an interesting comparison with Sweden here on RTÉ taking the current levels of spread of the virus in both the ROI and Sweden. It’s not comforting either in relation to how matters might go if numbers ticked upwards). And hospitals would collapse. That would overwhelm any health system. Unless those who advocate the so-called “herd immunity” strategy are willing to stand over not admitting those cohorts in the 65 area to hospital care. Which likely would lead to even greater numbers of deaths and/or the breakdown of social and civil order as people revolted against governments who would carry through such a measure impacting on themselves or their loved ones. Or perhaps one lengthens the timescales. To absurd degrees.

As it happens David McWilliams did a not dissimilar exercise at the weekend here. 

Let’s assume that the current situation is sustainable, ie the daily new confirmed case numbers (265 as of 6th May, though it was more than 800 on certain days in April) won’t overwhelm the health system. Let’s also take the best-case scenario from Italy implying 10 per cent of the population have already had it. This means we can subtract 461,390 odd people from the total population.

Recall that the 75 per cent immunity threshold in Ireland equates to a total of 3,691,125 new infections minus that 461,390.

By any calculation, reaching that 75 per cent without a vaccine would take years. My worst case number crunching arrives at a figure of more than 30 years. Even the sunnier statistical estimates suggest that, without a vaccine, we could have 14 years of this “on/off economy”.

Fourteen years. McWilliams seeks answers in a vaccine. I’m not sure there’s any such answer to be had given the track record with other corona viruses. But either as a rapid or a slow process clearly allowing the spread of the virus is a non-starter.

Consider the collateral damage to the society as a whole and indeed the economic damage as well. Many people wouldn’t work in that sort of a context. It would be simply too dangerous and the chances too random. Factories would close, businesses would remain empty. Many many workers would be sick with the virus. Many would sustain chronic conditions of lungs, heart and other organs that would impinge significantly on their health and quality of life. Take by way of example those aforementioned meat plants where Covid has impacted hugely on their ability to function.

One worker in a plant who took ill and thankfully survived was in hospital for 49 days. He is unlikely to return to work for a year. Perhaps that’s an outlier. Perhaps those who fall sick won’t be in hospital that long or won’t be in hospital. But they won’t be at work either. And that has a profound effect in and of itself:

The company has since installed partitions between workers but has had to scale back production, processing 200 instead 400 pigs an hour, because so many staff were out sick.

Or consider this example of a Dundalk nursing home where 60% of the staff were out with the virus and the measures taken to keep it running were quite literally borne of desperation. There’s a single quote from the latter which points up the absurdity of the push to ‘work’ absent all other considerations:

“Overall, 60 per cent of our staff were unavailable for work, some of them ill or in isolation, others fearful for themselves or for a family member with underlying conditions.” Some managers were also unavailable.

Or this far from funny comparison between the precautions taken in the Dáil and those in meat plants. 

We hear the idea the ‘cure mustn’t be worse than the disease’ in relation to the lock-down. But in this case the spread of the disease itself would be so bad it would shred social and economic activity.

And of course there’s another term for ‘herd immunity’ as used by those who have believed the spread of the virus throughout populations is a feasible route – one that has the ugliest historical and political resonances, that being survival of the fittest. At base that is what ‘herd immunity’ means in this context.

 

Comments»

1. CL - May 21, 2020

“Ireland will follow the lead of other European countries that have passed the peak of the coronavirus outbreak by beginning antibody testing early next month to determine the prevalence of Covid-19 in the population….
At the moment, there is no data to show (how) the extent of the spread of the infection in the wider population…
Dr de Gascun said…the idea underlying the prevalence testing is to go places where there have been larger outbreaks, and places where there are smaller or no outbreaks. Blood is taken from a representative sample of the population, matched for age, gender and ethnicity and laboratory tested. If the results indicates the prevalence is low (ie few have been infected) caution will need to be exercised, especially in the absence of a vaccine for the virus…
“We need to be careful on how to lift restrictions. As long as you have a susceptive population the virus will keep infecting. It could reach 60 per cent or more of the population before the virus runs its course,” said Dr de Gascun.

“If [the study shows] it is less than 5 per cent that is a concern, and we would need to be careful about lifting restrictions. If it suggested a prevalence of 15 to 20 per cent we can open it a bit more.”
https://www.irishtimes.com/news/politics/coronavirus-ireland-to-start-antibody-testing-early-next-month-1.4259083

To avoid confusion it might be useful to distinguish between Covid-19 and the coronavirus; Covid-19 is the disease caused by the coronavirus.
The purpose of the antibody test is to determine the prevalence of the coronavirus,-not the prevalence of the disease, Covid-19, as Harry McGee writes.
Dr.de Gascun asserts that the greater the prevalence of the virus the safer it is to lift restrictions; the greater the proportion of the population that has had the virus but not the disease, and have therefore developed immunity,(hopefully) the safer it is to begin reopening.
But can the asymptomatic continue to transmit the virus?

Can the experts be relied on?

“The government’s disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies.”
https://www.theatlantic.com/health/archive/2020/05/cdc-and-states-are-misreporting-covid-19-test-data-pennsylvania-georgia-texas/611935/

“The British Government has defended its position on track and trace, after NHS leaders warned that action to control the future spread of coronavirus is coming late in the day.”
https://www.irishexaminer.com/breakingnews/world/track-and-trace-strategy-coming-late-in-the-day-nhs-leaders-warn-1000875.html

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WorldbyStorm - May 21, 2020

“But can the asymptomatic continue to transmit the virus?”

A key question. isn’t it amazing how some in politics continue to act (actually some in the media too) as if these were all known quantities and it was possible to predict outcomes. Given that such a basic but fundamental aspect of transmisionby the asymptotic is still an open question I’d think great caution was the best way forward.

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CL - May 21, 2020

“But the public-health uncertainty is much bigger and more profound than American incompetence. The disease remains something of a mystery in patients; just as frustratingly, it remains a mystery at the population level, where social and political decisions must be made, and where nevertheless we have only something approaching best guesses about best practices. At first, epidemiological models made projections that were too high, then too low; lockdowns seemed first our last defense against a pandemic deluge, but the benefits are growing increasingly uncertain. We still have only the crudest understanding of which social-distancing policies work and which might be excessive; of the effects of seasonality; of why certain countries have been relatively spared despite quite limited precautions and others have fared quite poorly despite aggressive interventions.”
https://nymag.com/intelligencer/2020/05/facts-about-coronavirus-kawasaki-and-when-schools-will-open.html

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WorldbyStorm - May 21, 2020

That’s a very fair point. I’ve been scouring the internet looking for some definitive stuff on issues like longevity of the virus on fabrics, the dangers of being in say a room with a workmate, etc, etc. To say it is vague is being amazingly kind. Quite simply there’s very little in terms of clear data on those issues (another interesting point. On the continent here 1.5m is the recommended guideline in a lot of countries. 2m in Ireland and Britain. Which is it? Though I get the psychological aspect, ask people to stay 2m apart and then if they drift towards 1.5m and that’s safeish then no harm done. Ask them to stay 1.5m away and they drift to 1m not so great). Then there’s the randomness of who it hits and so on. The fact it is novel, that our understanding of it is limited that the effects are not at all clear is something I wish was more widely appreciated.

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WorldbyStorm - May 21, 2020
CL - May 21, 2020

The implicit assumption in the Guardian piece is that a high proportion of a population testing positive for antibodies will give a greater proportionate immunity and thus lead to a more favourable outcome such as a lower death rate; that Sweden would be better off with a higher percentage testing positive for antibodies as this would give more immunity.

This is not necessarily so. In NYC the areas and communities with the highest percentage testing positive for antibodies are the also the areas with the highest death rates.

“Over 40% of tested residents in just one Bronx neighborhood were found to have COVID-19 antibodies — a result that, Governor Andrew Cuomo said Wednesday, served as another indicator of the ravages of coronavirus within low-income communities of color….

The preliminary results for Morrisania found that 43% of those tested had COVID-19 antibodies present; that’s more than twice as high as the 19.9% average infection rate for New York City, as determined through previous antibody screenings.
Moreover, the hospitalization rate for Morrisania — 3.2 per 100,000 residents — was nearly double the average citywide hospitalization rate.”
https://www.amny.com/coronavirus/antibody-tests-again-confirm-nyc-communities-of-color-suffering-most-from-covid-19/

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WorldbyStorm - May 21, 2020

+1 Excellent point.

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CL - May 21, 2020

This also puts in perspective de Gascun’ approach cited above.
““If [the study shows] it is less than 5 per cent that is a concern, and we would need to be careful about lifting restrictions. If it suggested a prevalence of 15 to 20 per cent we can open it a bit more.”
So according to the de Gascun criteria areas such as the Bronx with double the antibody percentage as the average for NYC, and with twice the hospitalization rate, should relax restrictions before the rest of the city. Obviously nonsense.

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WorldbyStorm - May 21, 2020

Great spot CL. That’s troubling.

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WorldbyStorm - May 21, 2020

I know what he’s saying kind of. But it doesn’t seem to me to work. Presumably his thinking is that if say 20% of people had had it and had even short term immunity then they’d provide a barrier to its spread because they would interrupt the mechanism by which it spread ‘naturally’ since they would lower the probability of non-infected people catching it. But as you say the examples from real world contexts do not appear to support that contention.

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makedoanmend - May 22, 2020

There is no hard and fast % for herd immunity. There are several factors that need to be considered such as the virality of the disease, incubation times, etc. that have influence how we respond or how effective herd immunity becomes in the Long Term. Long Term.

When I was studying about the animal health a year ago, the ideal number was ~90% or better. I’ve since read that some think in relation fo covid-19 that ~80% might be sufficient.

In any case, 20% isn’t cutting the mustard by a country kilometer and, as yeese have pointed out in this thread, we don’t have near enough hard data in order to extrapolate information useful for polity policy.

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2. Alibaba - May 21, 2020

Really liked this piece by George Lee:

‘With so many people straining at the leash to break out of lockdown, many point to the different experience in Sweden with no lockdown. It raises questions about whether Ireland’s social, travel, and work restrictions needed to be so tough here after all. For anyone who asks that question of Chief Medical Officer Dr Tony Holohan, he has a very sharp and succinct answer: “Have you seen the intensive care admissions figures for Sweden?”‘

And Lee concludes ‘Our healthcare system simply could not have coped with the more relaxed approach taken by Sweden.’ Well, that’s very telling in more ways than one.

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WorldbyStorm - May 21, 2020

I’m actually impressed by Lee’s approach on this. I’d have thought he’d be more in the business ‘friendly’ camp.

That’s true re it being on various levels. A sort of back-handed compliment. On the other hand the system here ramped up capacity very fast but no capacity could deal with an outright so-called herd immunity approach.

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makedoanmend - May 22, 2020

Take this as being completely flippant response on my part WBS in the first sentence below. I know I’m using it out of the context of your use above:

Et tu WBS. “…herd immunity approach…”

Herd immunity is not an approach or a policy. (Herd immunity is the result of of a process, and it is not full proof at that.)

Medicine is the active intervention of humans in diseases, accidents or disorders in order to aleviate or to ‘cure’ a condition that would not otherwise be alleviated or remedied without intervention.

As you rightly say the “so-called” herd immunity wheeze dreamed up by the market-cures-all-ills of the Tory idealogues is based upon the unfounded belief that no intervention is a perfect response in these circumstance, and therefore business and the markets will eventually decide who wins and who losses – as is natural and ordained by…

The Herd Immunity approach of the Tories was, at a very fundamental level, a politically motivated policy. It is based upon a core belief in govt. non-intervention for individuals coupled with the belief that free markets always provide the best outcomes. (We just aren’t meant to ask who receives the rewards of the outcomes, or why some individuals [bond holders] do receive govt intervention.)

Given Trump Adminstration’s response(s) in the USA, I have to wonder if these ideologues aren’t all too unhappy with recent events. If they can condition populations to accept death as the price of free markets, what’s to stop their ideology of accumulation and domination?

(On another note, I read that Midlothian Scotland Area (incl Edinburgh) with a ~ pop. 850,000 only had 40 ICU beds available before the pandemic.)

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Alibaba - May 22, 2020

I suppose those of us on this thread are all on the same page about herd immunity. But getting back to George Lee’s approach, it is true he gets ‘a sort of back-handed compliment’. His take on comparisons with Sweden was very well made. But my comment was also a sideways swipe at Lee given his Fine Gael politics and his alignment with the very forces responsible for wrecking the health system. Lee is an apologist for this. Not only does he made no criticisms, he candy-coats it, as he does with Fine Gael’s ramping up the capacity. He was and most likely remains an austerity junkie. Moreover once elected on his first outing as a Fine Gael candidate he took umbrage when they didn’t genuflect to his expertise and give him a Minister’s role or as he said “virtually no influence or input” and so he took himself back to reportage. As cynical as it may sound, and although Lee can make astute judgements, the fact remains that a national broadcaster gives us so much of his careerist-driven utterances is groan-inducing without a doubt.

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WorldbyStorm - May 22, 2020

You’re absolutely correct makedoandmend to point that out re the incorrect use of the term ‘herd immunity’. Indeed it’s something I’ve tried to deal with by having it in ‘inverted commas’ and using ‘so-called’ in the first usage and some other usages on the post but I should have used it every time. It’s part and parcel fo the problem of using terms that are appropriated by the right and not making it sufficiently clear that their appropriation is incorrect.

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WorldbyStorm - May 22, 2020

Alibaba, sorry completely agree and I don’t think in my response I was clear enough either, that back-handed compliment referred to how our own health system wasn’t fit for purpose, though as you say GL won’t work through the logic of his own comments on this!

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makedoanmend - May 22, 2020

Nah WBS, given the thread context and your written responses therein, it would take a pretty twisted mind to think you were abusing the term or using it for other purposes. I’m certainly twisted – just not that twisted. 🙂 Yet.

My point about the term was tangental to the main discussion, but I still think core to the entire pandemic discussion and future ramifications. Herd Immunity was made a political term by the Tory party.

I can’t help but notice that as free market ideology matures it converges in many aspects with certain one-party state outcomes and results. I mean FFG were very content to let 200+ people die on Irish streets over their last term in office, and they seem to absolve themsleves of all responsibility because free-markets. How are they any different to those whom they claim moral and political superiority?

But there is an added potency to how free market idealogues often use the necessary ambiguities in science, for example, to forward their policies – herd immunity just being a recent concrete example. They use the very fact that proper science never claims to know any “truth” but only to better understand conditions through a very precisely defined method (the scientific method) about the universe in which we exist. It is a neverending quest, so to speak.

And that gets my goat.

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WorldbyStorm - May 22, 2020

Agree makedoandmend. And there’s such an incredible political element to this (as with everything but it’s just more obvious almost). Take the comments BTL on this:

https://www.irishtimes.com/business/our-warped-sense-of-perspective-bodes-ill-for-ireland-s-economy-1.4259285

The antagonism to the public sector, the idea that medical advice to the govt on restrictions is driven by people in the public sector etc is incredible given it is nurses, and bus drivers and doctors and so on who are on the front line of this.

I was thinking today that for all the complaints about millennial being snowflakes and unable to endure any hardship from the right what is very evident in the current period is that any restrictions are treated as one stop short of 1984 by that self-same right.

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3. makedoanmend - May 22, 2020

I was thinking much the same about Lee’s response. Context and his expressed public beliefs (such as we can actually know them) matter very much. Therefore, I took his utterances with a grain of salt.

While people on this thread are pretty much on the same page with regard to HI, it is those who are not that matter pretty much right now and might matter more in the future.

My hypothesis is that the ruling UK party initial response was driven by purely political ideology with science bastardised to provide a validated policy response using the term Herd Immunity. Practically speaking, we would hope that the science of pandemic policy informed govts first and foremost, and any pandemic policy would certainly express caution and temporary social regulation in order to fight an unknown pandemic; if only to buy time to construct a workable long term remediation solution.

Image if a communist govt had said it would sacrifice workers lives to the pandemic in order to drive forward historical dialectical progress. Why, the free market ideolgues and rank-and-file would be in a moral and twitter tizzy.

It would be impratical to suppose all politics, and especially the current ideology driven almost solely by capital considerations, would be ignored. Given the poor initial response across Europe, free market ideology certainly played a role in allowing the pandemic to spread quickly.

What is at stake, imo, is how our societies respond to such situations. Whether we like it or not, the Irish govt’s response was fundamentally different from that of Sweden, and initially the UK’s and Netherland’s. Irish policy still seemed informed by a total social consideration as opposed to just business considerations, if only just. Might it not adopt a more “radical” sectional approach, emphasing capital over people, if a second pandemic wave arrives?

And I’m trying to ignore the Trump Adminstration’s fubar response.

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WorldbyStorm - May 22, 2020

“Image if a communist govt had said it would sacrifice workers lives to the pandemic in order to drive forward historical dialectical progress. Why, the free market ideolgues and rank-and-file would be in a moral and twitter tizzy.”

This.

+1

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