Worrying times

[David Gilbert]

But do the new codes attribute the cause of death to Covid-19 or do they merely say that a deceased person tested positive for Covid-19?

The NHS is reliant on its small army of clinical coders to get this right. They are the real experts (that's to say, not me). The emergency codes are used to collect data on the reason for hospital admissions and for use on death certificates. So for admissions U07.1 is used for people who’s diagnosis for COVIS-19 has been confirmed by pathology and U07.2 is used where the virus has has been diagnosed without pathology (with three subsets for clinically-epidemiologically; probable; and suspected COVID-19). At the end of all this we should be able to use the data to match, through the Hospital Episode Statistics (HES), COVID-19 admissions to discharges (a proxy for recovery) and deaths.

There is likely to be data on clinical tests, but that was never part of my remit.

So, the reason for death would be attributed to code UO7.1 or code U07.2, indicating Covid-19, regardless of whether the deceased also had say, cancer, motor neurone disease or another serious disease? I ask because it's presumably important to know how deaths are classified when interpreting mortality rates.

I'm now stretching my knowledge as a former data user to technical matters on how these data are collected.

So it depends to the cause of death. The death certificate will show the disease or condition that initiated the train of events that led to the death. If a person had been admitted with sepsis or a significant head injury and was found later to have COVID-19, but still dies from sepsis or the head injury, it's sepsis or head injury that will go on the death certificate as the underlying cause of death. The clinician may recognise that COVID-19 had played its part in the death and that will be recorded as a contributing factor. The clinician won't use the codes, the coders at the Office of National Statistics are responsible for doing that from death certificates and I imagine they have an algorithm for converting words to ICD-10 codes.

[JustinHorton]

Meanwhile

[Paul McKeown]

And I would plead with those who want to argue about the disease, to give reference to the science, rather than just stuff thrown up by journalists or politicians or some talking head, or worse still their personal wisdom. Even if it isn't a reference to a peer reviewed paper or a letter to an academic journal, at least keep it to the level of an expert writing about the science and giving specific reference to papers that they themselves have read. If we don't have this discipline, we are simply arguing the toss, and I don't see the point of that.

[JustinHorton]

There was only ever talk of "herd immunity" in the UK.

Sweden are persevering with it, and they're The Guardian's favourite country.

What purpose does this serve? What does it mean? Do we have a quote from the Guardian saying this? Is anybody here representing that newspaper?

.
Even if it isn't a reference to a peer reviewed paper

Just to note that because events are moving so fast, not everything that is being produced by the scientific community is actually undergoing peer review. The Oxford study certainly wasn't peer-reviewed for instance (not sure, off the top of my head, about the Imperial paper). Everybody involved is quite open about this, there's no subterfuge, but it should be borne in mind.

[Tim Spanton]

A range of experts quoted by the BBC (for those who have not seen it):

The flu comparison

In contrast, the figures put forward for flu - 8,000 deaths a year - is different.

It is actually the number of deaths over and above what you would expect to happen in any given year.

In fact, it is perhaps a little low. Public Health England uses a figure of 17,000, based on recent winters.

Many more actually die with flu, but this figure gives you an indication of how many more die because of flu.

In comparison, the daily coronavirus death figures and the modelling by Imperial, simply look at those who die with the virus.

They do not tell us is to what extent coronavirus contributed to the death.

How many extra deaths could there be?

A team from University College London (UCL) has attempted to unpick this by looking at the expected number of deaths you would normally see, and then mapped out how many extra deaths coronavirus could cause.

The paper, which has not been peer reviewed yet, shows those from the at-risk groups - the over 70s and people with health conditions - have a 4.4% risk of dying in the next year regardless of coronavirus.

That is to say, one in 20 would not be expected to be alive one year later.

To factor in the impact of coronavirus, there are two variables which are as yet unknown - how much it increases the risk of death by, and how many people become infected.

If it turns out to be as deadly as flu and just 1% of people are infected (the upper limit of what we should be aiming for given the measures in place according to researchers), the number of extra deaths will be under 1,400.

But many believe it will be more virulent than flu, so the researchers mapped different scenarios.

If it was five times as deadly - a "reasonable" estimation, researchers said - there could be 6,900 excess deaths.

If 10% of the population were to be infected with more relaxed measures, the excess death figures would increase 10-fold. But these are just models.

What is needed now that the virus is spreading, is for researchers to get good access to hospital data and in particular intensive care records, so they can more accurately work out the impact the pandemic is having, says Amitava Banerjee, who is leading the UCL research.

Prof Robert Dinwall, an expert in sociology from Nottingham Trent University, says it is also important to consider "the collateral damage to society and the economy".

He cites the mental health problems and suicides linked to self-isolation, heart problems from lack of activity and the impact on health from unemployment and reduced living standards.

The economic hit is something University of Bristol researchers have now looked at. Their conclusion? Trashing the economy costs lives.

They found the benefit of a long-term lockdown in reducing premature deaths is outweighed by the cost in terms of lost life expectancy from a prolonged economic dip.

And the tipping point is a 6.4% decline in the size of the economy - on par with what happened following the 2008 financial crash - which leads to a loss of three months of life on average across the population because of factors from declining living standards to poorer health care.

Next steps

There are, of course, other factors at play here. Left unchecked - or not checked enough - the deaths would come very quickly.

This in itself would overwhelm the health service, putting even more lives at risk, because care may not be available for others whether that is a heart attack victim, a stroke patient or simply someone who has had a fall.

But, given that suppressing the virus is almost certainly not going to make it go away, and the prospects of a vaccine being available in the near future are considered slim, at some point the government is going to have to weigh up the full benefits and costs, to help it decide on the next step.

[Paul McKeown]

Thanks, Tim. That's a better post than many here. Of course, the economic effects will kill many. It would be interesting to see analysis of this effect.

[Paul McKeown]

Just to note that because events are moving so fast, not everything that is being produced by the scientific community is actually undergoing peer review. The Oxford study certainly wasn't peer-reviewed for instance (not sure, off the top of my head, about the Imperial paper). Everybody involved is quite open about this, there's no subterfuge, but it should be borne in mind.

A fair point, Justin. But the papers currently being produced will nevertheless form part of an academic canon, and will be referred to as such on equal terms by later peer reviewed papers.

And my plea remains. Cut the egotism and the bull**it, folks.

[JustinHorton]

A range of experts quoted by the BBC (for those who have not seen it):

The flu comparison

In <snip> the next step.

As far aa I can see this is this piece from three days ago, but to some degree cut up and re-ordered, dunno why. (It's usually better to provide a link than reproduce a whole piece anyway.)

[JustinHorton]

The economic hit is something University of Bristol researchers have now looked at. Their conclusion? Trashing the economy costs lives.

They found the benefit of a long-term lockdown in reducing premature deaths is outweighed by the cost in terms of lost life expectancy from a prolonged economic dip.

And the tipping point is a 6.4% decline in the size of the economy - on par with what happened following the 2008 financial crash - which leads to a loss of three months of life on average across the population because of factors from declining living standards to poorer health care.

Incidentally, the only reason Triggle (who has not distinguished himself in recent days) seems to refer to this paper, which I don't believed has been peer-reviewed either, is that it was reported and promoted by the Times newspaper. Professor Portes for one is very much unimpressed.

[Michael Farthing]

If the assumptions and models used in producing this paper are correct, then it is clear that strict isolation measures are necessary, despite the economic cost.

As witnessed by this direct quotaton from the paper:

It is important to note that we do not quantify the wider societal and economic impact of such intensive suppression approaches; these are likely to be substantial.

[NickFaulks]

And the tipping point is a 6.4% decline in the size of the economy - on par with what happened following the 2008 financial crash

That only happened because top priority was given to bailing out our wonderful financial services industry - as appears to be happening again, even though we have barely finished paying for the last debacle. Isn't it amazing that after the banks have been stress tested to check that they can handle any crisis, the instant reaction to an actual crisis is to weaken the tests? ( no it isn't ).

[David Sedgwick]

My original post was a genuine wish for all in the chess community to avoid the worst that this pestilence is bringing, whether medical or economic, whether personally experienced or amongst friends and family.

I have deleted an earlier post in which I criticised another poster personally. I should not have made such comments in what was supposed to be a support thread.

[JustinHorton]

Possibly useful explainer

[Mick Norris]

Matt Hancock has now tested positive.

Whether the country would run better without him, Johnson and some of the others is a good question; they wouldn't be on my list of key workers

They are members of the elected Government. Moreover, at present you still live in a country where you are at liberty to make the comment which I have quoted.

If you think that a different set-up would serve the nation better, be careful what you wish for. I have heard some pretty horrifying reports about the potential outcome in Iran.

No, I don’t want to live in Iran; nor in China or North Korea, nor in Putin’s Russia or Trump’s America, but I haven’t wanted to live in this country when we elected Heath, Thatcher, Major, Cameron or May either

Then again, I didn’t want to return last Thursday, for the first time since my dad died in 2016, to the registry office where I had registered his death, the solicitors who dealt with his estate, nor the funeral directors who organised his funeral; nor this Thursday to the crematorium where we had said goodbye to him; Thursday was my daughter’s 4th funeral before her 15th birthday, and with another terminally ill relative, she may well attend a 5th before she is 16

What I am acutely aware of, though, is that other people will be making a similar journey, often wracked by grief, rather than the relief we felt when my aunt finally died from her terminal illness, and often without the experience and resources that I have acquired

You’re probably aware that this football season hasn’t seen me at Gigg Lane, but instead during it I have met, albeit mostly briefly, more than a hundred NHS staff on visits with my uncle and aunt to hospitals in Chorley and Preston; I have met these mostly for the first time, although I did meet a sister who had cared for my dad on the ward on which he died, which was an opportunity to thank her; I’ve met staff who deal with safely discharging elderly people with physical health problems plus early stage dementia, social workers and support workers, care staff in the community, at a nursing home and a care home, and staff of all sorts at the assisted living home near Chorley where my uncle now lives

These people, and many more like them, were let down by Jeremy Hunt, by call me Dave and strong and stable Theresa, by coke it’s the real thing George, and spreadsheet Phil, by £350 million on the side of a bus Johnson, and they continue to be let down by incompetent Hancock

Like many other low paid workers, they are doing their very best in the current circumstances, and I’d like to see all of them have access to tests for the virus ahead of the Prince of Wales, the Prime Minister and the Health secretary, because they are key workers; I don’t really see what’s hard to understand about that, any more than they should have PPE where needed and we haven’t organised that either

Posters here will have voted for parties led by austerity Swinson and the idiot Corbyn, to stop the Tory party, and know that failure will result in more people dying; Paul likes us to show our sources, so here’s an article with a reference to Steve Hilton, one-time adviser to David Cameron saying that

austerity policies in the UK caused an extra 130,000 deaths

I don’t want to see anyone get sick, or die, but they will; it’s tragedy to read stories like this and quotes from grieving families like

We feel doctors at the moment really are open to the disease and they need a bit more protection than what is being offered. We doctors feel like sitting ducks.

I do live in a country where I can say this, but it is also one where lots of the press is owned by government supporting people who don't pay UK tax, and thus don't fund the services on which we rely, but print lies; and one where the government is considering bailing out Virgin, an airline owned jointly by Richard Branson, a rich billionaire non-UK taxpayer, and Delta, a solvent American airline, yet can't actually support UK taxpayers struggling through no fault of their own

Take care, and stay safe

[JustinHorton]

Hilton is a grifter, mind. (Obviously I generally share the sentiments about austerity, I'd just like to hear them from a less cynical voice.)