316 - Covid in September

I think interest is steadily reducing, but I shall continue to keep an eye on the progress—or its lack—with this issue.

These local cases maps shows the positive cases in a week for areas in the North-West (Morecambe to Worksop, York to Liverpool) in units of about 7200 people, updated daily. To show how much the situation changes I show what was available on first 08Sep,17Sep. Generally the data is 4/5 days behind, so the 08Sep map shows the incidence of cases for the 7-day period 29Aug-05Sep. The second is from 17Sep. [showing 06-12Sep]. the third will be the following week, eventually

Essays 293, 299, 300, 303, 306 and 311 relate, and remain relevant as references to what was known (and picked up by me) at the time. 

A summary for September follows.

I am hopeful that we in the UK will set up a regime of frequent and widespread testing so as to allow us to be aware where it is we need to raise our precautionary levels. It is pointed out that if a large proportion of us have, say, a negative test within the last seven days, that mass of the population can behave as they would have done in 2019. But to do that we not only need to be able to provide and afford mass repeated testing of the order of millions per week, we also need to be able to afford, as individuals, to isolate without significant loss. At the moment it is clear that one would not name one's contacts to the track/trace system if one was aware that in doing so you would cause them to lose their income for the next two weeks. If, instead, people required to isolate had, say, 80% of their pay provided by the state whether or not they could work from home for the quarantine period, that might well resolve the issues. The government is consistently unable to make a clear statement that does not then change within a short time; the message thus received is that the government is a long way from having a grip on the situation and in turn that implies they don't have a grip on a range of other matters. In particular, the general direction that the country moves in is what we look to our state organs to provide – and this is what we do not have. The people at the top are collectively seen as weak, especially in comparison to the past and to other available people; the direction in which we choose to go is evidently not in any sense a consensus and one wonders whether the Conservative party would serve the nation far better if it fractured into constituent parts – and then we would all be served far better by proportional representation.

I'm struck by the leap in UK cases, such that the UK has now passed (on the 8th) its own limit for need-to-quarantine of 20 cases per 100,000 in the 7-day cumulative figures. I think of this as a leap of stupidity, so characteristic of the UK of late; England especially. I am embarrassed to be English, not that I have ever particularly subscribed to such a meme, being British and European – and, if pushed, a Geordie or Cornish, but not English. One cannot live on the periphery and easily associate with the centre.

On the night of the 9th we had the announcement of increased general restrictions; the new message, "Hands, Face, Space" and the maximum of six for groups. Meanwhile, the stupidity of suggesting we are prepared to break international treaties is a distraction designed, I think, to draw attention elsewhere. It is a stupidity because we would forever be pariahs; just suggesting it makes us untrustworthy as a nation. Such is the disaster that this government represents. It is likely this is a negotiating ruse, inwhich case this more mnerly a demonstration of stupidity, cupidity and something darker, such as an intent to destroy. It is a move towards anarchy, I think; how far can we be pushed before we all do a Cummings and say "None of this applies to me"?

As of Friday 18th, the North East is in a modified lockdown, 'rule of six' for all of UK. imminent lockdowns in other places. Perception is that the gov't has lost the plot, since what the NE thought was appropriate was different from what was set by London. This demonstrates failed devolution which will break down to a battle for power that London wants to win, but shouldn't, ekse we'll all have even less trust in our institutions. Trust would be engendered by giving power to the locals, even if they get it a bit wrong.

On the right, the the blue bar graph is the latest  ONS case count for the UK. 20 cases per 100,000 in any 7-day period works out at around 1.3k on this graph; above that and we break the UK boundary for need-to-quarantine. We passed this on 30Aug. It is the return of school (and hence work) without compensating reductions elsewhere, plus a horde going abroad for holiday, that I blame for this rise. The argument, if there is one, is that the cases 'are among young people' who are relatively very safe from severe illness; that is of no consequence if you're an older person dealing with the young, directly or indirectly so. We must keep the current case count low enough.  We learned earlier that prevalence AND reproduction rate are important; both need to be kept low.

This next pair of charts is created and maintained by me from Worldometers data and corrected as and when I notice there has been a change in the supplied data. These are both divided by population and with a logarithmic y-axis, doubling with each shown grid line. This serves to spread out the many coloured lines somewhat and perhaps shows change as readily as any other method. I changed the righthand of these two to more easily see where the quarantine-on-return line is. So, by my figures, Sweden was briefly in the quarantine-on-return class, and Portugal reached it at the end of August, while Italy is still 'safe', just. Not that I see any sense in travelling abroad; while our figures are (so) high, we're in a state where other nations would want British visitors to quarantine on arrival.

The oscillations (Sweden, most)  are effects of the ways the nations collect data. Just occasionally there is an adjustment backwards as if someone has attempted to attribute dates more sensibly. Sweden especially seems to work a short week. It disturbs me that the general trend of these graphs is upwards, though it is good to see that Belgium is steadily getting something of a grip upon its own issues; claims that the UK is worst in Europe are all defeated if you look at Belgium's figures.

This comparative nation graph shows the continued state of the currently selected major nations. I've kept the top four, and I select from the many items of data I copy each day (for example, I record Pakistan but don't show it). Again, log scale base two for the y-axis. It seems to me as though the situation is remarkably steady from the start of August, with RSA cases declining, those of Spain and India growing. As ever, the process of counting is made difficult as that requires a test as evidence, and the provision of testing has a dramatic effect of the level of incidence recognised. If the UK situation is in any sense typical, then the prevalence in the spring was enormously higher than we thought at the time. This was reported and discussed, but the need for information was, I suspect, swamped by more immediate needs.

Here the data points are faint and the dotted line is 7-day average. I suppressed the legend, replacing it with labels in appropriately coloured text boxes.

This blue and yellow graph (blue deaths and yellow cases)  records the UK position, so that the two curves can be overlaid. I changed the factor from the previous version, from eight to ten. The faint line is the data, the dotted line is the 7-day rolling average, which sometimes extends beyond the current date. 

My perception is that the increasing separation of the blue and yellow lines indicates that we're finding more cases. Also it is suggested that the virus is weakening in effect, which would preserve the virus – and us, too. Perhaps this coronavirus will join the legion of others known as the common cold. But the rising trend of active cases is very worrying, implying an imminent surge. This is really bad; there is not much one can do at an individual level about this.

I have added below the invidious nation comparison for points in the month, only showing per capita figures and ordered by deaths, updated as the date arrives. Worldwide we're looking at 0.01% deaths (pretty trivial in comparison to other causes) and 0.3% cases. Health figures are often given per 100,000 of population, so divide by ten; e.g., a UK aggregate figure of 61 deaths per 100,000. The worry, for the Northern hemisphere, is that we really do need all the numbers much lower before winter hits; the experience is that when we move indoors, illness spreads much more readily. I expect campaigns for vaccination for things like influenza in an effort to reduce the incidence of all illnesses.

DJS 20200903

Related pages:

Essay 291 - Effects of an outbreak  what it says, effects, but some description of what we have (and not)

Coronavirus (Y10+)   modelling problems

Epidemics                  more general theory

Infectious disease      looking at the 2020 problem, particularly effects of the reproduction number changing.

Essay 298 Covid Consequences       surprisingly prescient, considering when it was written.

Essay 299  Covid in April

Essay 300  Covid in May

Essay 303 Covid in June

Essay 304 Covid Disparities           A report on the report, including what it doesn't say.

Essay 305  Risk

Essay 306 Covid in July

Essay 311 Covid in August                 

Essay 316 Covid in September          this very page

Viruses are very small                        worth reading, I think.

Recent notice that children, and therefore the mass numbers in school, show a wide range of symptoms for early stages of coronavirus infection, where vomiting and diarrhoea are sufficiently common to be added to the recognised indicators.

Also, the general understanding now is that the bodily risk definitely increases with age at around 12% a year, so the high current incidence in younger folk (say under 25) is not worrying. 50,000 cases in the school age group night produce one death, 5000 cases for a death at about 30 but more like five cases for a death among the very old.  See. Compound interest would suggest that 12% a year means add six years to double the effect; the wife and I are 30 years apart in age so I'm thirty times more at risk, 1.12³⁰ = 30.

In response to a FB post:

Hands, face, space; 

Handbag, keys, mace? 

Only going down the street, 

Need mask and gloves in case I meet

A friend.

Found 20200915, this purports to explain what connects obesity with covid additional risk. That there is a connection is unduisputed.


I have attempted an edit to show the relevant content, but do read it for yourself.

The physical pathologies that render people with obesity vulnerable to severe COVID-19 begin with mechanics: Fat in the abdomen pushes up on the diaphragm, causing that large muscle, which lies below the chest cavity, to impinge on the lungs and restrict airflow. This reduced lung volume leads to collapse of airways in the lower lobes of the lungs, where more blood arrives for oxygenation than in the upper lobes. 

Other issues compound these mechanical problems. For starters, the blood of people with obesity has an increased tendency to clot—an especially grave risk during an infection that, when severe, independently peppers the small vessels of the lungs with clots. In healthy people, “the endothelial cells that line the blood vessels are normally saying to the surrounding blood: ‘Don’t clot,’” ... because the virus injures endothelial cells, which respond to the insult by activating the coagulation system.

Add obesity to the mix, and the clotting risk shoots up. 

Immunity also weakens in people with obesity, in part because fat cells infiltrate the organs where immune cells are produced and stored, such as the spleen, bone marrow, and thymus. The problem is not only fewer immune cells, but less effective ones. [...] They make fewer molecules that help destroy virus-infected cells.

People with obesity vaccinated against flu [have] twice the risk of catching it as vaccinated, healthy weight people. That means trials of vaccines for SARS-CoV-2 need to include people with obesity, because coronavirus vaccines may be less effective in those people.

Beyond an impaired response to infections, people with obesity also suffer from chronic, low-grade inflammation. Fat cells secrete several inflammation-triggering chemical messengers called cytokines, and more come from immune cells called macrophages that sweep in to clean up dead and dying fat cells. Those effects may compound the runaway cytokine activity that characterizes severe COVID-19. 

A discussion at home about very large people revealed that there are folk with a BMI over 150. And there's me thinking 30 is bad. Long lists of people over 1000 pounds (440kg). Super-obese is BMI > 50. Some 7.7% of US citizens exceed a BMI of 40. The graph (source) shows this is not improving. There is a strong correlation of obesitywith a lack of education (see, Fig 1), poverty and food poverty – disadavantage in general.

Email: David@Scoins.net      © David Scoins 2018