EU Covid Situation

McGiver

bilston wrote: »

At the moment, I think talk of a second wave is slightly premature, I think it is coming and will come, but there is a chance that some of the increase at the moment can be explained by better track and tracing and better testing capabilities. But a relaxation of restrictions is bound to lead to some sort of rise in cases. Can this be kept under control?

Nice data there!

I agree it's likely down to better testing and tracing - we may be catching more asymptotic cases.

The deaths don't show increases, but they will always lag so I'd compare the 9 July avg with say 9 September avg deaths to the see if there was an increase. If not then we're catching more asymptotic or mild cases.

The only country that is a concern is Spain, the increase is large both in relative as well as absolute terms. However, it's largely localised (North and North East) to specific regions and is being dealt with by the local governments.

McGiver

darjeeling wrote: »

I'm expecting that countries will keep trying to find a balance, allowing as much economic and social activity as is possible without provoking a repeat of the earlier health system crises.

Unfortunately the testing technologies and capacity available will not by themselves be enough to prevent outbreaks, so I think we can look forward to a game of epidemiological whack-a-mole throughout the autumn and winter.

Schools, workplaces, venues, clubs etc will be closed temporarily when new outbreaks appear so that testing and cleaning can take place.

Wider imposition of restrictions and even lockdowns may be needed as and where community spread takes hold.

We are already seeing these kinds of closures and restrictions in many countries and so we have a foretaste of the disruption I expect to come.

Vigilant testing, continuous media campaign (to keep people vigilant), certain social distancing measures, universal mask requirements in enclosed spaces, no large assemblies indoors and outdoors will be required for now indefinitely, until a mass vaccination campaign will have started.

I can see schools as being a big issue. It cannot be postponed really but the effect will be large, children are generally asymptomatic or just have gastrointestinal Covid symptoms and will spread it. You're basically mixing dozens of households in each class. Will we see online schooling? Unlikely in Ireland. I could imagine it in Finland for example.

This is going to be a major Covid vector... Will be interesting to watch.

MadYaker

seanb85 wrote: »

Personally I do think Europe is in what can be described as a second wave, we are seeing sustained but slow growth in case numbers in most countries, it is not rapidly increasing but looks likely to be more prolonged than the first wave as it is unlikely to be stamped down via lockdown.

I think we will only see one “wave”. I also think this talk of waves is a bit out dated in 2020. It happened in pandemics of the past when the world was less organised but this time I think we will continue to suppress this initial wave so much that it will drag on until we have a vaccine in 2022 or whenever.

Bit cynical

With regard to waves, what happens in an unchecked outbreak is that cases rise until a certain proportion of the population are either dead or immune (mainly immune in the case of Covid) and then cases gradually fall.

Restrictions mean that cases don't need to rise as high before falling. Fewer overall get infected and fewer die but the downside is also that fewer also gain immunity. Ideally a vaccine would become available before restrictions have to be lifted or before people find ways around them.

What we are calling a "wave" is really countries and regions that were relatively successful at suppression initially (and therefore fairly low immunity) now seeing a resurgence of cases after lifting restrictions.

darjeeling

McGiver wrote: »

Nice data there!

I agree it's likely down to better testing and tracing - we may be catching more asymptotic cases.

The deaths don't show increases, but they will always lag so I'd compare the 9 July avg with say 9 September avg deaths to the see if there was an increase. If not then we're catching more asymptotic or mild cases.

The only country that is a concern is Spain, the increase is large both in relative as well as absolute terms. However, it's largely localised (North and North East) to specific regions and is being dealt with by the local governments.

I think the increase in cases is real, though it's still quite modest.

Estimates of the reproduction number (R) for Germany show an average of 1.15 over the last 3 weeks (figures from Robert Koch Inst):




Estimates for France (from covidtracker.fr) are similar:



The increase in cases is still small and could be sustainable for quite some time at this rate, but if R were to pick up even a little towards 1.5 or higher, then the acceleration would be a lot more rapid.


While some countries have significantly increased testing over the last month (notably France and Spain), still the percentage of positive tests is generally trending upwards:



I think a big part of the reason we've not seen a rise in hospital admissions and deaths is that there are still far fewer cases than at the peak of the epidemic in March and April.

Back then estimated detection rates were mostly in the 1%-20% range for countries in W Europe (Imperial Coll report 30 March, Goettingen Uni Apr 14 estimates) whereas now they're likely closer to 50%.

Looking at the percentage of positive tests going back to March we can see the impact of increased testing, particularly from May onwards:


So - to take Ireland - a peak of 1,000 cases detected per day in early April could have represented a true number closer to 10,000 new infections, while a figure of 50 new cases today might correspond to 100 actual infections.

Another factor behind the lower fatality rates is the reduction in cases among older people, perhaps because of better outbreak prevention in care homes than was happening earlier in the year.
e.g. France case numbers for age groups over time:

hmmm

MadYaker wrote: »

I think we will only see one “wave”. I also think this talk of waves is a bit out dated in 2020. It happened in pandemics of the past when the world was less organised but this time I think we will continue to suppress this initial wave so much that it will drag on until we have a vaccine in 2022 or whenever.

"Waves" in the case of 1918 were also very different in terms of the virus. The initial wave was pretty minor, the second was brutal, the third was bad, and subsequent waves began to become more minor.

We're still dealing with largely the same virus, and you could argue we are still in the first wave. It's unclear if there will be a second wave with a coronavirus, hopefully not - with influenza the virus mutates constantly.

But we still face the risk of a "real" second wave, so we need to press on with suppression and vaccine/treatment development. Covid is bad now, but it could still mutate to become worse.

plodder

Can anyone explain why Spain's daily cases are now at the level they were in March 22 (ignoring the last spike), but the level of daily deaths is negligible and nothing like the level it was in March 22? Graphs in attachments. The lead-in to the latest wave (in cases) is a lot longer to the initial one, so you would expect the number of deaths to be similar to the initial one.

CelticRambler

Two simple explanations:
(1) back in Feb/Mar, there was so little known about the virus and the illness, testing was effectively limited to people who were already know to be "probably positive" ; the real rate of infection (asymptomatic and mildly symptomatic) was likely to have been considerably higher. Now there's a lot more routine testing, so more cases are being detected making it look like the numbers are as bad as before but those "before" figures were only showing a small part of the problem. The percentage of deaths-per-case would be affected in a similar way.
(2) as in many biological challenges, it would be reasonable to assume that Covid-19 rapidly killed the most vulnerable individuals when it first appeared, especially in those countries where the most vulnerable were deliberately grouped together and cared for by those most likely to infect them. Six months on, the disease profile has evolved to show less death and more long-term illness, and the age profile is less biased towards the elderly.

plodder

CelticRambler wrote: »

Six months on, the disease profile has evolved to show less death and more long-term illness, and the age profile is less biased towards the elderly.

Are there any figures for that? In terms of the threat to each country's health systems, you'd expect number of cases in ICU to be the main indicator of interest. I wonder are there up to date figures for that as well, by country?

CelticRambler

plodder wrote: »

Are there any figures for that? In terms of the threat to each country's health systems, you'd expect number of cases in ICU to be the main indicator of interest. I wonder are there up to date figures for that as well, by country?

It's way too early to be looking for reliable figures for long-term illness. Long-term means years. No-one, anywhere, has had Covid-related illness for years yet. At the moment, we're still at the stage of collecting evidence of potential problems in the making (e.g. apparently permanent lung damage secondary to relatively mild illness in young adults) - see here for one perspective: https://news.berkeley.edu/2020/07/08/from-lung-scarring-to-heart-damage-covid-19-may-leave-lingering-marks/

It's also difficult to establish any meaningful figures for the "threat" to a country's health care system, as countries have vastly different systems - from the free-at-the-point-of-care services like the NHS to the $$$$$$$-profit-based services in the US; and within that spectrum you have the ability of politicians to make decisions that will cripple a service that would otherwise cope quite well - or to recognise that they're in serious trouble and take drastic action before things get out of control.

plodder

CelticRambler wrote: »

It's way too early to be looking for reliable figures for long-term illness. Long-term means years. No-one, anywhere, has had Covid-related illness for years yet. At the moment, we're still at the stage of collecting evidence of potential problems in the making (e.g. apparently permanent lung damage secondary to relatively mild illness in young adults) - see here for one perspective: https://news.berkeley.edu/2020/07/08/from-lung-scarring-to-heart-damage-covid-19-may-leave-lingering-marks/

So, there's no figures for prevalence of long term illness then yet? Or it's anecdotal at least.

It's also difficult to establish any meaningful figures for the "threat" to a country's health care system, as countries have vastly different systems - from the free-at-the-point-of-care services like the NHS to the $$$$$$$-profit-based services in the US; and within that spectrum you have the ability of politicians to make decisions that will cripple a service that would otherwise cope quite well - or to recognise that they're in serious trouble and take drastic action before things get out of control.

Regardless of the funding model, it seems to me that ICU occupancy is some kind of measure of the level of stress on a country's health system. If there's a better one then fair enough, I'd like to read about it.

I guess where I am coming from is we have the official advice and we have the views of "mavericks" like Michael Levitt. But, I'd like to hear much better rebuttals of what he is saying than what I have heard so far.

Lillyfae

plodder wrote: »

So, there's no figures for prevalence of long term illness then yet? Or it's anecdotal at least.

Long term= years. Nobody had Covid-19 years ago. There could be long term illness, it's possible, but nobody who has had Covid-19 is suffering from long term illness right now. So there's no evidence, anecdotal or otherwise.

McGiver

plodder wrote: »

Can anyone explain why Spain's daily cases are now at the level they were in March 22 (ignoring the last spike), but the level of daily deaths is negligible and nothing like the level it was in March 22? Graphs in attachments. The lead-in to the latest wave (in cases) is a lot longer to the initial one, so you would expect the number of deaths to be similar to the initial one.

Simple.

1. Positive cases moving to lower age brackets.
2. Time lag.
3. Health care system geared up and with free capacity.

plodder

Lillyfae wrote: »

Long term= years. Nobody had Covid-19 years ago. There could be long term illness, it's possible, but nobody who has had Covid-19 is suffering from long term illness right now. So there's no evidence, anecdotal or otherwise.

That would imply that there's no evidence that the disease profile has evolved to show more long-term illness then.

But, there must be some evidence of illness lasting six months at least. So, how prevalent is it?

CelticRambler

plodder wrote: »

That would imply that there's no evidence that the disease profile has evolved to show more long-term illness then.

But, there must be some evidence of illness lasting six months at least. So, how prevalent is it?

Well, if you google "covid 19 long term effects" you get about 3,140,000,000 results - does that count as "prevalent" in your book?

There is plenty of evidence to show that people who got sick in December are still suffering (I was talking to one of them last night). Yes, that's anecdotal, and no it's not a long-term illness (because it's only six months, not years), but researchers from every developed country are reporting multiple unexpected on-going complications affecting several different body systems (particularly circulatory, respiratory, renal and nervous) in younger and older patients. What exactly are you looking for beyond that?

plodder

CelticRambler wrote: »

Well, if you google "covid 19 long term effects" you get about 3,140,000,000 results - does that count as "prevalent" in your book?

No

There is plenty of evidence to show that people who got sick in December are still suffering (I was talking to one of them last night). Yes, that's anecdotal, and no it's not a long-term illness (because it's only six months, not years), but researchers from every developed country are reporting multiple unexpected on-going complications affecting several different body systems (particularly circulatory, respiratory, renal and nervous) in younger and older patients. What exactly are you looking for beyond that?

We need more than google searches. When this thing started it was all about protecting the elderly and vulnerable from dying, and now you are saying it's about long term effects. It's not unreasonable to ask what is the prevalence of these effects. What percentage of people are suffering ill-effects continuously after becoming affected? Maybe nobody knows the answer yet and that is fair enough, but we need to know as soon as possible because it affects the way we respond to this, if the percentage is very small versus a percentage that has a significant impact on the population.

gabeeg

plodder wrote: »

No

We need more than google searches. When this thing started it was all about protecting the elderly and vulnerable from dying, and now you are saying it's about long term effects. It's not unreasonable to ask what is the prevalence of these effects. What percentage of people are suffering ill-effects continuously after becoming affected? Maybe nobody knows the answer yet and that is fair enough, but we need to know as soon as possible because it affects the way we respond to this, if the percentage is very small versus a percentage that has a significant impact on the population.

100% with you on this

The following from the CDC is the closest I can find of any attempt to put a number on this issue, but frankly it's not a very satisfying report.


https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm

CelticRambler

plodder wrote: »

When this thing started it was all about protecting the elderly and vulnerable from dying, and now you are saying it's about long term effects.

What is this "it" you're referring to? The virus is the virus, and the disease is the disease, and the political response to it is a political response. To date (and in the context of this thread) there has been no rational disease management strategy adopted by any EU country other than Greece.

So it's a bit pointless looking for data about the relative impact of long-term effects (of which there are many strong contenders) when no government in Europe is willing to control the disease with the kind of aggressive response we'd see if something similar affected cattle or horses or pigs.

Bit cynical

Handy interactive map of change in 14-day notifications. This is a measure of the number of cases reported in the last 14 days as a proportion of the previous 14 day period.

https://ourworldindata.org/grapher/biweekly-growth-covid-cases?region=Europe

In the high group are Norway, Denmark, Iceland, Netherlands, Ireland, Spain and Greece.

plodder

gabeeg wrote: »

100% with you on this

The following from the CDC is the closest I can find of any attempt to put a number on this issue, but frankly it's not a very satisfying report.


https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm

Thanks for that. It does give some kind of picture, but doesn't seem to say much about severity of symptoms which you would need to understand the effect the virus is having on health systems. We need more of this kind of research.

tobefrank321

CelticRambler wrote: »

Well, if you google "covid 19 long term effects" you get about 3,140,000,000 results - does that count as "prevalent" in your book?

There is plenty of evidence to show that people who got sick in December are still suffering (I was talking to one of them last night). Yes, that's anecdotal, and no it's not a long-term illness (because it's only six months, not years), but researchers from every developed country are reporting multiple unexpected on-going complications affecting several different body systems (particularly circulatory, respiratory, renal and nervous) in younger and older patients. What exactly are you looking for beyond that?

Those suffering long term effects (discounting the dead of course) would appear to represent a tiny minority. Here's an example of someone who had a severe dose but he makes no mention of long term effects, just tired and anxious for a couple of weeks.

https://www.msn.com/en-ie/money/other/jonathan-pryce-s-secret-battle-with-covid-19/ar-BB17Mulr?ocid=spartan-ntp-feeds

Didn't make any of the newspapers at the time, not sensationalist enough. A thousand stories like this will always be trumped by someone who appears to have long term complications (a couple of months after being infected).

Sensationalism sells papers, always has.

darjeeling

The current epidemic in Spain looks to be much the largest in Western Europe, so I would expect any emerging trends to appear there first.

Looking at covid hospital admissions in Spain, we can see these have been increasing exponentially over the last six weeks:



While numbers remain relatively small, the accelerating trend is already ringing alarm bells in the health system in Spain.
Media reports in the last two days have described a new field hospital for covid patients being built in Zaragoza and a decision by a large Madrid hospital to suspend non-essential operations (link).

ChikiChiki

For those that have been following any sign of Spain going back into lockdown, more specifically Madrid?

owlbethere

Do they implement contact tracing in other countries? What is community transmissions like in other EU countries?

plodder

Some interesting articles in the Sunday Indo today, incl. another professor from Stanford University (not Michael Levitt) saying lockdown is/was a big mistake, and Covid admissions to ICU drop to new low in Europe despite rise in cases. Eg in Germany 1% of ICU beds are occupied by Covid patients despite the recent increase in cases there.

I can understand that health authorities will be cautious about new information like this, and I support the cautious approach we are taking. I just hope that when it comes to new general or local lockdown decisions, it is based on hard data like ICU occupancy or deaths, rather than number of cases detected.

Ce he sin

plodder wrote: »

Some interesting articles in the Sunday Indo today, incl. another professor from Stanford University (not Michael Levitt) saying lockdown is/was a big mistake, and Covid admissions to ICU drop to new low in Europe despite rise in cases. Eg in Germany 1% of ICU beds are occupied by Covid patients despite the recent increase in cases there.

I can understand that health authorities will be cautious about new information like this, and I support the cautious approach we are taking. I just hope that when it comes to new general or local lockdown decisions, it is based on hard data like ICU occupancy or deaths, rather than number of cases detected.

I'm intrigued by your claim that ICU admissions are dropping to a new low when there's a graph just above showing admissions rapidly rising in Spain.
Also, the numbers in ICU in Italy, which has only just begun to show a significant increase in the number of of new cases daily, are slowly increasing.

Lillyfae

Ce he sin wrote: »

I'm intrigued by your claim that ICU admissions are dropping to a new low when there's a graph just above showing admissions rapidly rising in Spain.
Also, the numbers in ICU in Italy, which has only just begun to show a significant increase in the number of of new cases daily, are slowly increasing.

The graph displays hospital admissions, not ICU admissions.

Wallander

Here's an interesting English piece from El Pais (Spain) looking how the death rate is 96% lower and hospitalisation rate 90% lower in their current second wave v first wave:

https://english.elpais.com/society/2020-08-17/more-cases-among-young-people-and-a-lower-death-rate-how-the-coronavirus-epidemic-has-changed-in-spain.html

plodder

plodder wrote: »

No

We need more than google searches. When this thing started it was all about protecting the elderly and vulnerable from dying, and now you are saying it's about long term effects. It's not unreasonable to ask what is the prevalence of these effects. What percentage of people are suffering ill-effects continuously after becoming affected? Maybe nobody knows the answer yet and that is fair enough, but we need to know as soon as possible because it affects the way we respond to this, if the percentage is very small versus a percentage that has a significant impact on the population.

Off you go so and invent a time machine to travel 5 years into the future and report back with your findings.

CelticRambler

CelticRambler wrote: »

So it's a bit pointless looking for data about the relative impact of long-term effects (of which there are many strong contenders) when no government in Europe is willing to control the disease with the kind of aggressive response we'd see if something similar affected cattle or horses or pigs.

This I found utterly mind boggling. When the foot and mouth started here, which by the way, is well understood and doesn't even kill animals, the country went into extreme lockdown mode immediately. When a new disease that actually kills humans emerged, we dithered for weeks. In the UK they dithered for over a month, and to some extent, still are. The US are still dithering.