Generic Virus Thread

[KentVillan]

https://theconversation.com/global-poverty-coronavirus-could-drive-it-up-for-the-first-time-since-the-1990s-140662

Quote

Global poverty: coronavirus could drive it up for the first time since the 1990s

June 16, 2020 10.03am BST

 

As COVID-19 slows in developed countries, the virus’s spread is speeding up in the developing world. Three-quarters of new cases detected each day are now in developing countries. And as the pandemic spreads, governments face juggling the health consequences with economic ones as this shifts to becoming an economic crisis.

Our research shows that the poverty impact of the crisis will soon be felt in three key ways. There is likely to be more poverty. It is likely to become more severe. And as a consequence, the location of global poverty will also change.

Having looked at estimates from a range of sources – including the Asian Development Bank, Goldman Sachs, IMF and OECD – we considered three possible economic scenarios stemming from COVID-19, where global income and consumption contracted by 5%, 10% or 20%. We found that the economic shock of the worst-case scenario could result in up to 1.12 billion people worldwide living in extreme poverty – up from 727 million in 2018.

This confirms our earlier estimates that the coronavirus could push up to 400 million people into extreme poverty, defined by the World Bank as living on less than US$1.90 per day – the average poverty line in low-income developing countries. This number rises to over 500 million if using the World Bank’s higher average poverty lines for lower middle-income (US$3.20) and upper middle-income (US$5.50) developing countries.

The potential increase is driven by millions of people living just above the poverty line. These people are likely to be badly affected because many of them work in the informal sector, where there is often little in the way of social security. Such a rise in extreme poverty would mark the first absolute increase in the global count since 1999 – and the first since 1990 in terms of the proportion of the global population living in poverty.

All hypothetical, and based on modelling, so take with a pinch of salt.

But it does put into context what the human cost could be beyond the disease itself.

Edited June 22, 2020 by KentVillan

[snowychap]

 

[villakram]

Anyone venture out yet? 

Any tales of inappropriate post liquid-lunch tweeting?

[villakram]

16 hours ago, KentVillan said:

https://theconversation.com/global-poverty-coronavirus-could-drive-it-up-for-the-first-time-since-the-1990s-140662

All hypothetical, and based on modelling, so take with a pinch of salt.

But it does put into context what the human cost could be beyond the disease itself.

https://xkcd.com/ #2323

[sne]

Looks like anti-vaxxer and Covid-19 skeptic Novak Jokovic is eating some humble pie after his disastrous tennis tournament where a bunch of staff and players including himself has gotten infected.

 

[KentVillan]

1 hour ago, villakram said:

https://xkcd.com/ #2323

The main thing that bothers me about modelling is that it's presented as "science".

Modelling is really useful, and it has loads of important applications, including in science. But it isn't evidence. You feed evidence into a model. Your model is an output. I wish the govt scientists and other commentators would be more up-front about this when they tout modelled values as "the science".

So many people banging on about R0 values, excess deaths, case counts, etc. etc. as if they are a concrete, uncontested piece of information. They are all susceptible to data collection errors (which can be enormous systematic biases), problems with modelling assumptions and so on.

Epidemiology is roughly as "scientific" as political polling or economic forecasting - i.e. not very. It's a social science, with all the issues that entails - intractable problems, extremely complex / chaotic systems, feedback loops, lack of controls, observer effects, etc.

That's not to say I think the modellers are doing anything wrong methodologically (I wouldn't know), I just think they're overselling the capabilities of their approach, and using bad faith arguments to avoid critique and protect their interests.

It would be no surprise if a lot of the prevailing wisdom on Covid-19 gets rewritten every month or so for a good few years. It's such a complex problem. I'd have more faith in Suso identifying a decent striker in the Belgian league than I would in Neil Ferguson nailing the transmission dynamics of Covid-19.

[blandy]

30 minutes ago, KentVillan said:

Your model is an output

I just think they're overselling the capabilities of their approach, and using bad faith arguments to avoid critique and protect their interests.

Crikey! I disagree. I don't consider a model to be an output, I consider it to be a toolset, a process of calculation, based on a set of parameters. The modelling produces an output that is as accurate as the parameters used. I agree a number of the parameters and data used have differing levels of certainty and accuracy and that this leads to outcomes with margins of error. There is little absolute certainty and what I've seen this has carefully been emphasised by the scientists and modellers.

On the other hands I have seen bad faith and motivations from the politicians, massively so. They have so often basically lied and made stuff up that they've lost whatever credibility and credit they started with when there was a surge of support for them at a time of crisis.

I completely understand that the economics and the impact on large numbers of people of the measures that have been taken (lockdown) have been very large. There is an honest argument to be made around releasing the limitations because of the toll on livelihoods and so on. But you (the politicians) have to be honest in making it. It goes like this (ish) "the cost of lockdown is enormous in terms of people's jobs, education, ability to feed their families, their mental health and so on, and yes, while there are thousands of new virus cases every week and around 100 people dying every week, this is unfortunately something that we cannot avoid without causing even worse consequences through lockdown (and then outlining what those are)" It's the herd immunity argument, really. I'm not saying I agree or disagree with it, just that it is something that can be understood as a logic. But politicans sidelining the scientists and advice while lying about motivations is reprehensible.

 

[KentVillan]

I meant the figures reported from “the model” are outputs. The model itself is obviously a conceptual framework or a series of calculations or however you wish to present it.

But at the moment, model outputs are being presented as evidence (ie inputs) which drive decision making. That’s fine, obviously, to use model outputs to inform decision making, but it’s not “the science”, it’s an awful lot of judgment, inhibited by knowledge gaps, and perhaps even personal biases.

What has destroyed my faith in the Imperial group is their nonsense paper saying lockdown saved 3m lives across Europe. It just doesn’t show that. Their argument is completely tautological.

[KentVillan]

https://thecritic.co.uk/issues/july-august-2020/ignoring-the-covid-evidence/

Quote

The Royal Society’s motto is nullius in verba — “take nobody’s word for it” — but at every stage we have failed to apply scrutiny where it is due, or even to stop and check we are on the right ladder before we carry on climbing. For the country that is the birth-place of scientific inquiry and epidemiology it is astonishing. My godfather, professor of physics at Oxford, told me that the three most scientific things you can say are, “I don’t know”, “prove it” and “I’ve changed my mind”. Let us do each in turn.

“I don’t know”: Care homes

My first thought while watching TV footage of this emerging highly-infectious disease in Wuhan and later Lombardy was, “This is mostly old people,” and reports on the impact of co-morbidities on mortality were available from the European Centre for Disease Prevention and Control by mid-February. So: how can it possibly have made sense for the UK government to guide (until 12 March) that it was “very unlikely that people in care homes will become infected with Covid-19”, even while SAGE minutes recorded scientists’ unease at this likelihood? This simply could not be the case, as the inevitable royal commission will point out.

 Fatally, they didn’t just say “I don’t know”, a holding statement while parameters clarified and data accumulated. There was no application here of the precautionary principle they inflicted on the rest of us. Instead, they issued specific guidance that left care home managers powerless as Covid-positive patients were discharged from hospitals back to the homes. To protect our NHS, which only faulty modelling had suggested needed protecting, we actively seeded the disease into its most vulnerable demographic.

Until mid-April, with the escalating deaths in care homes agonisingly clear across Europe, government policy was still for patients to be discharged to care homes from hospitals without requiring negative tests. And so the toll: around half of UK Covid-19 deaths are care home residents, despite them accounting for only 0.6 per cent of our population. It is what France, Spain, Sweden, Lombardy and New York also got wrong.

What could, should the government have done? In China and South Korea, with astonishingly low death rates, care homes required two consecutive negative tests 24 hours apart before accepting patients discharged from hospital, and instituted regular temperature checks on all residents with compulsory quarantine for anybody symptomatic. In Germany, an insurance-sponsored health system creates structural overcapacity, with hospitals paid for each night a patient is retained, thereby creating an incentive for retention rather than discharge (unlike in our NHS).

The whole piece is good, and he goes on to tear into the reliance on modelling, even when the models were starting to be contradicted by empirical evidence.

[HanoiVillan]

Think that article is a mix of very good points and very bad ones personally.

[KentVillan]

Which points do you think are bad?

[bannedfromHandV]

Genuine question because I don’t know - did a single patient ever actually step foot in one of those ‘nightingale hospitals’ that the govt were ever so proud of? 
 

[chrisp65]

2 minutes ago, bannedfromHandV said:

Genuine question because I don’t know - did a single patient ever actually step foot in one of those ‘nightingale hospitals’ that the govt were ever so proud of? 
 

I think they were sent by Yodel and ended up thrown over the fence of various Care Homes.

(some yes, but not many, nowhere near capacity)

But that doesn’t make it a bad waste of money. 

One of the Dragon hospitals near me had something like 450 bed capacity and at its peak it had about 20 patients.

The alternative optics, 20 patients dying in corridors coughing covid onto the vending machines, or being abandoned at home, refused an ambulance...

 

 

 

[KentVillan]

I don't think the Nightingale Hospitals were necessarily a bad idea. Having too much capacity is better than having too little.

What was a bit of a con was the idea that an already understaffed NHS would be able to treat patients properly in these hospitals, when they barely have enough staff for the existing hospitals.

A friend who is a GP told me at the start of this outbreak that she couldn't understand why there was all this focus on buying / building ventilators, when they are complicated to run safely, and the real bottleneck would be the availability of specialist doctors who are experienced in managing a patient on a ventilator.

Separately, there also seems to be some agreement among doctors (but I really don't understand this part of the debate) that it's much safer to keep patients on the "unassisted" oxygen support as Boris Johnson had, rather than on a ventilator (which is a last resort), so the focus on ventilators may have been something of a wild goose chase.

[chrisp65]

I think the ventilator idea involved putting people in an induced coma. Not ideal when it’s a Leisure Centre staffed by student nurses.

The unassisted oxygen was much more straightforward.

Johnson actually died three times but the spirit of Churchill came upon him. 

[bannedfromHandV]

10 minutes ago, KentVillan said:

I don't think the Nightingale Hospitals were necessarily a bad idea. Having too much capacity is better than having too little.

What was a bit of a con was the idea that an already understaffed NHS would be able to treat patients properly in these hospitals, when they barely have enough staff for the existing hospitals.

A friend who is a GP told me at the start of this outbreak that she couldn't understand why there was all this focus on buying / building ventilators, when they are complicated to run safely, and the real bottleneck would be the availability of specialist doctors who are experienced in managing a patient on a ventilator.

Separately, there also seems to be some agreement among doctors (but I really don't understand this part of the debate) that it's much safer to keep patients on the "unassisted" oxygen support as Boris Johnson had, rather than on a ventilator (which is a last resort), so the focus on ventilators may have been something of a wild goose chase.

I’m leaning toward the entire past 3 months being that.

[HanoiVillan]

27 minutes ago, KentVillan said:

Which points do you think are bad?

Actually I think I should take that back. Re-reading it, I had misunderstood one of the arguments and was mistakenly wound up about something else (I had misremembered and thought his reference to 'The Free Swedes' was to a far-right political party - I now realise that it's just a weird stylistic thing that he's doing and that I'm getting mixed up with The True Finns).

I would say though that his argument that 'Care homes might have been able to weather an unsustainable, but brief, cocooning of the most vulnerable while the virus passed through the rest of society to build group immunity' is very dependent on the idea that the herd immunity threshold for the virus is about 20%, which in turn is coming from this idea of 'immunological dark matter'. I am no scientist so I am absolutely not in a position to judge this argument one way or the other, but from what I can gather this is a theory rather than a fact, and quite a lot seems to depend on it in terms of this argument.

I think his argument re care homes that you've quoted above is exactly right, but that the point re German hospitals is a whole separate can of worms (obviously 'creating an incentive for retention rather than discharge' would have been helpful in this particular case, but the majority of the time has some fairly significant downsides).

[Seat68]

1 minute ago, chrisp65 said:

 

Johnson actually died three times but the spirit of Churchill came upon him. 

We’ve all been there. 

[KentVillan]

Just now, HanoiVillan said:

Actually I think I should take that back. Re-reading it, I had misunderstood one of the arguments and was mistakenly wound up about something else (I had misremembered and thought his reference to 'The Free Swedes' was to a far-right political party - I now realise that it's just a weird stylistic thing that he's doing and that I'm getting mixed up with The True Finns).

I would say though that his argument that 'Care homes might have been able to weather an unsustainable, but brief, cocooning of the most vulnerable while the virus passed through the rest of society to build group immunity' is very dependent on the idea that the herd immunity threshold for the virus is about 20%, which in turn is coming from this idea of 'immunological dark matter'. I am no scientist so I am absolutely not in a position to judge this argument one way or the other, but from what I can gather this is a theory rather than a fact, and quite a lot seems to depend on it in terms of this argument.

I think his argument re care homes that you've quoted above is exactly right, but that the point re German hospitals is a whole separate can of worms (obviously 'creating an incentive for retention rather than discharge' would have been helpful in this particular case, but the majority of the time has some fairly significant downsides).

Good points.

Yes, I think the 20% thing is still a big puzzle, definitely not something that has been conclusively answered.

The strongest argument I've seen for the existence of this lower level of herd immunity (i.e. 20-30% rather than 60-80%) is that London's Covid outbreak (which was weeks ahead of the rest of the UK) slowed down before the other regions - whereas if lockdown was the primary driver of reductions, all the UK's regional outbreaks should have hit a turning point at roughly the same time, as a result of lockdown. Instead they all seem to have followed similar, staggered epidemic curves (with varying levels of intensity).

That suggests the virus hit some kind of natural barrier to transmission that wasn't purely lockdown-related - e.g. population immunity. But of course, if it was population immunity, we don't know how durable that population immunity is.

I'm not fully in with the lockdown sceptics, but I tend to think that recent weeks have seen fear overtaking rationality.

Just as an example of something that baffles me: we're pretty sure, anecdotally, that lockdown has led to an increase in mental health and domestic abuse problems. Surely that suggests that we need some kind of emergency "tracking" system for these problems? I'm surprised the opposition haven't proposed this.

The debate needs to be broadened out now, so that we're talking about "overall health and wellbeing", rather than this laser focus on one medical condition.

[HanoiVillan]

3 minutes ago, KentVillan said:

Good points.

Yes, I think the 20% thing is still a big puzzle, definitely not something that has been conclusively answered.

The strongest argument I've seen for the existence of this lower level of herd immunity (i.e. 20-30% rather than 60-80%) is that London's Covid outbreak (which was weeks ahead of the rest of the UK) slowed down before the other regions - whereas if lockdown was the primary driver of reductions, all the UK's regional outbreaks should have hit a turning point at roughly the same time, as a result of lockdown. Instead they all seem to have followed similar, staggered epidemic curves (with varying levels of intensity).

That suggests the virus hit some kind of natural barrier to transmission that wasn't purely lockdown-related - e.g. population immunity. But of course, if it was population immunity, we don't know how durable that population immunity is.

I'm not fully in with the lockdown sceptics, but I tend to think that recent weeks have seen fear overtaking rationality.

Just as an example of something that baffles me: we're pretty sure, anecdotally, that lockdown has led to an increase in mental health and domestic abuse problems. Surely that suggests that we need some kind of emergency "tracking" system for these problems? I'm surprised the opposition haven't proposed this.

The debate needs to be broadened out now, so that we're talking about "overall health and wellbeing", rather than this laser focus on one medical condition.

I agree on both points. The 20% thing in particular is very interesting, and would have enormous implications if true, so hopefully we'll learn more about that one way or the other.