An interesting thoughtMay 4, 2020 Tim WorstallHealth Care49 CommentsOf course the expert on this is Hector. But still: England’s excess death rate is one of the worst in Europe and the number is not dropping like it is in other countries including Italy and Spain, data shows Maybe the NHS isn’t a good way to organise a health service? previousEntirely correctnextPerhaps not the right decision 49 thoughts on “An interesting thought” Bloke in Wales May 4, 2020 at 8:01 am Hector’s latest post shows that it is dropping rapidly bilbaoboy May 4, 2020 at 8:21 am https://order-order.com/2020/05/03/head-ons-international-death-comparisons-unbelievably-difficult-uk-best-transparent-timely-reporting/ We include deaths in the wider community, they don’t. Dodgy Geezer May 4, 2020 at 8:30 am Early days for an appreciation of what happened, and we have to make a lot of guesses. But it seems to me that the death rate was due rather more to our particular social systems and administrative efficiency. We got hit by a new disease and didn’t know what to do. So we actioned our ‘Flu pandemic’ plan. This anticipated caring for huge numbers of people with breathing difficulties. So we rapidly cleared all our hospitals of non-critical patients and built several new ones. Which was a reasonable thing to do at the time. We could do it efficiently because we had a central command structure for the NHS. And meant that large numbers of old folk were returned to care homes. Turns out that Covid-19 is much more dangerous to the elderly, and much less dangerous to the young and middle-aged than flu. So, while we were waiting for the expected huge influx of 35-year olds, all the 80-year olds were catching the disease in care homes and dying like flies. If we had had a less efficient bureaucracy, or if we had a social system in which the old were scattered around in society living with their families, we would not have had this mass death experience amongst them… Pat May 4, 2020 at 8:38 am It seems to me that deaths from C19 are falling on the same pattern that they rose on, i.e. a bell curve. However a lot of the excess deaths are from other causes as Hector has pointed out. May I posit that the obsession with C19 to the exclusion of all else has resulted in more deaths from other causes? Mr Ecks May 4, 2020 at 9:02 am Nobody is “dying like flies”. The disease hits the old worst but is still just a bad winter flu. If the disgraceful “from” and “with” capers were sorted out CCPvirus would be seen as a mid to high level bad flu–which it is. MC May 4, 2020 at 9:08 am It is a tribute to the religious awe that has been created for the NHS that more people don’t stop to consider that maybe, just maybe it’s a bit shit, and that’s why people are dying. We have worse health outcomes than France or Germany generally, so we should naturally expect to cope with an outbreak worse too. Tractor Gent May 4, 2020 at 9:14 am It’s interesting to compare the progress of this virus with SARS & MERS. They were nastier but controlled early so they have died out – no reservoirs of infection anywhere. This one has spread throughout the world, so the infection is mostly everywhere and will stay around for a long time – there is no realistic prospect of extinguishing it like SARS & MERS. With that in mind, those countries that successfully contained it – Oz, NZ, Taiwan, even perhaps the rest of China – have very hard decisions to make about restarting global contacts: they still have a large population of people who have never been exposed. Since we can’t stop it, we should just let it rip now as it’s already culled a lot of the potential victims anyway, and they will go from it, or die first, sooner or later. It’s also possible that there is in fact significant herd immunity from a lot of recovered asymptomatic or mild cases, but we won’t know that until proper sampled antibody testing gets going (which should have started as soon as reliable tests were available). I’m in the ‘high risk’ group (70+) but it hasn’t stopped me going to the supermarket or for walks locally – I’ve probably done a lot more walking locally as I’m not getting exercise from generally living life as before. If I get it soon & die, C’est la vie, as I would otherwise die from it later anyway. I may survive it anyway, which would be a mental positive if I know that (until it mutates & I get the new version…) BraveFart May 4, 2020 at 9:31 am https://www.theguardian.com/world/2020/apr/26/virologist-christian-drosten-germany-coronavirus-expert-interview Q: From where you stand, how is the UK handling the situation? A: It’s clear that testing was implemented a little bit too late in the UK. Public Health England was in a position to diagnose the disease very early on – we worked with them to make the diagnostic test – but rollout in Germany was driven in part by market forces, which made it fast, and that wasn’t the case in the UK. The Meissen Bison May 4, 2020 at 9:48 am until it mutates & I get the new version… Aha – Covid’s Metamorphosis. Jim May 4, 2020 at 9:58 am The cult of the NHS means that the conclusion drawn will always be it would have been far worse if we didn’t have a Stalinist centrally controlled healthcare system, despite the evidence that a more market based one (Germany) resulted in far better outcomes. Face it, there is literally nothing the NHS could do that would shift that attitude. It kills hundreds if not thousands of people every year via a combination of incompetence, laziness and downright murder (the Gosport scandal) and yet it is still lionised as wonderful. My feeling is that every NHS hospital could have a HGV out the back with a refrigerated container shipping away the dead bodies that they’d killed each week through neglect and incompetence and still the usual suspects and the clapping seals of the public would applaud it. If mass deaths laid right at its door by official investigations doesn’t tarnish its image, what the fuck would? Dodgy Geezer May 4, 2020 at 10:04 am @Mr Ecks “…Nobody is “dying like flies”….” Well, the Total Mortality is higher than recent flu epidemics, but, I agree, still in the same ball-park. I note that over the last 20 years or so, excess winter deaths have been going down, so this surge is unusual in that respect. It’s also a lot more sudden. Excess winter deaths – presumably influenza – typically ramp up for a month or so, stay high for a month and then slowly decline over the next month. This epidemic has hit very rapidly (because the virus is new – less immunity?), and it is only because lethality is pretty much confined to the elderly that we have not been overwhelmed by cases. I think that when the dust settles we will see that the elderly have taken a substantial hit, while most other sectors have been unaffected. If that is so, I think it is not unreasonable to indulge in this common simile….. bloke in spain May 4, 2020 at 10:07 am @ Tractor Gent Headed for the same demographic, my attitude is if you catch it there are are two outcomes. You survive. You don’t survive. As from the individual’s point of view the outcomes are identical. In the latter you aren’t there to experience the problem. What’s the point in worrying about it? Andrew M May 4, 2020 at 10:08 am Here’s an uncomfortable truth: The quality of healthcare provision doesn’t make much difference for Covid-19 patients, since there’s very little that doctors can do for it. What matters is not catching the damn thing in the first place (not being an international hub, having basic infection-control measures, self-isolation with symptoms, isolate the vulnerable), and being in good health in the first place. That last point is where the UK really fails, with one of the highest obesity rates in Europe. Obesity isn’t everything, but it’s one of the few statistics that we can use to make international comparisons. It suggests that the average Brit is generally in worse health than the average European, for whatever reason. Roué le Jour May 4, 2020 at 10:08 am If the virus doesn’t burn out in the UK as elsewhere then the failure to seal the borders is a far more likely candidate than the NHS. Jonathan May 4, 2020 at 10:09 am @ Mr Ecks: ” The disease hits the old worst but is still just a bad winter flu.” Maybe not: ” Italians Who Died of CV Tended to Lose About 10 Years Off Life Expectancy … However, a study by researchers from a group of Scottish universities has attempted to do so. They found that the years of life lost (ylls) for the average Briton or Italian who passed away was probably around 11, meaning that few of covid-19’s victims would have died soon otherwise.” via Steve Sailer Jim May 4, 2020 at 10:24 am “Obesity isn’t everything, but it’s one of the few statistics that we can use to make international comparisons. It suggests that the average Brit is generally in worse health than the average European, for whatever reason.” I’ve been noting for some time that the pictures of the people who have died under the age of about 60 do not show many thin people. Indeed we have become so inured to people being over weight that a person who is in fact in the correct weight range for their body size is told they look ‘too thin’. I’m 6’0″ and 13 stone level which puts me borderline overweight (BMI of 25.5). When I say to people that I’m dieting to try and get my weight down they all say ‘You don’t need to lose weight!’ The virus is a wake up call to the middle aged – if you don’t look after yourself you may well die young from this, and there’ll be nothing the much vaunted NHS can do about it. Step away from the pies, fatty! bloke in spain May 4, 2020 at 10:31 am “That last point is where the UK really fails, with one of the highest obesity rates in Europe.” This is one of those accepted facts I suspect is absolute bollocks. I’ve been to most of Europe. I’ve never noticed the slightest difference in the proportion of landwhales amongst the inhabitants. I’d even doubt there’s any rise in incidence in the UK. I can remember my grandmother’s generation & stocky solid women were the norm. And men with a bit of weight on them were favourably judged. Wouldn’t be the least surprised if the average was now lower if one allowed for height increases since kids got properly fed in their early years. The culprit is the measurement standard. bloke in spain May 4, 2020 at 10:40 am “I’m 6’0″ and 13 stone level which puts me borderline overweight (BMI of 25.5).” FFS! I’m 3 inches shorter & 2 stone lighter. But I do have a genuine problem. I’m one of those people can”t accumulate fat. If I don’t exercise my weight goes down, not up, as I lose muscle mass. When I was doing hard physical work & very fit I was 12 1’2 stone. What the hell are you worried about? Gareth May 4, 2020 at 10:51 am “Maybe the NHS isn’t a good way to organise a health service?” Other countries have been prescribing hydroxychloroquine while UK waits for the results of a number of clinical trials. Not sure what they are doing in Germany though. A large ICU capacity might mean they didn’t clear out their hospitals like UK. There is also some speculation that a pneumococcal vaccine might be providing some indirect protection. John May 4, 2020 at 10:57 am “Excess death rates” according to the ONS. The same ONS whose death numbers include cases where “COVID-19 is suspected but no formal diagnostic test has taken place”. The ONS figures are a crock of sh1t as are any forms of comparative data derived from them. PJF May 4, 2020 at 10:59 am Here’s an uncomfortable truth: The quality of healthcare provision doesn’t make much difference for Covid-19 patients, since there’s very little that doctors can do for it. Really not sure that’s true. There’s enough anecdotal evidence around the “Trump pills” to indicate they can be useful if applied correctly (i.e. not as in “studies” which seemed designed to show failure), and enough anecdotal evidence to indicate that a lot of what doctors do actually makes things worse. Agree with the lard bucket angle. Recusant May 4, 2020 at 10:59 am Jonathan Steve Sailer, like Greg Cochran, has not come out of of the Rona well. They have both turned into pearl-clutching old ladies. ‘Choose your position; choose your scientist’, applies here as everywhere else. We could listen to Sir David Spiegelhalter, Cambridge statistician, who says that your chances of dying of this are the same as your chances of dying within the next year. So, it just speeds up what was just about to happen in any csae. PJF May 4, 2020 at 11:10 am @ Jonathan, the “years of life lost” point can also be made for flu victims. Not sure what it has to do with Mr Ecks point re. comparative fatalities. Bloke in North Dorset May 4, 2020 at 11:14 am Tractor Gent, I’m not quite in your demographic but like bis heading that way. My view is that I didn’t work hard all and make lots of sacrifices like missing nativity plays, birthdays, wedding anniversaries to make first my family and then my retirement financially secure only to spend it moping around the house getting one exercise a day. I know how to manage risk, I sail single handed, and I don’t want to die, but I do want to live and this isn’t living. Adventure before dementia was my motto, I suppose it should now be adventure before C19. As to obesity, this is probably out of date because I read it a couple of weeks ago, and ICU doctor was saying that when they have patients with breathing problems one way to relieve it is to put the patient on their stomachs and that’s very difficult with the morbidly obese. This means they’re more likely to go on a ventilator and as we’re learning the outcome of that measure is rarely good. The other problem with obesity is that there is evidence that it lowers the immune system so their bodies own defences are weakened. Now we’re in to the old definition of obesity again, my BMI is also 25.5 and people look at me quizzically when I point out I’m classed as overweight. Gamecock May 4, 2020 at 11:18 am “This is one of those accepted facts I suspect is absolute bollocks.” Exactly. “Obesity” numbers are completely fabricated. Both the number of cases, and the impacts. The Meissen Bison May 4, 2020 at 11:48 am I have no idea what my BMI is. Rather as with alcohol ‘units’ I have no use for the information and anyway scales belong on fish. Was it one of the Dennises who conceded that if one tied a sash around his middle, he might easily be taken for an Easter egg? He doesn’t appear to be the slightest cast down by it – rather the opposite. Dongguan John May 4, 2020 at 12:02 pm Seems unwise to judge how countries are doing now. Could well still be early days and those suffering now get it over and done with quicker than those who are seemingly doing well. If in the end the death rates are much the same then those who didn’t lock everyone up and got it over with will have done better. Who knows? Jonathan May 4, 2020 at 12:12 pm @ PJF: ” Not sure what it has to do with Mr Ecks point re. comparative fatalities.” I wasn’t really addressing that, as at the moment there’s no way to know what the actual figures are, I was merely pushing back against the idea that it’s only old codgers who are at death’s door anyway who are dying. Andrew M May 4, 2020 at 12:49 pm PJF, We’re broadly in agreement then. Distributing generic pills is something even a poor African country can achieve; whereas destroying elderly lungs with expensive ventilators is a luxury only affordable in a rich place like northern Italy. Or to put it another way, pouring more cash into the gaping maw of the NHS isn’t going to help; and might well make things worse. Bloke in North Dorset May 4, 2020 at 1:02 pm I was reading an article by an ICU doctor on Quillette over lunch and he covered lying the patient on their front and its the problem with the morbidly obese isn’t just medical [my emphasis]: This technological advancement is crucial, as the damage COVID-19 can do to a patient’s lungs is considerable. The lungs of these patients become infiltrated with fluid and scar tissue, limiting the normal function of gaseous exchange while becoming very stiff. As a consequence, many of these patients require ventilators to generate high inflation pressures to fill the lungs modestly. To further manage this problem COVID-19 teams are using a strategy of routinely “proning” patients, a practice used commonly in the ICU I am working in, as well as in others. Proning patients, or turning them on their front, can help redirect oxygen to healthier parts of the lungs and give damaged areas a chance to rest and recover. This is a therapeutic strategy well known to ICU doctors but infrequently used and certainly not deployed on the scale that it is being used now. Proning patients carries risks: It requires a team of seven people to turn the patient, taking great care not to pull out or dislodge any lines or tubes that are providing life-sustaining treatments. Humans are not used to lying face down for 16 hours and thus great care must be taken to protect the body from pressure injuries to the face and other parts of the body. Rob May 4, 2020 at 2:13 pm Italians Who Died of CV Tended to Lose About 10 Years Off Life Expectancy Actually, they lost ALL of their life expectancy. I expect what it meant to say was that on average those who died of Covid-19 were ten years younger than average life expectancy, but even this is misleading as those with”co-morbitities” would be likely to die younger than “average” life expectancy anyway, though not by ten years. rhoda klapp May 4, 2020 at 2:26 pm I’ve posted this elsewhere today, but in reply to Andrew M the following link shows what other health providers are doing for covid patients. In this case East Virginia Medical School. https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf Please read it, and note that they have a list of prophylactic meds which are OTC in the US. They aggressively treat suspected cases before the test results come in. This is the time when intervention might keep them out of hospital and subsequent progression to the ICU. The equivalent protocol in the NHS at that point is to send you home to get worse. That is the national policy. It results in the NHS missing the best opportunity to save you. And killing its patients unnecessarily. MyBurningEars May 4, 2020 at 2:30 pm @Rob But you can account for remaining life expectancy given comorbidities and the studies that have done so suggest those who are dying are still losing a surprisingly high number of life years, they’re not all at death’s door even if they’re mostly quite old and mostly quite sick already. Turns out you can live with a few things wrong with you for quite some time these days. MyBurningEars May 4, 2020 at 2:58 pm @Rob https://wellcomeopenresearch.org/articles/5-75 COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study [version 1; peer review: awaiting peer review] Abstract Background: The COVID-19 pandemic is responsible for increasing deaths globally. Most estimates have focused on numbers of deaths, with little direct quantification of years of life lost (YLL) through COVID-19. As most people dying with COVID-19 are older with underlying long-term conditions (LTCs), some have speculated that YLL are low. We aim to estimate YLL attributable to COVID-19, before and after adjustment for number/type of LTCs. Methods: We first estimated YLL from COVID-19 using standard WHO life tables, based on published age/sex data from COVID-19 deaths in Italy. We then used aggregate data on number/type of LTCs to model likely combinations of LTCs among people dying with COVID-19. From these, we used routine UK healthcare data to estimate life expectancy based on age/sex/different combinations of LTCs. We then calculated YLL based on age, sex and type of LTCs and multimorbidity count. Results: Using the standard WHO life tables, YLL per COVID-19 death was 14 for men and 12 for women. After adjustment for number and type of LTCs, the mean YLL was slightly lower, but remained high (13 and 11 years for men and women, respectively). The number and type of LTCs led to wide variability in the estimated YLL at a given age (e.g. at ≥80 years, YLL was >10 years for people with 0 LTCs, and <3 years for people with ≥6). Conclusions: Deaths from COVID-19 represent a substantial burden in terms of per-person YLL, more than a decade, even after adjusting for the typical number and type of LTCs found in people dying of COVID-19. The extent of multimorbidity heavily influences the estimated YLL at a given age. More comprehensive and standardised collection of data on LTCs is needed to better understand and quantify the global burden of COVID-19 and to guide policy-making and interventions. Gareth May 4, 2020 at 3:29 pm Bloke in North Dorset, Interesting stuff on the ventilator/proning issue. One of the UK ventilator projects is a modified iron lung – Exovent. It just covers the upper torso. Iron lungs might be old-fashioned but they would allow patients to remain conscious rather than being sedated. The common perception of iron lungs is for paralysed polio patients but as there is no paralysis with covid-19 the patients probably wouldn’t need to be in the machine 24 hours a day. It could be switched off, opened and the patient helped to turn over, or washed or to eat, etc. There is also a thing called biphasic cuirass ventilation which uses a closely fitted chest shield as the pressure vessel. Non-invasive ventilation would avoid the need for sedation and high pressures so should be easier on elderly patients but, whether they were as effective as regular ventilators, I don’t know. Jonathan May 4, 2020 at 4:13 pm @Rob: “. I expect what it meant to say was that on average those who died of Covid-19 were ten years younger than average life expectancy, but even this is misleading as those with”co-morbitities” would be likely to die younger than “average” life expectancy anyway, though not by ten years.” From Table 2 in Steve’s article: ” For example, 50-something men who died of CV with zero long-term conditions had an expected additional life span of 35.81 years, while those who died with 1 LTC lost an expected 35.03, while those with 5 LTCs lost 19.39.” Recusant May 4, 2020 at 5:58 pm MyBurningEars The Scottish research that says that the average years lost was more than 10, managed to miss out all people who were in care homes and did not take account of the severity of any comorbidity. Since the median life expectancy in the care homes is five months, one could say that this research is very full of bovine faecal matter. MyBurningEars May 4, 2020 at 7:01 pm @Recusant The hospital deaths are still a large proportion of all deaths and the fact they seem to have lost a lot of life years is not something to dismiss in my view. Actuaries looking at the data seem to have come to similar conclusions and seem to have come down very hard against the “at death’s door” theory. My original inclination was that the life-years lost would be relatively small as within each group I assumed most deaths would be occurring only in the most clinically vulnerable groups but talking to an actuary about this has changed my mind, their ability to predict longevity even in people with multimorbidity is apparently very good. Have a look at https://mobile.twitter.com/covid19actuary?lang=en which may or may not change your mind, but it isn’t just the medical researchers who think this. Ummmm May 4, 2020 at 7:04 pm French are saying they looked at non-diagnosed respiratory patients in December and tested samples for Covid and of the 24 they had one positive from December 27th. The US also said a death in California turned out to be Covid at least 2 weeks before what was believed to be the first death in Seattle area. If it has been around for at least a month or more longer than previously thought surely that has an impact on the numbers and the lockdown timing etc. It’s quite possible early deaths were put down to flu. MyBurningEars May 4, 2020 at 7:08 pm @Recusant Also think you’re way off with the care home figure though maybe it’s using a different definition. Here’s an answer to a parliamentary question from 2017: https://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-09-05/8937 The Department does not hold any data on average life expectancy of elderly residents in care homes – however the Department does hold published data on a resident’s length of stay in a care home where a service user’s stay ends due to their death. While this is occasionally used as a measure for life expectancy, this does not record stays for individuals in care homes where their stay ended because they moved from one home to another. The statistics show that the average length of stay in a single residential care home in England that ended in a service users’ death was around 26 months, although this statistic does not include any previous stays in other homes. The published source is: http://www.pssru.ac.uk/archive/pdf/3211.pdf Looking at the source, the mean figure is (as you might expect by the skewed nature of survival data) a lot longer. Rob May 4, 2020 at 7:26 pm I think the French one is a false positive. A death in December would mean it circulating for a least a month before, and with no prophylactic measures being taken, as the virus was unknown. It would have swept through the population and the peak would have hit around February, with hundreds of deaths per day. Gamecock May 4, 2020 at 8:11 pm Anecdata. I have noticed that most everyone sticks to distancing. Those I have observed NOT distancing were most children (they don’t know any better), a few black men, and a few old white men. Black women practice hyper distancing. When I say something to the black men, they apologize and move back. No problem. When I say something to the old white men, it’s as if they didn’t even hear me. Even as I back away from them, they keep approaching. It’s as if they never heard of distancing. Or haven’t heard that there is a virulent virus that’s killing so many people that it’s a pandemic. These are the most vulnerable, and yet they don’t do what they can do to avoid it. It’s baffling to me. PF May 4, 2020 at 8:25 pm GC “Old white men” This is out in the open air? Where the chances of catching it and all that are “relatively” minimal. And “relatively” is everything – cars, motorbikes in your case (in the UK NHS they are generally referred to as “donors”, and statistically for good reason), heart, strokes, etc… Gamecock May 4, 2020 at 10:12 pm PF, you could argue that it is a reasoned response, that they understand what their risks are. I don’t believe it is. Pcar May 5, 2020 at 1:18 am @bis May 4, 2020 at 10:40 am I was one of those people can”t accumulate fat (5’8″ 58/60kg, 27″ waist 16-39) until I hit 40; prior to that I sank to bottom in swimming pools if I didn’t swim fast @Gareth, PJF Other countries have been prescribing hydroxychloroquine while UK waits for the results of a number of clinical trials UK State, MSM and @BiGs too infected with #OrangeManBad and TDS virus, we must die is preferable to them Chloroquine – Gov banned export in Feb/Mar. BNF – No prescription required. Pharmacists: We won’t sell to you without prescription “designed to show failure” – yep, give when hours from death and/or overdose, ignore “don’t use if…”. Best results are take before infected, next best when symptoms develop PF May 5, 2020 at 3:56 am GC They’re spooking you. It’s the ultimate adrenalin rush / game of chicken for the poor old codgers. Revenge for that time they wet themselves / nearly drove their Corolla into the ditch as you buzzed them in your GT350R….. (I’m being childish – your take is probably more accurate, and perhaps they simply haven’t kept up with any recent news!) john77 May 5, 2020 at 8:07 am @ Gamecock Maybe the old white men are copying M’Lud and enjoying watching you get out of their way. This side of the pond, I am finding that a large majority of people observe social distancing with most of those who don’t being young or middle-aged women who either don’t know what 2 metres looks like or expect me to jump in the air/through a fence/hedge to get out of their way. bloke in spain May 5, 2020 at 8:30 am @Pcar “I was one of those people can”t accumulate fat … until I hit 40” I’m now getting on for 30 years past that & still got the problem. But by PHE’s standards I live a phenomenally unhealthy lifestyle. I’m likely off their scales for all their disapproved indulgences apart from the obesity measure. Doesn’t seem to do me the slightest harm although I’m hoping it’ll reduce my life expectancy. I wouldn’t want to run out of money. Pcar May 5, 2020 at 5:55 pm @Gamecock May 4, 2020 at 8:11 pm Or haven’t heard that there is a virulent virus that’s killing so many people that it’s a pandemic Killing so many people? Really? Wuhan Virus Pandemic? No, Scamdemic Month Six and Global Population ~7.8 Billion – 7,800,000,000 Global Deaths 255,595 as of May 05, 2020, 17:48 GMT (~0.003%) Annual Flu Deaths just in UK is ~25,000 and all cause annual deaths in UK ~680,000 Reaction is baffling to me Leave a Reply Cancel replyYour email address will not be published. Required fields are marked *Comment Name * Email * Website Save my name, email, and website in this browser for the next time I comment.