Interesting thought Polly

Shockability is a primal quality. Lose that, and you lose all humanity. Latest figures say there have been 93,000 deaths involving Covid-19 in the UK. I am trying to imagine how high 93,000 stacked coffins would reach, or how deep a plague pit would be to hold 93,000 bodies. Because they are disposed of decorously out of sight, there are no such gruesome pictures to jolt the senses.

Would it be a taller pile, or a deeper pit, than the 8 million abortions since legalisation?

61 thoughts on “Interesting thought Polly”

  1. You could bury all 93000 bodies in a cube of 30 metres each side. Being generous and allowing for the bodies put in coffins, not all squished together. Not that our Polly has ever been noticed for numeracy.

  2. assuming a coffin is 1.9 metres * 0.3metres *0.4 metres.
    Sorry, typo, 50 days average deaths, assuming an average population of 63million with an average lifespan of 80 yrs.

  3. “Would it be a taller pile, or a deeper pit, than the 8 million abortions since legalisation?”

    At 24 weeks a foetus weighs about 600g (although vast majority carried out at under 13 weeks). Average adult weighs about 76kg. Even before coffins, then, I’d say the “pit” for all the abortions in the last 53 years would probably be rather smaller than the Covid one.

    Well, that was 10 minutes of my Friday well-spent…

  4. @Bloke on A470 – how do you measure relative sadness? Is 600g of murdered baby more or less sad than 76kg of person dying after a long and relatively fulfilled life, of an incurable and agonising cancer?

  5. So even on the hysterical ‘Death with Covid’ figures rather than ‘Death from Covid’ we are told that roughly 6 in 7 deaths that have happened over the period are not with Covid.
    So some 85% of deaths are not Covid.
    How many were caused by lockdown then? Ruined business, loneliness, depression –> suicide?

    If you use ‘Death from Covid’ I wonder if you can tell the difference from ‘death from winter flu/pneumonia or any of the other final straws for the terminally ill’?

    The testing is now using such absurdly high replications that false positives dominate it. Expect a change to the testing regime, and a miraculous reduction in positive rates. In US, after Jan 22nd. In UK: when Doris needs a boost/distraction.

  6. @TtC

    Don’t think there’s any way that false positives can be “dominating” the test results. Sure, they happen, but dominate? No way. If they did, the positivity rate (including of the random sampling done for the ONS and REACT surveys) would presumably have stayed roughly level throughout the epidemic, with peaks or troughs in the virus prevalence having hardly any impact. But in fact there are very clear patterns in the positive results which are compatible with both changes in contact rates (eg during lockdowns) and observed demand for hospital beds. That’s not compatible with the vast majority of positives being due to systematic error.

  7. Lets be honest. Given that most deaths from Covid-19 are people over 80 or with existing conditions, lots of them would have died anyway, just of something else.

    We’ve backed ourselves into a corner now. What happens the next time there’s a bad flu year? You can get 30k+ flu deaths in a bad year. Do we trash the economy again with lockdowns then? Or do we “heartlessly” not?

    And we’re now well over 10,000,000 legal abortions in the UK since it was legalised. Why didn’t the ‘right to choose’ lobby hold a parade to celebrate when they passed that milestone?

  8. @Bloke InTejas

    The interesting thing about deaths in the UK in 2000 being 610,000 is that the UK’s population is now 15% higher now than it was in 2000. Add 15% to the 610,000 deaths in 2000 and you get 701,500.

    Anything less than that dying in 2020 means that on percentage terms 2000 was a worse year than 2020.

  9. I’ve been crunching the official stats from NHS England (available here- https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/weekly-total-archive/)

    Page 3 is the most interesting- deaths by pre-existing condition. Up to the week ending 7th of Jan we can see the following:

    pre-existing condition
    Yes No Total
    Total 51,522 2,208 53,730

    Breakdown by Age group
    0 – 19 yrs 22 6 28
    20 – 39 294 48 342
    40 – 59 3,241 357 3,598
    60 – 79 19,393 906 20,299
    80+ 28,572 891 29,463

    By my calculations, that’s 4.11% of deaths with no pre-existing condition, and 6.62% of the total with a pre-existing condition were under 60. 0.76% of deaths under 60 had no pre-existing condition.

  10. It’s a bit like this story about all the gold ever mined. HSBC calculated it in the early 00’s, could fit it in two double decker buses. Now, 3-4 max?

    Give me 90k bodies, a caterpillar tractor and legal immunity and I’ll fit it all in a small 2-bedroom bungalow near Leatherhead.

  11. @ Andy ex-Taiwan
    That begs the questions “what is a pre-existing condition” and “what *counts as* a pre-existing condition for this analysis”? I am deaf in one ear – a bit of a nuisance but very rarely likely to affect my chance of dying.
    Most people with a pre-existing condition who have died of Covid-19 were highly unlikely to die in 2020-2023: a youngish Actuary wrote a blog to demonstrate this to anyone numerate enough to understand.
    We need to get this right *before* looking at the vast cost in human lives as a result of diverting the bulk of NHS resources to dealing with Covid-19 and of the lockdown. Was the panic justified or was Jair Bolsonaro right?
    IMHO Imran Khan was right Pakistan has had only 47 Covid-19 deaths per million and a lockdown would have cost far more but Trump was wrong (the USA hasn’t the worst death rate in the Americas but it is unnecessarily bad as a result of his anti-mask rhetoric in an attempt to win an election). Sweden has more than ten times the death rate of Norway and eight times that of Finland so they probably got it wrong – would require an awful lot of GDP damage to fully offset that and it is implausible that the optimum balance is at Sweden’s end.
    Polly *may* not have noticed that *all* the countries with the worst death records have left-wing governments or, in the case of Andorra and San Marino, are tiny and completely surrounded by countries with left-wing governments.

  12. Objectively we should be measuring the mortality in “Years of Life Lost” not just counting corpses. There is a huge difference in that very rare case when a previously healthy person aged 30 dies compared with the more common case of someone in their mid 80’s.

  13. @ Andy F
    Agreed, but the “years of Life Lost” is not normally zero for someone in their 80s: it may only be 20% of that for a 30-year-old but it still matters.

  14. “That’s not compatible with the vast majority of positives being due to systematic error.”

    In the last week of last university term, Cambridge tested all its asymptomatic students. All the positives turned out to be false positives. Every one. (I assume that this was determined by re-testing.)

    “it is unnecessarily bad as a result of his anti-mask rhetoric”: the evidence on masks seems to me to be meagre and inconclusive. Anyone who has confident views on masks, pro or anti, is probably being a chump.

  15. @john77: “Most people with a pre-existing condition who have died of Covid-19 were highly unlikely to die in 2020-2023: a youngish Actuary wrote a blog to demonstrate this to anyone numerate enough to understand.”

    Do you have the link to hand? If so, would you please post it?

    I ask because many of the old folk killed by Covid lived in care homes. The median stay in British care homes isn’t very long: BUPA figures –

    “The median length of stay was 19.6 months for all admissions. Median length of stay for people admitted to nursing beds was 11.9 months and for residential beds it was 26.8 months. In the PSSRU study, average length of stay was predicted at 29.7 months following admission.”

  16. Bullshitted its way up to 93000 has it now?

    10000 “cases” a day? Or is it 50000. PCR bullshit.

    Most deaths –as said above–old ill with 2 to 3 other conditions (ultimately fatal themselves) present.

    NHS figs of people prev healthy taken to death by c19 alone =approx. 1500–388 under 60.

    Remember Operation Moonshite? Johnsons Great White Hope in Liverpool –using the new slightly more accurate Lateral Stream Test. Johnson wanted us all tested 10 times a week–how he must have imagined the “case” numbers would soar.

    Instead I believe the false positives went down by massive numbers.

    Not enough cases = no LD justification= no LD and panic subsides. People have time and mental peace to review the Johnson gang and their performance in getting 50-200 thousand killed by lockdown . No more ” vax saviour” crap for Johnson.

    So now Moonshot is abandoned ( the 100 billion price tag might have helped) and the state disses their own LST saying it is inaccurate –next to the known useless PCR test .

    Testing everybody who dies/goes into hosp with the useless PCR test and listing a shitload of deaths nothing to do with C19 boosts the numbers both of cases and tests. Counting multiple positive tests of same indiv as a seperate new case is also a scam.

    To add insult to injury many of the dead will be LD victims added to C19 list by false positive PCR tests.

    Johnson is running a scam to save himself and his crew.

    And possibly running the WEF agenda.

  17. Locally the numbers have been going down and the govt blamed it on people not wanting to get tested over Christmas, seemed strange to me they didn’t want to take credit for their recent round of restrictions before Christmas that they brought into to control rising numbers.
    Also if they don’t think the restrictions (including closing churches) had any impact why did we bother in the first place. Surely the answer is stop testing asymptomatic people and the numbers will get better.

  18. @John77- broken down further on page 4 of the spreadsheet, for example, 17% had chronic kidney disease, 26% had diabetes (but please note 72% have ‘other’, and as the totals add up to more than 100% there were patients with multiple conditions.)

  19. Most people with a pre-existing condition who have died of Covid-19 were highly unlikely to die in 2020-2023: a youngish Actuary wrote a blog to demonstrate this to anyone numerate enough to understand.

    They were highly unlikely to die in 2020 to 2023 – so long as they didn’t have an additional complication like a respiratory disease. Which is what we saw last winter (2019/20) – a very mild flu season resulting in lots of feeble ancients making it through (only to be whisked away by Covid). Feeble ancients live when things are easy and die when things get rough. So the youngish actuary wasn’t giving the whole story, because Covid-19 isn’t the only grim reaper in town.

    . . . unnecessarily bad as a result of his anti-mask rhetoric in an attempt to win an election . . .

    UK Covid cases plummeted during spring/summer last year when we were maskless, even after lockdown restrictions ended. Despite a mask mandate since the end of July (and varying degrees of further lockdowns) cases and deaths are reportedly through the roof. Maybe having a damp, festering mess permanently in front of your mouth isn’t a good idea

    Khan the kunt is calling for masks outside now. Hysterics rejoice.

  20. @john77: and what about the tens of thousands with cancers going undiagnosed and thus will die sooner than necessaty? Do they get £400bn splurged on cancer care to make sure they’re not abandoned? How about the millions suffering from mental health issues exacerbated by the lockdowns? Will they get hundreds of billions spent on mental health problems? What about flu itself? It manages to kill tens of thousands of people every winter, perhaps we should make sure they’re not ‘abandoned’ and lock the entire country down from October to May every year?

    This notion that ‘nobody must be allowed to die from Covid’ while consigning millions more to illness, affliction and death from more ‘normal’ medical issues, and impoverishment from economic depression is not only insane, it’s morally bankrupt.

  21. Bloke in North Dorset

    Perhaps someone could tell me us this person died of, with or from Covid:

    The most distressing part of their struggle is the air hunger. You can spot these patients easily, as they grasp the masks to their faces with both hands and gasp visibly for air.

    Once we decide to palliate someone, we give them morphine to reduce their respiratory drive, and ease this feeling. We give them benzodiazepines to lower their anxiety, antiemetics to stop them from feeling nauseous, and other medications to prevent them from needing to cough. We then take off their masks.

    It is important that these medications are given before their masks are removed, otherwise they will die terrified and gasping. This decision is made for about two or three patients each day on my ward, out of 20 or so. However, this process does not always run smoothly. Sometimes these medications are prescribed but not given in a timely fashion, or at insufficient doses. With so many patients, we cannot keep an eye on them all; to watch whether what we are doing is working.

    And of course they’re all old, so it doesn’t really matter:

    I am allocated B Bay, in which there are five patients. My patients are mostly men, ranging from their early 30s to their 60s. This is younger than normal on HDU because — as I explained to the man — we only have beds for people with a fighting chance. I read their charts to update myself on what happened overnight.

  22. I’ve never (long before the COVID stats issue) been convinced the with/from distinction is especially meaningful in practice. If someone dies in a traffic collision or a thirty-something dies due to a cancer of their liver, that’s not pleasant but at least it’s clear-cut. Ish. What if the tumour in the liver metastasised from a cancer elsewhere in the body, and the primary cancer would itself have likely been fatal but the cancer in their liver finished them off first? What if the primary cancer was itself likely caused by an underlying genetic condition like Lynch syndrome, or due to a radiation or chemical exposure incident? What if the road traffic collision was deliberate homicide or the result of intoxication due to chronic alcoholism? We can have careful guidelines about what primary cause a death gets attributed to, but they’re not going to all fall into neat and mutually exclusive categories. It’s a fact of life (or death) that many events tick multiple boxes.

    In reality most deaths happen in the elderly, most very elderly people have multiple health conditions, and if one nasty thing doesn’t finish off a ninety year old, there’ll be another round the corner to finish the job. But perhaps not for a few years yet.

  23. @dearieme

    You’re a numerate chap and you know better than to rely on a tiny sample like that.

    https://fullfact.org/online/cambridge-pcr-false-positive/

    No way you can conclude from this that the main driver in hundreds of thousands tests per day is the false positive rate, and the main driver in trends in those test results is presumably some unspecified factor causing trends in the false positive rates that due to wild coincidence match the patterns of social contact restrictions and hospital demand. Even more perverse when looking at all the Cambridge student-testing data shows the week you’re talking about was an exception.

    There’s serious stuff to be said about the issues surrounding the PCR test but this really isn’t one of them.

  24. Those looking at the actuarial link will be wondering how long people live and have the idea that most people who died of COVID will have had a reasonable length of time to go. I urge caution. Actuaries deal with averages and means are very poor ways of evaluating risks. We do not know whether those carried off with COVID will have been at the healthy end of those with co-morbidities or the less healthy end. Thus we don’t know how the future mortality profile of the pool will be affected.

    In my firm we’ve assumed COVID deaths are effectively randomly selected from the groups of people at particular ages. That approach works rather well as we’ve not got millions of people on the books, merely hundreds of thousands. Assuming random selection doesn’t matter that much. It might prove that actually we’ve got the longer lived people left, our assumption will cost us money, or the longer live were carried off and we’ll be quids in. But the amount at risk is small so we don’t care.

    The UK government however can’t, or rather shouldn’t, make such a casual assumption.

    As for @BiND’s linked article that is truly terrifying and shows a casual disregard for medical care ethics. They are easing suffering but like my example we don’t know whether those selected are those what will pull through or not, those that would have lived longer or not. And I seriously doubt they care. So the ones that look like hard work to support are given morphine and sedatives whether they would pull through or not. WTAF?

    That’s one thing US medical care delivers, a real effort to keep people alive until the money runs out as the fear of being sued if efforts are not made is real. Here the NHS just covers up deaths from negligence and then pays out to keep people quiet.

  25. @Dearime. The trouble with the PCR tests and medical care is that the warnings of a second wave were from those responsible for organising the response. Instead they seem to have decided not to train nurses in respiratory care, not to use the Nightingales, not to look building resilience for those affected. Instead they’ve decided to scare people into staying home, to promote PCR tests as cases when there was no real signature of deaths or even hospitalisations from COVID after March/April.
    This means everyone has rather seen them like the boy who cried wolf. That wouldn’t be an issue but it was their sodding job to prepare for the risk they were right. And all they did was lockdown and then hope we could vaccinate everyone. This is costing hundreds of billions and it’s a fucking disaster.

  26. Cumulative excess deaths metric is published here, Figure 2:

    https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html

    What is interesting is that there does appear to have been a noticeable net impact around the month or two at the very peak of the first wave. Then the death rate was bang on trend pretty much until year-end, with a very slight acceleration perhaps. Over the course of the year, it was a bit like having three average flu seasons instead of one; not really that bad if you are objective about it, and not really a great reason to smash 10% or whatever off your GDP and run up world war increases in national debt.

    With the new strains, this second wave could be materially worse however – higher transmissibility can lead to exponentially higher cases unfortunately. It may justify caution far more than it was in the first wave. Unfortunately we burned up so many resources supporting the first wave that it’s harder to repeat the trick second time around. It’s lucky the vaccine could at least backstop the costs at some point.

    Obviously the peaking of the second wave isn’t really appearing on the chart yet.

    You can’t really judge the impact of the pandemic until some time after it has ended, certainly after the next winter season. The excess death rate will probably be negative for some time afterwards as many people who died only had their time brought forward by months, which is not good but certainly less of a tragedy than cutting down the young.

    There should be a distinction made between sacrificing livelihoods for a disease that kills 1% of sufferers and a disease that kills 1% of sufferers a month or year early. The future years of life lost are vastly different.

    Unfortunately epidemiology is a bit like weather forecasting – at the point we need predictions to base decisions on, the uncertainty bounds are so wide the models are only the loosest of guesstimates. By the time we have enough data to calibrate the models to be rather accurate the pandemic has already run its course.

  27. @ Jim
    Quite! the cost in other lives lost because of concentration on covid-19 is one of the things that we have to weigh in the balance: most visibly cancer and suicides but multitudes of other causes – which is Professor Whitty tried to get people to look at “excess deaths”.

  28. @ Andrew Again
    The research looked at the separate averages for each age of those with co-morbidities and those without.
    There are also separate sets of data for those who have died with covid-19 but are assumed to have died from other causes. However the PHE analysis including everyone who died within 28 days of a positive test as having died of covid muddies the water somewhat

  29. It’s pretty easy to show lockdowns are a disproportionate response without digging around in reams of data. There are ~60m people in the UK. We’ve had Lockdowns and tiers (essentially less strict lockdowns) for a year. Even if we say that year was only 10% worse, 6m is a lot of Quality Adjusted Life Years.

    If lockdowns saved all 500k victims in Ferguson’s model (which the model did not claim), they would need to average 10 years of average quality life to justify the sacrifice of the general population. A tall ask for a population skewed towards the elderly and care home residents.

    And all that is before we begin to think about suicides, cancers, etc. Or the impact on already festering social divisions – which will be particularly acute with less cash to bribe the interest groups. And then there’s the precedent – plus the long term political fallout…

  30. @Jim

    “and what about the tens of thousands with cancers going undiagnosed and thus will die sooner than necessaty”

    There is an argument that ticks me off which is made quite frequently by some of the lockdown arch-sceptics – a group with whom I have a certain amount of sympathy in general. Hector Drummond made what was generally a very fair point listing all the really serious negative consequences of lockdown but I took issue with the fact he’d stuck in all the deaths from other conditions going untreated. Now I happen to think those deaths are really serious, really grim, and likely to distort “excess deaths” measures which many people hope will be the gold standard for measuring Covid deaths (as a way of getting round the with/from debate and getting a clearer comparison against a counterfactual).

    Hector’s argument was that these deaths formed part of the general Covid hysteria but I’m not sure if he was overreaching to the point of disingenuity or if he thought he was making a serious point. If the latter then I can’t get my head around it, as I can’t grasp how he causally attributes them to lockdown policy.

    If you’re willing to let hospital capacity take more severe strain because you’d rather our economy, society and the cause of liberty should be as unencumbered as possible, then just as night follows day, other folk who rely on that hospital capacity are going to suffer. That’s just how it is, unless you’re one of the few people who disbelieve the Covid epidemic is real and the number of respiratory patients is shooting upwards. Depending on your personal views and values it is perfectly arguable that even this is a trade-off worth making. I don’t think it would be majority view, particularly among cancer patients and their relatives, but it wouldn’t be an inherently immoral or illogical position to take.

    But if you think the poor sods bumped down the hospital waiting lists due to ballooning Covid demands are an absolute tragedy and every effort must be undertaken to save them, I can’t see how that’s compatible with demanding fewer restrictions on social contact and increased virus transmission – and inevitably, not much further down the line, more beds taken by Covid patients and fewer by anybody else.

    Strongly agree with @Jim that “nobody must be allowed to die from Covid” would be a daft line to draw in the sand and completely distort the cost-benefits calculations. If you go out and stick values on things and tot the figures up, there’s likely an “optimal” number of Covid deaths (more precisely, an optimal pandemic strategy that happens to result in this many Covid deaths) that’s somewhere north of zero. Though actually computing an optimal strategy means accepting some kind of epidemic model which is fraught with error/uncertainty… Perhaps the best you can do from such a model is an order-of-magnitude type prediction and some grasp of the dynamics of the situation. But the dynamics of infection do matter, no matter how little you trust the models for them, and clearly one Covid case begets another in a way that lung cancer cases don’t. The comparison with seasonal flu is an interesting one as that has the ability to kill tens of thousands of people and strain NHS capacity. We don’t ignore flu, and do have extensive vaccination campaigns and a seldom-used policy of targeted school closures if felt necessary.

    But a different perspective on it is that we don’t ever expect seasonal flu to risk causing hundreds of thousands of deaths or potentially exceed double or more of existing NHS capacity. There’s too much pre-existing immunity, too low a fatality rate, and flu has an R-number about 1.3 rather than (unconstrained) 3ish for Covid. Even if you’re a very strong sceptic of the policy responses governments have thrown at Covid so far, it’s pretty clear that Covid needs to be handled differently to seasonal flu because the tail risks it poses are more substantial. The more relevant comparator is a mildish-to-moderately severe pandemic flu, but that’s still not quite like-for-like because anything you do on the transmission control side needs to be substantially more heavy-duty for Covid than pandemic flu on account of the higher base value for R. And anything you do on the healthcare capacity front alone is unlikely to be enough – even a 50% boost to capacity is an extraordinary leap that can only realistically be made through compromises on quality of care. But if infections and hence potential hospitalisations can double in the matter of weeks then unless the curve flattens out pretty quickly (by itself through natural disease dynamics, or by policy) then such gains can be eaten away before there’s any opportunity of further expansion. Not saying capacity flexibility is a bad thing – aside from the obvious benefits, might well have had fewer infected patients sent back to care homes if hospitals had felt less pressure for beds in the first wave – but you can’t handle order-of-magnitude level challenges that way.

    It’s even plausible that a moderate-to-high severity pandemic flu would kill more people than Covid due to a higher fatality rate, yet require substantially less stringent policy response in general due to lower R producing a naturally flatter epidemic curve. It may cause far more harm in those sections of the population it sweeps through, but infect a smaller proportion of the population and do so at a slower rate, hence its consequences may be easier to manage and its spread easier to inhibit. In comparison, an R0 of 3 is bloody hard work to control or suppress, and even if the consequences of infection are usually mild, the sad exceptions add up very quickly if you don’t get it under control. It’s sensible to be level-headed about the cost of that relative to the cost of potential interventions, but the way the world looks today I’m doubtful there’s a ready supply of easy answers no matter high your granny-death (mostly men actually, so presumably grandad-death) tolerance levels are set.

  31. So Much For Subtlety

    If you’re willing to let hospital capacity take more severe strain because you’d rather our economy, society and the cause of liberty should be as unencumbered as possible, then just as night follows day, other folk who rely on that hospital capacity are going to suffer.

    Only if you are substituting like for like. What makes you think that every bed taken up by someone with Covid is a bed taken from someone with cancer? They are different parts of the hospital.

    What do Covid patients actually need? Well they are not getting much and seem to need little. The emergency hospitals built by China, America and Britain – which have been grossly under-used – provided them with a camp bed and little else. What do they need? It turned out that ventilators were killing them. So they need someone to turn them on their faces, keep them fed and watered and what else? Drug them up if you have accepted they will die. This is not a big user of operating theatres for instance.

    Most of the deaths have taken place in nursing homes where they get no hospital care at all. The aim of the NY, New Jersey and British governments was to keep the old out of hospital and leave them to die. It seems to have worked in that the hospitals have not been over crowded at all.

    It does not seem to me that Covid patients are using up much except nurses time. No reason for oncologists to be over worked. No reason for operations to be cut. No reason for beds in other parts of the hospital to be crowded – and we can build vast bed space fairly quickly but it has not been necessary.

    So it would seem that your argument is based on a fallacy.

  32. @Oblong

    Something else that frustrates me about lockdown arch-sceptics is the way so many of them have rehashed the same arguments for each lockdown – but in each case we have had different data, different uncertainties. The kneejerk responses to this one which don’t take into account evidence of faster transmission this time seem a bit lazy to me, or suggest a cognitive bias of not wanting to appear to have had a change of mind. You could still make an argument against lockdown now, but you couldn’t honestly do so on the basis that hospital capacity looks fine and it would be a stretch to say people will change behaviour to stop transmission voluntarily anyway. Kudos for not falling into that trap.

    Agree that we can only judge policies in retrospect but sadly that isn’t much help for policy-designers or setters! Excess deaths has its flaws but is definitely one of the more useful metrics available. The big problem is we lack counterfactual excess death figures for alternative policies, which is what you really need to judge the effect. That gap either gets filled by modelling disease dynamics, which has all the well-known flaws, or (something quite in vogue in public health the last few years) by using “synthetic controls” made by averaging out countries which followed particular policies. Though given differences in demographics, policy implementations and data collection between countries, I might even trust that less than pure modelling.

    @JK277

    Think there’s some merit to doing broad-brush comparisons to a worst-case scenario. The weakness of your argument is that QALYs actually have a very technical definition in health economics and relate purely to “health utility”, not to the wider concept of utility of the kind Bentham and Mill would have us employ. The Q is for HRQOL (health-related quality of life) and not subjective QOL in general. While lockdown will have had several knock-on impacts on HRQOL they won’t average anywhere near 10% average reduction.

    Perfectly fair to say you’re using a wider concept of “util-years” or something, though I think the 10% figure still needs some evidence – it’s clearly subjective and varies from person to person. But if you’re totting up at a population level, you actually need to define a social welfare function, since economists don’t necessarily calculate aggregate utility at a societal level: https://en.wikipedia.org/wiki/Social_welfare_function

    This is probably the biggest issue with your argument, though it is clear the choice of SWF is itself subjective. Many SWFs penalise inequality of outcomes, as the concentration of disutility among the dying would produce. This may actually be realistic if you consider what your worst-case counterfactual of 500k deaths involves – queues of dying people unable to get into hospital and quite likely a very visceral and deep-seated regret that more could not have been done to save them, especially if other countries had managed their death toll more successfully. I imagine if this played out that a decent proportion of people would agree with a statement like “living under restrictions might have made me feel X% worse, but I would rather not have lived in a society where we abandoned hundreds of thousands of people to die in such desperation and without medical care.” If you think I’m stretching things with that, you might at least accept any politician presiding over this situation would be unlikely to get a ratings boost out of being so level-headed over simple aggregate utility. That would suggest an element of social preference for outcomes in which harms are not concentrated on the unlucky few even if this means society accepting a greater burden on aggregate – which is precisely why these alternative SWFs are often argued to be more reflective of what people actually value at a societal level.

    Just as a minor point – lockdown sceptics often bring up the suicide stat as if it is real clincher but I’m dubious of its power. Annual suicides are about six thousand annually in the UK so even a substantial rise isn’t likely to be much more than a rounding error in comparison to the uncertainty over the exact figure for Covid deaths. Ascribing causality is even trickier since the suicide rate follows trends of its own. There’s an interesting and, considering the source, surprisingly balanced discussion at https://www.newstatesman.com/politics/health/2020/11/suicide-rate-UK-pandemic-lockdown-corona-virus-covid As an aside, in economic recessions there tends to be a rise in suicides somewhat offset by a fall in road deaths since declines in economic activity tend to reduce traffic. I suspect that will play out in the 2020 stats too.

    An alternative ballpark estimate of whether policies have been “cost-effective” might be taking discounted life-years purportedly saved compared to the worst case scenario (if you run with 500k deaths or whatever you need to bear in mind these will likely have bitten down substantially into lower age ranges, not just the 80+ even if it likely would include fairly few under-50s, due to the breakdown of healthcare provision this scenario involves) then multiply by the statistical value of a life-year (I think GBP 60k in HM Treasury Green Book, which is higher than what NICE use for drug evaluations but is the figure the Department for Health used in pre-Covid pandemic planning) and comparing to the estimated economic cost of the policies employed (again, bearing in mind the counterfactual still involves substantial disruption due to illness and reduced trade/tourism etc, so you can’t just use the annual GDP hit). Unlike your method this doesn’t account for the subjective costs of restrictions, though. One minimum combination that gets you to the GBP 100 billion mark is 400k people gaining a bit under 4.5 years on average. Upgrade or downgrade those assumptions and the monetary value changes proportionately…

  33. So Much For Subtlety

    MyBurningEars January 9, 2021 at 12:56 am – “Something else that frustrates me about lockdown arch-sceptics is the way so many of them have rehashed the same arguments for each lockdown – but in each case we have had different data, different uncertainties.”

    And yet a bad policy is a bad policy no matter how the details have varied. Given that this seems to have been Bad Policy from the start – based on fraudulent modeling and little else – there is no reason to think the situation has changed so radically as to make their bullshit less bullshit.

    “You could still make an argument against lockdown now, but you couldn’t honestly do so on the basis that hospital capacity looks fine and it would be a stretch to say people will change behaviour to stop transmission voluntarily anyway.”

    Why would people have to change behaviour? It does not look as if any change short of staying in all day has any effect. At the start it looked like hospital capacity was going to be an issue because of the ventilators. But it turned out that those were killing patients. So everyone rushed to build emergency hospitals that have not been used. Since then there never has been a good argument for hospital capacity being an influence here.

    “Many SWFs penalise inequality of outcomes, as the concentration of disutility among the dying would produce. … That would suggest an element of social preference for outcomes in which harms are not concentrated on the unlucky few even if this means society accepting a greater burden on aggregate”

    And so we get people defending the US government’s decision to let old people die so deaths would not be concentrated among Blacks. The disease kills randomly, more or less, but a government decision to minimise inequality picks on the less favoured races. That is not a good outcome.

    “you might at least accept any politician presiding over this situation would be unlikely to get a ratings boost out of being so level-headed over simple aggregate utility.”

    That is true. We have a problem with a feral media that makes good policy hard.

    “Just as a minor point – lockdown sceptics often bring up the suicide stat as if it is real clincher but I’m dubious of its power.”

    Of course you are dear. You would be.

    “An alternative ballpark estimate of whether policies have been “cost-effective” might be taking discounted life-years purportedly saved compared to the worst case scenario”

    That just encourages Ferguson to lie in his models to produce a worst-case scenario that forces the government to do what he wants.

  34. @SMFS

    Sadly your post is almost complete balls. The fact many people died without going to hospital doesn’t mean hospitals aren’t or weren’t under pressure – obviously in many cases it wasn’t worth the care home sending them there and they wouldn’t have done so with any other severe respiratory infection, in other cases perhaps they would have liked to if they felt a bed would be found but the capacity issues made this infeasible. This doesn’t mean there weren’t lots of sick people in hospital, some dying and rather more (thankfully) surviving. To accommodate Covid patients, areas which were previously being used for other things have been repurposed. To take one of your examples, operating theatre have often been converted to makeshift ICUs (I believe because of facilities they offer). And ICU is one of the most nursing-intense areas of a hospital, so expanded ICUs actually increase demand on nurses. And indeed doctors – to take another of your examples, I’m genuinely aware of oncologists being redeployed to said ICUs. Staffing pressure not being helped by the number off sick of course. The field hospitals are an emergency overflow measure to counteract the tail risk of a severe surge in cases. They’re the equivalent of buying a call option on the size of epidemic peak – or rather, given their own limited capacity, a bull spread. They can’t offer the same level of care as a fully equipped hospital – my understanding is this is partly a staffing issue and partly because they just don’t have the kit to manage the more complex needs many of the frailer Covid patients have – which is why they’re only being used as a last resort once existing hospitals have no more capacity that can be diverted.

  35. “That just encourages Ferguson to lie in his models to produce a worst-case scenario that forces the government to do what he wants.”

    Fwiw you don’t need a fancy epidemiological model to get a ballpark figure for the worst-case scenario and the 500k figure was in many ways one of the least interesting parts of Ferguson’s report – you could get there, more or less, just from looking at some of the basic inputs like the estimated fatality rates and R0. The latter gets you to the herd immunity threshold and the former tells you how many deaths you’ll rack up reaching it. The main point of Ferguson’s report was the modelling of the dynamics of the spread, a feel for the timings the epidemic might play out in, and some potential policy responses. The 500k unmitigated deaths figure around what was already projected but the media only seemed to pick up on it after Ferguson stated it.

    To be fair there are a couple of ways a dynamic model can help clarify your mortality projections. One is that in practice an epidemic doesn’t halt in its tracks the moment the herd immunity threshold is reached – there’s a phenomenon called “epidemic overshoot” but it’s usually pretty small. Can be worse for fast-growing epidemics though. Another is that it gives you data about the timing of infections and size of the peak, so you might account for reduction in fatality rate over time due to improved treatment (not much use if the peak arrives too soon) or more dramatically the potential rise in fatality rate during periods healthcare capacity is breached. You can also use an age-stratified model with a social contact matrix to see how the disease is expected to spread through the age-bands – it may be that herd immunity is reached with disproportionately fewer, or more, of the at-risk age groups affected, which alters your death toll accordingly.

    Just looking at IFR and R0 should still get you in the right ball-park though. Bearing in mind the UK looks set for well over 100k deaths despite quite stringent intervention, and it seems likely that the endgame will be vaccination rather than herd immunity reached through infections alone (judging by current incidence and mortality we don’t seem to be anywhere near the herd immunity threshold, as that would have slowed transmission well down even without a lockdown), I’m not sure the 500k figure looks particularly unrealistic.

    Re whether anything helps bar everyone staying under house arrest indefinitely – there’s another Imperial report on how good compliance has to be (not using Ferguson’s agent-based model iirc but rather a compartmental one) which suggests the outcomes are highly nonlinear depending on whether compliance is the right or wrong side of a critical value. Just thinking about this as a statement about a dynamic system, it seems very plausible to me mathematically. Whether the critical level of compliance is societally attainable in practice is a multi-billion pound question – if you try but fall just short, the outcome is pants despite all the cost and effort involved. If it seems tantalisingly within reach, the temptation must be to redouble efforts and have an extra push because the dividend from getting there is so great… I think we see this a lot with politicians in many countries ramping up restrictions at the moment. If actually nothing will get us to that point then it’s time to ask very tough questions, including potentially “how should our society manage the imminent deaths of hundreds of thousands of people and just who should we try to save?” On the brink of a mass vaccination effort, that would be a pretty weird time to change tack like that, so I can’t see it happening. And it’s not something any political leader would feel keen to discuss openly. Pretty clear why all the hard-headed post-nuclear armageddon planning was done in deep secrecy…

  36. @MBE – “so many of them have rehashed the same arguments for each lockdown – but in each case we have had different data, different uncertainties.”

    Interesting posts. I agree with this – it was one of the points I was trying to make about my own thinking, I am happier to accept lockdown this wave than last given the new evidence.

    I think the main reason is that we haven’t yet seen the bulk of the deaths or hospital capacity stretch from this second wave, so propose haven’t got hindsiggt to update their mental models. It’s also very human to repeat arguments in the face of mixed evidence – after all socialism has for some remained humanity’s saviour over and over again despite purges, famines, repressions and economic malaise.

    Whilst I think there is a good case to argue that lockdown was an excessive response in the first wave, it’s harder this time. One of the shames about excessive caution first time around is that we burnt so much money that doing it a second time is going to be more crippling than it should be. Thankfully the vaccines make the sustainability of a policy stance less of a question than it might otherwise be.

    But I’m also very conscious that it’s easy to judge with hindsight. No politician or epidemiologist is going to look at the mid-point of their projections and base policy on what’s *probably* going to be ok. They want a margin of safety as they know people will blame them for a pandemic is a way they don’t for e.g. annual flu deaths.

    If the earliest models suggested 500k might be killed by COVID without policy response in a pessimistic scenario and we’ve had 70k excess deaths with another wave to come despite a lockdown response… then the models weren’t actually a million miles off in scientific terms when you consider the huge uncertainties involved at the start. Right order of magnitude at least! That may be as much luck as judgment given what we’ve learned about the Ferguson model coding since but you’re right, people forget that simpler pandemic models exist that are less informative but don’t suffer the same drawbacks of complexity.

  37. Bloke in North Dorset

    Here’s the link to the article I quoted: https://unherd.com/2021/01/inside-the-covid-ward/

    Re lockdowns and other lighter measures, this time it really is different, there is light at the end of the tunnel and it now become a race to get the most vulnerable vaccinated and not a case of learning to live with it. By not having a lockdown we are condemning a section of population when we know that there’s a vaccine that would prevent their death on the way.

    Its also worth noting that at this time of the year most of the hospitality industry is either closed or running at a loss so the economic hit is less that it would be in the middle of summer.

    Another reason to try to reduce infections is to reduce the chance of a variant emerging that is resistant to the vaccines.

    The questions that we should be asking now are: how do we speed up vaccinations and at what point do we start easing the restrictions?

    Oh, and good posts MBE, thanks.

  38. Argh my last post should have said ‘people haven’t got hindsight to update their mental models yet’. Typo- apologies.

  39. So Much For Subtlety

    MyBurningEars January 9, 2021 at 1:19 am – “Sadly your post is almost complete balls. The fact many people died without going to hospital doesn’t mean hospitals aren’t or weren’t under pressure”

    No but the fact that in both Britain and America they rushed to open more beds only to have them unused suggests the hospitals were not under pressure. They have been re-opening the Nightinggale hospitals at a fraction of their March size because they know there is no particular demand. The models were garbage. The hospitals have not been under pressure.

    https://www.express.co.uk/news/uk/1380929/why-are-the-nightingale-hospitals-not-being-used-EVG

    https://www.dailymail.co.uk/news/article-9108133/Londons-Nightingale-hospital-just-300-4-000-beds-use-reopens-week.html

    “This doesn’t mean there weren’t lots of sick people in hospital, some dying and rather more (thankfully) surviving.”

    Many of them dying because their medical care was killing them. As the quote above shows, doctors have been happy to hasten death.

    “To accommodate Covid patients, areas which were previously being used for other things have been repurposed.”

    And yet hospital beds have been sitting unused because the demand was grossly over-stated. And this time around they are not bothering. Your argument is specious.

    “To take one of your examples, operating theatre have often been converted to makeshift ICUs (I believe because of facilities they offer).”

    Where?

    “And ICU is one of the most nursing-intense areas of a hospital, so expanded ICUs actually increase demand on nurses.”

    No, again this is a fallacy. ICU patients are nurse-intensive. If you fill an ICU with other patients they do not magically become nurse-intensive.

    “I’m genuinely aware of oncologists being redeployed to said ICUs.”

    Where and how many? What are they doing when there is no treatment?

    “They can’t offer the same level of care as a fully equipped hospital”

    As I said. They don’t do much. But there is not much that can be done.

    MyBurningEars January 9, 2021 at 2:02 am – “Fwiw you don’t need a fancy epidemiological model to get a ballpark figure for the worst-case scenario and the 500k figure was in many ways one of the least interesting parts of Ferguson’s report – you could get there, more or less, just from looking at some of the basic inputs like the estimated fatality rates and R0.”

    Sure. As I said. Garbage in, garbage out. You have a solution you like, you pick the numbers going in to get the result that results in power, influence and funding.

    “You can also use an age-stratified model with a social contact matrix to see how the disease is expected to spread through the age-bands”

    All of which is fascinating. And irrelevant. The models are useless without reliable data and honesty in application. Two things that have been noticeably absent.

    “Just looking at IFR and R0 should still get you in the right ball-park though.”

    So are we close to 500,000 deaths yet?

    “(judging by current incidence and mortality we don’t seem to be anywhere near the herd immunity threshold, as that would have slowed transmission well down even without a lockdown)”

    Of course because you can’t get to herd immunity with a lock down.

    “I’m not sure the 500k figure looks particularly unrealistic.”

    I am sure the need to save face means that one way or another 500,000 people will somehow die of Covid-19 before it is all over.

    “there’s another Imperial report on how good compliance has to be (not using Ferguson’s agent-based model iirc but rather a compartmental one) which suggests the outcomes are highly nonlinear depending on whether compliance is the right or wrong side of a critical value.”

    So they are covering their arses. It is not their fault their models are garbage, it is our fault for not listening to their advice, but it is chaos! So if it works, they are still going to claim they were right. Brilliant.

    “Just thinking about this as a statement about a dynamic system, it seems very plausible to me mathematically.”

    Now. No one was saying it *then*. Oddly enough.

    “Whether the critical level of compliance is societally attainable in practice is a multi-billion pound question”

    Yes. If only someone had spent some time thinking about this before they inflicted trillions of pounds worth of damage on the world economy. If only, you know, we had some professionals whose job it was to plan this sort of thing?

    “If it seems tantalisingly within reach, the temptation must be to redouble efforts and have an extra push because the dividend from getting there is so great…”

    General Haig turns to medicine. The people you attack said there were too many unknowns, as you now admit, and they said the models were garbage, as you are egding towards, and they said it was unlikely to work any better this time – which you specifically attacked. And your only response is to blather at length while changing the subject.

    The last lock down was a non-solution to a non-problem. There is no reason to think it will work any better this time. But it will hurt.

  40. BiNd–you can buggeroff with yr bollocks about how nasty it is to die gasping for air. Sickening childish bullshit. Some POS female Beak read out exactly the same emotional shite in a court re an anti-LD activists case. As was pointed out later–if I am tailgated in a minor car crash–should I take a huge set of glossy photos of car wreck horrors to court and use that as my case? If emotional vapouring is what everything is now about.

    The kind of shite you are peddling is exactly HOW this fucking hysteria was started.” Do you want to die suffocating for days/weeks–if not kiss the arse of tyranny and sign up for a nasty new world”.

    Lots of deaths are nasty. And if the mother-fucking scum of the NHS boss class are so full of compassion maybe the bastards should try using some of the 6-8 odd actual TREATMENTS that exist for c19 but NHS wont touch. Because they’d take a pin to Blojob’s bogus casedemic bubble. And the same with those already dying from assorted other conditions. Even if some of them HAVE another 2 or 3 years to go then treating them is an infinitely better approach than using vents more likely to help kill them.

    Pseudo-intellectuals can sod off as well. Number-crunching and cockrot about a vax not proven to be effective let alone safe . Shite about “we haven’t seen 2nd wave peak deaths in hosps yet” . The same tired old “mega-death in the next two weeks” twaddle that was being played in May last year. And was a pack of shite back then.Accepting the pack of lies about 70000/93000 deaths is another sign of bs on the job. All these posts accepts all the lying garbage the state puts out as a given.
    Blow out of your arses lads.

    Are there 10-50000 “new” cases a day and which hospitals are they going in then? Because that WOULD swamp for real an NHS that says it is emptier than this time last yr. It is lying shite Johnson and his gang are working.

    If your stats talk was just intellectual wanking it would be of no importance. But it is enabling mass ruin and tyranny. The Johnson gang are getting a taste for giving orders even if they are not WEF stooges. And the forthcoming economic mess will be made far worse by Biden’s antics to come in the USA.

    Lots more are going to die from LD and economic ruin than this POS virus has ever killed.

  41. @MyBurningEars:
    EQ5-D measures quality of life against metrics which include mobility, usual activities and anxiety / depression. Granted it’s unusual to apply it to the healthy but not completely so – it is designed to take account of the negative side effects of health treatment.

    Yes, you could have <10%. But you could also use Ferguson's actual figure (250k IIRC), account for those who would die anyway (2/3 based on said model IIRC), account for lower quality of life in the vulnerable population where most deaths occur etc.

    10% was plucked entirely out of the air to illustrate just how much benefit lockdowns have to bring due to scale of the harmed population vs the vulnerable population. At 10% and making huge allowances to the lockdown case, I get 10 years of life saved (actually a little over 12). Without those allowances it's probably over 30.

    You could adopt other percentages or actually calculate it, but it's a high bar given that this is only the direct effect of imprisoning and isolating the population.

    "a very visceral and deep-seated regret that more could not have been done to save them"
    Even if we used a broader utility function, I'm not sure that's credible. People may well object, but it will have negligible impact on their life and happiness – unless someone close to them dies.

    "a decent proportion of people would agree with a statement like"
    Revealed preferences. If they truly agreed, measures would hardly be necessary.

    "you might at least accept any politician presiding over this situation would be unlikely to get a ratings boost"
    Sure. But politicians' popularity seeking is hardly a guide to good policy. It doesn't lead me to conclusions on social preferences. Dispersed costs and concentrated benefits is trite economics.

    But hey, I can't change government policy – I can't even leave my home to protest it. I'm just going to enjoy the schadenfreude as all those lockdown supporters are horrified by the political fallout of the next decade or two. I don't know exactly what form it will take yet, but the result will be vicious divisions not social cohesion.

  42. @john77: thank you for the link. But I suspect his results may be vitiated by the facts – if facts they be – that (i) many of the ancients who have perished have lived in care homes where they have been disproportionately exposed to infection, and (ii) the ancients in care homes are not a representative sample of ancients, but are biased heavily towards people near death – see the BUPA figures I quoted.

    @myburningears: I disagree. I think those Cambridge data show unambiguously that if prevalence is low then test results will be dominated by false positives. For anyone who hadn’t realised that fact it’s a useful lesson.

    A separate lesson is that ten thousand student-age people did have a prevalence of zero in the last week of Full Term in December. I’d have found that hard to believe if it hadn’t been so carefully established. How on earth was it achieved?

  43. @BiND: thanks for the link.

    “CPAP … This comes via a tight mask that goes over your face to help you breathe by forcing air into the lungs at high pressures, keeping the airways open. I am told that it feels like you are suffocating.”

    I’ve slept with a CPAP for years. It doesn’t feel as if I am suffocating. (I suppose that my pressure setting might be lower than for the poor sods with Covid.)

    “The patients hate proning, since the masks dig into their faces, their backs hurt and their arms go numb, and WE DO NOT HAVE MASSAGE TABLE-STYLE BEDS WITH HOLES FOR THEIR FACES.”

    Why the fuckety fuck not? The NHS has had months of notice to buy beds with face-holes, just as it’s had months of notice to upgrade oxygen availability on the relevant wards, and months of notice to train more nurses for ICU work. It really is time to hang some NHS bureaucrats pour encourager.

  44. Hang on; suitable use of plenty of pillows could be used to simulate beds with face-holes. Why isn’t this notion pursued on the wards? Surely I can’t be the first person to think of it?

  45. Bloke in North Dorset

    Mr Ecks,

    Save your time. I haven’t read a single post f yours since I followed one of your links to a story about pedos and pizzas or something, I gave up, after a couple of paras. I dint read you comment, only saw my name.

  46. Dear Mr Worstall

    Something has been killing more people than ordinary this year.

    Excess deaths to week 52 amount to about 80,000 for the UK. 2020 is a 53 week year, adding perhaps another 12-14,000: cue additional hysteria.

    For England and Wales, 2018 excess deaths were about 21,000 for the year, making 2020 about four times worse in excess death terms, out of a total of 604,000 deaths to week 52.

    I have been plotting excess deaths by age groups for England and Wales:

    https://www.flickr.com/photos/[email protected]/50806314173/in/dateposted-public/

    Having killed so many oldies last year, there are fewer available to die this year. I suspect that the latest lockup for our own good™ is a last ditch effort to claim credit for a natural decline in deaths in the early part of this year.

    Sir Vallance Bedspread, Mr *hitty, Boris Johnson and UTC and all have saved us!

    Gongs all round and ignore the devastation.

    DP

  47. Damn and thrice damn.

    Excess deaths for England and Wales was about 73,000 to week 52, making it about three and a half times worse than 2018, not four.

    On Mr Legiron’s blog, the graph appears in the comment.

    Does anyone have ideas on how to deal with week 53?

    One thought is to pretend it doesn’t exist.

    DP

  48. @ dearieme
    Yes, there is a scandal that Scottish Care Homes, and to a lesser extent, English ones have suffered from the discharge of patients infected in NHS hospitals BUT the Scottish deaths are a small %age of the total (because Scotland has a small share, c.8%, of the population).
    Care Home residents account for around one-third of all England’s covid-19 deaths in the period covered by the first set of official stats that I could find but also only about one-third of covid-19 deaths among over-65s. That is because 89.85% of all deaths reportedly due to covid-19 were among the over-65s. Simplified – 5 out of 9 covid-19 deaths were OAPs who were *not* in Care Homes (and 1 in 10 were under-65s).
    So they are facts BUT misleadingly stated facts. Firstly “many” is still a minority; secondly a large proportion of those in Care Homes these days are in good physical health but suffering from dementia and nowhere near death’s door. New regulations have made Care Homes horribly expensive for the middle classes, home helps being far cheaper, so frailty is no longer the primary reason for going into Care.

  49. Care homes are expensive for the middle class (actually, anyone who has made financial provision for themselves) as the council is allowed to double dip on their charges to pay for the people who didn’t make provision.

    Bit like having a surcharge on your mortgage to pay for council house tenants. Still whether taken as a surcharge or with menaces (HMRC) it doesn’t really matter. One way or another you’ll be fleeced.

  50. @john77: thank you for that. A question: “Care Home residents account for around one-third of all England’s covid-19 deaths in the period covered by the first set of official stats …”

    Given the common standard of official stats, forgive me if I ask whether Care Home residents who fall ill and are taken to hospital, there to die, are recorded merely as hospital deaths or as Care Home resident deaths?

  51. @ dearieme
    ONS show the deaths of Care Home residents by location (Care home, Hospital, Elsewhere and Unknown). Someone had presumably asked that question earlier and they decided it was a good one so they provide the information in a secondary table in the same file.
    So, yes, they are shown as Care Home resident deaths in the table for Care Home Resident covid-19 deaths compared with all covid-19 deaths

  52. @ Mr King
    That is only literally true if you choose to go to one of the relatively few Care Homes actually owned by a council.
    What actually happens is that local authorities demand that privately-owned care homes charge below cost (a little above marginal cost) for LA-funded residents so the Care Home charges self-funding residents extra to cover for the LA-funded ones’ share of fixed overheads and to provide the owners with a livelihood/profit.

  53. @ john77: “local authorities demand that …” So why don’t the care homes tell them to take a running jump?

  54. @ Andy ex-Taiwan
    If you read through the blog you will discover life expectancies for people with diabetes, chronic xyz etc are non-zero.
    For dementia without other co-morbidities, life expectancy is only moderately lower than for people of the age and sex classified as healthy: I suspect that many (?most) of these were infected in Care Homes by other residents discharged from hospital.
    The table does not distinguish between Type 1 diabetes and Type 2 diabetes: it is quite possible to live for half-a-century while suffering from Type 1 diabetes; OTOH the causes of Type 2 diabetes increase the mortality rate from other causes of those suffering from Type 2. A significant share of the multiple conditions comprise co-morbidities of Type 2 Diabetes

  55. @ dearieme
    Some do – if they can fill the home with fully self-funding clients. BUT most would-be residents of Care Homes are not fully self-funding (if they don’t own a house or if a dependant has the right to stay living in it then there are rarely enough seizable assets above the retention allowance to pay for the Care Home for the rest of their lives), so the LA has effectively monopsonist power in its area. Yes, a majority of elderly people live in owner-occupied houses but it is only the last survivor whose house can be seized to pay Care Home fees and the minority living in rented property tend to be more frail than owner-occupiers [reverse causality – the healthier earn more hence more likely to be owner-occupiers].
    There are a few Care Homes that have decided to market themselves heavily to attract wealthy self-funding clients as luxury hotels with nurses attached but the extra costs involved make them more expensive for the middle-class customer than a basic care home including the cross-subsidy to the LA-funded resident.
    For most Care Homes the option is leaving rooms empty and receiving nil or accepting the LA’s mean offers and receiving an inadequate amount then relying on cross-subsidy from self-funders.

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