Coronavirus

Me and Mrs Scoobydoo took a drive to Cheddar late yesterday afternoon after all the shops there had closed for the day. We'd been couped up all weekend after our trip to Cornwall was cancelled at the 11th hour and we just wanted to get out of the house for a couple of hours and have a walk in some nice scenery where we thought it would be reasonably deserted. However, there were groups of people everywhere. The rock climbing experience was still taking place with a group of around 8 people. Plus there were large gatherings of people in the car parks near the top of the gorge. Around 6pm all the car speed merchants were gathering to race up and down the gorge. Having said that, it wasn't difficult to keep away from these crowds but it just struck me that these people are going to find it difficult when the call comes to totally self isolate. Maybe it was their last hoorah before the inevitable. Should we have even gone out of the house? I don't know.

You’re barking!

Darwinism in action, the human race will die out and cats inherit the Earth.

If I was provided euthanasia as an alternative option I would genuinely consider that very carefully. I can’t stand the idea of enforced incarceration in solitary confinement but likewise don’t want to be a burden to the authorities, especially the NHS. 

Hopefully I won’t be getting the letter. Although my medication suggests I’m in an at risk category I can’t believe I’m anywhere near the most vulnerable 1.5m in the country. Most days I run 8 miles and do a 50 mile bike ride on weekends. Despite the meds which I’ve been on for 15+ years I barely ever get the colds, bugs and normal flu which spreads through my workplace and social groups every year. People of a certain age and the obese would be better candidates for the efforts of people running around with food and medication supplies. 

You'd rather die than stay at home for a bit to protect yourself and others? Really?

New rules here announced over the weekend. Now, there are to be no gatherings of more than two people. Obviously this doesn't apply to family units.
Shops, like the UK, are short of some items. Here it's toilet rolls, eggs, flour and snacks like crisps. These are all in very short supply. Other shelves, like canned vegetables, are depleted but they are still available. I need to stock up on tea bags because if they run out then I may go all Rambo !

If you are fit and healthy (no pre-existing medical conditions) and under 50, the likelihood of you being hospitalised is very small. 

For the general population, I would (very) broadly expect this to happen (n=100 patients)

EDITED

Start 100 people

75% get the virus (n=75)

30% require healthcare (n=25)*

30% require admission (n=8)*

50% of those require ICU admission (n=4)*

50% of those will not survive (n=2)*

We are hearing that the ones in the higher risk group tend to deviate more towards 10% death rate and the younger ones more towards 1% so the above is average. If you look at the ones that I have marked with *, this is where healthcare capacity comes in. Right now we are potentially doing a little better than this but as pressure is applied, the * parts may begin to fail for some patients in access, ability to refer, available beds and treatments and so on. This is where we begin to see shift. So, as a fit and healthy individual your chances of dying are very small indeed but as time goes on, those odds may begin to shorten because if you are unlucky enough to reach line 3 or 4 in the above model, those % may have worsened.

Yes exactly.

Viral load viral load. 

A healthy person receiving a surface based dose from a supermarket trolley is unlikely to become very unwell with it. However, the moment the become infectious at home, they begin shedding it all over the place. The family members next to them become exposed to higher levels of the virus and when they get it, they are worse. Imagine then the third person who has been in the house and exposed to two people shedding. This is all unproven at the moment but there is evidence for it both in this strain and other coronal strains out there today. Look at the critically unwell and dead younger people - disproportionately healthcare workers and so massive exposure. As a result then we expect there to be a progression of severity for a while, until anyone isolating at home with others has had it. Then social distancing should help keep transmission levels and severity as low as possible.

The point remains that you are still likely to fight if off easily if you are young fit and healthy but its a bit like me handing you 100 skittles, 1 of which may kill you. You would certainly decide not to eat them all. You may decide not to eat any at all as the risk is not worth it. Now consider, that you had to eat one of them regardless. You would have a certain degree of anxiety knowing 1 of them would kill you but the odds are in your favour. What I am suggesting I suppose is that it is not a given that only 1 of those skittles would kill you if you are fit and healthy. Depending on other factors, perhaps 5 or 6 may be poison. If you were in the high risk group, 10 of those skittles may kill you as a starting point. add the viral load factor in and its not unreasonable to say 15.

In a way this is what flattening the curve is about. COVID19 is out there now in the community. It isn't going away. Just like other corona viruses and influeza, it will stay circulating in the community until enough people have had it that the only real way for it to survive is to mutate in to a new strain which is different enough for it to get around our antibodies. So, really it is about ensuring that we don't get overwhelmed. If we had the perfect healthcare system - flawless - and absolute capacity, you would see a mortality rate of 4% perhaps. With no healthcare at all maybe 9%. This is where the focus has to be on delaying transmission (social distancing), reducing viral load (social distancing, hygiene practices), and increasing healthcare provision. 

What they initially wanted was to avoid a double peaked pattern as I believe they had with SARS/MERS. When isolation measures were lifted, they hadn't infected enough people for spread to remain at low levels. If we end up there, that second peak is due in the winter with obvious challenges there in healthcare seasonality.