COVID-19: Day 127: I feel less optimistic

Warning: Discussing death is difficult, and if you feel you will be offended by this discussion, please don’t read any further.
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In my last post (on day 121 of 2020) I indulged in a moment of optimism. I am already regretting it.

What caused my optimism?

My optimism arose because I had been focusing on data from hospitals: the so-called ‘Pillar 1’ data on cases diagnosed as people entered hospital, and the subsequent deaths of those people in hospital.

These were the data sets available at the outset, and they tell a story of a problem in the process of being solved.

My last post pointed out that each new ‘Pillar 1 case’ arose from an infection roughly 18 days previously. Applying a trend analysis to that data indicated that the actual rate of ongoing infection that gave rise to the Pillar 1 cases must currently be close to zero.

I think this conclusion is still correct. But elsewhere – particularly in care homes and peripheral settings – things are not looking so good.

Pillar 1 versus Pillar 2 Testing

Although each Pillar 1 or Pillar 2 ‘confirmed case’ designates a single individual with the corona-virus in their body, the two counts are not directly comparable.

  • Cases diagnosed by Pillar 1 testing correspond to individuals who have suffered in the community but their symptoms have become so bad, they have been admitted to hospital.
  • Cases diagnosed by Pillar 2 testing correspond to a diverse range of people who have become concerned enough about their health to ask for a test. This refers mainly to people working in ‘care’ settings.

Diagnosing Pillar 2 cases is important because they help to prevent the spread of the disease.

But whereas a Pillar 1 case is generally very ill – with roughly a 19% chance of dying within a few days – Pillar 2 cases are generally not so ill and are much less likely to lead to an imminent death

Summarising:

  • Around 19% of Pillar 1 ‘Cases’ will die from COVID-19.
  • In Pillar 2 ‘Cases’ the link is not so strong, but these cases give an indication of the general prevalence of the virus.

We should also note that as the number of tests increases, the indication of prevalence given by Pillar 2 diagnoses will slowly become more realistic.

What does the data say: 3 Graphs

Graph#1 shows the number of cases diagnosed by Pillar 1 and Pillar 2 testing.

Slide1

Pillar 1 diagnosed cases are falling relatively consistently: this is what led to my aberrant optimism. However Pillar 2 cases are rising.

This rise in part reflects the higher number of tests. But it more closely reveals the true breadth of the virus’s spread. This rise is – to me – alarming.

Graph#2 below shows Pillar 1 and Pillar 2 cases lumped together. This shows no significant decline.

Slide2

However, because deaths are more closely associated with Pillar 1 diagnoses, the number of daily deaths (Graph#3) is declining in a way more closely linked to the fall in Pillar 1 cases.

Slide3

Overall 

The NHS is coping – but the situation outside of hospitals looks like it is still not under control.

This reality is probably a consequence of the long-standing denial of the true importance of the care of elderly people, and the attempt to ‘relegate’ it from the ‘premier league’ of NHS care.

Considering the forthcoming lightening of regulations, it seems likely that viral spread in the community as a whole is currently very low. Thus a wide range of activities seem to me to be likely to be very safe.

But the interface between high risk groups – care workers in particular – and the rest of us, is likely to be area where the virus may spread into the general population.

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Discussing death is difficult, and if you have been offended by this discussion, I apologise. The reason I have written this is that I feel it is important that we all try to understand what is happening.

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One Response to “COVID-19: Day 127: I feel less optimistic”

  1. Dominic Says:

    I appreciate your analyses of the data- thanks!

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