A Health Economic perspective on COVID-19

29th March 2020

The current COVID pandemic has brought a very thorny and difficult issue to the forefront. How much money should we, as a society, spend on keeping people healthy/alive? No-one has ever fully got to grips with this question, but it has never been more important than now.

The reason why I say this is that the US Govt has set aside two trillion dollars to deal with the crisis, in the UK it is over three hundred and fifty billion pounds, which is almost three times the current yearly budget for the entire NHS. Is this a price worth paying?

I know that some people will instantly dismiss such a question as being cold-hearted, and simply stupid. ‘You cannot put a value on a human life.’ Is an argument that I have heard many times, almost whenever health economics is discussed.

The counter argument is that – if funds are not limitless – then we should focus on doing things whereby we can do the most good (save the most lives) for the least possible amount of money. Or use the money we have, to save the most lives. In fact, this is why the National Institute for Health and Care Excellence (NICE) was established.

NICE reviews interventions and decides whether they provide value for money. The economic term for this is cost-effectiveness. This work is complex and often relies on assumptions that can be difficult to verify.

However, keeping this as simple as possible, NICE tries to compare healthcare interventions against each other by using a form of ‘currency’ called the cost per QALY.  A QALY is a Quality Adjusted Life Year. One added year of the highest quality life would be one QALY.

People with conditions such as cancer, or severe heart disease, or who are suffering from chronic pain can be considered to have a quality of life less than one. For the sake of argument, we can say that their quality of life is 50%. Thus, one year of additional life gained for them, would have a value of 0.5 of a QALY.

It also needs to be borne in mind that not everything that is measured using a QALY, relates to saving, or extending, lifespan. For example, someone could have chronic hip pain, and a quality of life of 0.5. Then they have a hip replacement, and their pain goes away, their quality of life can improve from 0.5 to 1. If they live another twenty years, they will have gained 20 x 0.5 QALYs = 10 QALYs.

Obviously, things can get significantly more complicated than this, and the validity of the measured quality of life is a matter of considerable debate.

However, the fundamental question as always, comes down to the following. How much are we willing to pay for one QALY? [How much can you afford to pay for one QALY?] Not just the NHS, but the country as a whole? The current answer, in the UK, is that NICE will recommend funding medical interventions if they cost less than £30,000/QALY. Anything more than this is considered too expensive.

This figure is not set in stone and can vary depending on circumstances. Interventions for young children tend to get more spent per QALY, and powerful lobbying groups can bring pressure to bear on that figure.

However, the figure of £30,000 is generally accepted – if not widely publicised.

Which means that, if we are going to spend £350,000,000,000.00 in the UK, on managing the coronavirus, how many QALYs do we need to get back? The simple answer is to divide three hundred and fifty billion by thirty thousand. Which leaves us with slightly more than eleven and a half million (11,666,666).

To put it in more stark terms. In order to spend three hundred and fifty billion pounds, we require a return on investment of eleven point six million QALYs. If not, NICE would reject it.

[For those who think this an impossible/inhuman calculation, you always have to consider how many other lives could be saved, how much other suffering, or death, could be prevented, by spending three hundred and fifty billion pounds in another way. Because that is what you are really trying to work out].

Are we likely to achieve this level of benefit? Of course, any attempt to model this requires several assumptions to be made. However, the model we can use in this case only has four variables, two of which are (pretty much) known. The variables are:

  • How many people will die?
  • What is the average age of death?
  • What is the average reduction in life expectancy in those who die?
  • What is the average quality of life of those who die?

[In truth, average age of death is only needed to calculate the average reduction in life expectancy.]

So, for example

  • 500,000 die
  • Average age at death 78.5
  • Average reduction in life expectancy 3 years
  • Average quality of life of those who die 0.7

QALYs lost: 500,000 x 3 x 0.7 = 1,050,000

Using these figures, if we spend three hundred and fifty billion pounds – in the hope of reducing the ‘QALYs lost’ figure to zero, then each QALY will have cost £333,000. Which is more than eleven times the maximum cost that NICE will approve.

Of course, people will immediately object to this model, and for valid reasons. How do we know how many will die, how do we know the average quality of life of those who die, how do we know the average reduction in life expectancy?

In fact, we do know two things with reasonable accuracy. First, we can be pretty certain about the average age of death, and we can also be fairly clear on the average quality of life of those who have died.

What is less certain is how many will die, and the average life expectancy of those who have died. At this point we need to look at the ‘variables’ in the model in a little more detail. This is UK only.

Number who may die

The 500,000 figure for possible deaths, that I used in the calculation above, is the absolute upper range of the numbers that have been proposed, and it comes from modelling that was developed by the Imperial College in London. Their modelling has been since used around the world to guide Government responses. 1

On the other hand, the UK Government has used an estimated 250,000, for the upper limit of deaths – if nothing is done to prevent spread. Other figures have been much lower, but I am going to use 500,000 as the maximum, and 250,000 as the ‘most likely number’ in this model.

My minimum figure will be 20,000, as this has recently been suggested by the same Imperial research group. It seems low.

Average age of death

In Italy – which has had the greatest number of deaths – the average age at death is 78.5. This is comparable with age of death in other countries. I am going to use this as a non-variable 2.

Average reduction in life expectancy

This is more complicated. Using Italy, again, the average life expectancy is 82.5 years (both men and women). However, if people die aged 78.5, this does not mean you have reduced life expectancy by 3 years.

The average life expectancy in Italy, at birth, is 82.5 years. However, once you reach 78.5, you can expect another eight or nine years of additional life. [You will have avoided car crashes, early cancer, suicide and suchlike which reduce the ‘average’ life expectancy of the entire population].

On the other hand, those who are dying of COVID have multiple medical conditions. On average they have three serious underlying problems such as: diabetes, COPD, heart disease, previous stroke, active cancer and suchlike.

Which means that these 78.5-year olds do not have a life expectancy of eight or nine years. It will be far less. How much less? This is virtually impossible to calculate. I am going to estimate a half – or 4.5 years (an average).

Which means that, in this model, my lower figure of years of life lost will be three years. My upper figure is nine years and my ‘most likely’ figure 4.5 years.

Average quality of life of those who die

Again, this is difficult to establish. However, studies have been done to work out the ’reported’ quality of life in those with multimorbidity. Perhaps the most accurate figure I could find with that elderly people with three underlying serious health problems have a quality of life of 0.8.3

Using different figures in the model

Having put figures to the likely range of the variables, we can look at the cost per QALY in various scenarios. I am only going to look at three. ‘Best case’ ‘Most likely’ and ‘Least benefit.’

Best case

I am going to start by inputting the figures that would provide the greatest possible gain in QALYs. This is 500,000 deaths prevented, and an average gain in life expectancy of nine years [This assumes all 500,000 lives will be ‘saved’ with the actions taken]. Quality of life is kept constant at 0.8.

The calculation is:

500,000 x 9 x 0.8 = 3,600,000 QALYs

Which gives a cost per QALY of £97,200 [£3,5Bn ÷ 3.6m]

Most likely

We can then run the ‘most likely’ scenario, which is 250,000 deaths prevented, with an average gain in life expectancy 4.5 years.

250,000 x 4.5 x 0.8 = 900.000 QALYs

Which gives a cost per QALY of £388,888 [£3.5Bn ÷ 900K]

Least benefit

Finally, we can tun the ‘least benefit’ scenario, which is 20,000 deaths prevented, with an average gain in life expectancy of 3 years.

20,000 x 3 x 0.8 = 48,000 QALYs

Which give a cost per QALY of £7,291,666 [£3.5Bn ÷ 48K]

As you can see, none of these models achieves a cost per QALY that would be approved by NICE.

Disability Adjusted Life Years

I fully recognise that looking at human life in from this purely economic perspective can seem harsh, almost inhumane. Can we really stand back and watch an elderly person ‘drown’ as their lungs fill up with fluid ‘Sorry, we are not spending money on more ventilators, because it is not cost-effective.’ Or suchlike.

However, there is also a health downside associated with our current approach. Many people are also going to suffer and die, because of the actions we are currently taking. On the BBC, a man with cancer was being interviewed. Due to the shutdown, his operation is being put back by several months – at least. Others with cancer will not be getting treatment. The level of worry and anxiety will be massive.

Hip replacements are also being postponed and other, hugely beneficial interventions are not being done. Those with heart disease and diabetes will not be treated. Elderly people, with no support, may simply die of starvation in their own homes. Jobs will be lost, companies are going bust, suicides will go up. Psychosocial stress will be immense.

In my role, working in Out of Hours, we are being asked to watch out for abuse in the home. Because we know that children will now be more at risk, trapped in their houses. Also, partners will suffer greater physical abuse, stuck in the home, unable to get out. Not much fun.

Which means that we are certainly not looking at a zero-sum game here, where every case of COVID prevented, or treated, is one less death. There is a health cost.

There is also the impact of economic damage, which can be immense. I studied what happened in Russia, following the breakup of the Soviet Union, and the economic and social chaos that ensued. There was a massive spike in premature deaths.

In men, life expectancy fell by almost seven years, over a two to three-year period. A seven-year loss of life expectancy in seventy million men, is forty-nine million QALYs worth. It is certainly a far greater health disaster than COVID can possibly create.4

In Lithuania, the impact of the break-up of the Soviet Union was also dramatic, and damaging. Below is a graph, looking purely at deaths from cardiovascular disease. As you can see, starting in 1989 (when the Berlin wall fell) there was an enormous spike, representing hundreds of thousands of premature deaths. These same spikes, in death and disease, were seen across most countries in the former Soviet Union. 5

These, the downsides, can be calculated, using the figure that is the opposite of the QALY, which is the DALY. The Disability Adjusted Life Year. Or, to put it another way, how much harm are you causing with your interventions? I am not doing this calculation here, because it would have about ten thousand variables and would take far too long.

Despite this, the message here is that severe damage to an economy does not simply affect bank balances, it can be deadly. If we look at the result of social deprivation in the UK, the effect is (potentially) immense

This was highlighted in a review by Michael Marmot, who studied two areas of Glasgow. Lenzie, which was rich, whilst the other area, Calton, was poor (socially deprived). The findings were stark:

…we can see this in Glasgow. When we published the report of the WHO Commission on Social Determinants of Health (CSDH) in 2008, I drew attention to stark inequalities in mortality between local areas of Glasgow: life expectancy of 54 for men in Calton, compared with 82 in Lenzie.’ 6

A twenty-eight-year difference in life expectancy between people living approximately five miles apart. The difference? Money.

This, I hope, puts into some perspective the discussion on cost per QALY. I framed it, to start with, as a discussion about money, but it is not really about money. Health does not exist in some bubble, sitting apart from the rest of society. Health and wealth are closely interrelated.

Which means that I fear that we are taking actions that could, in the longer term, if we are not very careful, result in significantly more deaths than we are trying to prevent.

Even if we restrict the analysis purely to the cost per QALY and narrow the ‘health’ analysis purely to COVID, and deaths from COVID, it remains difficult to justify spending £350 billion pounds to control a single disease.

I know that many people will violently disagree with this analysis and will think I am some cold-hearted fiend. ‘People are dying, we must do absolutely everything we can. No matter how much it costs.’ ‘What would you say if it was your mother…’ and suchlike.

Well, I have spoking to my mother, who is 92. Her view is that she has lived long enough. She thinks the Government actions are a ridiculous over-reaction. She is going out shopping and chatting to friends… she will take no advice on the matter.

So, what would I do if it was my mother that is dying? I will say that she made her choice, and who am I to argue with it.

1: https://www.imperial.ac.uk/news/196234/covid19-imperial-researchers-model-likely-impact/

2: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf

3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818872/

4: https://en.wikipedia.org/wiki/Health_in_Russia

5: https://www.bhf.org.uk/informationsupport/publications/statistics/european-cardiovascular-disease-statistics-2012

6: https://journals.sagepub.com/doi/full/10.1177/1403494817717433

629 thoughts on “A Health Economic perspective on COVID-19

    1. Tom Welsh

      A good old-fashioned British lady! I am sure most of us can think of (or remember) older relatives who would have taken such a robust view – and evinced so little self-pity or entitlement.

      I can almost hear my own mother, who died in 1992, saying the same thing. (Indeed, now I come to think of it, I did – many times).

      Reply
    2. Jacqueline Marta V Hulll

      Sorry I have never thought along these lines. I accept that even if I had the brain power and the patience for seven years study, I could never be a G.P. Or Surgeon etc; Psychiatrist or Psychologist is fine. The very reason I am anti abortion is not on religious grounds, I have always believed I don’t have the right to directly or indirectly take another human beings life. Exceptions are obviously there. If someone was trying to take my life, self preservation would probably take over. If some young girl was brutally raped, fell pregnant and it was obvious the birth of such a child would traumatise her for years to come!!!

      Reply
    3. Lynda Cooper

      But surely it’s not about her not minding if she dies. It’s about if she gets the virus spreading it to younger people perhaps with young Family, who don’t want to die. It’s about the people that she has spread it to spreading it to others etc, etc It’s about all those people putting the NHS under increasing pressure. We ALL need to socially isolate, not for ourselves but for each other. To not do that is selfish.

      Reply
      1. Dr. Malcolm Kendrick Post author

        I think it needs to be borne in mind that younger people (despite what you hear on the news) simply are not dying from COVID. Yes, there have been about four cases in the UK of people under the age of 40 (at least two of which were simply unconfirmed media reports – a family said, and suchlike) . This is far, far, far, less than die from flu each year, and we do not socially isolate to stop people getting the flu.

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      2. Eric

        Maybe they are not dying yet in the UK? With the reports coming in from Italy and France, younger people make up about half of those in ICUs. Suppose no distancing was in place, you’d have 10x their number coming in at some point. How many would be surviving then?

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        1. AhNotepad

          Because of the way the figures are generated, such as Italy counting everybody who has corona virus, it being the cause of death, and China whose figures seem to depend on the current dictat of the CCP, it is difficult to know exactly what is going on. In the UK, it has recently become illegal to spread “fake news” about the virus, ie. if it doesn’t agree with the government line (and Neil Ferguson).

          Reply
          1. andy

            Hi Ah: I am beginning to suspect that politicians are keeping an eye on this blog. The suggestion to censor “fake news” to combat the virus was mentioned here a while back.

          2. Dr. Malcolm Kendrick Post author

            Hooray, a fully totalitarian state. Lovely to see democracy and freedom of speech obliterated in two weeks. I always said civilisation was a thin veneer. Didn’t realise quite how thin.

          3. AhNotepad

            It’s unlikely this blog will be shut down. While it is here, they know where we are and what we’re doing. However facebook is doing that, and Andrew Saul’s traffic has gone from around 1,000,000 to about 10,000, and he is just quoting the Chinese and New York hospitals which administer IV vit C. What is fake about that?

          4. Jacqueline Marta V Hull

            Hello Dr Kendrick,
            I have replied to this hypothesis before, my name is Jacqueline Marta, unfortunately I argued against the case you put? I will add that I also think your solution could be open to abuse. Unfortunately many Government systems are quite corrupt in this day and age?
            Thank you,

      3. Ornella Burns

        You are being selfish. You have to do some research then and look up viruses in general. You would not be saying such rubbish comments then. People have a millions/trillions of viruses in their body. (we are a living organism) They protect us. If that was not the case, then you would never ever leave your house. Your immune system determines whether you catch a virus (Coronavirus is a virus that comes from the cold family and there are over 65 strains) and the severity for each person will be different. Everyone has a different health makeup. Herd immunity is needed and I am not talking vaccines. Especially children, they get stronger and stronger with each other. Touching things (bacteria) which is immunity.

        We have to use our common sense.

        Reply
    4. David

      Really interesting article and really interesting way to frame the debate. However, do you not think there is a social costs incurred when 250k die (a 50% increase in the yearly death rate) in the space of a few months that does not exist when these people die in isolation of one another. Further, even without government restrictions there would be a reduction in economic activity. Therefore, to properly analyse the current government approach you need to consider it against a baseline incorporating the social and economic costs of doing nothing as well as the QALY * 30k. I think, given opinion polls showing a massive swing to the government, that the costs of the current approach would be smaller than the costs of doing nothing. But that is not to say its the perfect approach, I think the way you have framed it provides a way to assess which is least costly of a variety of options.

      Reply
    5. Bill

      You should rework the figures based on 50-100b GBP not 350b. The 350b is the govt war chest. The amount deployed will be less and some of what is used will be recovered later through fiscal and monetory policy.

      Reply
      1. Swiss_Danny (@Swiss_Danny_67)

        Yes and no…. a large amount of the difference betweeen 100 and 300bn are loans to cover economic activity that is lost forever…. that is an opportunity cost, and the cash that will be used to repay those loans wont be available for eg investment, dividends (ie pensions) etc.

        Reply
  1. Deb

    Dr K. Your analysis is spot on and mirror my concerns exactly. Add to that the fake statistics on death rates (only counting known infections vs the true population infection rate, etc) and the results are even more troubling. Thank you for starting this very important discussion.

    Reply
    1. dearieme

      “Add to that the fake statistics on death rates (only counting known infections vs the true population infection rate, etc)”: why must you write such hysterical drivel? The numbers aren’t fake, they’re merely wrong. They have to be wrong because nobody knows the the true population infection rate.

      Reply
      1. SwineOne

        It’s not hysterical drivel when it’s true. At least where I live, the media is reporting these number as though they were the actual death rates, without a disclaimer that they’re upper bounds and prone to huge errors because only critical patients are being tested. So, I concur with the OP that this amounts to fake news. I’ll go further and claim that the media is using it to promote mass hysteria so that nobody questions the lockdowns in place. Never mind how they report every single isolated case of young people dying from the disease, rarely if ever mentioning the death rate by age (which BTW is also over-inflated) and especially comparing it to death by influenza. They want everybody in a panic.

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    2. karenwatcher

      Prof Neil Fergusson who came up with the 250,000 million UK deaths proposal (who was also the scientist advising the UK Government on the slaughter of 6 million perfectly healthy cattle in the foot and mouth disease epidemic which was so disastrous) has revised down his infection figures to something closer to 5,500. Which makes your best/worst case scenario of 20,000 look cheap! I agree with your mother.

      Reply
      1. ricksanchez769

        I believe ol’ Neil missed the boat entirely on the Swine Flu predictions – seems he requires some super-glue for these models he keeps constructing. Models are fine as long as they are transparent for all (the pointy heads) to digest etc. I believe Neil kept his model close-to-the-chest so to speak so most all took them as ‘very likely’ scenarios –
        “Well, here’s another nice mess you’ve gotten me into.” said the world to Neil

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      2. chris c

        Lord Ferguson, please! (coming shortly). The Army have now been called in. Remember when that happened with F&M? They were tasked with removing the corpses to the funeral pyres as fast as possible. They couldn’t get hold of enough tippers so were hauling some of them in ordinary trailers, spilling infected blood and other bodily fluids all over the roads.

        One hopes when they are in charge of Covid 19 they will be better briefed.

        Oh and another classic, TPTB boasting about how quickly they built the new hospital, then suddenly realised how many people they would need to staff it.

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      3. Chris Rawson

        My father is 84, he think’s that it’s nature’s way of culling the elderly, he’s still alive due to a brilliant American surgeon, who performed a six-way Heart by-pass on him in 1996, in Boston, when he was on Holiday, aged 60. He can’t believe the Government are sacrificing future generations, just to keep 40,000 people like him alive, just so some ” charming Polish lady can wipe my arse in a care home for an extra 18 months, with me paying a grand a week “. His view is very practical, ” 40,000 less pensions being paid, extra housing coming to market, those inheritances being spent either in the economy, or debts being paid off ” … my sisters are mortified by his attitude, but I can see his point …

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    3. David

      Deb,
      I have a question relating to your comment, maybe you could help me understand.
      At the moment there is no policy in Scotland or UK to test the general population, therefore the testing that is being done is generally tartgeted at those that presumably are already displaying symptons. So in that regard it is a sample pool biased towards individuals most likely to have COVID-19.
      Yet despite the biased sample pool, the number of positive cases in Scotland, is roughly 14%. I can’t reconcile this difference. SUrely given the biased sample pool towards individuals with the virus would result in far higher positive tests?
      The only one thing I would add is that as the number of concluded tests increases so does the percentage of positive tests – on the 29 March positive cases accounted for 10% of all conlcuded cases in Scotland; on the 02 April positive cases accounted for 14.4% of all concluded tests.
      Thanks

      Reply
      1. Colin MacDonald

        There’s also a 10 percent false positive rate while missing 30 percent of the real cases, with the tests, just to further muddy the waters.

        Reply
  2. Jean Humphreys

    Thanks for that. I had already decided that at the first sign of the disease, I shall cut the phone link, and take a sharpie and write “No Heroics” on my upper ribcage.

    Reply
    1. Ian Roselman

      On the subject of statins, the New Scientist weekly podcast suggests that one of the (many) factors that seem to improve the effectiveness of the immune system is, you’ve guessed it, statins. The evidence offered is that people admitted to hospital with flu do better if they are taking statins. Now I think it more likely that these people have high cholesterol to start with and cholesterol is required to make vitamin D, among other things. Anyway, for myself I am taking lots of vitamin C, small amounts of other vitamins and allowing my LDL to soar to unprecedented heights (actually it is only about 8, in UK units). So far so good.

      Reply
      1. David Bailey

        It seems entirely possible that those taking statins feel (on average) far more achy and decrepit before the flu even starts in them, and thus end up seeking medical help when without the statins they would have soldiered on at home!

        What is the sense in medical ‘research’ like that!

        Reply
      2. Peter Downey

        Yeah, The Guardian quick crossword had a question about cholesterol today. Immediately my brain and mouth went all mad cow disease. The only clue I answered.

        Reply
    2. Tom Welsh

      I have seen suggestions that some medicines might aggravate the disease. Just as the over-administration of aspirin may have worsened the 1918 Spanish Flu’s death toll.

      Reply
  3. Simon K

    Thank you Malcolm for putting your head above the parapet.

    Brilliant, well-argued and rationale post. Just what’s needed. As you say, whether we like it or not, life does have a cost. Whatsmore, what sort of health service will we be able to afford once we’ve wrecked our economy and simply have less tax revenue to pay for what we enjoyed before this.

    I have no doubt that if you get the CCP Virus then it can be very very nasty and a horrible way to die. I’m also under no illusions that working in the health service on the front line of this is very hard and personally risky too. I could not do that job.

    The question though isn’t whether or not we should be trying to tackle the disease and minimise the suffering. The question is rather whether what the government has chosen to do is proportionate and effective (both in health outcome and in terms of cost). I’ve come to realise that the authorities/politicians have actually taken the easiest option available to them. There is zero risk to them, they will be able to claim a win whatever happens and none of them will suffer in any significant way. They will not lose their jobs and therefore their health won’t be negatively impacted in the ways that you describe for others in society. My business has been mothballed. I know many many others that have too. I’m also aware of some people who’s medical treatments have been postponed indefinitely.

    Thankfully, some people are starting to ask questions about the current approach (which should be permitted in a liberal democracy). Peter Hitchens and Melanie Phillips have also written pieces on their blogs challenging the path taken.

    Thank you again Malcolm. You’re a hero.

    Reply
  4. Felix FitzRoy

    Interesting calculations, but direct government support announced so far is about £60 billion. Much of this goes to alleviating poverty that would otherwise arise from unemployment and insolvency, and this expenditure will have major QUALY benefits. As you mentioned poverty is a major cause of QUALY loss. The main problem is that govt. response is far too weak. 10% of GDP or £200 bn might easily be lost this year, mostly borne by the already poor, whose life expectancy is declining, so major redistribution by more progressive taxation and combatting tax avoidance by the rich would have huge QUALY benefits.

    Reply
  5. Honest Jon

    You are correct. One would imagine that age, smoking, drugs, multiple comorbidities (the number of drugs patients are on) persistent suicide attempts will have been discussed, hence, the nhs Nightingale super wards in London, Birmingham and Manchester. To be brutal, you want to leave a physically and mentally healthy workforce intact after the devastation is over.

    Reply
  6. Tony Youens

    The problem I have with these calculations is the built in inequality. I’m 66 and in good health (generally) how would I fair against a 71 year old man? How does the calculation work if the 71 year old is Prince Charles? Also Richard Branson is currently trying to prise 6.5 billion from our government. How many QOLYs would that buy? How about sorry mate but you’ll have to die otherwise we’ll never get HS2 built? These are just a few examples but you get my point.

    Reply
    1. Tom Welsh

      “How about sorry mate but you’ll have to die otherwise we’ll never get HS2 built?”

      Or, even worse, “we might have to give up our vital thermonuclear deterrent – or even close down Porton Down and Aldermaston. Then how would we would manage to kill enough foreigners?”

      Reply
    2. Jennifer

      Tony, I certainly get your point. As some readers will know, I get a bit political from time to time with the topics discussed here. I worked in health services from 1965 to 2001; the peak of my NHS career spanned 1979 to 1997—and what a struggle it was —-for UK citizens, read into that what you like. The lack of staff and equipment is nothing new, as it was dire during those 18 years. Today’s frightening situation has hit us so quickly, and it is a sin that we have allowed the NHS to become degraded and run down for the majority of us, whilst others have accessed more than they ought to have been able to. The 13 years up to 2010 were used to undo the bad times, but all that has been reversed once again. My mother used to say to me “the poor will always be with us”, but I think we need to reflect on “the rich and greedy will always be with us”….so long as they are permitted to cream off the goodies in life.
      The “ill and dependant will always be with us”, and more so than now. So lets be a bit more compassionate and share out the goodies a bit better, and then the rationing of health services need not be the awful dilemma our medics are being forced into.

      Reply
    3. Jacqueline Marta

      Hi Tony,
      I completely agree with you. It’s not a level playing field, as the lyrics go in one of Leonard Cohen’s songs, “The rich get richer and The poor get poorer”
      To concur with Doctor Kendrick’s hypothesis, all things have to be equal before one could start-judging this idea. It would be good to know the median age of the group who have responded?

      Reply
  7. YAEL GAL

    I am very disappointed that you have joined the ranks of those who decided to play god and put a price on your fellow human beings’ lives. HOW DARE YOU DO THAT????

    I have known people with various diseases including cancer that every minute of their life was devoted to helping others. Maybe if your mother did a bit of that instead of going shopping and chatting with friends, she would have had a different outlook on the value of her life……

    Sorry if it sounds harsh and intrusive – but this is how I felt after reading your article.

    Yael Gal

    Yael Gal

    Managing Director

    PRAIUM MEDICAL SOLUTIONS

    Israel

    Tel: +972-52-8997766

    DISCLAIMER: THE INFORMATI

    Reply
      1. Adriaan Keij

        Sure, the price of ‘trying to fix’ a human life must be ‘infinity’, Big Pharma gangsters like Yael Gal, Managing Director @ PRAIUM MEDICAL SOLUTIONS will tell the world.

        Reply
      2. John Stone

        The problem is that however we value human life – and NICE guidelines are surely only a talking point since I do not believe the author has a high opinion of NICE – we only have finite resources. I believe one of the issues here is that we were unprepared and have not used resources wisely.

        Reply
      3. Henry Krinkle

        I love this entire line of thinking. (seriously) Only possible in a place where ‘royalty’, tea cults and Orwell existed is it possible. US trapped in ‘every sperm is sacred’ vs ‘pull yourself up by your bootstraps’ BS and other religious and conservative stupidity. It’s horseshit. USA is a captialist society and needs to also, put a price on everything. We have way too many fat ass citizens draining resources.

        Reply
      4. JDPatten

        The question is not about the price of a human life as much as it’s about the price of the species. We’re messing with changes Darwin would have been very interested in.

        Reply
      5. Angelica @ nixgluten.com

        My mother wanted to have every consideration and avoid hospice care when she was dying of cancer. She wanted every state of the art therapy and she could afford to travel to get it. Few people can afford that. She extended Stage 4 cancer for four years. I wouldn’t want to have missed her heroic battle. Her life was worth something even in that situation. It’s the same for people who can’t afford it. Some don’t want to pursue every avenue, some do. It’s not up to me or you to decide how much help someone gets. And human beings can’t be shoehorned into a standard of care that doesn’t fit them. As a doctor who takes issue with the standard of care in heart disease, I’d think you knew that. Even certain ethnic groups will refuse care that could save them because it’s too intrusive for them. My mom was the opposite. Neither is wrong. We all roll the dice and face the consequences with as much courage as we can. I think it’s pointless to make a defiant shopping trip now, it takes zero courage.

        Reply
      1. Dr. Malcolm Kendrick Post author

        This is a very difficult area, and discussions are filled with emotion – on either side. Many other people will agree with Yael Gal’s comment. I feel that these disussions are required, and hopefully people can come to some form of agreement. If people wish to attack me, I do not take this personally. In this case they are attacking the underlying philosophy namely that human life has a price. Whether that price is monetary, or to do with personal freedoms/liberty, or some other price. For example, 1.2 million people die in road traffic accidents each year, around the world. This could be reduced to zero if we banned all road traffic. Currently 1.2 million deaths per year is a ‘price’ that we are willing to pay to allow traffic on the roads. Whether or not people wish to see it this way?

        Reply
      2. Aileen

        Presumably a sharp decline in road deaths and injuries will be one positive outcome of all this (as happened in New Zealand during the 1970s oil crisis when people could only use their cars every other day).

        Reply
      3. Peter Downey

        “It’s not up to me or you to decide how much help someone gets.” It’s dilemma, Angelica. Dilemma one of the things that separate us from other animals. You are attaching arguments when there are none. I think Dr Kendirck is putting forward questions. I find your last sentence quite staggering. When one considers the time humans are on this earth, why bother with anything.

        Reply
    1. Tom Welsh

      I assume that the comment by “YAEL GAL” must be a spoof or some kind of attempt at satire. We can assume that the MD of an Israeli medical company would be fairly intelligent, which would not be compatible with such nonsense.

      Reply
      1. Anna M

        Actually, Dr. Kendrick, your comment about traffic accidents really made me understand what is wrong with this current approach. It is an insistence upon zero risk at the price of everything else. Also the comment about the price of the species. Then of course there is the old adage about the cure that is worse than the disease. Or, from Viet Nam, We had to destroy the village in order to save it.

        Reply
    2. abamji

      Rather aggressive. Read my comment below. My mother was a GP snd de oted her whole life to others; perhaps, being medical, sje understood when it’s right to stop. Futility medicine is bad medicine. Read my book “Mad Medicine”.

      Reply
    3. KidPsych

      These decisions are made every day. Any time a government passes health legislation, they are choosing who lives and who dies. Any time a health organization chooses to allocate resources toward one disease over another, they are choosing who lives and who dies.

      Reply
    4. Cy

      PRAIUM MEDICAL SOLUTIONS – I take it you are donating all your products free of charge in this current pandemic?

      Reply
      1. Shaun Clark

        I took a wee look at their Website. Seems they specialise in curing the ‘incurable. All around the world. So, we are saved then huh?

        Reply
    5. Anna M

      How do you dare to pretend that money is not finite? That decisions do not have to be weighed for the pros and cons, the downstream effects they have? How do you dare to let people who are already in need of care, such as cancer surgery, get cancelled to try to protect against a possible illness in the healthy? How do you dare to impugn the moral integrity of a 92-year-old when you know nothing about her? How do you dare not to see that the ones who are playing God are the bureaucrats? How do you dare to be callous toward working class people and business owners who are struggling month-to-month and whose lives will be destroyed by this quarantine and who must sacrifice their lives to save old people who have already had theirs? Who dares to allocate that others must make such a sacrifice?
      Well, I have cancer and I tell you what. I would rather get Covid-19 than have cancer treatments cancelled!

      Reply
    6. Jennifer

      YAEL GAL. Your response is contentious, and I notice it has stimulated many responses. When do you intend to start approaching the active and fit elderly persons doing their shopping, to ask them to desist attending to their own selfish needs, and join the hundreds of thousands of volunteers already offering their services to our nation? Grow up, man.

      Reply
    7. Jacqueline Marta

      Hi Yale,
      A little harsh perhaps, but I had the same reaction when I first read Dr. Kendrick’s hypotheses regarding The COVID-19 Virus. I was more surprised though by how many respondents agreed with him.
      I feel that if they agree, they should be ready to put their words into action? I am sure some committee could be put together and they could be the ones that decide who gets the chop and who doesn’t?

      Reply
      1. Dr. Malcolm Kendrick Post author

        There is a committee. It is called NICE and it has been deciding on the allocation of health resources for over twenty years. In the US HMOs make the decisions about what to fund and what not to fund. No country in the world funds everything. Healthcare rationing is everywhere in every country.

        Reply
  8. David Bailey

    Malcolm,

    I utterly agree with what you have written above!

    At 70 (considerably younger than your mother) I ignore the advise to stay cooped up in our house, and my partner and I go and shop together. I think it is grossly immoral to expect the youngsters to ‘protect’ me and the rest of us who are lucky enough to have grown old, by staying in and ruining their social lives, careers fitness, etc. It is also those people who will inherit a ruined economy and country.

    I asked you about QUALY’s in a previous discussion here – I don’t know if I contributed to your decision to write this article in this way, but if I did, I feel very proud.

    I also believe that this terrible saga also has also been seeded by dodgy medical science – another subject close to your heart. With that in mind, here are the latest comments to be found on the ever expanding link:

    https://swprs.org/a-swiss-doctor-on-covid-19/

    Dr Sucharit Bhakdi, Professor Emeritus of Medical Microbiology in Mainz, Germany, wrote an Open Letter to German Chancellor Dr Angela Merkel, calling for an urgent reassessment of the response to Covid19 and asking the Chancellor five crucial questions.

    The latest data from the German Robert Koch Institute show that the increase in test-positive persons is proportional to the increase in the number of tests, i.e. in percentage terms it remains roughly the same. This may indicate that the increase in the number of cases is mainly due to an increase in the number of tests, and not due to an ongoing epidemic.

    The Milan microbiologist Maria Rita Gismondo calls on the Italian government to stop communicating the daily number of „corona positives“ as these figures are „fake“ and put the population in unnecessary panic. The number of test-positives depends very much on the type and number of tests and says nothing about the state of health.

    Dr. John Ioannidis, Stanford Professor of Medicine and Epidemiology, gave an in-depth one-hour interview on the lack of data for Covid19 measures.

    The Argentinean virologist Pablo Goldschmidt, who lives in France, considers the political reaction to Covid19 as „completely exaggerated“ and warns against „totalitarian measures“. In parts of France, the movement of people is already monitored by drones.

    Italian author Fulvio Grimaldi, born in 1934, explains that the state measures currently implemented in Italy are „worse than under fascism“. Parliament and society have been completely disempowered.

    Reply
    1. chris c

      Be careful! I heard of someone who was thrown out of the supermarket for being “too old” and told to go home. There are only about 74 cases of Covid 19 in Suffolk and I doubt he was one of them.

      That Swiss site is brilliant, I saw it earlier but hadn’t realised until the previous blog it was being updated. An oasis of calm discussion of facts rather than the endless media hype.

      On average just under 1500 people die every day in the UK. Obviously from now on everyne who dies WITH coronavirus will be listed as dying FROM coronavirus, quite a different thing

      Reply
      1. markheller13

        Chris C, I visited the Swiss site a few days ago, and was initially impressed by the alternative views being put forward, but after a few days I have deleted it from my bookmarks.

        The site, in my opinion, does not discuss facts, it simply puts forward comments and views that all conform to one point of view – that most of the COVID-19 deaths quoted would have occurred even without the virus; that the world’s reactions to this virus are excessive and unnecessary; and that we should return to business as usual as quickly as possible.

        Unlike Dr Kendrick’s excellent site, there is no attempt to balance competing arguments, or put forward different hypotheses. For example, the 28 March post quotes a study saying that “half of the population may already be immunised, with most people experiencing no or only mild symptoms. This would mean that only one in a thousand people would need to be hospitalised for Covid19”. As far as I am aware, this is an extreme view, that is not shared by most experts in this field – but that perspective is not presented.

        I’m all for debate and the putting forward of alternative views, but I think this site is dangerous, because it takes such an extreme and unbalanced viewpoint, and attempts to persuade us that we do not need to worry about this virus.

        There are many things for us to yet understand about this virus, but it’s surely undeniable that health services all around the world are being overrun by it, leading to many many unavoidable deaths, and that the only way to avoid this in the short term is through intensive testing, and through taking appropriate social distancing measures.

        Reply
      2. chris c

        You have a partial point, he may not be entirely correct, but obviously the sky may NOT be falling as most of the mainstream media claims. Maybe it IS falling, we don’t have enough data yet, On the other hand closing down all of society/the economy for six months also has consequences which need to be explored. So do things which are not “fake news” like vitamin C.

        Reply
        1. AhNotepad

          I have been unable to find any mainstream publication which has said the sky is falling. It may be fake news.

          Reply
  9. Jane Leitch

    Thank you. Spot on. I’m now going to try it on my FB vigilantes. I can hear the Defargian screams before they start.

    Reply
  10. Soul

    Nice article. I agree. Economic matters and their health effects can not be ignored. As seen with the former Soviet Unions, a depressed economy has negative health effects also.

    That is something I’ve seen mentioned of late, the bailout money is essentially free to the government with interest rates near or even below zero. I’ve thought the more extreme economic measures being taken to shut down the economy have this in mind. I don’t know how long government officials can keep doing trillion dollar bailouts in America but i’m afraid we might find out.

    Here in America for the last few days there has been much reported on how the College of London have recently significantly decreased their projected death rates. The task force working on the corona Wuhan virus disgusted this issue the other day. I didn’t read the fine details but as reported ~

    “British prof who predicted 500k dead from coronavirus now estimating a radically lower number”

    https://www.thecollegefix.com/british-prof-who-predicted-500k-dead-from-coronavirus-now-estimating-a-radically-lower-number/

    excerpt:

    …The professor told the UK parliament’s select committee on science and technology yesterday that “expected increases in National Health Service capacity and ongoing restrictions to people’s movements” will likely mean only 20,000 coronavirus deaths in the UK rather than 500,000, according to New Scientist. That represents a 96 percent decrease from the original predictions. Ferguson said the death toll could even be “much lower” than 20,000….

    Reply
    1. Annlee

      A commenter on one of @man_integrated ‘s posts re logistics pointed out that the original study had 3 scenarios, and the 500,000 fatalities was the worst case (do nothing) scenario. The most aggressive action scenario – similar to what the UK government has now done – had 24,000 deaths. So not so different.
      As for deciding how much to spend and the ramifications thereof, I had a Twitter argument with someone railing against discrimination against the elderly if the number of ventilators proved insufficient – because discriminating against them is against the law. I should have elaborated, since I doubt the fool would look it up, but I stopped bothering with him after pointing him to the Birkenhead Drill.

      Reply
      1. Soul

        Dearieme – the link doesn’t work. That would obviously be a big bummer if ventilators were not saving a significant number of lives. Do you have another link?

        Reply
  11. lowcarbliver

    You make excellent points. However I think we are overlooking the crippling psychological effect that an unmitigated outbreak would have on the healthcare workforce. If you want our surviving health workers to have the levels of PTSD, suicide and mental health issues that war veterans have, an unmitigated outbreak will certainly get you that. And a significant number of doctors and nurses would die during, as well. Then what is the effect on the public consciousness of people watching their loved ones die at home for want of an ambulance/hospital bed. Of sitting next to their dead bodies for days because the authorities are too busy to collect them. How destabilising would that be for our society? I feel whichever way you cut it, the aftermath of this pandemic will be as harmful to all of us as the outcome of a world war.

    Reply
    1. Frederica Huxley

      Hence the need to flatten the curve. As with so many things in life, damned if you do, and damned if you don’t.

      Reply
    2. Geoff Arden

      thanks lowcarb_liver: your passionate advocacy seems to stem from believing the doomsday predictions of the IC … inventions .. fabrications?? They have refused to reveal what they used to calculate their data: that’s open science for you: curiously Prof Collins at Oxford has adopted the same highly ethical stance. Highly commendable; eminent scientists do not have to stoop to explain themselves.

      from here https://www.telegraph.co.uk/news/2020/03/28/neil-ferguson-scientist-convinced-boris-johnson-uk-coronavirus-lockdown-criticised/?li_source=LI&li_medium=liftigniter-rhr

      he was quoted as saying “Of his work on BSE, in which he predicted human death toll of between 50 and 150,000, Professor Ferguson said: “Yes, the range is wide,”

      now folks report “will likely mean only 20,000 coronavirus deaths in the UK rather than 500,000,”

      so 20yrs on, just doing the same stuff: and people believe him? take him seriously?

      He also felt an 18 month lockdown may be needed: at what point would people think, this guy is crazy?

      Reply
      1. andy

        Hi Geoff: My estimate of short term UK death toll from covid19

        Facts: there were 400,000 nursing home residents in 2019, of whom 14% were over 85 year old. Assuming 5% die, that would be 20,000, the most likely figure that could be attributed to covid19 say in a 4 week time frame. To date there were 4,000 plus deaths.

        Reply
  12. Lindyanne Ehrnrooth

    I think Yael Gal comments are completely out of order. Since when is a rational economic calculation ‘playing God’?
    Questioning, reasoning is not making divine interventions, or even purporting to.

    And to criticise your mother is beyond the pale.

    Reply
    1. AhNotepad

      Lindyanne, I think Yael Gal should look at how his/her country treats the people in Gaza before complaining about others. Removing splinters while there is still a plank in your eye comes to mind.

      Reply
  13. 103agency

    Thank you for raising this Malcolm. It is something I’ve been stressing since the start of this panpanic. We have to work out the cost of lives (many fragile already) saved today against the destruction of livelihoods and future happiness and prosperity. We need to get back in touch with death and not see it as the end.

    Sent from my iPhone

    >

    Reply
    1. JDPatten

      301,
      When I die, the world will end . . .
      as far as the then non-existent “I” is concerned.
      One does not see, one does not touch in death. There is nothing.
      You may go on getting in touch, but only in life.

      Reply
  14. Yolanda Heuzen

    Dear Doc,

    You are such a relief to me. Both you and Zoe Harcomb, and a few others beside, are the voice of reason, especially now that we are back in the dark ages.
    Personally, I am allergic to emotional blackmail, perhaps you are too? 😺 we need to be realistic, practical and kind. Throwing so much money about with little to no effect is not the way forward, I quite agree.
    Over here in Dutchland the government has gone utterly gaga (medical term) just as almost every goverment everywhere else on our beloved planet.
    Excellent article as per usual., thank you doc.
    BTW it is clear where you got that hefty dose of common sense from, your Mum is priceless!

    Cheerio,

    Yolanda Heuzen

    Reply
  15. Anne Michna

    Interesting post as usual. My point is that older people not following the rules, going out, meeting friends are being selfish (I am 72). They may say they have had a good life and are prepared to die, but in the interim period between being seriously ill and dying they will take up a hospital bed that could have been used for a seriously ill key worker who has been working incredibly hard to save lives.

    Reply
    1. Julia

      Perhaps they should also be the ones to have a discussion with their families and state they do not want hospitalisation or intervention should they become ill. A bit like having a Donor card or DNACPR and not informing your family.

      Reply
      1. AhNotepad

        Harry de Boer, I consider that view very judgemental, and takes no account of the mental damage being done NOW through these social restrictions, which are merely an exercise to control people and see how much they can get away with.

        If you want to look at selfish people, look at the ones who orchestrated all this.

        Reply
  16. jim w

    Never thought I’d say this, but pretty sure that you’re mistaken. The money has nothing to do with keeping people alive. It’s another huge transfer of wealth from the middle class, even worse than 2009. They are just using the “pandemic” as an excuse.

    Reply
    1. Harry de Boer

      Actually, we were still waiting for the big financial crisis in which we’ll surrender next to all our assets to the banks for cents on the dollar (or pound if you like) without actually being able to blame it on the banks. The coronavirus, even if it’s already for many years part of the ‘flue repertoire’ in 10-15% of the cases, if hyped enough–never mind the downgraded death estimates afterwards as the damage will be done already–will accomplish their goals with enough probable deniability for them.

      Reply
    2. Janet Love

      Jim, I reckon you are uncomfortably too close to the Truth on this…
      My standard, Foundational Question is never more relevant (IMHO) than now, “Qui bono?”
      – “WHO Profits ?”

      Pun intended.

      Reply
  17. Rio

    Thank you Malcolm. As ever, you are not afraid to speak up and we need that.

    I do not understand how we have become so ‘PC’ on one hand and so irresponsible on the other. Yup, its a horrible virus, and a particularly horrible way to go (though having watched horrified as both my aged Father (2 months ago) and not at all aged Husband (3 years ago) died gasping for breath from Pneumonia/Septicaemia I learned that that was considered ‘part of the process’) we seem to be ignoring some fundamentals here.
    People die and its often horrible. People have to die otherwise there would be too many us…oops, there are too many of us! People dying is natural… what is not natural (and really is playing God, is trying to stop that process at all costs). Viruses, plagues, diseases etc are natures way of finding balance. Where did we lose sight of the basic tenant of evolution….survival of the fittest ?
    When did we become so arrogant that we think we know better than Mother Nature?
    Of course have to weigh up the pros and cons of the actions we take, it would be unreasonable not to.
    At this point we are threatening the lives and livelihoods of the vast proportion of our population. Those fit and healthy people with good lives and good prospects for the future, (children included – for they will be the ones paying for this for a generation or two if we carry on like this) for the sake of the small minority, almost all of whom are neither fit nor have a long life expectancy and who (unpalatable as it may sound) will pass on relatively soon anyway.
    I dont believe the measures taken are sustainable or desirable. I think we have to be brave, face our demons, become humble, examine our beliefs and what we have done to this planet and make some very very tough choices.

    Reply
    1. Tom Welsh

      All four of my grandparents and my father died of cancer. I can assure everyone that it is no better a death than coronavirus. Indeed, pneumonia has traditionally been called “the old man’s friend” – not because it is a nice way to die, but because it is relatively quick.

      I believe that most doctors and nurses would confirm that, on the whole, there is no nice or dignified way to die. And some deaths are extremely horrible even to witness.

      The trouble is that our Western culture has been extremely successful in hiding the very existence of death. People go through their whole lives ignoring death, and assuming it cannot happen to them. (In previous generations only teenagers thought that way).

      When, as now, death makes itself known and cannot be ignored, many people get very indignant. It’s a pity, but it can’t be helped.

      Only for those who enjoy satire and are not easily offended: https://consentfactory.org/2020/03/26/the-war-on-death/

      Reply
  18. Julia

    Definitely a subject which needs discussed in a calm and rational way, without the use of emotive language or it becoming personal. I feel very conflicted myself. I am self isolating solely because my husband is/was in the middle of chemo. He simply can not afford to get Covid-19. In other circumstances, I would be following government advice only and volunteering. Unfortunately putting cost and health in the same sentence is always going to get people hot under the collar but now is the time to have those discussions; in a broader sense and with your nearest and dearest.

    Reply
  19. Andrew Larwood

    Great article and one I fully agree with. Using QALY as the measure defined by NICE is an arbitrary and completely irrelevant measure as it assumes that the “highest quality life” would be the same for each individual, which it cannot be. How does NICE apply QALY to patients with severe dementia, Alzheimer’s, MND, mysathenia gravis or severe cerebral palsy versus a patient with chronic pain that is resolved through such interventions like your example of a patient with hip pain and trouble walking who then has a hip replacement is “cured”?
    If QALY is used in a patient with severe dementia who can’t look after themselves, recognise family or interact socially and have violent outbursts, the QALY must be zero, yet we continue to look after them. What is the QALY if everyone is prescribed statins whether they need them or not?
    My take is that we are intervening to much to preserve life at all costs regardless of the degree of quality of life the individual may have following the intervention. In the current Covid19 crisis those afflicted badly and who survive will have ongoing respiratory problems in the future due to the damage that the virus does to the lining of the lungs so what is the QALY here?
    Perhaps the damage can be minimised if NO is used as a treatment but this probably has not been looked at by NICE as they’re so far behind the curve in adopting modern medicine technology and treatments it will be too late.

    Reply
  20. Shaun Clark

    Dr K. I commend you. If nothing else it is a conversation that must be had by all. Moreover, something must be done about smoking and diet, and could you, with the knowledge you have, (somehow?) factor such in? The sight of large numbers of folk hanging-out in front of the main entrance of York Hospital (for example), on drips etc., with missing limbs and what not, smoking, is a shocking sight.

    Reply
    1. Tom Welsh

      “The sight of large numbers of folk hanging-out in front of the main entrance of York Hospital (for example), on drips etc., with missing limbs and what not, smoking, is a shocking sight”.

      I didn’t think I could be so easily shocked, but I am astounded to hear that people are smoking – one of the best ways of making themselves more likely to be severely infected by the virus.

      Reply
    2. Stuart

      And it’s not just the patients. Until all smoking was banned on hospital grounds a few years ago, I would see nurses and doctors, many in surgical scrubs, smoking outside the entrance to Sydney’s Royal North Shore Hospital. You’d think that they of all people should know the medical consequences. There are still people smoking there despite the signs but they all seem to be patients, probably because it’s a sacking offence for the staff.

      Reply
  21. William Edmondson

    Good to see this Malcolm. There is more you can line up in your defence. Surely the comparator is not road kill, it is influenza? Flu is now treated like road deaths. A few thousand every year, and in bad years over 20,000. Just in UK. Sure, there are vaccines for wrinklies, and perhaps the deaths are disproprortionately higher in older folk so vaccines for them are a good idea. And cheap. But we tolerate flu. We panic in an extraordinary way over coronavirus. Something strange is going on politically which impacts negatively on our ability be calm and rational. That’s not your patch of course, but we should all pause to wonder what is really driving the panic.

    Reply
    1. markheller13

      William, it may be that COVID-19 turns out to be no more (or even less) malevolent than flu, but I think there are vital differences between the two viruses.

      Firstly, there is no vaccine for COVID-19, whereas there is one (albeit not always that effective) for flu.

      But most importantly, COVID-19 is MUCH more infectious (R0 rate of 2.5-3 compared to 1.3 for flu – presumably because it can be spread asymptomatically), which means that it spreads much more quickly.

      This means that it can – and does – overwhelm healthcare/ICU systems very quickly, with catastrophic consequences not only for those with the virus, but for other sick patients (who cannot access treatment), and for healthcare professionals.

      I read somewhere that COVID-19 is like having a whole season’s flu epidemic in a week, which neatly summarises why this is such a serious threat.

      Reply
      1. Geoff Arden

        thanks Mark; we respect your passion: some would suggest you are just reciting word for word the panic that the MSM has been enthusiastically promoting

        “I read somewhere that COVID-19 is like having a whole season’s flu epidemic in a week”

        so the prophets, who started the scare are now saying “will likely mean only 20,000 coronavirus deaths in the UK rather than 500,000,” We all need to recite word for word what we are told we need to think and believe. This is the newest version.

        All this stuff about RO rate: sounds very impressive but until serological testing of a large sample of a population is done, we cannot know the denominator: ie how many have (or have) had the disease:

        eg it could well have been around for months; (Dec? or earlier:) some folks could have had a minor or asymptomatic illness; developed immunity: now the PCR-based test will show them as “negative” whereas they are now immune; and can shake hands with someone currently “positive” but who should become “negative”, and developed immunity.

        So all this scare stuff about the RO: intending to impress us, sounding really technical; is just propaganda (to me). It’s like being lectured by nutritionists as to the correct diet. Eminenced-based down-talking.

        “there is no vaccine for COVID-19, whereas there is one (albeit not always that effective) for flu.”

        You seem enthusiastic about vaccines; (you are concerned? there is none for this corona?)

        the NNT for well people for a flu vaccine is 71 .. ie 71 people need to get jabbed, for 1 to benefit; well, you are welcome to get your vaccine.

        I try to suggest to folks that a static vaccine for corona; is like downloading viral software for your computer; and be still using the same version in 3 years time: real-world viruses are like computer viruses: they move on!

        Reply
      1. markheller13

        Geoff, thanks for responding to my post, I appreciate you taking the time to reply.

        What’s important to me is to listen to as many different views as I can, see which agree with the evidence, and then come to my own conclusions – which I fully accept could be wrong, particularly at this stage when there are so many unknowns.

        All the evidence I’ve seen suggests that this is a highly infectious virus, which spreads very quickly through populations. Healthcare systems in Spain, Italy, France, New York, and possibly soon the UK, have become overwhelmed in a matter of weeks, and many many eye witness accounts tell of intolerable conditions for medics and patients alike.

        I compare this to China, Taiwan and South Korea, where widespread testing and social distancing have been able to contain the virus very effectively, and see that this strategy can and does work – albeit at a cost.

        Finally, just to pick you up on your comment about flu vaccines – whilst it’s true that the effectiveness varies from year to year, your numbers are miles off the mark – effectiveness can vary from 10% up to 70%, but typically is around 40-60%

        Reply
        1. Gary Ogden

          markheller13: I don’t have a clickable link, but read Peter Doshi’s two papers in BMJ concerning influenza. Only about 15-20% of flu-like illnesses are actually caused by influenza viruses in a typical year, thus even were the vaccine 100% effective for a given population in a given year, it could only prevent 15-20% of cases of flu-like illnesses. Not good odds, given the documented serious adverse events the vaccine can cause, such as Guillain-Barrė syndrome. While relatively rare, it is certainly worse than the flu. The flu vaccine has in recent years become the most frequent vaccine for injury claims in the U.S. Court of Special Claims. In a program designed to compensate children for vaccine injury, the majority of claims, and the majority of those receiving compensation, are now for adults injured by the flu vaccine.

          Reply
      2. markheller13

        Gary, thanks for the information, very interesting. What I’d take from that is that a COVID-19 vaccine could potentially be very effective at preventing the COVID-19 illness, but not so good at preventing other flu-like illnesses. That would still be a good thing though, dependent of course on its side-effects.

        Reply
  22. Ulli Peiler

    this is a really interesting and thought provoking post. However, its premises assumes that all that money goes to the health system, which is not the case. GB is not an island, I know it is geographically, so, even if we did nothing or very little, to fight corvid, the economy would need huge support.

    Reply
  23. Elizabeth Joan Wade

    I have no confidence in NICE that promotes the dangerous drug statins and costs this country £ millions killing thousands of innocent patients unnecessarily. So how can anyone trust this organisation’s advice about this latest virus that’s also killing thousands of innocent patients?

    Elizabeth Joan Wade

    Sent from my iPad

    >

    Reply
  24. Dana

    Successful, inexpensive treatment Covid19 by Prof. Dr Didier Raoult, Marseilles, France, and also used by Dr. Zelenko in New York adding zinc sulphate; may not be suitable for those with heart conditions. Why are governments shutting down economies all over the world instead of mass producing and distributing this treatment?

    Reply
    1. Harry de Boer

      I’ve read there are over 500 producers of (hydroxy)chloroquine, and azithromycin is also widely available. At https://www.mediterranee-infection.com/covid-19/ we can see that over a 1,000 patients have been treated this way of which 1 has died as a result (small caveat: after 3 days treatment). Add a little zinc (sulphate) as per the dr. Seheult video ( https://www.youtube.com/watch?v=U7F1cnWup9M ) and I’m sure a lockdown won’t be necessary anymore as long as we ‘d be wearing face masks and use rubbing alcohol and soap liberally.

      Reply
    2. The Wizard

      It seems to be the case that proven, safe, tried & tested interventions ( IV VitC, ozone, hydrogen, activated ClO2, NO etc etc) are universally being ignored, side lined and diminished. I recently received an email from the team at Osmio Water in the UK. Their frustration is palpable. I have pasted the entire email below:

      In the last two weeks, the entire team at Osmio Water, especially George Wiseman, Dr. Maria Yermotliska, Dr, Jon Zhang and Mark Kent, have been working to inform the medical authorities and Government about a medical gas which we feel is needed and is being used right now in clinical trials in China, plus ramping up production capacity during difficult times for everyone.

      We are sharing this press release below with all our email subscribers, to request your assistance in forwarding this to any of your contacts in the medical or health-related profession, or writers and journalists to make people aware, especially any medical or journalist people there are in your network.

      Thank you for taking the time to read this. Your help is greatly appreciated.

      Best wishes,

      The Osmio Team

      HYDROXY GAS MACHINES COULD HELP BUT NO RESPONSE FROM GOVERNMENT

      The coronavirus continues to spread globally at unprecedented speed and the need to find new and effective medical treatments to alleviate the symptoms as well as a cure grows stronger.

      Businessman Mark Kent from Osmio Water says that portable hydroxy gas machines could help in the fight to reduce the number of hospital admissions and potentially enable an earlier return home, thus freeing up hospital beds at both ends. However, all attempts that he and several prominent medical professionals have made to raise the profile of these machines with the government are hitting a stone wall amidst an almost single-minded NHS procurement drive to obtain more ventilators.

      I’m at my wit’s end; we have been trying 24/7 to get through to the government and NHS decision-makers without success. We have contacted every Member of Parliament in the country, some of which have been extremely helpful and concerned for their constituents but even the contacts they have obtained for us have failed to get us anywhere other than running around what seems to be a perpetual loop to the department trying to procure parts for ventilators. Because hydroxy machines are neither ventilators nor parts for them this is a dead-end loop.

      We urgently need this type of portable ‘first responder’ type of treatment mass-produced and out there to help alleviate the symptoms at home at a time before people get too critical. It seems clear that the fear of a hospital bed not being available and with no other avenue being available to help alleviate some of the symptoms at home may well be leading to more hospital admissions than would otherwise be the case.

      Expert Dr. Zhong Nanshan from China who was the first to discover the Sars virus reports that in Wuhan, China; administering a mixture of hydrogen and oxygen gas has now become a front line treatment with positive responses from the latest trials that now involve over 1,000 COVID-19 patients.

      Hydrogen is not a cure for COVID-19 but is well known for reducing the chronic lung inflammation that along with viscous secretions is causing the high death rate as reduced inflammation gives the oxygen a chance of reaching the lungs but – and it’s a big but – this gas mix cannot be delivered outside of the controlled conditions of a hospital when it’s from medical cylinders and our hospitals are becoming overloaded.

      Portable hydroxy machines, however, can supply exactly the same gasses for safe and simple home use or administration by nursing staff at medical centres where patients are in distress but not quite hospital critical. If used early enough they have the possibility of preventing many from going critical in the first place and thus potentially help out our overloaded NHS facilities and staff at a minimal cost. They can be mass-produced, used time and time again and at a cost of less than a one day stay in hospital.

      We need to somehow get this through to the decision-makers. I fully understand that everyone is on major overload at the moment but the use of these machines may well help ease things significantly at minimal cost. We have tried in every way we know to make any significant contact and are reluctantly having to go public to try to get a focus on this type of machine.

      References:

      https://www.ers-education.org/events/coronavirus-webinar-series?fbclid=IwAR3AReIygRYr0TUWML97LIJ04wfFvWBgthNwOA6jwvuACVX7JTaKPAHREw8
      https://www.cebm.net/oxford-covid-19/covid-19-registered-trials-and-analysis/?fbclid=IwAR3yxaoEKjYP7zlaGLb48uo7HqsI_OprvV2wFUW9OKIdF20qOHvr7au61jk
      View at Medium.com

      Reply
      1. shirley3349

        Mixing oxygen and hydrogen sounds highly dangerous to me, explosive in fact. In an intensive care ward, full of electronic equipment, where the slightest spark could cause a catastrophe, it does not bear thinking about.

        Reply
        1. Michael Lee

          It is explosive if over 4.7% and the medical hydroxy machines keep the h2 concentration between 2 and 3%. Also the mhra nice approval process looks at the electrical and radiation and static and it has been made very safe by companies like Osmio.

          Reply
  25. abamji

    In my view a sound analysis. It’s not cold-hearted to accept the inevitable and for years I have argued that just because you can do something does not mean that you should. When my deaf, partilly blind, doubly incontinent mother fell and broke her shoulder aged 94 (she was confused because septic from a chronic and untreatable urinary infection) it took us a while to persuade the surgeons not to treat her, despite her having signed an advance directive. We can fix her shoulder, they said, and by the way we could also replace that arthritic hip…

    What should matter is not prolonging unwanted life but ensuring a comfortable and dignified death. For as in Adam all die.

    More on this in my book “Mad Medicine”.

    Reply
      1. Dr. Malcolm Kendrick Post author

        They do not. This is a myth. No doctor in the UK has spoken the Hippocratic oath for decades. Some have chosen to speak the Geneva declaration. I cannot speak for other countries but I suspect this is also the case.

        Reply
  26. Cathy Hood, RN, MS

    Another consideration that needs to be addressed is the question of why are medical care costs so bloody high? How is profiting by the struggles of others OK? As usual, here in the states, some companies are charging $4 to $5 for masks that usually cost less than $1; costs of ventilators more than doubled over night. Drug companies around the world are salivating at anticipated profits from potential treatments and/or vaccines. At the same time, I see almost no information on the role of medications that suppress immune function, like steroids. And why are we not actively testing vitamin D levels and prescribing high doses of vitamin C, D, A, and all the other nutrients needed for good healthy physiology – so much more cost effective than anything from PHARMA. Meanwhile, the US stimulus gives away enormous amounts of our tax dollars to corporations without transparency or over-sight, a gift from our self serving leader-of-questionable-sanity. While looking at the costs is very important, we should not ignore the real necessity and reasons for those costs. If we need to sacrifice our jobs and freedoms, why can’t corporations do so as well?

    Reply
  27. David Bailey

    Malcolm,

    I’d love to get your comment on the subject of ventilation.

    My guess is that people in poor condition who arrive in hospital have not been placed on a ventilator unless their condition is likely to improve.

    Now when people are in poor condition but also test positive for COVID-19, is it the case that they are automatically ventilated?

    If that is the case, I’d guess that this may be the cause of much of the extreme overload in health services across the globe.

    Reply
  28. Daniel

    How do we know 350 billion is anywhere near what is actually going to be spent? IF actual costs ended up being “just” 35 billion, wouldn’t the price of QALYS then come down to one tenth? Most optimistically it would then be 10K.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Of course that is ture. However, the current intention is to spend £350Bn. If you are willing to spend £350Bn, then you really need to know what you are getting for that amount of money.

      Reply
      1. Jacqueline Marta

        You could easily afford far more money being spent on treating sick folk, if all Western Governments sliced 25% from their Defence Budgets. Plus all Americans purchased one less gun this year and donated the money to Hospitals of their choice?

        Reply
  29. Sue Richardson

    Thank you Dr K. What is free speech for if not to say difficult things that not everyone will agree with? I have to confess that the math went by me, but your argument didn’t. One thing I had not considered was those who will be forced to self isolate with others who might abuse them. Children, women etc. It’s ok when you love your husband, wife, family etc, but how terrible if the relationship is abusive. I know a number of friends whose operations have been cancelled because of this virus. One was classed as ‘urgent’. She could well die. At what price her life? I am over 70 and am sticking to the lockdown rules, not because I might get the virus, but because for all I know I might have it and pass it on. I understand how your mother feels though.

    Reply
  30. Carol A Parker

    I agree with your mother and I am a grandmother of 4 little kids, 4, 4, 5 & 7…Who I love dearly and who all love me dearly. Yet, I do not believe that destroying the economy of the world and spending so much money on this is the right thing to do either. My husband and I have discussed this with her three children and their spouses and we all agree, as hard as that is to discuss. Our son-in-law and our son are surgeons and they wholeheartedly agree with us also.

    I/we all think the politicians are being coerced into spending all this money by a bunch of whiny babies who just don’t want to grow up and be adults and deal with life Because they’re so used to having the government hand them everything Without taking responsibility for their own lives.

    Thank you for the courage to post this. C

    It IS all about Love. Carol ATMortillaro Parker 307.690.3888

    >

    Reply
  31. Jerome Savage

    Challenging realism in muddied waters.
    The nub is ;
    ” I fear that we are taking actions that could, in the longer term, if we are not very careful, result in significantly more deaths than we are trying to prevent”
    My own mother feared the finale despite strong religious beliefs. But I recall a local elderly lady casually anticipating her demise, commenting “every dog has its day”
    Blasé or what ?
    Thank you.

    Reply
  32. Gary Ogden

    Thanks, Dr. Kendrick. I haven’t curtailed my activities, either. In fact, in recovery from cancer surgery, I must return to all my normal activities, especially physical activity.

    Reply
  33. rhod tibbles

    Dr Kendrick… thank you for injecting some financial v health/longevity realism into the whole covid-19 issue and its potential long-term impact on the world’s social and economic structure. Particularly with the funding of the NHS, seemingly heartless tho it is, there has to be a cost assessment for treatment to ensure the budget is not wasted. In terms of the hysteria over the number of deaths caused by the epidemic, as you have said in previous articles, don’t confuse causation with association. In The Sunday Mail today, Peter Hitchen’s somewhat controversial article makes the same point. All the fatalities have been attributed to Covid-19 when in fact 99pc at least of fatalities all had serious underlying medical conditions. One NHS Doctor reported all the effort being put into those patients who eventually died anyway, at the expense of those with other conditions who could be saved. The press clearly are causing more problems generating fear and panic than the actual virus itself… The virus in the vast majority only create minor symptoms. Isnt the problem that it’s the Government’s epidemic strategy that could easily cause a largely unnecessary social and economic timebomb ?

    Reply
  34. Jannice E Mordue

    The crucial thing is that your mother makes her choice. It should never be the NHS system that decides for her. It is clear from some recent public comment that there is no shortage of people who think the old are a nuisance and should either be culled or be willing to accept voluntary euthanasia for the general good. This is terrifying and unethical and should never be given public utterance. I recall the article in an issue of The Times, written by Max Hastings only last week, which sent a chill down my spine for this very reason. We in the UK are still supposedly living in a civilised country where the value of somebody’s life should never be in question. Orwellian thoughts about human life should stay between the covers of his books and in the cans of dystopian films, not be given house room in the real world,

    Reply
  35. Karen

    Thank you for bringing up Russia. The number of deaths from alcoholism, suicide and violence were staggering after the collapse of the Soviet Union. US Governments’ (State and Federal) responses have been irresponsible, both in terms of the money (debt) being thrown at this, the isolation of society, and the shut down of the economy. More elderly will die from loneliness than COVID-19, not to mention the health impacts of sitting in their homes day after day. With our economy already being on the brink, COVID-19 is convenient “cover” to use as an excuse for the toppling of global economies, which in reality are a direct result of global central banks’ actions over the years of encouraging massive govt, corporate and private debt. Shutting down the economy will only impoverish average people, rapidly creating the social ills that lead to death.

    When the government was comparing COVID-19 to the flu and refusing to stop incoming flights from China, S. Korea and Italy I was suspicious that they wanted it in our borders. The CDC’s “bumblings” were obviously not incompetence (no one is that incompetent), but deliberate to enable the virus to spread to various areas around the country. The CDC’s insistence on making their own (flawed) test and refusal to test suspicious cases ensured unnoticed spread throughout communities. Then when the govt began testing thousands of people at once it was clear that their intent was to panic people with exponential growth numbers of COVID-19 positives. The govt and media’s incessant reporting of terrifying numbers for “positives” and “deaths”, with minuscule numbers for “recovered”, and no mention whatsoever of the vast majority of mild to moderate illnesses (which never get counted in the “recovered” numbers because they were never hospitalized), is designed to instill fear and panic. Is it not highly suspicious and ridiculous that Hawaii had made a formal request to FEMA for morgue assistance to help with the overflow of dead bodies… when their official death count from COVID-19 was 1, which has since been revised to 0? The government’s obvious goal is to terrify society into accepting even more loss of freedom and more government authority over their lives. At what point do the crazy Conspiracy Theorists get to say “I told you so”?

    I originally believed this virus to be very dangerous, but posts like this have helped lend perspective to the fear mongering of our govt and media. I have since changed my opinion, and I believe we are on a far more dangerous path. If we allow our society and economy to be shut down for several months we will likely find out what truly high mortality looks like.

    Reply
    1. The Wizard

      Agreed. There is far more going on than we know. I know that Dr K “likes” a good conspiracy theory but believes that in practice these plans simply would not succeed. I think history can teach us much; what were we told at the time and what do we know now? Mass hysteria, panic, false flag operations are the tools of the trade for achieving desired outcomes/justfying actions. Here in the UK we NOW know about the “dodgy dossier” and WMD’s. At the time, amidst the hysteria, many were utterly convinced that Saddam simply had to press the button.

      Mega corporations and phenomenally wealthy individuals, shape our views and the societies we live in. Demand for a product can be created; anyone for a COVID-19 vaccine?
      Entire populations can be primed to accept without question, policies which limit rights and freedoms. Take a look at what Bill Gates is saying.

      https://healthimpactnews.com/2020/bill-gates-calls-for-vaccine-certificates-as-requirement-for-travel/

      Reply
  36. Göran Sjöberg

    Yes, yes!

    I recognized about the same situation with my own mother who, though contrary to your mother, slowly deteriorated at a nursing home where she finally at age 84 was caught seriously ill by a flu and then taken to a hospital, which was a mistake since she was not giving any serious care at that hospital.

    At that point she didn’t want live any more and as she frankly put it to me: “Help me to jump!” Well I didn’t need to do anything of thet sort. It was done by “nature” but she could as well have stayed at the nursing home which was a rather decent place in perspective.

    It was certainly not a question of money but just the course of “nature” – we will all finally die.

    Reply
    1. shirley3349

      At least a patient on a ventilator is heavily sedated and paralysed so they do not fight the machine.
      More distressing is the plight of the conscious patient on oxygen, who, increasingly exhausted, fights for every breath until eventually the heart gives out and death ensues. Unless the consultant takes pity and authorises the prompt, light sedation of the patient, which may depresses respiration sufficiently for a peaceful death to then take place.
      I have always failed to see the ethical justification for horrible deaths, but I am sure they still happen every day.

      Reply
  37. Roy Firus

    What a terribly sad excuse for a doctor you are.Yes – the price of a human life is just that -infinite. It is more than tragic that you both as a human – and especially as a doctor – have obviously never learnt that fact…you must have been sick that day in medical school when they lectured on the Hippocratic Oath.I can only hope that you on your deathbed never have to experience the same ice- cold thoughts that you have expressed here.- no matter how unhealthy you actually must be to have taken both the time and the energy to have written such inhuman nonsense. I honestly feel extreme pity for you but even more so for your patients …Please do us both a favor and cancel my subscription to your wisdom.

    Reply
        1. Adriaan Keij

          “I wish anyone paid a subscription.” I’d like to contribute, but how? Please tell me (us I hope…) how to donate.

          Reply
    1. AhNotepad

      Thank you for your so carefully considered wisdom. To show my commitment, I would be happy to attend your funeral,……………………….

      ………………………….

      ………………………….

      as a dancer.

      Reply
      1. AhNotepad

        Arrggghhh!!! My reply could be misread, it was addressed to the honourable Roy Firus

        Malcolm, I would be happy to pay a subscription, unfortunately there is no mechanism for such.

        Reply
    2. dearieme

      Opinions legitimately differ, Roy. For instance, I think that you are a bloody fool who has never grown up.

      Reply
    3. Karen

      First do no harm. In hospice I have seen much harm done to people by doctors providing futile care, thus increasing misery and suffering. I had 5 hospice admissions in the past 2 days that were presumed/confirmed COVID-19 – all but one were in their late 80’s or 90’s. One woman was 67 and everything that could have been done for her was. What is more harmful: providing comfort measures to a 93 year old who is not going to recover and regain any reasonable measure of quality of life, or sticking a tube down a 93 year old’s throat in a desperate attempt to keep them alive at any cost? Your judgmental words aimed at Dr. Kendrick ring hollow.

      Reply
    4. Jacqueline Marta

      I agree with much of what you say. Unfortunately I have only just joined this group, and I probably won’t stick around very long, as I had no idea that this reaction to Dr. Kendrick’s hypotheses about money over life would receive such a cold hearted response. Also all the people who think they have a right to decide about who lives and who dies? Is this a true picture of how people are today,?apparently without compassion or empathy, the things that supposedly make us Human Beings. I have found this experience so depressing. Do you believe that Doctor Kendrick holds the views he has aired, or is he just looking for a reaction from the public?

      Reply
      1. Jerome Savage

        Marta
        By the same logic, the health service should not be shackled with a budget, but it is – no doubt causing the end of many lives.

        Reply
  38. JDPatten

    Your mother:
    Does she grasp the reality of COVID deeply enough to truly make her decision?
    There’s a difference between going to sleep and never waking up due to massive stroke or MI (Common enough in 90-somethings??) . . . and being fully aware that you are dying by suffocation in the sea of fluids your own body is storming out in a desperate attempt to fight back and just stay in this Life.
    So then, the thing to do would be to go by NICE’s decree (Arrived at through what sort of arcane calculation well before COVID became the forceful reality it is?). That would maximize deaths not quite to the degree that spending nothing more than usual would.
    The result: COVID is defeated because everyone has either survived the infection or died. Nowhere for the virus to go.
    QALYs are then up because so many of those oldsters with QALY compromising conditions are now cremated. (Or lying in their flats undiscovered yet.)
    Small problem: The “healthy” survivors are not all really so healthy. Many experience what seems will turn out to be permanent cardio-pulmonary damage. COVID causes heart damage that, because of elevated troponin, looks just like MI. Patients get misdiagnosed and inappropriately treated. Corona virus is almost universally found in brains on autopsy.
    Maybe spending that huge amount now would forestall an even more logarithmically massive death rate than existing algorithms could possibly crystal-ball??

    Reply
    1. Harry de Boer

      Not all ‘corona virus’ is SARS-CoV-2. So it might well be that corona virus is found in every brain on authopsy, but is it this type of virus?

      Reply
  39. lorraine cleaver

    My grandmother is 97. She said it feels like the end of the world out there, but she still goes out. Her mental health nosedived after four days of being ‘shielded’. This is no way to spend your twilight years, cut off from those you love.

    Reply
    1. Harry de Boer

      I don’t know. Someone with enough money to rent them a load of buses must have had an interest in getting those people to gather and protest. But it’s a drama, first the government took away their cash, now their jobs are gone…

      Reply
  40. Ken MacKillop

    Hi Dr. Kendrick,

    I would like to suggest a hypothesis to explain the noted susceptibilities to CoViD-19 (e.g. T2DM, CVD, smoking). I owe it to you that I became aware of the endothelial glycocalyx.
    Michael Yaffe and others at MIT and Univ of Colorado are working on anti-coagulation therapies (with tPAs) for CoViD-19 patients with ARDS, based upon the observation that these patients typically have complications (microthrombi) in lung.
    The comorbidities of CoViD-19 all seem to be linked to likely compromise of endothelial glycocalyx.
    By the way, I think I got infected with SARS-2 in Feb. I had a regular dry cough that I was easily able to suppress at will, but persistent for a full week or more. I had mild sensation in URT, but no mucous secretions or significant inflammation. I have a severe case of CVID, with virtually no antibody production whatsoever. But my observation is that SARS-2 presents (to adaptive immune lymphocytes) unusually weakly anyway. While flu is very dangerous for the very young (with immature adaptive immune systems), CoViD-19 barely, if at all, even generates symptoms.
    I only recently (Dec. 2018) began infusing Ig (antibodies harvested from others’ blood) for my genetic immunodeficiency. Since that time I have occasionally become aware of a viral infection trying to get ahold of me (maybe two or three times), but that I have kept suppressed. This is a new experience for me (at age 61), although common enough for the immunocompetent.
    The Feb. episode was the last such. I generally get flu every year, and usually more than once. Flu shots do no good for me — I cannot respond with selective antibody production, having virtually functionless B cells.
    While I remained with the regular impetus to produce a dry cough (when far away from other people) I nevertheless thought the probability that this was due to SARS-2 infection low at the time, partly because this was still weeks before the contagion really picked up steam in my area. Symptoms were so mild that I did not think about self-quarantine. On the other hand, while I thought a 2nd strain of flu more likely at the time (I had already gotten full-blown flu in Nov. 2019), the symptoms were uncharacteristic of flu for me. SARS seems not to be viable in the longer term in URT, but does reproduce there initially adequately to generate mild sensation, according to my reading of the research (of SARS-1).
    Meanwhile, I am somewhat skeptical of the ideas based upon ACE-2 pathways. I have read a lot of the technical research literature on this. Maybe it is a secondary factor, but not primary IMO. Evidence seems to me to be unexplainably weak for this to be the primary reason for the comorbidities.
    My bet, rather, would be on compromised glycocalyx. Without comorbidities SARS-2 seems to be a quite weak pathogen, in comparison to flu for example. It represents a big danger for now because it is such a potent contagion (in part because it is a weak pathogen, not making most recognizably ill) and because it is novel, with no significant herd immunity yet generated. Because it seems such a weak antigen (in terms of adaptive immune recognition and response), I would tend to predict disappointing results with both therapeutics and vaccines, as both are usually based upon nucleic-acid signatures. Annual vaccinations may be required, not likely due to seasonal mutations, but simply to achieve much of any efficacy from year to year.
    Also, while T cells remain important in killing off a viral infection after invasion of cells, B cells (i.e. humoral response) and antibodies will not likely play as significant a role in resistance to CoViD-19 as with most pathogens IMO.
    I may be wrong, but if not most of the money and efforts in biotech to respond to the new virus will likely be fairly unsuccessful.

    Reply
    1. Harry de Boer

      About the glycocalyx, here is a nice explanation of why a well hydrated body and moist air are so important in fending off a virus: https://my.glycanage.com/article/fighting-viruses-with-glycans . I guess a smoker also voluntarily deteriorates the functioning of his glycans.
      The good Dr has explained here before how the insulin/glucose damages the glycocalyx in the arteries, would maybe high glucose and insulin levels also provide an explanation for the fact that such a large number of fatalities are diabetics or pre-diabetics?

      Reply
  41. Ken MacKillop

    P.S. For benefit of yourself and your readers, I live in Lowell, Massachusetts in the US by the way.

    Reply
  42. JDPatten

    I live in rural Massachusetts. Back in the 80s we had a nice vegetable garden going. The chipmunks thought it nice too. Nibble here, nibble there. The chipmunks gradually increased in number to a frightening degree. Over a couple of years they were everywhere – like that Alfred Hitchcock movie. They became smaller, scruffier, and riddled with grotesque tumors.
    Then, one Spring – no chipmunks. None whatsoever. None that I could see. There clearly were some few survivors because they started showing up again in tiny numbers a couple of years following the crash. No intervention.
    Plenty enough of them now. (How different is this population?)

    Take from this what you will concerning ourselves.

    Reply
    1. LSBennett

      Thank you Malcolm, for your brave and well thought out and explained article as usual.
      The thing that bothers me most during all this is the moralist certainty of many people that if you deviate from the program you are a killer. Exactly the sort of abuse you receive for daring to suggest people don’t need statins.

      Reply
  43. Fungi

    Always enjoy your interesting point of view. But let’s face it, the 2.2 trillion dollars isn’t being spent on one disease. This is a business bailout.

    Reply
    1. Harry de Boer

      Good point. Every bubble that pops needs a new, bigger bubble to keep the economy going. It could well be that a new one has been found/fabricated here.

      Reply
  44. Shaun Clark

    Its very, very interesting in that it would appear that most contributors to this blog would appear to be 60 +.

    Reply
    1. David Bailey

      Yes. I think some, like me, arrived here after a nasty brush with statins! Sometimes I think there was some value to taking those statins, because they changed my ideas about not questioning medical advice for ever!

      Reply
  45. Ken MacKillop

    Regarding (most forms of) diabetes, it bears noting that those with metabolic syndrome (aka pre-diabetes) but not overt diabetes (which is effectively equivalent to the loss of insulin granulation in beta cells, occurring with loss of 80% of beta-cell function regardless of the form of diabetes) will have unstable basal regulation of blood glucose — this is essentially true by definition. That is why MetS generates moderately elevated HbA1c.
    MetS generates moderate hyperglucagonemia — this is the mechanism by which BG becomes unstable and elevated. However, while insulin granulation is still preserved the acute prandial hyperglycemia and hyperglucagonemia of overt diabetes does not (yet) manifest.
    And the majority of the population will never become overtly diabetic due to genetic immunity. In these people MetS will persist as long as the subcutaneous adipose is saturated and carb tolerance is exceeded, with many serious health consequences. But in these same people the islets are genetically capable of expanding the beta-cell population adequately to maintain hyperinsulinemic compensation and avoid the so-called decompensatory decline of beta-cell function in those genetically susceptible to overt T2DM.
    Men have been universally observed as more susceptible to CoViD-19 complications and death than women.
    I submit that this is due to the difference in sex hormones, which are protective of women during fertile years. MetS is enormously more prevalent in men than in women, even beyond the period of fertility in the latter.
    Again, this ties in with the endothelial glycocalyx and elevated BG.
    With regard to the elderly, maybe no more explanation than associated reduction in cellular health and potency is required. But the elderly in urban/industrial settings are particularly insufficient in dietary protein and excessive in dietary carb’s. This degraded diet generates the familiar associated conditions of sarcopenia, weak bones, etc. It will also generate MetS and unstable blood sugars — in other words, degraded BG regulation.

    Reply
    1. Harry de Boer

      Can you translate this to English? I’m really scratching my head over this one… (Luckily I’ve got some Bourbon here to pass the lockdown).

      Reply
      1. Ken MacKillop

        OK, what I am proposing is that a large number of people in modern society are “insulin resistant” in vasculature. This can degrade endothelial glycocalyx, and probably more importantly and prevalently generates endothelial damage directly by excessive oxidative stress (for this, see M. Brownlee’s research of last decade or more — remarkably little attention paid to this seminal work, IMO).
        In the most thusly compromised individuals ARDS will result from CoViD-19. It is ARDS, and only ARDS, that makes this pandemic so serious.
        In tissues other than lung SARS-2 is a weak pathogen. In the more healthy individual, lung infection seems to generate a moderate dry cough — i.e. moderate inflammation or innate immune response — which resolves in a week or so, and even more mild or undetectable upper respiratory symptoms. So it was with me.
        It is remarkable to me how little attempt seems to have been made to explain why infants and children are so invulnerable to any serious complications of this infection, which is strikingly different than for flu. Microthrombi seem to be a predominant complication of the ARDS patients.
        In ARDS generally, IMO, recovery is dependent upon INNATE immune response and health thereof.

        Reply
  46. Tony

    Born to die: You can’t have one without the other and I am fed up with the promises of immortality being offered by ‘Specialists and the Government etc.’ which is clouding the issue of what is really just a serious ‘flu outbreak.

    Now in my mid 70’s, my body and I have survived just about everything that life has thrown at it, such as ‘flu, cancer, clicking joints…..marriage, divorce etc. and still here to tell the tale.

    The last thing I want is a Government interfering, controlling, imprisoning and mollycoddling me…I feel as though I’m Alice in ‘Boris in Wonderland’.

    Older people do die more often it seems; damn statistics again.

    Life is for living, but on my terms, and when the time comes, I’ll quietly shuffle into obscurity knowing that I was right….lol.

    Reply
    1. dearieme

      “Life is for living, but on my terms”: a reasonable outlook for normal times. But what is your intention now? Do you plan to do what you can to spread the contagion on the grounds that other people’s terms don’t matter to you? Sod ’em, they’ll all die one day anyway?

      Reply
      1. AhNotepad

        dearieme, that looks like the sort of manipulation of words, that might be performed by a barrister in a court,

        For every living organism, for something to live, something has to die. There may be 7+ billion people on the planet, but there are a lot fewer numbers of other species than there were even 100 years ago. Children who contact infections in their early years end up with a reasonable immune system. Those who stay too clean suffer when they do contract something. Children who live in households with a dog are less prone to infections than those without. To accuse someone of wanting to wilfully spread a virus is disingenuous.

        Reply
      2. Sue Richardson

        Good point. If we lived just for ourselves we would be the ones barging past people in the supermarkets to make sure we got our supplies, and blow everyone else. Balance must be the answer.

        Reply
      3. Tish

        We heard a first hand account today of a lady in her nineties who got bawled at by a couple of women in a local supermarket. They shouted that she shouldn’t be out and to go home. She was very upset, near to tears, and said she only came in for a cabbage, She had to go home alone and miserable. Nobody could have got near her to console her. This is bullying. This is selfish. It seems even more disgusting to those of us who disagree with the government’s measures. Some of you fear the virus. Some of us do not, but we fear the control.

        Reply
        1. AhNotepad

          The UK “government” are now talking of 6 months lockdown, oh, and it could go on longer. What are these ar530les playing at? It is those two sick specimens of sub-human women who should be in custody. Of course the extended lockdown would be decided by the best scientific and medical advice, er, perhaps because of another of Ferguson’s maniac predictions.

          Reply
      4. shirley3349

        Whatever we do or don’t do, the vast majority of people in this country, England, are going to get this virus because it is so infectious; many may have already caught it and recovered from it.

        For example, I had a very slight cold in early February with a mild, shivery feeling, not a proper fever. Was that IT? I stayed in bed for a few hours longer and indoors for a day or so and then carried on normally. So did I actually help spread the virus? Without an antibody test I cannot know that, or whether I am now free of infection, whether I am now immune from it, or if this was only a cold, after all.

        So I am now indefinitely confined to my home, for possibly no good reason. Fortunately, our bungalow is spacious with a large garden. But I look forward to my weekly trips to the supermarket like never before. And I have my husband for company unlike some poor folks. I miss my sons and grandchildren ever so much. My two grandsons have already spent a period of home isolation with a cough; so have they both had it too?

        I think the government has overreacted, partly out of guilt from deliberately running down the NHS since 2010. This whole self-isolation thing is likely to break down in a week or two as people become increasingly bored and restless Many older school kids are, I gather, now meeting in secret away from disapproving adult eyes, and (still) working parents can do nothing to prevent this. In any case, the only policing in our normally peaceful town, since the police station closed a few years ago, is the very occasional patrol car.

        During the various plagues in the past, they only quarantined the households of the visibly sick, not the healthy who went about their normal business and kept the economy running.

        I”m 70 and my husband is 73. We both hope to live through this, but not at the price of imprisoning the young and and the fit. Frankly, we feel this an abomination and that the country will pay a terrible price if this policy continues for much longer.

        We wonder how many of our contemporaries feel the same.

        Reply
  47. Marco

    The vast majority of the funds is to support the economy in various ways, not for saving lives. The next economic crisis has been well overdue, just waiting for some black swan event to trigger the inevitable downturn.

    People aren’t interested in getting sick, dying or endangering their loved ones. This makes tourism, travel, entertainment and related activities significantly less attractive regardless of government restrictions. We’ve seen a lot of the fallout before official policies emerged. Companies have been aggressively trying to protect their employees by cancelling trips at great cost to hotels, airlines and conventions. Marketing and other support sectors are following quickly.

    This is a bottom-up crisis with no room for politics to fundamentally stop it. Risking lives in an attempt to do so is most certainly in vein.

    Reply
  48. Laurence S. Wilson

    Thanks for your recent analysis. Is this email address the right one to ask you a question? My question relates to my guess that a NICE decision regarding statins has caused great difficulties for my wife who is a stroke survivor, twice over.

    Laurence

    Reply
  49. Lynn Wright

    Thank-you Dr Kendrick for the time taken to make these calculations. I predict the cost in human lives and suffering (suicide, child abuse, domestic violence, mental health, years cut short from the elderly due to isolation, etc. etc.) from the counter measures will far outweigh the damage done by this so-called SARS-Covid-19 virus.

    Reply
  50. Kevin Frechette

    Hi Malcolm,

    I’ve been interested in Wim Hoff and Buteyko breathing, and Pranayma for a while now. I have Asthma as well. Oxygen is carried by the red blood cells but it is also bonded to CO2 which forms a weak bond.

    If you hyperventilate, the CO2 gets blown off and the Oxygen forms a strong bond to the RBC and the blood goes slightly alkaline. This is the Wim Hoff trick to burning a lot of energy for his cold immersions.

    If you hypoventilate, the CO2, builds up and Oxygen bonds loosely but is more available to the cells and the blood goes slightly acidic. I can improve my asthma by holding my breath.
    If I exert myself beyond my breathing, I blow off my CO2 and can’t access the 02 until I get my breathing calmed down.

    Ray Peat is a Buteyko guru that thinks the high oxygen levels that are administered for COVID treatment is what’s damaging the lungs. Over oxygenation limits availability and creates an alkalyzing environment at a time when the bodies antioxidants are wiped out.

    The treatment may be worse than the disease.

    Reply
  51. sundancer55

    There’s soooooo much pork in that bill (some the public will really never know about) that it’s useless to us. It takes people a while to catch on, I guess. We. Been. Fleeced.

    AGAIN.

    I’m SOOOOOO tired of the words covid and 19 that I’m turning off my computer and leaving it off for a few days. I just can’t take it anymore. Every headline, every article is focused on this, and that’s just exactly what our idiotic gubmint officials wanted. We are playing right into their hands, and no 2 Trillion dollar “grant” is going to “save us” from anything. It will help politicians, but no one else.

    Reply
    1. Jerome Savage

      Sundance – politicians just react to demand, demand created by media headlines, ((a sirenic (got me a new word there) headline generates interest and therefore money,)) media are always looking for a headline. When its a health issue and a contagion and a new contagion at that and one that results in deaths, and doesn’t it come from bats ? and people eating bats ? – then bingo. The details are a triviality. Woe betide the politician who doesnt hyper react, and of course it’s not their money. And they will bask in the glory of life saving and assume the life saving mantle.
      And lo, there will be peace on earth – or something like that !

      Reply
  52. Martin Back

    Extract from a communication from the South African Minister of Health:

    RESEARCH TRIAL

    We are pleased that South Africa is participating in the Public Health Emergency Solidarity Trial that has been initiated by the World Health Organisation to conduct a clinical trial to find effective treatment for COVID-19.

    WHO has convened an independent group of experts to review evidence from laboratory, animal and clinical studies to prioritize treatments for inclusion in the trial. This independent group identified the following treatment options for inclusion in the trial:

    – Remdesivir : a drug which was previous used in an Ebola trial;
    – Lopinavir/ritonavir : a licensed treatment for HIV/AIDS
    – Lopinavir/ritonavir with interferon beta-la : used for multiple sclerosis;
    – Chloroquine or hydroxychloroquine : drugs used to treat malaria and rheumatology conditions respectively

    All participating countries will adhere to the same methodology in order to facilitate the worldwide comparison of unproven treatments. Other countries that have already confirmed their participation in this trial are Argentina, Bahrain, Canada, France, Iran, Norway, Spain, Switzerland and Thailand.

    Reply
  53. Dr. John H

    Malcolm,

    Thanks for your analysis!

    I think the big issue that needs to be addressed before looking at cost, is how serious is the Coronavirus? The dire projections that we have been told were created before there was much good data available.

    On the last blog I posted this:”12 Experts Questioning the Coronavirus Panic”
    https://off-guardian.org/2020/03/24/12-experts-questioning-the-coronavirus-panic/

    I know you have a lot of respect for Peter Gøtzsche, who is quoted there, and he thinks things are way overblown. Is he right?

    Yesterday, this came out “10 MORE Experts Criticising the Coronavirus Panic”
    https://off-guardian.org/2020/03/28/10-more-experts-criticising-the-coronavirus-panic/

    I also thought this video with Dr. John Ioannidis from Stanford to be very informative (posted in the last blog too):
    https://off-guardian.org/2020/03/29/watch-perspectives-on-the-pandemic/

    If they are right, then effective public health measures could be taken for a tiny fraction of the current amount being spent and done.

    Reply
  54. Håkan

    This web-site, the European Mortality Monitoring, presents weekly updates for total mortality for many European countries. Fewer deaths, so far, this winter compared to previous winters. It will be interesting to follow the development as the Covid-19 pandemy plays out.

    www. euromomo.eu

    Reply
  55. Graham Stephens

    Reminds me in many ways of my Army Medic days as I developed a presentation called the “Real Reality of First Aid”. Real realities are often about those things that are difficult to tackle. Still however, they need tackling in an appropriate manner. Well thought out and well put together Malcolm. Stay well. Graham.

    Reply
  56. Ken MacKillop

    P.S. If I have not already worn out my welcome, I’d like to add another opinion. The ever so prevalent analysis of progressivity in ARDS (as well as all sorts of autoimmunities and other diseases) based upon the assumption of an “overreaction” by the human immune system is IMO dead wrong and naive. It is a prevalent arrogance of the larger medical profession (including pharma and academia) that they understand, and can manipulate and improve, human immunology. Hah!
    Quite the opposite.
    A lot of the ACE-2 hypotheses employ this type of analysis.
    And the medical profession is fond of employing immunosuppressants and immunomodulatory drugs based upon the notion that they are manipulating and bettering the natural/intrinsic endogenous immune response. This is almost always a mistake, and decades of experimental results seem to back this up.
    Sustaining life is a race at the cellular level. We all lose the race in the end — eukaryotes are intrinsically mortal in the biological sense. That is, likelihood of death of the overall organism increases with cellular age. Trees and humans are the same in this regard, both being aerobic in metabolic nature.
    The chronic hyperanabolism generated by modern urban diet (and associated endocrinology and metabolic signaling) overrides cellular catabolism (which includes cellular repair), and hence the cells effectively “age” faster and lose the race between cellular damage and cellular repair earlier.
    ARDS is no different. As the race to sustain cellular life in lung(s) is lost the immune system responds appropriately, but inadequately. One of the most basic requirements for cellular life is the continuous generation of adequate energy and adequate supply of nutrients. Ultimately failure of this results in global necrosis.
    Hence I would predict the ultimate lack of success of immunosuppressive/immunomodulatory methods with CoViD-19, just as has been the case for decades with other conditions (including cancer).
    On the other hand, any intervention that can “buy more time” for the immune system to “catch up” will be effective in saving lives. Regular fluid removal and oxygen ventilation (i.e. mechanical interventions) are examples extant. Possibly some pharmaceuticals can work this way too.
    Hydroxychloroquine (alone or in cocktails), having been tried and studied (to a limited extent) perenially since the 1990s (and maybe earlier for all I know) as an antiviral has a number of interesting properties at the cellular level. But again, it is fundamentally admired as a cellular metabolic manipulator (of pH in certain organelles, immune function, etc.). The “wisdom” laid down over the history of earth in our genome, by natural selection and adaptation to environment, is much beyond human analysis and comprehension and works best I think. And indeed, there is already some case-study (aka anecdotal) evidence that more patients die with HCQ-based interventions than without (i.e. amongst controls where these exist, such as in the recent French study of CoViD-19 patients).
    HCQ-based interventions seem well worthy of much more study, but I would not hold out too much hope in the longer term.
    Relatedly, although tangentially, pharmaceutical interventions to suppress/inhibit glucagon will never be successful in treating diabetes. That is because glucagon is the most vital and powerful catabolic hormone in the body. It is ALONE responsible for the CONTINUOUS sustaining of fuel (both glucose and ketones) to brain. Any attempt to manipulate glucagon metabolism will result in a compensatory epigenetic reaction (in the alpha cells in endocrine pancreas) that will negate the desired manipulation, thus restoring the hyperglycemia of diabetes. This has been proven in the animal-model experiments. This is the way cells work to sustain life with robustness to a huge variety of varying environmental conditions. Introducing a drug is recognized by cells as simply another environmental variable to which they react.
    The loss of “intraislet decrement of insulin” in T1DM (and all advanced forms of diabetes) is similar. The alpha cells, after a few years of zero insulin signaling, change and become (unfortunately, and noone really understands why) latent and sloppy in response to hypoglycemia. This is why T1Ds are so much more prone to hypoglycemic events and consequences. The genome of the alpha cells are programmed in some way to adapt, but to something far more primitive (and unknown to us as yet) and not to the modern condition of diabetes.
    I have reason to believe that the top researchers at leading diabetes pharmaceutical firms such as Novo Nordisk very well understand this problem and limitation. I have read and listened to discussions by such pro’s.
    But I digress …
    Dr. Kendrick, if you find any of these ideas compelling maybe you can convey them to medical authorities (maverick though you may be regarded by them) or academics with some public benefit. I know none of these people in any country, and am not in the medical profession or industry. But I think I have some rare insights, having three rare genetic conditions. I focus upon the biology (molecular, endocrinological, and otherwise) as best I can, based upon self-education and reading of the research literature.

    Reply
  57. Jon A Every-Clayton

    You may wan to reconsider your comparison of the two-trillion dollar US “stimulus” to the UK annual NHS budget. Two-thirds of the money is going to individuals and corporations to help stave off economic disaster. The rest may go to help fight the pandemic.

    Reply
    1. Jerome Savage

      Jon A Every
      Isn’t it also reasonable to say that the total cost is as a result of measures taken to save lives ?

      Reply
      1. AhNotepad

        Oh dear, there is that false concept about “saving lives” again. How many do you kill in the process? “Saving lives” is NOT a scientific concept.

        Reply
      2. Jerome Savage

        AHN
        my comment is a reference to the spend – total Govt spend and the reasoning behind it. Lets say it has come about as a result of the Govts agenda/mania, trumpeted as life saving measures. The rationale is a different argument.

        Reply
  58. Joyce

    We are in unprecedented times(in my lifetime anyway). The world is in lockdown, terrified and begging someone/anyone to do something about it. All thought of individual illnesses pushed aside (rightly or wrongly, we won’t go there). It would be political suicide for our Government to talk about “fair” distribution of health funding. Which means they are damned if they do, and damned if they don’t. However if they don’t, and hundreds/’thousands die as a consequence, they will be crucified and unelectable for ever, so I can see their point. On a more morbid note, if doomsday is upon us, my age, together with my heart and cancer meds aren’t going to do much for me anyway, and it’s back to the survival of the fittest. (That’s presumably me down the spout!) Sorry to say but I don’t feel like taking my changes ignoring this, going about business as usual, and accepting what would seem to be, the inevitable consequences.
    On a lighter note – Jet2 seems to think it’s all going to be ok by the flood of holiday emails I am receiving daily from them! 😎 Lets hope they have have a crystal ball eh?

    Reply
  59. Tim Rahill

    Objective rational skepticism is a very healthy behavior. Thanks for sharing this coherent perspective Dr. Kendrick. I’m also concerned that the costs you’ve analyzed are just the tip of the iceberg if Govt continues employing universal strict isolation over targeted population isolation of the carriers and the most at risk. Obviously a massive increase in testing is necessary and that’s where more Govt spending needs to occur, NOW!

    Reply
  60. drtombaldwin

    Ouch! But you are right—we are behind the 8 ball, and can’t find our way out.  Ever wonder why so much of this stuff comes from the same area of China? Keep up the good work,  Malcolm!Dr. Tom Baldwin Sent from my Verizon, Samsung Galaxy Tablet

    Reply
  61. Shaun Clark

    OK. Let us (ahem….the Government), accept that this is &*^%$£” serious, and that the default is Lockdown. Then, get every GP (plus 1-other?), in the land to sign-off everyone who is over 50 and does NOT have ANY comorbidities/risks (Diabetes, high BP, heart/lung issues etc., etc.), as well as make comorbidity judgement on folk under 50 who could be considered as high risk – until this thing passes. All the affected folk are to stay in registered-Lockdown and are WELL looked after, and the rest go back to work. Simples. Maybe the folk given the clear can have a wrist band/ID. Those in Lockdown get the promise of a fully paid 2-week holiday when its all over.

    Reply
    1. AhNotepad

      Shaun, not simple at all. I am well over 50, and I don’t get diseases. There’s no reason I should. I maintain my immune system, simples. These simple?, one size fits all policy solutions, are destructive, cause a lot of stress, and ultimately will result in reduced life expectancy for many. Read “Virus Mania” by Torsten Engelbrectht and Claus Kohniein to see how the industry invents epidemics.

      Reply
      1. Shaun Clark

        AhN: For a big part of career I was in aquaculture (salmon, then shrimp/prawns, and then sea bream and sea bass – besides other species), this was back when most folk saw aquaculture as the answer to many food problems. Then big biz ‘discovered’ it… Anyway, for a time I was heavily involved in project management in the Black Tiger Shrimp biz which got virtually wiped out in Asia by a devastating virus disease (WVVS) in the 90’s. It brought many people to their knees, and much else, but in all probability was initially it brought about by greed, husbandry malpractice, and HACCP abuses – much like happened in Wuhan – besides a shocking disrespect for the environment. So, sadly I’ve had prior experience at what can happen when a virus goes rouge. The salmon biz too had its issues, but that is a loooong story for another day…

        Reply
  62. Ieuan Owen

    It’s a fair set of points you make. And I agree with sentiments.

    However – All your calculations are built on a figure of £350,000,000. Unfortunately that isn’t useful as a measure of what the government will “spend”. That is a figure they have quoted to sound like they are doing a lot and contains a variety of different types of interventions.

    The vast majority of that will actually be loans to businesses (with interest). The assumption underpinning will be that most of if gets paid back at some point, in a good outcome potentially more paid back than lent. The number also includes forms of state aid that actually have a positive economic benefit in some cases, or a difficult to measure value e.g. foregoing business rates or VAT

    So I’m afraid the numerator here is at least if not more difficult to calculate than the denominator.

    The truth is we have no idea and his decision is as much political as anything else, and we have a commitment to look after the most vulnerable. As we build greater understanding the maths will start to become clearer and decisions grounded more firmly in logic. (I hope).

    Reply
    1. Dr. Malcolm Kendrick Post author

      I think you missed three zeros off your figure? In truth, of course, things will never be that straightforward. However, I think of it this way. Our national debt is (guess, but I could look it up) £1.5Trn. By the end of it, our national debt may be £1.85Trn. That is £350Bn of additional debt. So, it can be established how much additional debt the Govt took on, and how much has been ‘spent’ on dealing with COVID-19. That could have been spend on something else.

      Reply
      1. Karen

        1.85 Trillion? That’s nothin’! We’re already in the hole at least $23 Trillion. We’re throwing more at this than your total debt! American style…go big or go home!

        Reply
  63. MMadörin

    Liebe Ursula, Hier das scheussliche Kalkül aus England. Der Typ arbeitet so kritischen Fragen der evidence based medecine – eigentlich ziemlich gut. Aber das was er hier schreibt ist ziemlich barbarisch. Lieber Gruss Mascha

    >

    Reply
  64. Tuan Nguyen

    We are very lucky in New Zealand to have a Prime Minister who is extremely mindful of the physical and economic well-being of Kiwis.

    Reply
  65. SteveR

    Thanks, Malcolm. A very interesting and thought-provoking post. It’s a thorny subject, as we would like to think the NHS has limitless capacity, but this is obviously not the case for a cash-limited service and difficult decisions have to be made. For what it’s worth, I would like to make a couple of observations.
    Firstly, I don’t know how much credence you can give to the £350bn figure. I can’t believe anyone has a clue how much this is going to cost in the long run. After all, they can’t even accurately predict how much it’s going to cost to build a new railway line. It strikes me someone has made up a figure, multiplied it by 10 and this has been released to the press in the hope of reassuring the currency markets and stock exchange. I think ‘£350billion’ sounds marginally more convincing than ‘blank cheque’.
    Secondly, the government have got to be seen to be doing something. 500,000 deaths on your watch, particularly with the back-drop of the relative disinvestment in the NHS over the past decade, doesn’t look good on your political CV and, I would imagine, makes it difficult for you to get elected next time.
    Finally, my main concern is who’s going to pay for all this in the long run? The financial fall-out from this pandemic is going to last much longer than the pandemic itself. The last time we had a serious economic downturn after the banking bail-out, the political will was to force the cost onto the poor. Over the past 10 years we have made some, how shall we say, ‘interesting’ decisions at the ballet box resulting in Trump, Johnson and Brexit. I cannot believe that this is a coincidence. I fear that, if similar policies are pursued this time, the ramifications will be far worse.

    Reply
    1. James DownUnder

      Darn! – stole my thunder ! 🙂 Yes, they must be getting absolutely DESPERATE…

      Worse still, if they add the Plaquenil or quercatain plus zinc, they’ll likely be more embarrassed…
      But this IS Good News, for it may well pave the way for Australian Hospitals to ‘give it a try’ – instead of stone-walling as they currently do.

      Reply
  66. Antoinette

    Firstly, how dare someone else decide how much my life, or anyone else’s life, is worth in cold hard cash. This wasn’t part of the contract, when I agreed to pay into the NHS and the Government all my adult life. I should have a say in whether my quality of life is good enough to make me want to continue to live or if I want to sacrifice my life for the greater good, thank you. In the meantime, I expect those that can, to protect me as much as possible.

    I totally disagree with what your mother is doing. If she she doesn’t mind dying aged 92 that’s up to her, but she’s no right to risk spreading it to others, who don’t want to die yet. I’m 71 and would like to live another 21 years, if I should be so lucky. Having said that, I would gladly die now, if it meant that my daughter will live. My only child, is being treated for cancer and doing quite well at the moment (fingers crossed) but people, who are ignoring the risks, are harming others. Tell your 92 year old mother, to consider other people, like my 36 year old daughter, who is now under house arrest for months (apart from hospital appointments, which make us nervous wrecks), before acting so recklessly.

    Not spending all this money in this crisis, wouldn’t help a single person with another illness get any better treatment, health care or social care, than they were, before the outbreak. Health and welfare have always been underfunded and always will be underfunded. It isn’t a question of either or. With our Governments, unless forced, it’s neither.

    How about, we don’t treat anyone at all. Let’s let every body die of whatever illness they contract. Save loads of money that way. Of course the poorest would still die first. No matter how much money was saved from not treating people. It wouldn’t be spent on making life better for the poor. The rich will always hang on to their wealth.

    I live on the borders of Wolverhampton, in the West Midlands, where the number of deaths from this virus has risen the fastest in the Country, despite the average age of the population being lower than elsewhere. The one hospital in the town has been struggling for years. The area is very deprived, but was there any investment here in the decades, since I moved here in the 1970s? No. Poverty has increased over that time, without there being any spending due to this virus. Government spending for this reason is even more necessary for the survival of the people of this town, as well as other similar ones.

    A quote I heard recently was “we spent 4 years risking our lives to fight a war for you and all we are asking is for you to stay at home for a few weeks.” Says it all about everyone born since the Thatcher years.

    Reply
    1. AhNotepad

      Antoinette, you didn’t agree to pay the NHS and government, you had no choice. It was not a contract, it was a fraud perpetrated when a legal fiction was created for you when your birth was registered. Refer to the Common Law Court for details http://www.commonlawcourt.com.

      People are not harming others, since with the information put about in the media it is impossible to know what the risks are, except that if you are alive, there is a 100% chance you will die. What of, and when, you don’t know, and this social destruction will hasten a lot of people’s deaths, but that’s Agenda 21 for you. What? You don’t know what Agenda 21 is? Something to read up then.

      As for poverty, money would be better spent on nutrition than medicine if you want health.

      As for spending “a few weeks indoors”, wait until tomorrow (Monday 30th) when you will receive a letter from Boris in Wonderland. The government (spit!) is now talking about a SIX MONTH LOCKDOWN!!!!! How do you feel about that?

      Reply
      1. Antoinette

        Don’t be so literal. I obviously didn’t mean an actual written contract. The National Health Service was set up the year before I was born, so it would have been a bit difficult to sign anything. I know how it came into being. I studied it as part of my training and I’m interested in social history anyway. As for it being a fiction: it wasn’t a fiction when I was extremely ill in my 20s. Without it, my family would have been bankrupt and homeless, and I would have been dead.

        What? You don’t think that anyone, but you, has heard of Agenda 21? Thank you so much for giving me a little light reading to wile away the hours in self isolation, but I assure you that I’ve got plenty, and I read the various views on Agenda 21 quite some time ago. You think that you are so superior, don’t you.

        “As for poverty, money would be better spent on nutrition than medicine if you want health.”
        I agree, but it hasn’t been. In fact the opposite has been the case during these years of “austerity”, and health and lives are at risk right now.

        With regard your final comment. My reaction is that, although I didn’t vote for this Government, I’m glad that it is doing this, at last, and you aren’t deciding on the course of action. Would your attitude be the same as when the Government in Germany in the 1930’s, decided that it was o.k. to exterminate the disabled and weak in order to have a better economy and a super strong population? That turned out well.

        This won’t go on for ever, and will not cost anywhere near the amount we spend on weapons and wars, but if it’s necessary to extend the period to control the spread of the virus, (and there’s no need to shout) I am for it.

        I was quoting someone else, (the clue was in the quotation marks) when I said a few weeks, but I understood his meaning. It is a few weeks when taken in comparison to his sacrifice, and serious risk, over four years.

        Reply
        1. AhNotepad

          Antoinette, I think you have mis-interpreted what I wrote. People have views they post here, for discussion, not because they think they are superior, including me. I am not going to respond to all the points you made, except to say you are entitled to hold them. The one point I will make though is about the “legal fiction”, I think you had the wrong end of the stick on that one. Here is an explanation why what you think was a “contract” whether it was written or not, is a fraud. http://knowledgeispower-uk.weebly.com/the-birth-certificate–the-legal-fiction.html it’s a bit of an entertainment style, but if people want to take ownership of their legal fiction in the UK, they can register on commonlawcourt.com

          Reply
      2. Antoinette

        Not sure what has happened here. I am unable to post this comment in response to your last one addressed to me. So here it is:

        I have no problem with others expressing views that differ from mine. If I did I wouldn’t have been married for over 40 years:-) There’s plenty of lively discussions in this house.

        It was your preachiness, especially your arrogant assumption that I couldn’t possibly have heard of Agency 21, because you are so much more knowledgeable, that I found so irritating, and was specifically reacting to.

        As for your commonlawcourt, I’ll stick with the system we’ve got, thank you. There’s plenty wrong with it, but yours achieves absolutely nothing. I like a good conspiracy theory, but if these two references are anything to go by, your world view is total paranoia, to the point where your “solutions” are more dangerous than whatever you see as a threat.

        I am not going to get embroiled in a political debate with you. Here in the real world, for all its faults, the NHS is the best thing ever created for the people of this Country. Of course I want it to be adequately funded and not constantly undermined, as it has been since the 1980s.

        Reply
  67. Tuan Nguyen

    The longer-term task is to reconstitute a sense of collective subjectivity out of this crisis. One glimmer of hope is the thousands of mutual aid groups springing up in response to the crisis. Inspirational organising is happening spontaneously, largely independently of the state and political parties. Through these groups, many people are getting to know their neighbours for the first time and rediscovering the basic practices of solidarity. While their immediate task is just to help people survive the next few months, they could well be the basis of grassroots democratic renewal when the lockdowns are over.

    Bucking the trend once again, New Zealand is showing the way forward, in the inspiring politics of compassion and kindness adopted by Prime Minister Jacinda Ardern and her coalition government during these times of COVID-19. https://bit.ly/39pw4ow

    Reply
  68. Tuan Nguyen

    We have also become increasingly aware of jobs that are done in the background, the importance of which we regularly fail to register. It is different now. Consequently, I’ve been thinking about a little book by Geoffrey Hosking called Trust: Money, Markets and Society. This is a book whose brevity and diminutive size belies the importance of its argument. What I believe the current crisis has brought into relief or revealed like lemon juice on invisible ink is what Hosking calls “unreflective trust”. By this he means the amount that we do in fact depends on others without consciously acknowledging it.

    Talking about travelling by air, he writes: “Which of us before boarding an aircraft, demands to see the pilot’s qualification to fly it, or checks every rivet, joint and fuel duct in it? Or even the competence of the engineers responsible for maintaining and repairing those parts. Obviously we do not. Yet our lives depend on the impeccable working order of every one of those parts, and on the skill and conscientiousness of the engineers. The fact is we take them on trust because everyone else does so and because aeroplanes very seldom crash. Besides, to do otherwise would require us to have time and skills we don’t possess. We don’t ‘decide’ to board an aircraft—we just do it.”

    In this process, we rely on and trust the workings of society in all its complex, manifold, and interlacing facets. We trust symbolic systems such as the sciences of aeronautics, mechanics, and metallurgy; we trust institutions of regulation and oversight, of teaching and training; we trust corporate health and safety standards; and we trust the media to accurately report risk. Now imagine for a moment just driving through a busy city in the morning and all the points at which your unreflective trust is implicit but absolutely necessary.

    “Trust”, Hosking argues, “especially unreflective trust is part of the deep grammar of any society. It generates the templates within which people relate to each other, and within which they think and feel about how to face the future”. These are society’s “invisible bonds”, and while there remains a constituency that wants to belittle and decry the actions of the government, I really hope that something good can come from so many of us beginning to see these bonds.

    https://bit.ly/345xWlH

    Reply
      1. David Bailey

        Malcolm,

        I am puzzled as to why you like Tuan’s post. I found it typical of a modern style of writing which says nothing very much in the most obscure way possible. I suspect that he wanted to transmit a subliminal message that we should all trust those clever people in Imperial College with their computer models!

        Planes are very safe because a very few crash, and the fallout from such events is catastrophic for the airline or the aircraft manufacturer. The trouble with blunders in abstract medical advice is that usually those responsible escape with a knighthood!

        Trust has to be earned, and in my book the top layer of medical science has done everything possible to destroy my trust in them.

        I must admit I felt a warm glow when I read Tuan’s piece the first time, but then I read it again. Maybe you didn’t have time for the second reading!

        Reply
    1. AhNotepad

      Tuan Nguyen, while I might trust someone who is doing a job with safety implications, that is because I might have some confidence in the oversight behind their function. I do not trust politicians, there is no oversight worth talking about, and most of them, especially at the top, are not able to exist in the same space as the truth.

      Reply
  69. Mike Wroe

    When the NHS has the PPEs and ventilators it needs and is able to test all NHS staff, should the restrictions be removed for the majority of the population? The 1.5 million at high risk and those who are retired (over 60) shield by Individual isolation for the former and social distancing for the latter? The rest of the population go back to work and revive the economy. I believe Sweden is, at least for the time being, trying something similar.

    Reply
    1. AhNotepad

      Mike Wroe, I don’t want your prescription of social isolation thank you. I am able to, and do, take care of myself, and do not need patronising.

      Reply
      1. Tony

        I share your views; I was brought up to stand on my own two feet, take responsibility for my own life & health and make my own decisions…..and if I got it wrong it was my fault….not someone else’s.

        I do not need ( nor trust) politicians, experts etc.

        This does not mean I don’t care for other people

        Reply
    2. chris c

      Yes it will be interesting to see what happens in Sweden. However I don’t see anything changing here at all soon. We are down for at least six months of lockdown, sod the consequences, and Boris was muttering about further restrictions.

      I suspect nothing will change until a vaccine is produced. This will be made compulsory and you will only be allowed out, or back to work, with a vaccine certificate. Or perhaps I am paranoid. On the other hand I have no doubt they ARE out to get me, well all of us . . .

      Reply
      1. AhNotepad

        The vaccine will not be compulsory. As with the SARS and swine flu vaccines there will be serious adverse effects, however I expect many people will clamour for it, under the delusion it will make them “immune”. Which it won’t. Instead it will damage their immune system.

        Reply
      2. andy

        Hi chris: to avoid grannycide, an economical solution has to be found quickly. Politicians are expecting an extended confinement of 3 to 6 months for the entire population. My suggestion for politicians ( if they are listening) is to identify all young and healthy people, infect them with the virus and then isolate them for 3 weeks. When they emerge from isolation they will be immune to the virus. In the UK 18% of the population is over 65 years old. Now identify the unhealthy people younger than 65 and include them in the isolation group. My model shows that 50% of population could benefit from acquired immunity. I will leave it up to government experts to calculate the enormous savings. So chris, if you don’t want to be vaccinated your best bet is to get infected, you have a choice. We should put all options on the table.

        Reply
  70. andy

    Gave up trying to follow the logic of economic models and QUALYs. Suppose a patient is treated for covad-19 and dies 3 years prematurely, would there be a net saving when pensions, health care and other gov. costs are factored in for the 3 years? Probably civil servants know cost of maintaining elderly people. If there is a drop in life expectancy the blame could be placed directly or indirectly on the virus. More savings will accrue.

    Reply
    1. mmec7

      Soul – Not in France, where the AFS has stepped in to halt the use of this drug in hospitals as its use has led to the death of several patients in various hospital, coronary side effects. Raoult, whose hospital was set up through government funding under Sarkozy, is not viewed with any favour by the medical establishment. They deplore his slapdash methods. The online magazine Le Point points up the full story.

      Reply
  71. Frances

    I listened to an interview on the BBC overnight with a spokesperson from the Imperial College London who said that this virus is very contagious, that it affects those with chronic conditions and the aged and that the death rate for the aged will be brought forward a few years. The shock to the health system is because these deaths will take place in a short period of time rather than spread out over a year or so.

    Reply
    1. David Bailey

      So why didn’t we use the same technique to combat flu, or polio?

      Because destroying the entire economy isn’t worth it!

      Moreover when the next virus comes along there will be no money to combat it – even if it is really severe.

      Reply
      1. Janet Love

        Far better to equip the population’s Immune Systems to perform it’s designated role, you know, the differences that sanitation, nutrition and social improvement did for the previous Centuries’ killer diseases. Before vaccination.
        But that makes little profit for Big Pharma..or Medium Pharma..or even Little Pharma, therefore no money for lobbyists and palm-greasing.

        Reply
  72. Gaetan

    No matter how you wanna look at it, be it from a business point of view or another, the media runs the show. They know their best card, which is fear. Scare the population and they will beg for drugs, vaccines or anything else there is to market to them as life saving solutions.

    It’s all irrational, shutting down whole countries, even young people with no medical conditions can’t go out or work, it is incredibly foolish. We basically given up our freedom (again).

    Apparently education 101 failed. We have evolved with viruses thru the ages and they also have helped us evolve. Because of them we are fully adapted to live as human beings on planet Earth. Even our DNA is part Viral. There would be a lot to write about this, which i won’t do here.

    Reply
    1. James DownUnder

      Not quite, but close.
      Ask ‘Who is pulling the Media’s strings?’
      Which country or group or Agenda… is positioning to make a killing out of this ?
      Not our Australian Government

      Reply
  73. elizabethhart

    I played golf today. Might be the last game for a while. After yesterday’s dictum from ScoMo (PM in Australia), we can only play in groups of two now…as gatherings are now limited to two people…that’s right, for ‘non-essential gatherings’ we’re only allowed to congregate in groups of two… What’s the evidence supporting this isolation policy?!?! https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/limits-on-public-gatherings-for-coronavirus-covid-19

    And the golf club might just shut down altogether soon given the reduced numbers who can play.

    The golf club and courses are usually thriving places, loads of people enjoying the challenge of golf, the exercise and the company, many staying afterwards to share a meal and/or a drink. Can’t do that now of course. Many are retired and older people. And many regularly look after grandchildren, a big help for families, although not sure what’s happening about that now. And a few have their own elderly parents to look out for too. These are people who are usually very active, movies, theatre etc, and travelling…enjoying retirement and it helps the economy.

    But that’s all wound back now. And of course there are lots of younger members at the golf club too, and this recreation has been severely interrupted for them, including the threat of close-down.

    From my perspective, I’m seeing this as people being isolated from each other. This is particularly sinister in the current climate as it limits people’s opportunities to discuss what’s happening. There’s very much a ‘Stepford Wives’ feeling. Very difficult to talk about things as you can imagine, particularly with one view dominating society.

    And of course people are genuinely really afraid of the virus, which I keep forgetting, as the WHO indicated it’s ‘generally mild’.

    So confusing isn’t it…? It’s ‘generally mild’ doesn’t resonate with the very scary news on this topic we get from the media and the government. (17 deaths in Australia so far, generally elderly people with co-morbidities. That’s in a population of 25.4 million…amazing how the government and media can make this seem so scary…along with the number of ‘cases’…)

    And they do say old people are the most affected by the virus…but it’s not ALL old people is it?

    We so need real hard data on what’s going on re the deaths in various countries, info re comorbidities, co-factors etc. We need to work out what is the real risk for older people, so that those who are still fit, healthy and active can weigh up the risk for themselves…if they’re allowed.

    Meanwhile…the whole world is being turned upside down… And the children, young people and others, who don’t seem to be much affected by this virus, are copping the most enormous consequences. Who cares?

    It’s astonishing how easily our freedom has been taken from us.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Is killing? I don’t think she actually has a machine gun out, spraying people with bullets. Perhaps it is possible to say that she may be increasing their risk. However, all the other people she is speaking to are old, and have also made the choice to speak to her. They have also made a decision. They may all die.

      Reply
      1. Janet Love

        Rest assured that the passing of Mrs Kendricks will not be mourned at the Exchequer… one less aged pension to pay…

        Reply
    2. JanB

      Markku – really? If, IF Dr. K’s mother were infected with the virus then she might pass it on to others in her social group. Or not. And those in her social group will, presumably, be aware of any possible risk and content to accept that situation. We old ladies have a good understanding of the importance of friendship and social interaction.
      Your remark, “she doesn’t have many days left in her” is lacking in tact, sensitivity and human compassion. I think an apology is in order.

      Reply
      1. Jennifer

        JanB. Yesterday evening I rattled off a reply to Marrkus, and fortunately, for the (mainly) nice folks on this blog, it flew off into the stratosphere, never to be published. Such rudeness, and nasty comments as his, have no place here on Dr K’s informative blog, which we look to for decent, polite discussion of many difficult topics. I have experienced some inadequacies of the NHS, but generally due to political decisions, as I mentioned earlier in this blog. However, I have witnessed the most humane behaviour without exception. Yes, some individuals have annoyed me over my years in practice, generally due to frustration caused by lack of staff and equipment, interfering with the care they knew was needed. Playing God? NEVER!!! Wanting to give the best of care?ALWAYS!!!!
        I am right in the middle of treatment to save my sight. I am receiving the most compassionate, caring (and expensive) service imaginative, but I am the first to accept that if the call came to postpone it, I would not, for one minute, think it was ageism, being a youngish 72 year old; no one makes these decisions out of malice, I am sure.

        Reply
        1. JanB

          Jennifer – I really love and value this community. It’s helped me enormously and I’ve come to recognise many people by their style of writing. In every mix of people there are going to be disagreements and even a bit of nastiness but by and large isn’t it great here. The ‘offness’ is the exception that proves the rule.
          I hope your eye treatment goes well.
          And to everyone else, I hope you all stay well in these troubling times.
          Cheers all,
          JanB

          Reply
  74. Judy Robinson

    Nothing complicated about this. Your mother said it perfectly. Just enjoy life and when its time to pay the Piper–PAY
    Great post. And hysterical actually. We have all gone mad.

    Reply
    1. Tish

      Brilliant Lord Sumption (recently retired Justice of the Supreme Court) spoke real sense on Radio 4 World at One today 30/03/20. It gladdens the heart and can be replayed on BBC Sounds (minutes 17-24). He is a wonderfully fluent speaker and has been dubbed the cleverest man in Britain.
      A brief outline:
      He spoke of the risk of an hysterical slide into a police state because police states do not usually result from being imposed on us, but from citizens, driven by fear, willingly surrendering their liberty in times of exaggerated threats. He said it is the right and duty of every citizen to look at what scientists are saying, analyse it themselves and form commonsense conclusions. He said we shouldn’t resign our liberty to scientists in a time of national panic and irrational overreaction.
      He criticised the Derbyshire police for acting beyond their remit. He said it is not illegal to drive to the countryside to take some exercise but the Derbyshire police have treated it as an infringement and enforced an incorrect prohibition. It is only a Government recommendation that we restrict this practice.
      He said the pressure on politicians has come from the public’s demands which drive the restrictions that will result in appalling hardships. He spoke of a lack of institutional scrutiny.
      He warns us against despotism.

      Reply
      1. andy

        Tish, apparently some governments are allredyencouraging citizens to inform on each other for not following guidelines.

        Reply
      2. chris c

        I try to walk daily to prevent my arteries blocking up again (be kind to your collaterals!)
        I could walk through the village where all the people live but I prefer to drive down the road and walk where there are few or no people. Is this a crime? Well some people think so, I waved to a couple walking down the road and they were gesticulating at me. My car needs a long fast run every so often or the “pollution control” equipment packs in, which is going to be expensive.

        I used to spend a lot of my time visiting my favourite places in the area, especially in spring watching the birds and wildflowers. This year I doubt I will hear a nightingale or nightjar.

        I can partly see the point of the Derbyshire police where hordes of tourists were invading local villages, but people walking their dogs in the middle of nowhere. not so much.

        Reply
        1. andy

          Hi chris, I am getting concerned about the possible drop in atmospheric CO2, it appears that the climate is getting cooler. The air quality has improved.

          Reply
      3. chris c

        Hahaha! You may have a point, Though it’s foggy, I mean my previous car did over 57 mpg. This one is identical except it has a “low emission” engine and is hard pressed to do 47 mpg. I’ve heard the same only worse about “low emission” trucks, buses and farm machinery. How can something that uses more fuel have lower emissions? Does not compute . . .

        Using vehicles less will decrease the “greenhouse gases” but will it actually effect the climate? The weather, maybe.

        Reply
  75. David Cockburn

    The great UK give away makes absolute economic sense whether you like it or not because cash costs almost nothing now… 0.5%… it keeps the vast majority safe and preserves the status quo. We like it and the government love it… no civil disorder and they keep their jobs. Modi on the other hand may be brought to the Hague in six months time.
    Your mum has applied common sense to her situation and I would not consider her life expendable compared to computer game obsessed teenagers whose robotic and sheep like connection to social media and fast food education makes them more suitable candidates for your proposed cull by some wankers who receive salaries to produce graphs to suit their masters’ commands. Your dear mum should listen to your excellent science based medical advice and ignore your ideas on valuing our cells our species and our universe with currency which from a science point of view has no real value. I hope she lives another twenty years.

    Reply
  76. Carl Francis

    Thanks for having the courage to write and post this. Whilst I gave up on academia some years ago in favour of something more practical, I used to lecture on the psychology of decision making. In years to come, when the hysteria has ceased to cloud our judgement, this fiasco will make a great case study in that area. It certainly provides considerable insight into what influences our rationality. CF CPsychol.

    Reply
    1. Tish

      Before these times I would have given what I considered a measured response to outrageous conspiracy theories and the like. Now, anyone may tell me as many ridiculous, impossible things as they like and I promise to give them all a very fair hearing, for my scepticism no longer has any bounds.

      Reply
  77. Stuart

    Here in Australia the media are breathlessly announcing that 17 people have died from Covid19, nearly all in their 70s, 80s or 90s (4 from the same nursing home). Had these same people died under normal circumstances we’d never have heard about it. Without discounting the risk to elderly and other vulnerable people, most of the population is at no more risk than they are in a normal flu season and children are reportedly at much less risk.

    Until an effective vaccine is developed and mass-produced, which will take 6-12 months or more, the population will be susceptible to the virus. So locking everyone up for weeks to months may reduce transmission but once the lockdown is lifted the virus will be able to spread as before, particularly if there are unsymptomatic carriers in the population (“Typhoid Marys”). Even if there aren’t any in the Australian population, we will have to open the borders sooner or later and one carrier will have us back in the same situation. Surely a more rational plan would be to have strict isolation for the very vulnerable (eg no visitors to aged care homes ) and let the virus run its course until sufficient people have been exposed that we’ve achieved herd immunity.

    Reply
    1. elizabethhart

      Stuart, I think their plan is keep everyone in lockdown until the vaccine is ready…really… Can you believe this is happening in our so-called ‘liberal democracy’?

      Re your comment: “Surely a more rational plan would be to have strict isolation for the very vulnerable (eg no visitors to aged care homes ) and let the virus run its course until sufficient people have been exposed that we’ve achieved herd immunity.”

      Please see my rapid response on The BMJ: Is it ethical to impede access to natural immunity? The case of SARS-CoV2: https://www.bmj.com/content/368/bmj.m1089/rr-6

      This was in response to the article: Covid-19: UK starts social distancing after new model points to 260 000 potential deaths: https://www.bmj.com/content/368/bmj.m1089

      Reply
    2. AhNotepad

      ”Surely a more rational plan would be to have strict isolation for the very vulnerable (eg no visitors to aged care homes ) and let the virus run its course until sufficient people have been exposed that we’ve achieved herd immunity.”

      Stuart, excellent idea, I’m sure any of your aged relatives who go into a care home will welcome being in familial solitary confinement. Unfortunately you won’t be able to ask them as you aren’t allowed to visit. Perhaps they will be grateful.

      Reply
      1. Anna M

        The fact is you get a one-way ticket when you enter a nursing home. Cutting off family visits might help, but it will be the staff who spend way more time with them and who go home and come back.
        If I ever go to a nursing home, I hope my stay there will be rather short.

        Reply
      2. Jerome Savage

        Re Anna M’s Comment March 31, 2020 at 1:18 am
        The economic meltdown in 2008 had the following effect on one banking supremo who cost my wee country 6 billion in a bailout. Was he “punished”.? No – nourished, well nourished. Other banking supremos didnt do so bad either. €30 mil pension anyone ? €1 mil bonus anyone ? God forgive the taxpayer for his/her extravagance in the face of financial oblivion.
        https://www.google.com/amp/s/amp.theguardian.com/business/ireland-business-blog-with-lisa-ocarroll/2010/dec/23/irish-nationwide-michael-fingleton-bonus

        Reply
      3. Stuart

        Well AHNotepad, better they don’t see their relatives for 3-4 weeks than they die prematurely from a preventable disease. Have you considered that by visiting your relative in the aged care home at such a time you are not only putting them at risk but all the other residents there as well? After all you could always simply phone them instead. In the aged care home in Sydney that had one of the first locally-transmitted cases of CV19 there have been 5 deaths out of 79 residents and another 13 (including several staff) have been confirmed as having the disease. That example should show just how vulnerable the elderly are.

        In any case, since I wrote my original comment a number of the major owners of aged care homes here have announced that they have closed them to all visitors.

        Reply
        1. AhNotepad

          Stuart, being in a care home, and alive, does not necessarily equal “good”. Several years ago my mother was in a care home, she was 98, in terrible discomfort, she was unable to hear me as her hearing lower frequencies was gone. Her memory appeared to be a matter of minutes, and many other problems, such as leg ulcers, incipient blindness etc. She just wanted to be left alone, and didn’t want to be here. I suspect there are many, many others in the same position, and are kept going despite their protests.

          Now the clever dick care home operators are preventing visits, adding no doubt to the distress of the elderly, social isolation, or more realistically, solitary confinement. This is what happens when you prevent their major comfort, visits from their children.

          Reply
    3. Tish

      For those of us with elderly parents in care homes, why not have a bunch of flowers sent, addressed to all residents and staff, from all your family.

      Reply
      1. Anna M

        Stuart,

        You mention 5 deaths in a care home. What I think some people are forgetting here is that there is not the possibility of preventing death, nor the possibility of eliminating the virus. The isolation is only meant to slow things down. Ultimately, large swaths of the population need to get it and get over it. Furthermore, I once worked in a very tiny nursing home and it was a bad flu year. A bad flu year, like the weather, comes every few years or so. I got it and was very sick for a week. Three of the residents died. The 5 you mention may have been in a larger care home. Residents die every single year, and it is often from colds, flus and respiratory infections. That 5 died is quite simply not alarming nor out of the ordinary. Thus I disagree that their deaths were either premature or even preventable. Ordinary illnesses carry them off every year. I read yesterday a comment on another blog that even in Italy, the death rate (so far) has not yet reached the death rate of 3 years ago, when the flu was a little worse than average.
        There may never be a vaccine as cold viruses mutate too rapidly.

        I definitely think that for people in a care home quality of life is far more important than quantity. Half the people in a care home or more probably aren’t physically and mentally up to taking phone calls. To pretend that phone calls or flowers is the same as a visit is really…clueless. What this entire essay by Dr. Kendrick is about is weighing the gains and losses by taking various tactics.

        Reply
  78. Rational Actuary

    (apologies in advance if any / all of what follows has already been said, no time to wade through all the comments)

    Dr Kendrick’s analysis misapplies the QALY calculation and also omits / ignores significant components of the complete equation of value.

    Hence his conclusion is severely flawed and should not be used as a basis for any public health or economic policy decisions.

    1. QALY misapplied

    QALY is a mechanism for comparing two potential scenarios in what is otherwise assumed to be a zero-sum game.

    In other words, when we choose between giving granny a new hip or saving junior’s life, we compare the cost-benefit of each and hope that whichever we choose will give maximum value-for-money-and-everything-else-that-matters to the system and society, implicitly assuming that our choice will have limited (if any) consequences for anybody else besides granny and junior.

    With limited resources QALY is the only rational approach, even if it does sometimes feel ghastly.

    However, with this virus a simplistic QALY-style calculation (ie to decide between intubating granny and locking down junior and the rest of society) can’t be used because the assumption that it’s zero sum game with no implications for anybody else simply doesn’t apply, ie the consequential effects of the Covid-19 policy choices are significant and not necessarily overlapping.

    2. Costs of large-scale Covid-19 deaths not accounted for

    Kendrick’s analysis effectively assumes zero marginal cost for allowing 500k to die in a manner that will require an outsize number of people to spend weeks in high / intensive care, on ventilators that haven’t yet been manufactured, beyond the capacity of the medical system in so many ways, and all while endangering the lives of otherwise healthy medical staff and crowding out all other patients while Covid-19 is clogging up the hallways and waiting rooms of hospitals with yet more people needing treatment.

    One can only imagine the PTSD and burnout that will follow for healthcare workers who have to live through situations not seen outside of wartime, daily choosing who lives and who dies.

    It could conceivably take years for the medical system to recover from such a nightmare.

    3. Incorrectly assuming no additional marginal deaths

    Further, many (quite possibly most) of the Covid-19 deaths will be on top of (not in replacement of) regular annual mortality, certainly for younger age groups and probably even for those in the 80+ age range.

    By definition that must be the case, since even Dr Kendrick will agree that the mortality rate even for those who are aged and with significant co-morbidities isn’t 100% pa.

    Yes, everybody dies eventually, but in reality Covid-19 would bring forward a large number of deaths by on average at least several or more years, at great cost to the medical system and society (for completeness in the equation of value, Kendrick should of course attempt to estimate the present value of the future “savings” from deaths brought forward, regardless of how macabre that sounds)

    4. Other economic costs ignored

    Kendrick’s analysis also fails to account for the potential and likely economic costs of all of the additional / accelerated deaths (eg work days lost to illness, funerals and caring for the sick and dying unable to find places in hospitals are the most obvious ones, but there are plenty of others) as well as the inevitable loss of general consumer confidence and demand (and economic stimulus required to address that) that will follow from a society beset by large-scale plague.

    Whether or not these costs are more or less than the cost of a lockdown and consequent economic stimulus is not an argument against at least making some attempt to allow for such costs in the calculations.

    5. Misuse of a single point estimate for worst case scenario

    In addition, Kendrick’s analysis fails to recognise that the worst-case scenario of 500k lives lost is a point estimate from one particular model applying one set of assumptions.

    Even if that is the most likely outcome (I have no idea if is), it certainly isn’t the only possible one, and worse outcomes are very much possible.

    Therefore using that number is perhaps acceptable if you’re a headline writer, but Kendrick’s analysis should be allowing for the fact that the actual worst case will be drawn from a distribution with a potentially *very* long tail.

    This means that there is a non-zero probability that the actual number of deaths could be much higher, and hence the costs referred to above (ie the ones ignored by Kendrick’s analysis) could all be even more significant (as a general rule it’s fair to say that as outcomes get further down the tail they will get exponentially more expensive).

    The unquantifiable nature of this factor alone is arguably sufficient justification for excess caution in these circumstance.

    Conclusion

    In sum, the methodology and assumptions of Kendrick’s analysis are incomplete and one-sided, which in turn means that any QALY numbers produced by it are almost certainly over-estimated, quite possibly grossly so.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Thanks for your peer-review. I think it is good to have a discussion on the matter. Of course there are a huge number of variables – many of which may never be known with any accuracy. This is a blog, and not an academic paper. It is designed for discussion purposes, not to calculate with pin-point accuracy.

      I think the most important issue, that you fail to mention, is any assessment of DALYs. Was this deliberate? You have skewed your review to looking only at the number of deaths, and costs, being potentailly far, far, higher. For example, I gave a single point estimate for the worse case scenario, and you suggest that things could be far worse than that. You state the worse outcomes are very much possible. But there is absolutely no basis for that statement. If there is, perhaps you could provide the evidence. In reality, since the original Imperial College study came out, nothing else has even got close to suggesting that 500,000 may die. The Oxford Evidence Based Medicine group have suggested a 0.2% fatality rate https://www.cebm.net/global-covid-19-case-fatality-rates (CI 0.17 – 0.25%).

      You also state that I am assuming no additional marginal deaths. This is not true, although I believe the increase in marginal deaths will be very much in the opposite direction. You appear to fail to recognise that, with attention focused almost entirely on COVID, other treatments are not happening, other patients are not being treated. I continue to work in the NHS, at the weekend (in OOH) our call volume is very much reduced. People are staying away – a proportion of them will die, unnecessarily. During the Swine-flu ‘crisis’ on 2009 we know that (in our small area), at least five patients were misdiagnosed with swine-flu (on the phone by half trained call handlers) who had other conditions that could have been treated – and normally would have been treated.

      Anyway, must head off to work. Thank you for your thoughtful contribution. I hope we may engage in constructive debate. Whilst I have been critical, of your criticism, you may many valid points.

      Reply
      1. Rational Actuary

        Thanks for your prompt and thoughtful revert, glad to be able to debate this with you constructively.

        >>
        Of course there are a huge number of variables – many of which may never be known with any accuracy.
        <>
        This is a blog, and not an academic paper. It is designed for discussion purposes, not to calculate with pin-point accuracy.
        <>
        I think the most important issue, that you fail to mention, is any assessment of DALYs. Was this deliberate?
        <>
        You have skewed your review to looking only at the number of deaths, and costs, being potentailly far, far, higher.
        <>
        For example, I gave a single point estimate for the worse case scenario, and you suggest that things could be far worse than that. You state the worse outcomes are very much possible. But there is absolutely no basis for that statement. If there is, perhaps you could provide the evidence.
        <>
        You also state that I am assuming no additional marginal deaths. This is not true, although I believe the increase in marginal deaths will be very much in the opposite direction.
        <>
        You appear to fail to recognise that, with attention focused almost entirely on COVID, other treatments are not happening, other patients are not being treated … a proportion of them will die, unnecessarily.
        <
        >
        During the Swine-flu ‘crisis’ on 2009 we know that (in our small area), at least five patients were misdiagnosed with swine-flu (on the phone by half trained call handlers) who had other conditions that could have been treated – and normally would have been treated.
        <>
        Anyway, must head off to work. Thank you for your thoughtful contribution. I hope we may engage in constructive debate. Whilst I have been critical, of your criticism, you may many valid points.
        <<

        Thank you again for your thoughtful response and constructive engagement.

        Thank you also for your service in combatting this disease, you’re doing God’s work for all the rest of us.

        Reply
      2. Rational Actuary

        Thanks for your prompt and thoughtful revert, glad to be able to debate this with you constructively.


        Of course there are a huge number of variables – many of which may never be known with any accuracy.

        An analysis of this situation (particularly one that aims to come up with a quantifiable numerical result as yours does) can’t omit significant factors because they are hard to quantify, or even those with unknowable effects.

        For the latter in particular we may have to posit broad ranges, but we must still include them in the calculation for sake of completeness, otherwise the final result is by definition unusable for meaningful discussion.

        I have no doubt that your analysis was done in good faith. Even so, and even if inadvertently, the end result in my view omits too many significant offsetting factors and hence comes to a conclusion that errs too far in one direction.


        This is a blog, and not an academic paper. It is designed for discussion purposes, not to calculate with pin-point accuracy.

        The problem with this logic is that you forget that many of your readers will quote your analysis as if it *is* an academic paper and likely forward it to all and sundry, who in turn will take it seriously because of your qualifications and expertise. That in turn may lead to some of them taking their civic duty in this matter less seriously than they should, since their shorthand interpretation will easily be “it’s only really affecting some old folks who would have died anyway”.

        Furthermore, even if we choose to overlook that your opinions are (deservedly) taken somewhat more seriously than the blog of a preening millennial social influencer, we can’t forsake completeness on the grounds that it’s “only” a blog.

        There’s no reason that a discussion (particularly one put forward by somebody with your experience and expertise) shouldn’t aim to at least reference factors that might argue against the point being made, again if for no reason other than so as to ensure that readers don’t jump to improperly informed opinions without considering material contrary viewpoints.

        Simply put, and as unfortunate and unfair as this may be, when it comes to such weighty matters in such difficult times a person of your stature simply doesn’t have the luxury of writing with anything less than an obsessively scholarly approach to every word.


        I think the most important issue, that you fail to mention, is any assessment of DALYs. Was this deliberate?

        Not at all deliberate, unfortunately I’m only an actuary and not a medical professional and hence had to google the meaning of “DALYs” as I type this.

        Of course that factor should be included in the calculation, again with reference to how it influences both directions of the outcome.

        For example, while I do take your point about the cost of DALYs arising from the treatment of well-cared-for-but-nonetheless-consequently-disabled Covid-19 survivors, a reasonably complete analysis must also account for the fact that absent an extreme lockdown there will be some number of people who will get Covid-19, won’t get treated or won’t receive standard of care (due to lack of capacity in the healthcare system), yet will still recover, but will then suffer lasting health consequences that might have been avoided by the sort of government response that you argue against.

        I have no idea which way the DALY calculation will affect the outcome in aggregate, but either way the full implications thereof certainly need to be included, along with any other significant factors that I might currently be ignorant of.


        You have skewed your review to looking only at the number of deaths, and costs, being potentailly far, far, higher.

        This is an inaccurate interpretation of my comments, as should be evident from my clear statement that the equation of value must make a proper effort to be complete, even if the components of the equation are hard to quantify or if they influence the result in a direction that might not fit my personal confirmation bias.

        Simply put, I did not aim to “skew” anything. I pointed out some objectively significant factors that you omitted and which arguably substantially tip the scales in a manner that potentially negates your conclusion. If there are other factors omitted that support your conclusion then those also need to be accounted for, and if in the end you reach the same conclusion then fine, but until that’s done I believe that the factors that I have identified effectively invalidate your conclusion from being so stridently reached.


        For example, I gave a single point estimate for the worse case scenario, and you suggest that things could be far worse than that. You state the worse outcomes are very much possible. But there is absolutely no basis for that statement. If there is, perhaps you could provide the evidence.

        This is not really a point worth arguing. Neither of us nor anybody else knows (nor could ever know) whether the final outcome would have been more, less or equal to 500k deaths if the UK had not changed its response to Covid-19 to a more restrictive lockdown plus greater economic stimulus.

        Regardless of your view of the various models and their projections (of which there are many that no doubt both of us have neither seen nor heard of), you must concede that there is room to posit varying sets of justifiable assumptions.

        At least some of those scenarios will get you to a bigger number than 500k, or even might get you to an equal or lower number but with rates and timing of infection and/or hospitalization and/or death that would lead to similarly dire medical and economic consequences as that of a number greater than 500k.

        Many of those scenarios could easily have worse consequences than over-reacting to the crisis, and right now our data on this disease is so early-stage that neither you nor I nor the most credible modellers can have any real conviction as to what the realistic set of assumptions truly are.

        Note that I said “could easily have worse consequences” not “will have”, and hence the question is whether you want to be wrong (which you will be, that’s the only guarantee in this situation) in a way such that the downside (ignoring upside since there appears to be little to none in the circumstances) is worse if you over-react or if you under-react.

        In this case the downside of under-reacting seems quite obviously worse to me (ie almost by definition a significant under-reaction will likely result in significantly more additional deaths and a more damaged healthcare system, and potentially just as much or even more economic carnage) than the reverse, and hence anything (including your analysis) that unduly influences people towards under-reacting is undesirable from a public policy and best practice compliance perspective.

        Scott Galloway made a point broadly along these lines just over a week ago. He was referring to waiting too long before you act, but the point applies equally to any action that is insufficient (ie waiting too long is simply the extreme case of not doing enough now):

        “What’s difficult about overreacting is it’s disproportionate to the problem at present. It’s deeply uncomfortable, because you are devising a solution to a problem that doesn’t yet exist and whose future scale you are guessing. Throwing vast resources at a guess is risky and hard to justify, yet if you wait long enough for the scale to unfold, it will be too late.”
        https://www.profgalloway.com/our-generations-test


        You also state that I am assuming no additional marginal deaths. This is not true, although I believe the increase in marginal deaths will be very much in the opposite direction.

        I can’t read your mind, so obviously I have no idea what your implicit assumptions were. I can only work with what you explicitly state in the analysis, which very clearly omits anything in this regard.

        Some quick maths to prove the point that there is a substantial risk of additional deaths, using what appear to be reasonably trustworthy sources for a back-of-the-cigarette-box calculation:

        — Annual mortality for 80 year old Italian males from 1991 data was 9%, rising to 22% by age 90 (https://mort.soa.org/ViewTable.aspx?&TableIdentity=2526). We obviously have to adjust these rates downwards (likely quite significantly) for 30 years’ worth of medical and other improvements to survival rates.

        — Given that there will obviously be somewhat more 80 year olds than 90 year olds (https://www.indexmundi.com/italy/age_structure.html) the weighted average mortality rate for Italian males 80+ is going to be a lot closer to the lower bound than the upper bound (beyond 90 there are almost no males still alive and Covid-19 disproportionately kills men, so let’s ignore 90+ and females for this simple analysis), let’s say probably somewhere around 13-14% before adjusting for improvements over the last 30 years

        Now let’s recall that the case fatality rate (CFR, the percentage of confirmed cases that die) for Italians aged 80+ is thus far in excess of 20% (https://ourworldindata.org/coronavirus) and that on average (again thus far) the disease kills men at almost 2x the rate of women (https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/), an effect that could conceivably be more significant at older ages.

        This implies that the CFR for 80+ men in Italy is probably higher than 30%. That’s the number you’d need to assume if you want to get a weighted average CFR of 20% if there are equal numbers of Italian men and women aged 80+. But we know that at that age women outnumber men quite significantly, so the male-only CFR could be as high as 40% for 80+ Italian males.

        Now let’s try and get from a CFR of 40% to the impact on general population mortality.

        Say we start with 1,000 Italian 80+ males. Assuming relatively moderate improvements since 1991’s 13-14%, we would expect around 100 of them to have died this year, so that’s our baseline.

        Now assume that some unknown percentage of them, say x% will contract the virus (this will obviously depend on government policy for reducing the spread), of which some unknown proportion y% will get tested (a function of testing policy and capacity), of which z% will show up as positive (z% will be somewhere close to 100% if the test is highly sensitive, ie calibrated for very few false negatives), and that of those we expect that around 40% of them will die as a result as per above.

        We therefore need x% * y% * z% * 40% * 1,000 to be somewhat less than 100 for net zero additional mortality (since some who don’t contract the virus will still die anyway). This implies that the upper limit for the calculation factor = x% * y% * z% needs to be somewhere less than 0.25 (ie to give us zero net additional population mortality for Italian males aged 80+).

        We can argue the toss all day long on what we should assume for x, y and z. FWIW, in my view, absent a lockdown, x% could be very very high, and y% no doubt similarly high (with or without lockdown) for an aged and infirm group that will presumably show symptoms quickly. In other words, we can’t preclude the possibility that x% * y% * z% is well north of 50% in aggregate (and remember that any value in excess of 25% = net additional mortality in this age group)

        Even if you disagree with my guesses for x, y and z the point remains that there are credible scenarios under which it’s possible that Covid-19 has already introduced significant net additional / accelerated mortality in Italy. I don’t think that it would be controversial to argue that there’s no evidence that the same couldn’t happen elsewhere, absent sufficient government response.

        Once again, the question simply is, do we want to be wrong (which we will be) on the side of under-reaction or over-reaction, and what are the costs and consequences of that when we are?

        In my view history tells us that we rarely want to be on the under-reaction side (but that’s an argument for another day).


        You appear to fail to recognise that, with attention focused almost entirely on COVID, other treatments are not happening, other patients are not being treated … a proportion of them will die, unnecessarily.

        I absolutely take this point. However, I’m not aware of any data that suggests that this is or could be as significant an effect (even in the worst case) as the potential worst case for Covid-19 is. We can only work with the data that we have, incomplete as it may be, in order to determine the assumptions that will lead us to a view of where we believe the greater threat lies.

        In particular, when one of those threats has a much large potential tail effect (ie far more people could die, even if the probability thereof might theoretically be low) then we have to over-weight that in our calculations since the consequences of being wrong are far greater. For more on this topic, please read Nassim Taleb, he covers this point far more rigorously and eloquently than I ever could.


        During the Swine-flu ‘crisis’ on 2009 we know that (in our small area), at least five patients were misdiagnosed with swine-flu (on the phone by half trained call handlers) who had other conditions that could have been treated – and normally would have been treated.

        Understood, this is indeed the tragedy of triage, whether the latter is explicit in the hospital waiting room or an unintended consequence of policy and/or public behaviour. Ghastly as it sounds, and without knowing much about the swine-flu crisis, we can’t discount the possibility that those unfortunate deaths might well have been collateral damage in the winning of the larger war.

        Sadly no doubt similar outcomes will arise from how society handles Covid-19. I’m not in any way qualified to decide what acceptable collateral damage is (and very grateful that I won’t have to do so), but I do know that at a public policy level any analysis that plays into that debate must include all possible factors in the calculation, hence this hopefully constructive and amicable discussion.


        Anyway, must head off to work. Thank you for your thoughtful contribution. I hope we may engage in constructive debate. Whilst I have been critical, of your criticism, you may many valid points.

        Thank you again for your thoughtful response and constructive engagement.

        Thank you also for your service in combatting this disease, you’re doing God’s work for all the rest of us.

        Reply
    2. AhNotepad

      ”In sum, the methodology and assumptions of Kendrick’s analysis are incomplete and one-sided, which in turn means that any QALY numbers produced by it are almost certainly over-estimated, quite possibly grossly so.”

      I guess Dr K must have been trained at the same school as Neil Ferguson then.

      Reply
    3. Tom Welsh

      Rational Actuary assumes, throughout his long comment, that “500k” (that is, I take it, 500,000) people will die.

      Not even the most pessimistic estimates are so high – even if you are talking about the whole world rather than just the UK.

      Yet nowhere does Rational Actuary cite any evidence for that number, let alone probide any arguments supporting it.

      I may not know much about medicine, but I have been trained to spot fallacious reasoning when I see it.

      “Gentlemen, you are now about to embark on a course of studies which will occupy you for two years. Together, they form a noble adventure. But I would like to remind you of an important point. Nothing that you will learn in the course of your studies will be of the slightest possible use to you in after life, save only this, that if you work hard and intelligently you should be able to detect when a man is talking rot, and that, in my view, is the main, if not the sole, purpose of education”.

      – John Alexander Smith, Professor of Moral Philosophy, Oxford University, 1914.

      Reply
      1. Rational Actuary


        Rational Actuary assumes, throughout his long comment, that “500k” (that is, I take it, 500,000) people will die.

        Not even the most pessimistic estimates are so high – even if you are talking about the whole world rather than just the UK.

        Yet nowhere does Rational Actuary cite any evidence for that number, let alone probide any arguments supporting it.

        That number is taken directly from Dr Kendrick’s original post, please re-read it. Then spend a few minutes on google and you’ll quickly find that 500k was the upper limit of the Imperial College projections for the UK.

        Reply
      2. chris c

        Actually over 500 000 people die in the UK every year anyway. The equation then becomes – how many MORE than that will die of Covid 19, and on the other hand how many MORE will die from the lockdown, including the cancellation of things like cancer treatment

        Reply
    4. Geoff Arden

      “for allowing 500k to die in a manner that will require an outsize number of people to spend weeks in high / intensive care, on ventilators that haven’t yet been manufactured, beyond the capacity of the medical system in so many ways,”

      surely this only applies to the outdated projections of NF: he knows nothing of intensive care: what do you?

      we understand he has tailored his extraordinary predictions somewhat; (by a factor of 90?)

      from 500,000 to 25,000 to now 5,700 ……. he has done this before ………

      when asked about his BSE estimates: he said “Of his work on BSE, in which he predicted human death toll of between 50 and 150,000, Professor Ferguson said: “Yes, the range is wide, ”

      many might be staggered at his seeming equanamity:

      RP Kitching said of his? later work on FMD; “The UK experience provides a salutary warning of how models can be abused in the interests of scientific opportunism.”

      “and worse outcomes are very much possible.” how on earth would you know, and why do you say things like that? You perhaps don’t mean it, but you have the manner of someone lording it over lessers: my total apologies if I have got it wrong; I am sure you are very meek and gentle.

      Till serological testing can be done; we will not know who has antibodies; those who do will most likely test negative and be immune; those currently testing positive (to the PCR test) should become negative and be immune as they develop antibodies. Expectations is that there already who have contracted a mild to asymptomatic illness and are now immune.

      Work from Stanford goes the opposite way to your unsubstantiated words: https://web.archive.org/web/20200325103650/https://www.wsj.com/articles/is-the-coronavirus-as-deadly-as-they-say-11585088464

      they suggest a fatality rate of perhaps 0.01%: I can say that with as much certainty, as you can throw sweeping statements of doom at us.

      I think if I quote what Lord Sumption said:

      “it is the right and duty of every citizen to look and see what the scientists have said and to analyse it for themselves and to draw common sense conclusions.

      We are all perfectly capable of doing that and there’s no particular reason why the scientific nature of the problem should mean we have to resign our liberty into the hands of scientists.

      We all have critical faculties and it’s rather important, in a moment of national panic, that we should maintain them.”

      Reply
  79. Jacqueline Marta V Hull

    If it’s awaiting moderating or whatever. It doesn’t sound very democratic to me? In my reply I haven’t used bad or threatening language. I have basically posted a truthful response on how I feel about the blog I read.
    Thank you,
    Jacqueline Marta
    P.S. I have spent ages trying to get in touch with the Website that Dr. Kendrick uses, to explain that I don’t have any other sites that I blog to, Plus I am using an old Apple iPhone.
    Thank you

    Reply
    1. Dr. Malcolm Kendrick Post author

      I have never blocked anyone from commenting on my blog. I have only stopped very few comments. My rules are. 1: no personal insults (although I allow personal insults about myself, because they do not bother me in the least) 2: No direct advertising – although people are allowed to promote things that other people are doing or selling. 3: Nothing that is completely incomprehensible to me – although some things get pretty rambly at times.

      I am aware that some comments simply fail to get through, and are blocked by WordPress. I have no control over this, and do not know why it happens. I presume there have been other complaints about certain people.

      Reply
      1. chris c

        FWIW I fairly regularly get blocked by WordPress – when it happens it usually involves several or all blogs, I have never found out what triggers this.

        One thing which only happens here – reading this blog and especially replying often eats a LOT of processor cycles. Maybe it’s the Government monitoring software . . .

        Reply
  80. Chris Exley

    There are many ways of saying the same thing; we are seeing a gross over reaction perhaps being directed by the WHO. Those who might be more vulnerable to covid-19 should have been offered advice and funding/support should they choose to take the advice. The rest of life should have been allowed to continue as normal. Why governments have behaved like sheep in following each other over this proverbial cliff is open for debate. Perhaps many like the UK Government did not want the public to know that thousands of people every year die in this manner. Once the Chinese opened Pandora’s box and named this year’s bug this was always going to happen. There is neither sense nor science leading our approach, unlike the attitude of the author’s mother.

    Reply
    1. Tom Welsh

      “…we are seeing a gross over reaction perhaps being directed by the WHO”.

      Sorry to go off topic; I just can’t help it.

      “Hope I die before I get old…”

      – “My Generation” by The Who, written by Pete Townshend and sung by Roger Daltrey – both alive and healthy in their mid-70s.

      Reply
      1. chris c

        Hahahahaha!

        Yes I’d like to know FAR more about how to become one of the many for whom it is a trivial disease, or not much above trivial. Prince Charles for example, and I hate to say it but Boris.

        I’m pleasantly surprised that the BBC have not (yet) included vitamin C on their list of “fake news”.

        Another interesting point was the length of time the virus can live on different surfaces. It dies quickly on copper, which is a surface antimicrobial, but lasts a lot longer on plastic and stainless steel. That ties in with something I read long ago – that hospital-borne infection only really took off when all the Victorian brass (containing copper) fittings were replaced with . . . plastic and stainless steel.

        Meanwhile have you seen the contents of the Government food parcels? Pasta, breakfast cereal and biscuits. They mention fruit though it may well be tinned, in syrup. They do not mention vegetables let alone meat and fish – though there may be some in the “tinned goods”, probably mechanically recovered meat cooked in Omega 6 oil with ingredients and additives, How the hell do they expect this to keep the old folks healthy?

        Reply
        1. andy

          Hi chris: re your question on how long can virus live on different surfaces
          Yesterday I picked up a letter from the post office and that question popped into my mind. I immediately put the letter down and washed my hands. That letter will be in isolation for 48 hours.
          Did some googling and discovered that mucus is the ideal medium for preserving viruses. I suspect that viruses are capable of manipulating human behaviour. The virus is present in mucus on nose and mouth. The temptation to touch ones face is irresistible, and that is what the virus wants us to do in order to infect others. Wearing a mask trains us to keep our hands away from the face, that is the primary purpose of the mask.
          Coughing to spread atomized virus laden mucus particles is another useful strategy. First comes the dry cough that seems benign, coming from an asymptomatic person. Most awesome is explosive diarrhoea. All symptoms designed to increase spread of infection.
          We underestimate viruses because they are tiny and have no brains to devise strategies. Our brains function by means of neurones and synapses that could be manipulated by signals from a virus. For a virus to infect a cell and take over it’s function requires some sort of intelligence that is operating on a quantum scale. Our cells and immune system work on the same level, it will be up to them to defeat the virus.
          Suppose that the virus can become dormant under unfavourable conditions, think of a seed or spore, or the virus could survive in mucus of another species like a dog or cat for a prolonged period. Should we try to eradicate this virus or coexist?

          Reply
          1. AhNotepad

            Should we try to eradicate this virus or coexist?

            andy, my vote is for coexist. This virus should never have been developed, but now it’s here, I don’t see how it could be eradicated. I suspect it will go back to it’s natural state if left alone. So we don’t have much of a choice. The current government impositions cannot go on for long. we will be told what to do, the restrictions may be increased. At some point civil unrest will break out. How many people will that kill?

      2. chris c

        Interesting stuff! I recall a virus which infected mice or rats and caused them to approach cats – which ate them and became infected. Then there is a fungus I think which causes ants to climb to the top of a grass stem and die, where birds eat them and become infected.

        The last time I had explosive diarrhoea was decades ago, since low carb and especially giving up wheat my bowels are regular as an atomic clock.

        Someone I was talking to the other day suggested we needed snow to kill off the virus. I suspect this is 180 degrees wrong, most of these things are “winter viruses” and I wonder how they are affected by environmental temperature and sunlight. Probably better than spraying everywhere with disinfectant from drones (yes it really was suggested)

        Reply
  81. elizabethhart

    Article by Fauci in NEJM

    Covid-19 – Navigating the Uncharted
    https://www.nejm.org/doi/full/10.1056/NEJMe2002387

    Have a close read…

    Consider for example: “If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.2”

    Reply
    1. Jeffrey Dun

      I am confused by the use of terms.

      My understanding is that the Case Fatality Rate (CFR) is the number of deaths of people with covid19 compared with the number of documented cases. For the CFR the numerator and denominator are reasonably well known.

      On the other hand we have the Infection Fatality Rate (IFR) which is the number of deaths compared with the total number that have contracted covid19. In this case we don’t know the denominator.

      Obviously, the CFR is always significantly higher than the IFR. For example, the Centre for Disease Control and Prevention in the USA estimates that at this point in their flu season there have been 24,000 flu deaths from a total number of confirmed flu cases of 284,840. That is a CFR of 8.4%.

      The article you quote says that “If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%”.

      If the CFR of covid19 were less than 1%, that would be truly marvelous.

      Similarly, when they speak of the CFRs for SARS & MERS, is it really the CFRs to which they refer ?
      Mixing up these concepts can be misleading in terms of a virus’ lethality. It’s certainly confuses me.

      Reply
  82. Steve Prior

    Hi Dr Malcom Kendrick

    I think you have made a very valid point but in doing so you may have fallen into a kind of missunderstanding. In this case it’s not a missunderstanding about CHD or Statins or some other medical question but non the less important.

    Money and the Money System
    My comment relates only to your point about money or as I prefer to call it the money system.

    There is a problem with discussions about money. The problem stems from a flawed premise or understanding in the way the money system works.

    The media get it wrong, the government either gets it wrong IE incompetence or they lie about it. Central banks keep it fairly well obfuscated as do big high street banks.

    The UK goverment is sovereign and has it’s own currency which in our case is called the £pound. A sovereign government has a limitless amount it could spend in it’s own currency in products and services which are in it’s local country provided the currency is allowed to float against other currencies.

    Not so with countries in the Euro Zone who are forced to sell bonds in the bond market. That is until the ECB changes it’s rules to suit it!

    In theory it’s against the rules for the government to monetise it’s own debt. Rules set up by humans to suit their agenda.

    There is a kind of way out of this problem. It’s Quantitative Easing.

    The Bank of England can and does buy bonds in the so called secondary market. This is what’s called Quantitative Easing https://www.bankofengland.co.uk/monetary-policy/quantitative-easing

    March 2020 is £645 billion

    Buying back bonds tends to push up asset prices like houses, shares etc

    So Government issue Bonds, pension funds buy Bonds. Then as part of quantitative easing, the Bank of England buy back the same Bonds which are kept on their balance sheet as digits on a large spreadsheet.

    The only true limit on resources relate to real people, real nurses and real ventilators etc.

    There was a time many decades ago in which money in circulation was tied to how much gold was held by a country. This was conveniently abandoned when it suited nation states who wanted money for things like war.

    Along comes a handy solution and is something called Fiat Money.

    Fiat money is what we now have and according to Wikipedia – “Fiat money is a currency without intrinsic value that has been established as money, often by government regulation.

    Fiat money does not have use value, and has value only because a government maintains its value, or because parties engaging in exchange agree on its value.[1] It was introduced as an alternative to commodity money and representative money.

    Commodity money is created from a good, often a precious metal such as gold or silver, which has uses other than as a medium of exchange (such a good is called a commodity). Representative money is similar to fiat money, but it represents a claim on a commodity (which can be redeemed to a greater or lesser extent)”.

    Governments maintain it’s value through something called taxation. We are therefore inclined to want money to pay our taxes which in turn create some kind of social order.

    So, the problem in using money as an argument about real resources is that it’s not a true connection. Nation states use it and it’s scarcity when it suits them. It helps to keep society functioning

    I sigh every time the media asks a Government politician, where’s the money going to come from? The answer is always the same… tax payers money, borrowed or taxed. Money is so highly politicised that it suits all parties to continue the obfuscation or possibly more likely that our politicians simply don’t understand the system in which society functions or doesn’t as the case may be.

    Such an appaling waste which keeps people in poverty when it doesn’t need to happen.

    Reply
    1. Sasha

      In my opinion, the value we assign to commodities (like gold, for example) is also arbitrary. Which makes arbitrary the value of money backed by that commodity, doesn’t it?

      Reply
      1. Steve Prior

        Yes it is. Ultimately this is about trust in whatever value we give it. The “we” being Governments, businesses, banks, financiers, people etc… It is a kind of confidence trick which we all buy into.

        Quite a clever one really and if it broke down, I suspect there would be chaos and or people would invent new currencies or new measures of wealth.

        As a by the way comment, Worgl did create it’s own script during the great depression. It was called the mirracle of Worgl. It was shut down by Austrian Banks. http://www.lietaer.com/2010/03/the-worgl-experiment/

        In theory, there would be nothing wrong with local councils to create their own currency. Businesses already do it but they are called vouchers or coupons.

        Reply
      2. Tony

        Steve, you make a valid point, few people understand the very basics of our currency;

        From Wikepedia: ‘Fiat money is a currency without intrinsic value that has been established as money, often by government regulation. Fiat money does not have use value, and has value only because a government maintains its value, or because parties engaging in exchange agree on its value.’

        Buying a property with a mortgage, is not borrowing money, but monetising the perceived property value and printing the equivalent ‘paper’ money, plus interest, that you payback (hopefully) with more ‘paper’ money. Think of Monopoly money…..

        So during this ‘Pandemic’ the Government (as you correctly state) just ‘prints’ more money, calling it bonds……

        Now as long as ALL major economies do the same thing by a similar amount of their own GDP, we will emerge from this ‘crisis’ with a still level playing field on the International markets
        .
        The UK has no other choice but to follow the herd of Nations.

        The higher you are in the financial hierarchy, the less you will lose.
        The lower you are in the hierarchy, the more you will lose.

        So as the traditional song (Billy Benett 1930) goes:

        It’s the same the whole world over
        It’s the poor what gets the blame
        It’s the rich what gets the pleasure
        Ain’t it all a bloomin’ shame?

        Keep taking the tablets!

        Reply
    2. Dr. Malcolm Kendrick Post author

      Thanks for that. I think? I do realise that money is a strange and fluid concept. I am certainly aware that, following COVID, the rich will have become considerably richer – and everyone else considerably poorer.

      Reply
    1. Chad S

      I thought the same thing when this first started. There were many comments about what a strange flu season it was: starting early, lasting longer. Many friends and my wife getting ill with a high fever (like 102F) and coughing that lasted one to two weeks, but few other symptoms. It may have been out in the world much longer than expected and many more could have already experienced infection than we know. I am in the USA.

      Reply
      1. chris c

        A few weeks ago I felt a bit greebly for a few days, then developed pink eye, only in my left eye.It lasted about half a day before my immune system blatted it. No other symptoms or noticeable temperature. Maybe that was Covid 19 with an effective immune system, or of course one of the other “winter viruses”

        Reply
    1. andy

      Hi elizabethhart: that would be very educational, similar to a “snakes and ladders” board game except played on a computer screen. Some free suggestion: Go up if you land on a square with, wash your hands, self isolate, eat meat, eat 2 brazil nuts, eat sardines, wear a mask, etc.. Go down if you land on a sure with, flatten the curve, obese, high blood pressure, diabetes, inulin resistance, take statins, follow low fat diet etc.. This could be very popular game for children as well as the politicians.

      Reply
  83. Martin Back

    Belarus is doing the world a favour by providing a much-needed control case. They are keeping calm and carrying on with no worries about the virus, although they already have 94 confirmed cases.

    Let’s see if they live (or die) to regret their inaction.

    Coronavirus: Belarus president refuses to cancel anything – and says vodka and saunas will ward off COVID-19
    Professional football has ground to a halt around the world because of the coronavirus pandemic, with one notable exception.
    https://news.sky.com/story/coronavirus-belarus-president-refuses-to-cancel-anything-and-says-vodka-and-saunas-will-ward-off-coronavirus-11965396

    Reply
    1. andy

      Martin, I can see the logic in what Belarus is doing. The alcohol in vodka will kill viruses if used as a mouth wash multiple times a day, probably more effective than Scope. Could also be used as a nasal spray or hand sanitizer. Vodka is also a natural product. A sauna stimulates the immune system and sterilizes the body.

      Reply
      1. shirley3349

        Given the price of vodka, or any alcohol, won’t the temptation to swallow will be irresistible. Not good for one’s health in Andy’s quantities, but a way of passing the time when it hangs too heavy.

        Reply
        1. andy

          Hi shirley: re the vodka cure
          I have not done any calculations or experiments about required quantities. Governments could subsidize price of vodka like they do for sugar. This therapy needs to be done for only 3 weeks or so while the curve, the economy and the people are being flattened. Resisting swallowing the medicine would teach self discipline.There could be health issues with any cure.

          Reply
  84. elizabethhart

    Interesting that there’s a negative article about Neil Ferguson in the Murdoch paper The Australian, titled: Coronavirus: Questions over modelling behind UK’s strict restrictions. 30 March 2020. Here’s the link, but might be behind the paywall: https://www.theaustralian.com.au/world/coronavirus-questions-over-modelling-behind-strict-restrictions/news-story/e6b928a4587119ad63b15e3af249ddf7

    Also interesting that the Murdoch paper has started to tone down it’s hysterical coverage of COVID-19…

    Some snippets from the article about Ferguson:
    ******
    His name is forever tainted with a seriously flawed forecast about foot and mouth disease that resulted in the unnecessary slaughter of millions of livestock that saw pyres burning across Britain and cost farmers their livelihoods.

    That was in 2001, and now the man who convinced then-Prime Minister Tony Blair to take such extreme action to handle the foot and mouth outbreak is behind Imperial College data that the UK government is relying on to inflict the most extreme social isolation measures in the coronavirus pandemic.

    Given Professor Ferguson’s unquestionable influence on UK action, and possibly by extension Australia’s two-person social distancing policy that came into effect overnight, his numbers are being carefully scrutinised by others.

    Before the UK went into lockdown, Professor Ferguson’s team warned 260,000 people would die if the less restrictive measures remained in place. But just days ago, Professor Ferguson told a parliamentary committee the numbers of deaths would be “substantially less than 20,000,’’ and his team predicted it could be as low as 5,700 – less than the annual toll from seasonal flu – with at least two-thirds of deaths in people who would have died anyway from underlying health conditions.

    After an outcry about his changing stance, Professor Ferguson insisted he had been consistent throughout the crisis and that the revised prediction of the potential death toll was because of the strict lockdown put in place by the British government after following his advice.

    Professor Ferguson claimed over the weekend that the lockdown would have to stay in place until the end of June, claiming any lift of measures earlier, say in May, would “be optimistic’’.

    Yesterday Deputy Chef Medical Officer Jenny Harries mirrored Professor Henderson’s epidemiological assessment, warning it could take six months before a semblance of normality began to return.

    Dr Harries said the lockdown measures would be reviewed in two to three weeks.

    She said: “If we are successful and have squashed the top of curve we say that’s brilliant but we cannot suddenly revert to a normal way of living, (for those efforts) it will be wasted and we would see a second peak over the next six months.’’

    Dr Harries predicted that it would take three to six months before society could get back to normal, warning: “It’s plausible it could go further than that’’.

    The British government has effectively put the nation under house arrest and sparked nationwide anxiety on the basis of Professor Ferguson’s mathematics, most severely impacting those aged over 70, who have been told to remain indoors.

    Some police forces have hotlines to dob in a neighbour if they exercise more than once a day – an ominous Stasi-like development.

    All the while the British economy is tanking, with predictions the unemployed will rise to 2.75m and GDP plummeting 13.5 per cent.

    Another professor, Michael Thrusfield of Edinburgh University has claimed Professor Ferguson’s “severely flawed’’ errors 19 years ago led to the cull of more than six million animals that did not need to die. Another government study also found Professor Ferguson and his team at Imperial College used models during the foot and mouth crisis that “were not suitable for predicting the course of the epidemic and the effects of control measures. The models also remain not validated. Their use to predict the effects of control strategies was therefore imprudent.”

    The same Professor Ferguson predicted as many as 69,000 deaths from swine flu in 2009 when only a few hundred died.

    Professor Ferguson’s coronavirus gloom, contrasts with a study led by Sunetra Gupta, professor of theoretical epidemiology at Oxford University, who believes fewer than one in a thousand of those infected with coronavirus need hospital treatment, with most having mild or no symptoms. He also believes that millions of Britons may have already had the disease.

    Another critic of the Imperial College study is John Ioannidis, a professor in disease prevention at Stanford University. He told The Telegraph UK: “The Imperial College study has been done by a highly competent team of modellers. However, some of the major assumptions and estimates that are built in the calculations seem to be substantially inflated.”
    ********

    Again, this is an interesting take in the Murdoch press, considering how much they have done to fear-monger and panic people about ‘COVID-19’…

    Reply
    1. Steve Prior

      My father was an engineer and a statistician.

      He convinced me of two things; be very careful of the question one is asking IE that which is being tested/measured, and for Gods sake make certain your decimal point is in the right place!

      Whenever the BBC or anyone mentions the number of people infected, I’m reminded of my father’s warning.

      The actual infection rate is false because it’s really the number of people tested who are found to be infected. We aren’t testing enough to understand the real infection rate. This means all the projections are guestimates.

      If we had testing kits for every person in the UK, and measured whether one is infected or whether one has been infected I think we could return to chatting with buddies, playing tennis or doing whatever grabs your fancy.

      Next project…Invent cheap, easy to make testing kits!

      Reply
      1. andy

        Hi Steve: re testing everyone
        Trying to visualize how this will be done. On a certain date test 100% of people and find out who is not infected. A week later test 100% of the non infected people from the last test. Repeat two more times. This will answer all the questions about the virus. Maybe not.

        Reply
  85. Mike Patterson

    Excellent piece which should have been read by Every Single Politician before nuking their nation’s economy.

    Reply
    1. Geoff Arden

      Hi Andy: you talked about repeated testing;
      Prof Jay Bhattacharya of Stanford talked about testing. The current test is a PCR test, aiming to pick up proteins, that they think come from the virus: note: it does not identify intact virus.

      He wants to do a study in the Stanford region, with a different test: serological testing, looking for antibodies. The working premise seems to be: if you have antibodies, you have had the bug, and you now are immune. (Statement unleashes a torrent of nuanced comments).

      It gives an estimate of just how many have had the bug; and added to any currently positive PCR tests; gives some sort of denominator value.

      Reply
  86. BobM

    I think this is a very difficult disease. I had to back off Twitter because the fighting about this disease and our response to it became too rampant and all encompassing.

    From a layman’s perspective, it’s a tough disease to analyze. 50-75% of people are asymptomatic, yet apparently are carriers and communicable (though I have seen no indication of for how long or even how they are communicable). If you look at certain countries like Iceland with tons of testing, the numbers appear to be skewed to the younger people, who are asymptomatic. If you look at places that test less, you see they are highly skewed toward older people.

    On the other hand, it’s hard to grapple with reality. In my town, we have a family where the father (as of the last update we got last week) was in the ICU due to this virus. He is the patriarch of a family with two younger children (about the same age as my kids) and I think is not as old as I am (55). Does he have comorbitities that caused him to be susceptible? I don’t know.

    But I follow a lot of doctors on Twitter, and they are showing (younger) people who were intubated or died from this virus, and they do not look as if they were sick beforehand.

    Also, from my perspective, it’s further confusing in that it seems highly communicable. We had a case in my state (CT, USA) where one person went to a party and caused 20+ people to come down with the virus. There’s also the “famous” story of “patient 31” from South Korea, who supposedly led to 1,000+ other people becoming infected. Meanwhile, both my kids had the flu (one tested positive and one was not tested, just assumed to have the flu), yet neither my wife nor I got the flu, even with them living with us. (It’s possible we already had antibodies against this version, but it’s not possible to say for sure.)

    And then you look at cities like NYC, where they are overwhelmed with patients. This is from NYC:

    https://www.worldometers.info/coronavirus/country/us/

    “172 new ICU admission in the last day, vs. 374 in the preceding day, may indicate a decline in the growth rate”

    (This comes from a Twitter feed of Cuomo, and Twitter is blocked for me on this computer.) That’s over 500 people admitted to the ICU in two days. That seems a bit more than the flu.

    I could keep going, but when I try to rationalize whether it’s better to attempt to “flatten the curve” versus allow (certain) hospitals to get overwhelmed (or even whether the procedures we’re taking actually do flatten the curve), it’s a difficult analysis with no good outcome.

    And I know people are going to say, “but what about Sweden!?” (Or South Korea, Singapore, Hong Kong, etc.) The US isn’t those countries. We have family in Sweden, and as a country, they are more likely to follow rules than we in the USA are. We’re going to have our Mardi Gras and our Spring Break, virus be damned. We tend to be rule breakers, not rule followers.

    Anyway, I’ve rambled enough. But this is really the tip of a massive iceberg, with no good solutions. And the solutions that can be implemented in some countries may not be applicable to others.

    Reply
    1. David Bailey

      Bob,

      I suspect what you report may still be the result of twisted statistics (not from you!).

      You wrote: ” In my town, we have a family where the father (as of the last update we got last week) was in the ICU due to this virus. He is the patriarch of a family with two younger children (about the same age as my kids) and I think is not as old as I am (55). Does he have comorbitities that caused him to be susceptible? I don’t know.”

      This is the problem, you might be describing a guy aged less than 55 – let’s say 48 – on intense chemotherapy – the papers tell you how many children the man has, and show an undated picture, but omit the essential information. Another question which I wonder about is just how unusual it is to find a guy of 48 without comorbidities in ICU after, say flu, in a town of your size.

      Some newspapers seem to specialise in reporting unusual medical stories that are particularly heart rending, revolting, or idiotic. Thus there was a story going the rounds a while back about a man who died after eating a slug as a dare!

      Many of the enthusiasts for global warming, seems to pick and choose what to focus on. Thus the 2018 summer in the UK was glorious and dry, if not a little too hot, and this was described in a way that attributed it to CO2 (there is always a vagueness to such reports). The UK summer of 2019 was nothing like the same, so the focus shifted to ‘Climate Change’, which allowed any flooding to be vaguely attributed to CO2 (even though many think that cutbacks in the cleaning of drains, dredging of rivers, etc. may be far more relevant). Someone, preferably John Ioannidis, needs to set the parameters for any data gathering and reporting to avoid further bias.

      Normally a virus which produced mild symptoms (or none) in the vast majority of people, would not be a cause for great concern, even if it kills the most vulnerable. For example, norovirus is estimated to kill 200,000 worldwide each year.

      https://en.wikipedia.org/wiki/Norovirus

      Reply
  87. James M

    A helpful contribution so thank you to Dr Kendrick. The article does however completely miss the alternative course of action.

    In a modern, developed democratic nation the alternative course of action here implicitly seems to be to do nothing. But let us be clear that doing nothing means sending home people in their masses to die in the streets and at home. This would cause huge civil unrest in a democratic society such as the UK’s, and as such is not a possibility. Sorry to the people who think it is madness to spend so much keeping people alive (of which I am probably one) but that is the price of living in a humane and orderly society.

    The answer has to be to build enough ‘hospital’ beds with ventilators as quick as possible to maximise the roll out and deaths so we can get on with our normal lives. For me this is what we are doing but said in a much better way for the masses which is to save lives but really we are trying to build a system to maximise the number of humane deaths we can have in order to return our lives to normality as quickly as possible.

    Also whilst understanding modelling is a complex exercise the calculations in this piece are built up on incorrect numbers. The governments £350bn package includes £330bn of government-backed guarantees on commercial lending, ie if no one paid their loans backto the commercial provider then the government would step in. Clearly the purpose of being loans (not grants) is they have to be repaid from future profits when normality returns. £300m of guarantees probably equals £15bn of of spend (adj for loss given default and an 80% guarantee). That said the analysis also does not include the wider cost on the economy outside of government spending which is massive so it needs to be re-run to even give a semi-accurate view. There isn’t a wider economic cost of other diseases like cancer because the economy isn’t shut down but here if it is then it should be included.

    My conclusion is if we want to live in an orderly society then there isn’t much choice but to scale the death numbers as fast as we can humanely do so and that means pausing the economy and staying at home for now. The cost of humanity as we know it is going to be very expensive.

    Reply
    1. Dr. Malcolm Kendrick Post author

      I fully agree that, in the UK, we have not been prepared. Successive Govts have shaved down hospital beds and ICU beds – and they have got away with it up to now. Germany has at least x3 the number of ICU beds, and ventilators. They are actually taking in patients from other countries. Were we to have been as prepared as Germany there would be no COVID crisis.

      I do not want to see people dying in front of me. Although, as a doctor, it is not a sight that I am unused to. I fully agree that we need to ameliorate the harm as much as – reasonably – possible. But the situation is not simply deaths now vs no deaths. There we be enormous consequences to what we are doing now

      Reply
      1. Martin Back

        In the Ioannidis video he points out that Italy has 1/3 the ICU beds per capita of the US, and that they are 95-98% full in winter, so it didn’t take a big increase in patients to overwhelm them.

        Reply
      2. Joyce

        Germany taking patients from other countries? Sorry to be so cynical Malcom, but this is probably follows the backlash from the rest of Europe after their refusal to use “their” precious E.U. Funding to assist Italy. This meant China came in and offered to help. Bet that put the cat among the pigeons! It obviously worked, as they can’t do enough now; or so they say. I’m actually just as suspicious of Germanys Covid 19 figures as I was initially of China’s. Politics/Power, it will sadly never change. An inherent human weakness.

        Reply
      3. Eric

        Yes, Germany has more ICU beds than many other countries, and they are not full yet, while they are usually 80% full. The reason is that they began early discharges and cancellations of non-urgent surgery in the first week of March. Heard about this from a nurse couple we are friends with who work at the local hospital, as well as reading about it in the national press.

        Better prepared, yes, adequate, no! There were concerns even in February that were not enough trained staff in ordinary times, let alone with 100%, extra makeshift ICU beds and staff falling ill. Hospitals and government have been scrambling to get extra ventilators and masks just like everywhere else. There was a story about a delivery of 5 million masks “lost” at a cargo airport in Africa. Presumably, the vendor sold to a higher bidder.

        I just read an interview with the head of the pneumology department of the Berlin Charité:
        https://www.spiegel.de/wissenschaft/medizin/corona-krise-wir-koennen-nicht-einfach-eine-zweite-charite-bauen-a-99ca62d2-a2b9-48bf-877d-0b361f7eb687

        As of yesterday, he had 21 patients in his ICU, out of these 6 flown in from France. But even he was afraid that with exponential increases, he could be overwhelmed within to weeks.

        @ Malcolm: I can understand your frustration that the NHS was starved by misguided austerity and now there’s plenty of money for compensating for the shutdown. As others and I have pointed out, some of that money was needed anyway, and it may not even be real money.

        Not that I read that we need to ameliorate the harm, I think we are mostly on the same page. So you agree that social distancing is the correct answer, you just disagree about the degree of shutdown? That is a good debate that we need to have! I also think that the most drastic measures like shutting down any non-essential businesses or not allowing people out of the house even for outdoor exercise, like some Southern European countries have done in their despear, will do more harm than good and lack the evidence. But even in Germany, where the decrees are less draconian, many business needed to go into (government subsidized furlough because they cannot get parts or their markets collapsed). To reiterate my point, the economic damage is there even if you do nothing, and the amount of stimulus does not change significantly by how drastic the shutdown is.

        @ Joyce: not sure what you mean. It was decided that a total of more than €30 billion of funds for fiscal and natural disasters can be used to assist Southern European countries. They are now debating how to go further, and that will unfortunately result in the usual debates.

        As for the infection numbers, they are probably the most accurate bar those of South Korea, but like everywhere, there are still too few tests. As for the number of deaths, part of that is luck (many younger people returning from ski holidays) and diluting by doing more tests and early tracking. And from everything I have read, all experts say that every death with a positive test is counted, and every death that looks like it could have had covid involved is followed up.

        Reply
      4. Jerome Savage

        Dr Malcilm Just found this a bit of a living in a bubble comment. If the UK crisis is as a result of inadequate health care investment, does this not apply to every country adopting crisis measures? It appears that no health service is immune, (NPI) be it as a result of lack of investment, an unprecedented health issue or new tough approach by WHO wishing to assert themselves on world stage.
        Or combination of these ?

        Reply
    2. David Bailey

      James,

      You seem to be missing the point that most of these deaths are deaths of people who are close to death anyway. If (say) someone is dying from cancer or the inevitable effects of the treatments used to cure them (including damage to the immune system), then it matters little that they finally succumb to the flu, a common cold virus, or goodness knows what – they died of cancer, and everyone involved sees it that way.

      Arguably we would live in a more humane society if we did rather less to prop up people in the final weeks of their lives.

      Reply
      1. Tony McKenna

        Good point. We have this sad case reported in our local paper in Yorkshire.
        The woman’s husband says

        “Although she was really ill and would in all probability have died very soon, if not at the same time, the death certificate will show the primary cause of death as Covid19″

        If we did not have this statement we would have had to assume this was a young ish person dying OF the virus. In fact I assume that everyone who dies at the moment will be categorized as dying OF the virus if at all possible.

        Whether this is an early campaign for more funding, or to cover @r$es for over reaction or something else, I don’t know. But the all cause mortality figures will be very interesting.

        Reply
  88. Deb

    ‘Flattening the curve’ has the effect of buying time to find effective, or more effective treatment options. It’s not about waiting one to two years for a vaccine. Like it or not, those in hospitals now around the world are acting as guinea pigs for various treatment options. They are providing information about what appears to work, and what doesn’t appear to work. It’s not controlled trials, but trial by fire. Once we have somewhat of a handle on treatments, hopefully within the next month, we can work on ‘going back to normal’. I don’t see a good way to unwind the situation without another spike, but hopefully we will have treatment options that work pretty well.

    Reply
  89. Tish

    I have just posted on what Lord Sumption, former Justice of the Supreme Court, had to say on Radio 4 World at One today. He has spoken out wonderfully. Unfortunately my post may get missed through my having plonked it way up the list. If you wish to hear important sense from him, please scroll up!

    Reply
      1. Tish

        Yes but they allowed the police to defend themselves afterwards. It doesn’t tend to work the other way though, eh?

        Reply
      2. David Bailey

        Unfortunately the BBC lost the idea of engaging in even-handed discussion years ago.We stopped watching TV last autumn so that we didn’t need to continue to fund them through the license fee.

        Reply
      1. Shaun Clark

        I’ve worked at lot in Asia, as well as Iran (up to the revolution in ’78), Israel, Bahrain, Dubai, Oman, plus a few other countries, and that’s only the places I’ve worked AND lived in, and so I was sitting back waiting for the stories to unfold. I’m only too aware of how ‘face’ matters with theocracies, as well as with many of the worlds despotic bampots. Take care, and please keep up your grand blogging effort!

        Reply
      2. James DownUnder

        Rule # 1 “The Doctor always lies” – esp. in anyone’s government communique.

        (apologies to the Gallifreyan Traveller…)

        Reply
    1. Göran Sjöberg

      I think you are right!

      Well, Wuhan is a 10 000 000 community if I have not misunderstood anything and with a 1 % mortality rate in an “ordinary” influenza epidemic this would amount to 100 000 deaths.

      Reply
  90. Soul

    I thought this an interesting video. It might explain why Italy is an outlier, recording much higher death numbers from the Wuhan virus compared to other countries. Italy uses a more liberal system to record deaths from the virus. As an example, according to the video if you pass away from cancer, but had tested positive for the virus despite having no symptoms, your death certificate will state that you passed away from the Wuhan China virus.

    Reply
    1. Eric

      Same thing in Germany. The first death in the northern state of Schleswig-Holstein was a 78 year old man with cancer in palliative care who was tested four days prior to his demise. One might be inclined to say he died with the virus rather than from. But in many other cases, the distinction is not so easy, which is why they are being counted.

      Reply
      1. David Bailey

        Yes, but shouldn’t there be some way to disentangle this? I mean presumably if someone dies of cancer accelerated by flu (say), the main cause of death on the death certificate is written as cancer, not flu? If that is so, can’t the death certificates be used to produce a better measure of deaths?

        Reply
        1. Dr. Malcolm Kendrick Post author

          Death certificates are split into main cause(s) of death, and secondary causes. So, if you die of sepsis from a wound infection, caused by a hip replacement operation two months previously. Primary cause of death would be sepsis, the operation would be a secondary cause that accelerated, but did not directly cause the death. As COVID is now a ‘notifiable’ disease, if someone if found to have COVID and they die, it is most likely the COVID will be recorded as the primary cause of death. Even if it wasn’t. This is not a precise science. In Italy is seems as though everyone diagnosed with COVID, who then dies, will be recorded as having died of COVID – whether they did, no not.

          Reply
  91. elizabethhart

    Another interesting article in the (Murdoch) Australian…

    Coronavirus: Europe death rates start to level off (The Australian, 31 March 2020)
    Coronavirus death rates across Europe’s hardest hit countries appear to be slowly levelling off, while scientists are watching how Germany has kept its death rate much lower than its neighbours.
    On Monday, Spain recorded another 537 deaths to take its tally to 7,340, and in Italy there were 812 deaths, bringing their death toll to 11,591.
    For both countries, the exponential curve for both infections and deaths has started to level and most of those who have died have been elderly and with underlying health conditions.
    In Italy, there have been calls from car manufacturers to restart production next week, subject to government approval.
    Fiat Chrysler wants to reopen three plants in Melfi, Mirafiori and Atessa. The Agnelli family wants to reopen its Ferrari plant on April 14.
    In the United Kingdom, the number of deaths is expected to peak in the coming weeks while the number of infections is tipped to fall. On Monday there were 180 deaths – again a number lower than anticipated – to bring the total death toll to 1,415.
    Epidemiologists say five per cent of London’s population of 10 million and as many as two million across the country could already have had the virus in a mild or asymptomatic form.
    However the nursing federation says one in five nurses are off sick with suspected coronavirus symptoms and doctor groups believe one in four doctors are similarly infected.
    UK Prime Minister Boris Johnson, who continues to direct the country’s response to the pandemic from isolation at 11 Downing Street, has ordered 17m tests to identify the presence of
    coronavirus antibodies to help work out who has had the virus.
    While he is recovering from the virus, it has emerged his chief Adviser Dominic Cummings has now gone into self-isolation with COVID-19 symptoms. Prince Charles, meanwhile, has now come out of seven days of quarantine.
    At this point, with an enforced lockdown, the number of deaths in the UK has been far lower than the original expectation of around 20,000 or even the more recently updated forecast of 5,700 deaths.
    Scientists have told Westminster that possibly two thirds of deaths that have occurred so far have been from people who would have died of their underlying conditions.
    But in preparation for the coming weeks when hospitals may be overrun, the makeshift Nightingale Hospital at the Excel conference centre in London is ready to take in 500 patients and can be expanded to take 4000. Other temporary hospitals are opening in Manchester and Birmingham.
    Statisticians are looking to Germany for clues as to what the virus outcome might be.
    Italy’s numbers appear worryingly high, but experts say that is because every person who dies with coronavirus is recorded as dying from it.
    “Only 12 per cent of death certificates (of people listed as dying from coronavirus) have shown a direct causality from coronavirus,” said Professor Walter Ricciardi, scientific adviser to Italy’s
    health ministry.
    “The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.’’
    He said while 12 per cent of death certificates have shown a direct causality from coronavirus, the other 88 per cent of deaths had least one comorbidity – and many had two or three. Each year in Italy there are 17,000 deaths from influenza.
    In Germany, on the other hand, any underlying health conditions – often heart disease – are usually noted as the cause of death, rather than the coronavirus.
    Germany has also tested a broader spectrum of the population – including children and those who showed the mildest of symptoms at the earliest stages, including contacts of known infections – rather than the Italian and British methods of mainly testing the very sick who have been hospitalised.
    Germany says they have found 63,000 infections, of which there have been 545 deaths, a death rate of 7 per 1m population.
    In Italy their 11,000 deaths equates to around 178 deaths per 1m of population.
    Australia’s rate per 1m of population is 0.7 and the UK’s is 18. Spain is 157 .
    The age profile of infections also illustrates how Germany has tested a wider age range of the population than others – its median age of those infected is 46.
    Eight in ten Germans with the disease are under 60 and are able to withstand the virus much more robustly. In Italy the median age is 63, in the UK it is 64. But again, in Italy and the UK the figures reflect the median age of the very ill coronavirus patients, and isn’t indicative of the infections throughout the whole country.
    German hospitals haven’t been overwhelmed with cases; and like the UK and Australia, the Germans are trying to shield their older populations from contracting the disease.
    Interestingly, German researchers also believe the virus was imported into the country from fit and healthy skiers who had been in the Italian alps and so could shrug it off more easily.
    Meanwhile the French Minister of Research, Frédérique Vidal, said clinical test results on four possible coronavirus treatments will be known at the end of the week.
    The clinical trials of four possible treatments began a week ago, and involve more than 3,000 volunteers across Europe. The trials will determine the best treatments among the ebola drug Remdesivir, the anti HIV treatment Lopinavir-Ritonavir, the long standing malaria drug Hydroxychloroquine, and interferon-beta.

    Reply
    1. andy

      Gary, re the question “So, the question is, if we didn’t have a lockdown in 2017, and we didn’t have a lockdown in 2018, and we didn’t have a lockdown in 2019….why do we have a lockdown now?”

      China introduced lockdowns to prevent spread of a virus and now there is a pandemic. Every country should follow their lead. Have to slow down the death of metabolically compromised seniors so as not to overwhelm ICU’s. The logic is sound, everything needs to be flattened, the steamroller approach. So. now some politicians are saying flatly, ” I couldn’t stop the steamroller”.

      Reply
      1. AhNotepad

        andy, China eventually introuced lockdowns after having tried to keep it quiet for over a month. The figures from China are still suspect, and the figures from some other countries are just as misleading.

        Reply
  92. Ingrid Chafiie

    Thank you for these open words, which follow logic and confront us with reality. I am 80 years old and agree with your mother’s word: “I lived long enough!” Consequence – if I get the virus and cannot cope on my own with it, I should have the courage to say yes to death. But please, sedate me until I am gone! — Ingrid

    Reply
  93. Tish

    I like the French but what has happened to their Liberty, Equality and Fraternity I wonder? They do have rather a reputation for hypochondria though.

    Reply
  94. Soul

    I read that in Australia and the Netherlands they have begun testing the old TB vaccine against the corona virus. I wouldn’t be surprised if the TB vaccine helped prevent most of the nurses being tested from catching the Wuhan China disease.

    There are several ways to boost the immune system. As we discuss here, taking more vitamin C, getting out in the sunshine to make vitamin D, improving ones diet, eating chicken soup, etc can all help boost ones immune system.

    Being the medical community where natural ideas tend to be dismissed I’m not surprised that the nurses are looking at the TB vaccine to boost their immune system. I hope it works well for them and few nurses taking part in the study catch the virus.

    “Century-Old Vaccine Investigated as a Weapon Against Coronavirus”

    https://www.bloomberg.com/news/articles/2020-03-30/century-old-vaccine-investigated-as-a-weapon-against-coronavirus

    excerpt:

    “A vaccine that’s been used to prevent tuberculosis is being given to health-care workers in Melbourne to see if it will protect them against the coronavirus.

    The bacillus Calmette-Guerin, or BCG, shot has been used widely for about 100 years, with a growing appreciation for its off-target benefits. Not only is it a common immunotherapy for early-stage bladder cancer, it also seems to train the body’s first line of immune defense to better fight infections.

    With an immunization specifically targeted against the pandemic-causing Covid-19 disease at least a year away, the World Health Organization says it’s important to know whether the BCG vaccine can reduce disease in those infected with the coronavirus, and is encouraging international groups to collaborate with a study led by Nigel Curtis, head of infectious diseases research, at the Murdoch Children’s Research Institute in Melbourne…..”

    Reply
    1. Dr. Malcolm Kendrick Post author

      This sounds like nonsense to me. You cannot ‘train’ the immune system to do anything, very much. The reason for immunity against previously encountered infections is that the body creates specific antibodies that remain in the body, and will recognise and lock onto the (seen before) invasive organism very quickly, thus killing them before they can start getting into cells and taking over the DNA. Giving the BCG (which is used against TB, which is not a virus) to stop COVID, seems as likely to work as immunising with tetanus, to stop measles. But hey, if it works, it works.

      Reply
      1. AhNotepad

        As well as the action of antibodies attacking the pathogen, is there any other mechanism that suppresses the development of symptoms, perhaps because the immune system recognises the pathogen and realises a full on response is not needed?

        Reply
        1. andy

          Hi AhN, there is talk about viral load as a risk factor. Perhaps quorum sensing is the mechanism whereby this virus decides when to launch a full blows attack to overwhelm the immune system and kill the host.

          Reply
          1. AhNotepad.

            andy, I think the viral load factor may be an issue. A pathogen will wear down the immune system until the reserves can no longer cope. This I think is the reason for ensuring adequate vitamin reserves, then the pathogen is kept in check and cannot overwhelm the system.

          2. andy

            AhN, I believe you are talking about Medical Nutrition Therapy (MNT) a concept that is not widely promoted as a tool against this virus, except on this blog.

          3. AhNotepad

            I wouldn’t have thought of a label like that. A problem with labels is they are used as a target by those who lack the common sense to understand that prevention is better than cure. Prevention is possible, cure is more elusive.

      2. Soul

        When I read the article I was thinking of Dr. Faustman and her research work with the old TB shot. I seem to recall her mentions that the TB shot wasn’t about TB but that it upped or improved the immune system. Could be nonsense of course. Imagine we’ll be finding out in the future if the nurses results turn out well.

        Reply
      3. Soul

        Here is a video of Dr. Denise Faustman where she discusses hers and others research work with the TB vaccine and the immune system.

        Dr. Faustman has been talked about often in the past. I don’t know where her current research work stands. From the little I know they looked promising back a few years ago.

        “Reversing type-1 and more! – FYI Diabetes Exclusive Interview with Dr. Denise Faustman”

        Reply
  95. Eric

    Very impressive blog post, Malcolm.

    I came late to the party, so apologies if this has been said in one of the 280 comments so far, but the figure quoted that the government is spending is not just to deal with the fallout from the national shutdown, but it is also stimulus to deal with the international disruption.

    Even if most nations on earth had decided to ignore the issue and carry on, we would still be faced with a worldwide recession, only it might be on the order of maybe 5% instead of the 10% predicted now, which would still have required billons of stimulus in the UK alone. And it is too late to get to undo the decisions that were taken.

    What we need now is a smart exit strategy. Two things are currently missing that worked well in Taiwan, Hong Kong, and South Korea (I left out China as their numbers might be cooked):
    – everyone required to wear masks in public
    – aggressive testing and tracking (yes, including cell phones)

    On top of that, testing for immunity appears like a good idea.

    Reply
    1. AhNotepad

      Masks are a false flag IMO. Rather like the pathetic dropping things on the ground and running away as the recipient advances to pick it up. Princess Diana was able to shake hands with those who had aids, there is a huge tuberculosis death rate which has been going on for years, why not masks for that?

      Reply
  96. Joost van der Mandele

    While this was a great read, there’s one gargantuan mistake: the 350 billion is not to save lives, but to save the economy.

    Therefore, the whole equation falls flat on its face.

    Another thing is that if you do nothing, you will not only get 2.5%x60% a death rate among the population, you will /also/ overwhelm the ICU’s, creating death rates much much higher and increasing deaths among much younger people. This, too, turns the equation on its head.

    Reply
    1. Dr. Malcolm Kendrick Post author

      It is not a gargantuan mistake. Please read what I have written again. Essentially, any Govt can choose to spend money on various things. The UK Govt has chosen to pay a potential cost of £350Bn to prevent (a maximum of) 500,000 people dying. By shutting down the UK economy, it is hoped that these 500,000 will not die (which may or may not be true). Whilst this money is not going to the NHS, it still represents the amount of money that the UK Govt is willing to spend on preventing deaths. Ergo, the cost per QALY calculation is valid.

      I do not understand the second part of your argument. The 500,000 represents the maximum number of people who will die – if nothing is done. That has been modelled (whether accurately or not). You cannot just start to add in extra deaths, the extra deaths have all been added in.

      Reply
      1. Eric

        I don’t think your blog entry addresses the point that stimulus would be needed even if the infection was allowed to run its course unabatedly.

        About the second point, I would assume the maximum number of 500,000 deaths includes the fact that you would suddenly see significant number of younger people dying – correct?

        But the average number of years lost, which you assumed to be 9 in your best case (a 78 year old dying instead of living another 9 years), may be way too low if you get an average age of even 50. Also, their average qol might have been closer to 1. It would be really important to get those numbers!

        Reply
        1. Dr. Malcolm Kendrick Post author

          Of course it would, and a change in average age of death, or quality of life, or suchlike, would require looking again. However, the average age of death is never going to be 50. Last time I looked, the number of people in South Korea who died, under the age of 40 was 1. A widely publicised case, in the UK, of a 21 year old girl dying of COVID turned out to be wrong. She had a cough, she died of a heart attack. Her death was not recorded as COVID. Medical statistics are very difficult to collect accurately, there is always a huge amount of bias.

          Reply
      2. Eric

        So I am curious. What would you do if you were king? From your latest comments, I don’t think you would just let it run its course.

        Reply
        1. Dr. Malcolm Kendrick Post author

          I wouldn’t have started from here, that’s for sure. The problem is that we have found ourselves in a situation through terrible planning, a deliberate running down of beds, ICU beds, and the NHS as a whole, so that there is no solution that does not lead to disaster – one way or another. Its a bit like asking the pilot of a plane what he should do, after complete engine failure, with no runway in range. You’re going to crash land, and lots of people are going to die, it doesn’t really matter where you point the plane. Best probably to avoid built up areas. What really matters is what the Govt chooses to do once this is all over. Whatever they do now, they cannot avoid the crash.

          Reply
      3. David Bailey

        Malcolm,

        In your analogy you forgot to mention the alternative of landing in the Hudson river!

        Surely the first question to be answered is precisely how many people are having their lives cut short significantly (say by more than 6 months) by COVID-19! We are told this disease mainly kills the old with co-morbidities – which surely opens up the possibility at one extreme that a negligible amount of life is being lost, and at the other extreme that this is a real threat.

        If we follow down the current path, I doubt there will be money for any NHS service.

        I’m only just in the danger zone, as I am 70, but I don’t want this absurd lockdown done in my name, I’d rather take my chance, and I am damned if I will stay cooped up in my house for the next few months either. The lack of exercise might kill me!

        Reply
        1. Steve Prior

          Hi David Bailey

          Hopefully the Doctor who owns and runs this site will allow this post to go through. This website is primarily a discussion about health and in this case covid 19 and it’s repurcussions but I do think it’s important to discuss the money system or we will be missing something vital.

          You said “If we follow down the current path, I doubt there will be money for any NHS service”.

          I don’t blame anyone for talking about money as if it’s in short supply but there is no limit to the amount of £s the Government could make available at almost the drop of a hat or numbers in a spreadsheet.

          The media, financiers, banks, the treasury etc are always suggesting that our taxes fund government spending and it simply isn’t true.

          I don’t want or expect anyone to accept my assertion at face value, you must always check and double check statements to help ensure their validity.

          Yes, it’s true that taxes are utilised as part of the balance sheet. Taxes are also used to actually give our £s value. When a Government says it has run out of money, it issues bonds, these bonds are an IOU. The bond holders have effectively swapped their cash for these bonds.

          There is nothing to stop The Bank of England from purchasing these bonds if they wished to. As it stands at the moment, it’s mostly pension funds which buy these IOU’s or bonds.

          The BoE said it would “keep under review the case for participating in the primary market”, suggesting it could eventually buy bonds from the government or companies directly rather than on secondary markets as it does now. https://www.reuters.com/article/us-health-coronavirus-britain-boe/bank-of-england-ramps-up-bond-buying-cuts-rates-to-near-zero-idUSKBN2162KT

          If the Bank of England does decide to buy in the primary market, we IE the UK is effectively borrowing money from itself and is money which could be spent into the economy.

          Money in £s has never really been a limiting factor provided it is used to purchase products, services, people and other resources priced in £s and provided the £ is allowed to float against other currencies. This distinction is key.

          The real limit we face relate to the physical products, services and people who live and work in the United Kingdom.

          Do I expect the Government or The Bank of England to explain this so that people understand. No I don’t for lots of reasons.

          My frustration with all discussions about money is the obsfucation, the money system is out of obvious sight. Governments are always talking about tax payers money, the media are always asking, where’s the money going to come from etc. And we the people accept the whole premise.

          As part of anyone’s own research, and if they have the time and inclination there are a couple of short Bank of England videos. I assume, they are from the Bank of England but in this age of fake news, who knows!

          My points (which are themselves highly simplified) are to use due diligence in all things health/medical and to do the same about the money system.

          At some point perhaps I will start my own blog about this topic but based on bitter experience people’s eyes tend to glaze over. Us humans are funny in a way. It would seem videos about cats doing crazy things get millions of views and views on videos about money get a few hundred. Even the Bank of England videos only gets tens of thousands.

          And yes, proper understanding of the money system could stop all this nonsence about Austerity from all the Political Parties.

          Cheers

          Reply
          1. Sasha

            I agree. I keep saying that the question “where the money is going to come?” doesn’t make sense. Nations in control of their currency can create as much money as they want.

          2. Mr Chris

            Sasha
            They can print as much money as they like, if they want to import stuff, the other party has to accept it at a certain value. That is the moment of truth

          3. Sasha

            Chris, all major economies do it. Check, for example, how much money Chinese printed in 2008

          4. AhNotepad

            I agree as well. You are correct describing the stimulus as “currency” and not money. The problem is this stimulus, ie flooding the system with printed currency devalues what already exists, and costs everybody. It is not a free handout, it is a debt, but the rich will still benefit.

      4. Eric

        Of course you wouldn’t have started there, and it must be frustrating to have seen austerity preached for years only to allow the rich get richer and install more tax havens in a country that is essentially rich. Same here, by the way, only to a somewhat lesser degree.

        Ok, let me ask, what would you have done if you had become king at the start of this year?

        Reply
      5. Eric

        @ Steve Prior:
        Very much along the lines of my thinking.

        The stimulus is (motly) not to pay for the cost of the shutdown but to compensate for the loss of trust. Just think of the 2008 crash. There was nothing keeping people at home or physically impacting the shops, offices and factories, yet the economy tanked because there was a lack of trust (in business partners, orders, payment of bills, etc.).
        Goverments and central banks spent tons of money and somehow, in most countries, it did not end up increasing national debt signficantly? Why? Partly because it was making up for book money that went poof. Also, because many banks and other companies were effectively nationalized, and governements made a pretty penny after stock markets had picked up again and they sold their shares.

        So saying that the stimulus is there to just pay for the intervention of quarantene and lockdown is just faulty analysis.

        Back to the discuss about the nature of money. Saying that it is scarce is a way to allocate ressourses, i.e. decide what percentage of a national output goes to social spending and what goes to private equity. In the West, we’ve all seen the general trend towards allowing equity to reap more, all in the name of austerity or competitiveness. Maybe this trend is most pronounced in Anglo countries.

        Paul Krugman (Nobel laureate and NYT opinion columnist) keeps saying: VSP (very serious people) are only concerned about national debt when Democrats are in power.

        Now, within the concept of taking money at face value and looking at preparedness, in $/capita, the US sits at 10k, and most developed Western countries at about 5k:
        https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

        @ Malcolm
        Just for the comparison of preparedness and hospitals: Germany was at $5500, the UK at 4200. in 2016. Not so much of a difference, especially if you consider the vagaries of exchange rates and correct for GDP/capita. One would expect the NHS to be vastly more efficient since it is a single payer and single vendor system, whereas you have a weird mix of non-profit and private insurance companies on the payer side in Germany, and a weird mix of publically owned, non-profit-owned and for-profit hospitals, and most GPs and consultants are actually in private practice. All of these types of hospitals have to at least survive or ideally turn a profit on subsidies at the state and county level (which are paid for providing the capacity) and insurance reimbursements (which are being paid for actual treatments).

        While reimbursements used to be paid for the individual services (e.g. actual number of days spent in hospital), that was changed years ago where hospitals are paid lump sums for procedures. This removed the incentive to keep patients longer and gave an incentive to have good results, thus being able to discharge more quickly. As a result, the number of beds fell, as did staffing levels. For the remaining beds (still at 3x the UK number), it is best for the hospitals to perform more procedures, and arguably many procedures performed in German hospitals are not strictly necessary, which is probably not good for the patients. This explains why it was able to clear hospital wards without an outcry, but the mystery remains how this was paid for with only 20% more money per capita after adjusting for GDP.

        Reply
    2. KJE

      If only all the money was to save the economy – tell that to all the self-employed and freelance people who will get nothing or next to nothing if they are not eligible for Universal Credit, all the landlords whose tenants have been falsely told that they don’t need to pay rent – but who can be prosecuted for not getting gas safety tests carried out even though the tenants are too scared to let a gas safe engineer in – and all the very small Ltd companies for whom there is no support or bail out apart from loans which will have to be repaid – from what?

      Reply
  97. Gary Ogden

    Anna M: Easy. The rich are the banksters. They always win, because they control the supply of money, and take a guaranteed cut from every new bill they print.

    Reply
    1. andy

      Hi AhN: the evidence has convinced me that scientists have been creating genetically modified viruses, the GMVs. The challenge now is to discover how this new virus behaves.

      Reply
  98. Odette Hélie

    The money you put on saving one’s life, you do not put on another life . That can sometimes mean a modest short-term benefit instead of a big long-term benefit. As liberal and rich societies, we accept quietly that countless years are lost because of pollution, poverty or mental health problems. Let’s stop the hypocrisy, the self-righteous riffraff and let’s have a calm discussion informed by humane but nonethelss pragmatic ethics.

    Reply
    1. Angelica @ nixgluten.com

      I’ve never accepted quietly any of that. I’ve always been against the corporate masters who outweigh my opinions by sheer dollars. Put the blame where it is: corporations who can’t be bothered to be cleaner. It’s the equivalent of someone walking down the street defacating in public. Yet it’s OK because the corporation is rich. Nobody’s accepting that quietly. We just don’t get a say until we’re the captain of an industry ourselves. I hope you’re not deluded enough to think that voting, as it stands today, is an antidote to this. Democracy is vulnerable to greed, it’s demonstrated every day. We’re told that people want fewer regulations. I don’t remember ever asking for that. Pretty sure that’s the captains of industry talking.

      Reply
  99. Angelica @ nixgluten.com

    This is a terrible tragedy for everyone, whatever the economics of it is. I don’t agree with your mother at all. I have no particular love for my sick and painful life, and my grandmother had a similarly sick and painful body which I probably inherited. But I wouldn’t go out and put others at risk because it would be selfish. I get plenty of time walking on my street, crossing when I see a neighbor and waving instead of chatting. Being “locked down” doesn’t mean becoming a mole person. And this is a great time to learn to use Skype or whatever. I’m also getting more done on this year’s crochet project than ever before. It feels good to have a little introspection and time with my husband. We’ve been making more and more complex meals for fun. I’d say my QALY just went up.

    Reply
    1. Tish

      But Angelica, you appear to be writing from the premise that the whole thing is not being exaggerated. There is ample evidence that there is enormous exaggeration. Is it right that those of us who do as Lord Sumption suggests and dutifully inform ourselves properly, should be bullied into house arrest by people we believe to be behaving ridiculously? Dr Kendrick’s mother has every right to do as she pleases. There is no law saying she is wrong. I salute her.

      Reply
      1. Angelica @ nixgluten.com

        This is the most recent CDC (US) non-preliminary results of the flu (which is still happening alongside Covid-19) https://www.cdc.gov/flu/about/burden/2016-2017.html So the most rosy-posy estimate says at least 100k Americans will die of Covid-19. Add about 40k from normal flu, as usual. Yeah this is real.

        What would make hospitals have to fight over PPE’s and deal with shady sources to get it? Thieves? You really think nurses steal PPEs so they can sell it back? And even if they did, what caused the uptick in demand? Why would respirators be 5x the price they were a few weeks ago? Why would there be all new brokers in Shanghai trying to get shipments of PPEs to the US? Why would the FDA have to change regulations nearly on the fly to get more PPE’s into the country which are reclassified as “industrial” instead of medical?

        If this is a hoax, I’d like to know who organized it. If it’s a hoax, it’s all our jobs to figure out who it is and bring them to justice. Not to be in denial and sarcasm mode.

        Politicians may sit around talking about QALY and the value of one’s life, but we shouldn’t. Because we’re all about to find out how much our health system cares about our life an what it’s worth.

        All people have had non deadly coronaviruses every year at flu season, they’re classified under the common cold. They tend to linger and involve the gut and make you cough. This is a mutation we knew could happen. And it has. Time to be a bro, not a hack.

        Reply
        1. AhNotepad

          Some one to look at is Fauci who has pushed for gain-of-function engineered vira for years. When the funding was withdrawn in the US, research was continued in Wuhan, and unfortunately it got out. This is not a natural mutation. We live with virus components, they make up a significant part of human DNA.

          Reply
  100. Phil Craddock

    Dr. Malcolm Kendrick
    Post author
    March 31, 2020 at 3:44 pm

    0

    0

    Rate This

    I wouldn’t have started from here, that’s for sure. The problem is that we have found ourselves in a situation through terrible planning, a deliberate running down of beds, ICU beds, and the NHS as a whole, so that there is no solution that does not lead to disaster – one way or another. Its a bit like asking the pilot of a plane what he should do, after complete engine failure, with no runway in range. You’re going to crash land, and lots of people are going to die, it doesn’t really matter where you point the plane. Best probably to avoid built up areas. What really matters is what the Govt chooses to do once this is all over. Whatever they do now, they cannot avoid the crash.

    You’re spot on here Dr K. and I notice that the Government now have the Ringmaster General in control of the press briefings, Mr Gove. This man will try to convince you that he can make a silk purse from a rodent’s ear and today’s “Conference” was nothing more than a blatant “Look how wonderful we are” Party Political broadcast. Questions evaded as usual – the press posing questions cannot come back remember – but these daily updates are now nothing more than a political strategy to defend this Government in their decision to follow certain “scientific experts”.

    Reply
  101. Gary Ogden

    Oh, brother. First we have Covid-19, now “England’s Eroding Coastline,” cover article in the April Natural History magazine. What next?

    Reply
  102. elizabethhart

    Very grateful to Tish for alerting us in a previous comment to thoughtful commentary by former UK Supreme Court judge Lord Sumption.

    Lord Sumption’s comments are extremely important to consider in the current situation, please see below and circulate:

    In a BBC World at One interview, former Supreme Court judge Lord Sumption warned that coronavirus rules marked the UK’s “hysterical slide into a police state”, paving the way for a society to turn despotic. Have a listen via the link, full transcript below: https://unherd.com/thepost/lord-sumption-on-the-national-coronavirus-hysteria/

    Lord Sumption:

    The real problem is that when human societies lose their freedom, it’s not usually because tyrants have taken it away. It’s usually because people willingly surrender their freedom in return for protection against some external threat. And the threat is usually a real threat but usually exaggerated. That’s what I fear we are seeing now. The pressure on politicians has come from the public. They want action. They don’t pause to ask whether the action will work. They don’t ask themselves whether the cost will be worth paying. They want action anyway. And anyone who has studied history will recognise here the classic symptoms of collective hysteria.

    Hysteria is infectious. We are working ourselves up into a lather in which we exaggerate the threat and stop asking ourselves whether the cure may be worse than the disease.

    Q: At a time like this as you acknowledge , citizens do look to the state for protection, for assistance, we shouldn’t be surprised then if the state takes on new powers, that is what it has been asked to do, almost demanded of it.

    A: Yes that is absolutely true. We should not be surprised. But we have to recognise that this is how societies become despotisms. And we also have to recognise this is a process which leads naturally to exaggeration. The symptoms of coronavirus are clearly serious for those with other significant medical conditions especially if they’re old. There are exceptional cases in which young people have been struck down, which have had a lot of publicity, but the numbers are pretty small. The Italian evidence for instance suggests that only 12% of deaths is it possible to say coronavirus was the main cause of death. So yes this is serious and yes it’s understandable that people cry out to the government. But the real question is : Is this serious enough to warrant putting most of our population into house imprisonment, wrecking our economy for an indefinite period, destroying businesses that honest and hardworking people have taken years to build up , saddling future generations with debt, depression, stress, heart attacks, suicides and unbelievable distress inflicted on millions of people who are not especially vulnerable and will suffer only mild symptoms or none at all, like the Health Secretary and the Prime Minister.

    Q: The executive, the government, is all of a sudden really rather powerful and really rather unscrutinised. Parliament is in recess, it’s due to come back in late April, we’re not quite sure whether it will or not, the Prime Minister is closeted away, communicating via his phone, there is not a lot in the way of scrutiny is there?

    A: No. Certainly there’s not a lot in the way of institutional scrutiny. The Press has engaged in a fair amount of scrutiny, there has been some good and challenging journalism, but mostly the Press has, I think, echoed and indeed amplified the general panic.

    Q: The restrictions in movement have also changed the relationship between the police and those whose, in name, they serve. The police are naming and shaming citizens for travelling at what they see as the wrong time or driving to the wrong place. Does that set alarm bells ringing for you, as a former senior member of the judiciary?

    A: Well, I have to say, it does. I mean, the tradition of policing in this country is that policemen are citizens in uniform. They are not members of a disciplined hierarchy operating just at the government’s command. Yet in some parts of the country the police have been trying to stop people from doing things like travelling to take exercise in the open country which are not contrary to the regulations, simply because ministers have said that they would prefer us not to. The police have no power to enforce ministers’ preferences, but only legal regulations which don’t go anything like as far as the government’s guidance. I have to say that the behaviour of the Derbyshire police in trying to shame people into using their undoubted right to take exercise in the country and wrecking beauty spots in the Fells so that people don’t want to go there, is frankly disgraceful.

    This is what a police state is like. It’s a state in which the government can issue orders or express preferences with no legal authority and the police will enforce ministers’ wishes. I have to say that most police forces have behaved in a thoroughly sensible and moderate fashion. Derbyshire Police have shamed our policing traditions. There is a natural tendency of course, and a strong temptation for the police to lose sight of their real functions and turn themselves from citizens in uniform into glorified school prefects. I think it’s really sad that the Derbyshire Police have failed to resist that.

    Q: There will be people listening who admire your legal wisdom but will also say, well, he’s not an epidemiologist, he doesn’t know how disease spreads, he doesn’t understand the risks to the health service if this thing gets out of control. What do you say to them?

    A: What I say to them is I am not a scientist but it is the right and duty of every citizen to look and see what the scientists have said and to analyse it for themselves and to draw common sense conclusions. We are all perfectly capable of doing that and there’s no particular reason why the scientific nature of the problem should mean we have to resign our liberty into the hands of scientists. We all have critical faculties and it’s rather important, in a moment of national panic, that we should maintain them.

    Reply
    1. Tish

      Thank you Elizabeth for reproducing this so thoroughly. To me, these issues are of utmost importance for it is a slippery slope we could go down. It would be much harder to get back up it.

      Reply
    2. Angelica @ nixgluten.com

      Bosh. A country trying to protect its people from death is the exact opposite of a police state.

      Reply
      1. AhNotepad

        Angelica, shutting down a country while claiming to be protecting its people from death, by doing the very things that cause social dislocation and which is known to cause increased deaths a couple of years down the line for an age group which would have not met their end so soon, is disingenuous. They decision makers are either ignorant, or evil, and the best option we can take is “ignorant”.

        Reply
    3. chris c

      Thank you, that was excellent! I saw him on TV and thought there is someone speaking truth. Maybe he will have to resign from the Lords “to spend more time with his family” and be replaced with a pod person who doesn’t deviate from The Narrative.

      Looks to me like they have bolted a turbocharger onto Austerity and called it Lockdown.

      I thought this was surprisingly good from the BBC

      https://www.bbc.co.uk/news/health-51979654

      Reply
  103. Eric

    Interesting piece in Der Spiegel today, interview with medical statistician Gerd Antes, who heads the German Cochrane Center:
    https://www.spiegel.de/wissenschaft/medizin/coronavirus-die-zahlen-sind-vollkommen-unzuverlaessig-a-7535b78f-ad68-4fa9-9533-06a224cc9250

    – confirms that every death that is connected in any way to CoViD is currently being counted as a CoViD death because it is too difficult to distinguish
    – says we need to wait 8 months to see if there was a real dent in yearly mortality
    – on the other hand, he sees the very real disaster playing out in Northern Italy or Alsatia and says German government had no choice other than to act like it did to gain time and sort out the facts later
    – says we need randomized screening for infection and antibodies to obtain the data to make better decisions
    – is reasonably confident that there will be sufficient hospital capacity because there was more to begin with and measures were introduced early but acknowledges he could be totally wrong
    – he stresses the need to weigh benefit and risks (such as mental health and economic impact) of interventions going forward but does not attempt to make a cost benefit calculation for the current measures

    Then from the guardian, so no summary needed:
    https://www.theguardian.com/world/2020/mar/31/virologists-to-turn-germany-worst-hit-district-into-coronavirus-laboratory

    https://www.theguardian.com/business/2020/apr/01/now-the-world-faces-two-pandemics-one-medical-one-financial-coronavirus

    Reply
    1. Eric

      two more points to add to the summary of the Spiegel article:
      – Memorable quote: We are waiting for a tsunami to hit, but we don’t have the faintest idea how high the wave is going to be.
      – Testing: he has anecdotal evidence that testing criteria are still highly arbitrary (travel history, contacts, symptoms, county, willingness to pay out of pocket).

      Reply
  104. Tony

    Here is an interesting take on events so far, from Dr Mercola, and how in the future Google and other ‘Tech’ companies are looking for powers to ‘help governments’ monitor events in real time.

    Is this to control us (the population) or a genuine health intervention?

    Summary:
    STORY AT-A-GLANCE
    Google’s parent company, Alphabet, has launched an online portal for COVID-19 testing that will be under the auspices of Verily, it’s health care and life sciences arm
    To apply for testing, you have to fill out a symptoms checklist and provide your travel history, health status and information about contact with individuals known to be infected. You must also provide a valid Google account and cell phone so that you can be tracked should your test be positive
    Verily’s COVID-19 testing portal will give them access to infection and health data, combined with the ability to track in great detail the exact whereabouts of a majority of Americans (anyone who uses the online portal)
    The tracking system about to be launched in the U.S. is eerily similar to that already being used in China, where residents are required to enroll in a health condition registry. Once enrolled, they get a personal QR code, which they must then enter in order to gain access to grocery stores and other facilities
    According to Bill Gates, we need a national tracking system, and positive tests for infectious disease must be publicly identifiable so that people will know to maintain social distance from infectious individuals

    Link to full article:
    https://articles.mercola.com/sites/articles/archive/2020/04/01/live-coronavirus-map.aspx?cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20200401Z2&et_cid=DM495111&et_rid=841323007

    Reply
    1. Dr. John H

      Looks like you didn’t get to the “April Fools” part in the article:

      “While this is our annual April Fool’s edition, 99% of it is true. The only detail that is made up is the “Corona Waze” app by Google. The World Health Organization, however, is indeed developing an app that has been described as “Waze for COVID-19.”

      Reply
  105. andy

    Size of stimulus package will depend on how long the virus can survive in the environment. There are estimates how many hours or days the virus can survive on various surfaces. The assumption being that the virus will eventually die if it does not find a human host. The solution now is to quarantine everyone for 3 weeks. Infected people will either recover or die and the viruses in the household will also die. Maybe the quarantine should be extended to 6 weeks to allow the last virus in a household to die, the one that is on the cereal box. Everyone is not infected at the same time so the countdown for a country should starts 3 weeks after there are no more new cases. Self isolation will only delay infection if started too early and people venturing back into society. So what is the ideal quarantine period for a country or the world? Politicians are expecting things to get back to normal when the virus is under control, is this realistic? Only thing we track is the body count.

    Reply
  106. Eric

    Very fitting article:
    https://www.theguardian.com/world/2020/mar/30/catastrophe-sweden-coronavirus-stoicism-lockdown-europe

    Sweden is doing the experiment for the rest of Europe. In terms of reported infections, the are behind Germany, in terms of deaths a little ahead on the curve, with all the uncertainty about reporting this entails. Two weeks from now we’ll know if we were overreacting. I am just not sure whether to admire their pragmatism or consider it cynicism. And Sweden has a reputation in Scandinavia for looking after its people too much.

    Also of interest:
    https://www.theguardian.com/world/2020/apr/01/china-pivots-to-tackle-silent-covid-19-carriers-as-us-says-a-quarter-of-cases-may-have-no-symptoms

    “Authorities reported 130 new asymptomatic cases on Wednesday, bringing the total number of such cases under observation to 1,367. Previously, China has regarded asymptomatic patients as a low risk and not included them in their tally of confirmed cases.” — Ok, that’s part of the explanation of their miraculously reduced numbers.

    “Those concerns were reflected on Tuesday by Robert Redfield, the director of the US Centers for Disease Control and Prevention (CDC), who said in a rare interview that as a many as one in four cases have no symptoms. He told NPR: “That’s important because now you have individuals that may not have any symptoms that can contribute to transmission, and we have learned that in fact they do contribute to transmission.”

    As a result, the CDC was now “aggressively reviewing” its recommendations on use of face masks, potentially extending their use based on the assumption that more people in “high transmission zones” were already infected but without symptoms.”

    Reply
  107. Eric

    The difference between Sweden and its neighbors is already beginning to show:

    And no, spread of infection does not depend on population size:

    Reply
    1. Jerome Savage

      Eric Can we confirm that their testing regime is not just accelerating faster than the others ?

      Reply
  108. JDPatten

    Angelica: I salute you in your stand on your considered perspective on Reality.

    Opposing factions: Reality is slowly creeping up at the expense of conspiracy theories and cognitive bias. Even POTUS is acknowledging that the situation is dire (All the while lying that he knew this before anyone else. HA!). Politicians and despots alike will have to accommodate Reality at some point. We all will. That point will be at the expense of how many lives as it gets put off?
    Yours?

    Reply
    1. AhNotepad

      You can’t believe the UK figures, Total recovered cases have stood at 135 for well over a week, and I cannot remember how much earlier than that. How accurate are the other figures?

      Reply
      1. JDPatten

        So, don’t believe the figures. Look at your morgues. Look at the crematoriums. Look at the undertakers. Look at the backlog that these institutions here and elsewhere are struggling to accommodate. Look at NYC.
        Are you trying to deny something by struggling with figures?

        Reply
      2. Jerome Savage

        JDP
        Re Italy & unintended consequences.
        FROM the SWISS DOC whose note taking is worth a look. (Though the heading of the piece with a reference to “propoganda” makes a little uncomfortable.)
        https://swprs.org/a-swiss-doctor-on-covid-19/
        In recent weeks, most of the Eastern European nurses who worked 24 hours a day, 7 days a week supporting people in need of care in Italy have left the country in a hurry. This is not least because of the panic-mongering and the curfews and border closures threatened by the „emergency governments“. As a result, old people in need of care and disabled people, some without relatives, were left helpless by their carers.
        Many of these abandoned people then ended up after a few days in the hospitals, which had been permanently overloaded for years, because they were dehydrated, among other things. Unfortunately, the hospitals lacked the personnel who had to look after the children locked up in their apartments because schools and kindergartens had been closed. This then led to the complete collapse of the care for the disabled and the elderly, especially in those areas where even harder „measures“ were ordered, and to chaotic conditions.
        The nursing emergency, which was caused by the panic, temporarily led to many deaths among those in need of care and increasingly among younger patients in the hospitals. These fatalities then served to cause even more panic among those in charge and the media, who reported, for example, „another 475 fatalities“, „The dead are being removed from hospitals by the army“, accompanied by pictures of coffins and army trucks lined up.
        However, this was the result of the funeral directors‘ fear of the „killer virus“, who therefore refused their services. Moreover, on the one hand there were too many deaths at once and on the other hand the government passed a law that the corpses carrying the coronavirus had to be cremated. In Catholic Italy, few cremations had been carried out in the past. Therefore there were only a few small crematoria, which very quickly reached their limits. Therefore the deceased had to be laid out in different churches.

        Reply
        1. JDPatten

          Jerome,
          I was in the U. S. Navy on active duty (Viet Nam era) for four years, followed by a two year period in the RESERVES! That’s how the military works – always enough experienced people on hand in case needed.
          War and $ for the capacity take priority.
          All aspects of healthcare everywhere are very sensitive to the BOTTOM LINE. Most U. S. hospitals and their managers are in it for profit. Empty hospital beds and empty procedure rooms and unused equipment hurt the bottom line. That leads straight to NO RESERVE. Look at Germany. They’re doing better there (Seem to be!?) because they’ve maintained a better RESERVE.
          The clear knowledge that greed has led to overwhelmed health care pretty much everywhere in the world would – perhaps should – lead anyone to panic.

          Reply
        2. AhNotepad

          Jerome, thanks for that post. It seems everyone likes a good panic, supported by statements such as “you can’t be too careful”. I would say people can be driven to unrealistic actions while pretending to be being careful, but in reality that is just a cover for panic.

          Reply
      3. Jerome Savage

        JDP
        Agreed. It seems that is so but as populations age and accumulate “war wounds” of one sort or the other, how can society cope and retain healthy functioning ?
        PS A quick glance at the above, the following extract from the Swiss doc : “Eastern European nurses who worked 24 hours a day, 7 days a week supporting people in need” seems a bit contrived – unless he is referring to the entire level of care provided en mass by East Euro nurses.
        Important to exercise & keep contacts and U probably dont need me to tell U that !

        Reply
  109. David Bailey

    I am still trying to discover a statistic that will distinguish between two extreme possibilities:

    1) Almost all the deaths are of people who were very close to death anyway, and so what we are really seeing a crisis built out of panic. If COVID-19 were not notifiable, almost all these deaths would be recorded as having other causes of death.

    2) Most of these deaths represent a real and growing problem. And the numbers of deaths each day will climb far above the natural death rate of about 1600 per day.

    Despite all the discussion so far, I am completely unable to distinguish between these two possibilities, or to decide on an intermediate position, or even to determine if the relevant information is even made public. This seems a truly bizarre situation when people are losing their livelihoods all the time.

    Reply
    1. markheller13

      David,

      I too am struggling to understand this, but I think the evidence of healthcare services being overwhelmed in Italy, Spain, and increasingly here in the UK tells us that there is a significant amount of 2)…

      Reply
      1. David Bailey

        Mark,

        Thanks for your response.

        Well since it is repeatedly explained that this disease is normally mild, except for old or sick individuals, there I am left with considerable suspicion. At the very least, some sort of effective death toll which excludes those considered to be already on their death beds would help.

        My views have been shaped considerably by these two links:
        https://swprs.org/a-swiss-doctor-on-covid-19/
        and
        https://off-guardian.org/2020/03/24/12-experts-questioning-the-coronavirus-panic
        (The latter contains the views of named experts in the field. Ominously this site needs to use some sort of protection against denial of service attacks – hence the 5-second delay to access it).
        There are also the views of John Ioannidis to consider:

        (These are links I have posted earlier here).

        Finally, I speculate that patients may have been ventilated in this crisis when normally their underlying condition would have been seen as reason to simply offer palliative care. This would have exacerbated the load on the medical facilities substantially.

        Reply
      2. Jeffrey Dun

        Last November experts were publishing reports warning that the NHS was under too much pressure to deal with the seasonal flu.

        In December of 2019 the NHS had to implement “emergency temporary beds” in 52% of its hospitals to account for their regular “winter crisis”. Most of those hospitals still had temporary beds operating from the previous winter.

        https://www.theguardian.com/society/2019/dec/02/nhs-winter-crisis-extra-beds-created-by-52-per-cent-of-uk-hospitals

        Looks more like underfunding the NHS to me.

        With regard to Italy, Dr Ionannidis said in his interview (posted below) that most hospitals in Italy are coping, it is only those in the hot spots that are under severe pressure.

        Reply
  110. psychotrend

    Very useful post, I was looking for some costing info for a blog I am preparing. Is there not also a calculation regarding traffic accidents and if it’s worthwhile to install say a pedestrian crossing?
    Regarding your mum, mine was of the same mould, at 93 she was offered a scan to help test for dementia, she declined, I’m old she said of course I’m losing my memory, scan a younger person who you may be able to help. I lost her just after her 94th birthday, quietly at home with much equipment provided by the NHS to make her final days very comfortable and thankfully pain and drug free. I did however have to fund her live-in carer, help wasn’t easily forthcoming from the ‘system’.
    Regards,
    Barry Morgan

    Reply
    1. Shaun Clark

      Mmmm. Was he talking about how many affairs and children he’s had/got? Sounds very much like it. I think there is a clue in there somewhere.

      Reply
  111. elizabethhart

    As an example of a citizen’s action in demanding evidence for the current lockdown and infringement of our civil rights, please see below my recent response to the Labor opposition leader in South Australia:

    Mr Malinauskas, are you telling me you are unable to find out the names of the unelected people who are influencing policy, whose recommendations are severely hindering our freedom of movement and association?

    You say you are “working in a constructive manner with the State Government”? At the designated ‘social distance’ I presume? Or do politicians have special dispensation from the constraints put on others?

    Media reports indicate lockdowns in Australia are going to continue for 90 days, i.e. three months, see for example in NSW. https://www.abc.net.au/news/2020-04-02/nsw-lockdown-to-be-lifted-in-90-days-as-coronavirus-cases-fall/12112182

    I’m concerned that the development of natural herd immunity is being deliberately impeded by this lockdown. In this regard see my BMJ rapid response provided previously.https://www.bmj.com/content/368/bmj.m1089/rr-6

    This is especially significant as we head into winter. Is independent and objective advice being sought on this matter?

    While I appreciate there may be special measures required to slow the spread of the virus, I question whether the over-the-top rules implemented by Prime Minister Scott Morrison are necessary. The public must be able to access the evidence supporting the rules designated by Mr Morrison.

    Mr Malinauskas, I suggest you raise this matter directly with Mr Marshall and ensure we have transparency in regards to the specially convened Go8 group which is advising the Chief Medical Officer/Director of Human Biosecurity Professor Brendan Murphy, and Mr Morrison and state premiers.

    We also need public access to the modelling data provided by this Go8 group, we need to see the evidence supporting the current infringements on our liberty.

    The handling of the current COVID-19 situation is the most significant political experience in my lifetime, with governments severely curtailing citizens’ rights, and impacting adversely on the economy and society. Critical analysis of this situation is starting to emerge, see for example this article out of the UK Why we must resist the corona-tyrants. https://unherd.com/2020/04/why-we-must-resist-the-corona-tyrants/

    I look forward to your prompt response on the serious matters raised.

    Sincerely
    Elizabeth Hart

    Reply
  112. Richard Hall

    Thank you for this clear assessment really the politicians should be looking at this or maybe they have but decided it was too uncomfortable to deal with
    I am working in Slough as a GP which is supposed to be nationally a high density area for Covid 19
    we have had patients of ours going in and out of the local hospital all elderly most with multisystem disease and most you would think would be a dead cert for significant problems if not death, they are being tested positive for CV19 and yet seemingly not much wrong, they get discharged back to us and see OK, it is odd, we are puzzling at this and wondering what is the false positive rate for the PCR test which has been much vaunted. There has been opinion that the virus is pretty much everywhere, and I am beginning to wonder either this bug isn’t as bad as we thought or there is a lot of background contamination going on and that is equally odd. It seems to me provided a decent AB test can be provided without cross reactivity to autoantibodies that will be the only way we can move forward. Not scientific I accept purely anecdotal

    Reply
  113. Soul

    Read about a disappointing study the other night. The study was about how much sun exposure people in Miami receive, either in winter or in summer. I personally have found sun exposure helpful for me with avoiding the flu/cold bugs. Since I’ve begun to sun bathing or using a sun lamp in winter time I haven’t experienced a bought with the flu or cold bug in over 10 years.

    The Miami study measured patients vitamin D levels, using vitamin D as a measure of noon time sun exposure. The results were – in winter time Miami residence averaged a testing level of 17ng/ml. During summer time the results barely changed. Summer results were 19ng/ml. Optimal testing levels according to the book I’m reading are 50ng/ml.

    with more people being at home with the government closing the economies down, hope people get outside more. Doing so might help shorten the corona viruses impact.

    Reply
    1. Eric

      It would be interesting to compare Australia and South Africa to Europe or the US. After all, they are in their summer, and this might tell us if things get better in summer (unless everyone there is slathered in sunscreen).

      Reply
      1. Soul

        I don’t recall reading about vitamin D testing levels for people living in Australia. I do remember though reading several times complaints on how fearful people of Australia are of the sun. They stay out of the sun and when in the sun cover up with sunscreen and clothing I’ve read.

        Don’t recall seeing information on S. Africa.

        There was an interesting article on India and vitamin D status. It mentioned that in India they don’t have a seasonal flu season or as much of a flu season compared to countries in colder climates. The article can be seen here ~

        (To add the next day this article came out, India’s government issued some type of lock down for their people. I don’t know their situation concerning the Wuhan virus. India’s hasn’t been in the news here concerning the virus.)

        “Former CDC Chief Dr. Tom Frieden: Coronavirus infection risk may be reduced by Vitamin D”

        https://www.foxnews.com/opinion/former-cdc-chief-tom-frieden-coronavirus-risk-may-be-reduced-with-vitamin-d

        Saw a possibly interesting article this morning concerning Brazil. Brazil’s president was saying he did no plans to shut down their countries economy. He went on to say the COVID-19 was nothing more than a flu bug. I don’t know if Brazil has higher vitamin D levels compared to other countries but many people are poor there and work in the sunshine. Sunscreen would be a luxury many could not afford in that country I would think.

        Reply
  114. KidPsych

    Unsurprising news:

    https://news.trust.org/item/20200402092110-6rvk1

    FTL: The New Orleans metropolitan statistical area ranks among the worst in the United States for the percentage of residents with diabetes, high blood pressure, and obesity, a Reuters analysis of CDC data shows. An estimated 39% have high blood pressure, 36% are obese and about 15% have diabetes.

    Reply
  115. Eric

    https://www.spiegel.de/wissenschaft/medizin/corona-pandemie-was-uns-die-zahl-der-toten-verraet-a-ca5dc909-716c-44ac-806f-530a10916121

    Another interesting article with self-explanatory graphs. Essentially, they say that on average, if people are going to die, they do so 10 days after infection is diagnosed, hence the number of deaths should track the new infections from 10 days before. Seems to track for most countries albeit with different factors that reflect the amount of testing if test conditions are not changed (test criteria or labs running out of capacity). So past deaths can be used to calibrate current infection numbers. In Gemany, the percentage of positive tests have fallen from 20 to 10% indicating that testing has even increased and testing should be confined to narrower criteria to conserve capacity:

    Still, at some point any country’s labs are running out of capacity, so random testing would be needed to establish true levels.

    Reply
    1. Eric

      Peter at hyperlipid had a blog post along the same lines (but about Omega 6 PUFA) a few weeks ago. On top of that, when you got obese on corn oil and then fall sick and have no appetite, you are releasing plenty of stored linoleic acid with disastrous consequences.

      Reply
  116. Shaun Clark

    There was a comment made somewhere recently on this Blog that Brazil Nuts (might) not contain any selenium. Well, this info is from the USDA. Maybe the USDA lied? Seems pretty good to me.

    Brazil nuts, raw, Nutritional value per 100 g.

    (Source: USDA National Nutrient data base)
    Principle Nutrient Value Percentage of RDA

    Energy 659 Kcal 33%
    Carbohydrates 11.74 g 9%
    Protein 14.32 g 26%
    Total Fat 67.10 g 221%
    Cholesterol 0 mg 0%
    Dietary Fiber 7.5 g 20%

    Vitamins
    Folates 22 μg 5.5%
    Niacin 0.295 mg 2%
    Pantothenic acid 0.184 mg 3.5%
    Pyridoxine 0.101 mg 8%
    Riboflavin 0.035 mg 3%
    Thiamin 0.617 mg 51%
    Vitamin A 0 IU 0%
    Vitamin C 0.7 μg 1%
    Vitamin E-γ 7.87 mg 52%
    Electrolytes
    Sodium 2 mg 0%
    Potassium 597 mg 13%

    Minerals
    Calcium 160 mg 16%
    Copper 1.743 mg 194%

    Reply
    1. Gary Ogden

      Shaun Clark: Perhaps you didn’t find the complete list of nutrients in the USDA database. According to the USDA database I use, the top ten foods containing selenium, in µg/g are:
      1. Brazil nuts 19.17
      2. Yellowfin tuna 1.08
      3. Orange roughy 0.88
      4. Chicken liver 0.83
      5. Sunflower seeds 0.79
      6. Rockfish 0.76
      7. Lobster 0.73
      8. Swordfish 0.68
      9. Oyster, cooked 0.66
      10. Bacon 0.62

      Reply
    2. Phil Craddock

      Shaun: I get my brazil nuts from Sainsburys in the UK and the packet specifically states that these are high in selenium – 175 μg per 100g.

      BTW – with carbs at 11.74%, I guess your nuts must have a sugar coating! By comparison, mine are only 3.3%.

      Reply
      1. Gary Ogden

        Phil Craddock: The USDA nutrient database says that Brazil nuts contain more than ten times (1917µg/100g) the amount listed on your package. Don’t know what to make of this!

        Reply
  117. AhNotepad

    Today’s UK figures show 563 deaths today. On Radio 4 Inside Science they were discussing the figures and one made the statement that the figures were slowing down because of the government steps. They did not have today’s figures. The point I am making is that figures are picked and claims made as to what has influenced the figures, but no evidence is used, just the methods outlined in “Doctoring Data”.

    Reply
    1. jillm

      Update from Queensland. Population over 5 million. Deaths from COVID-19. 3. Not up to one in a million yet.

      Reply
  118. shirley3349

    Regarding Richard Hall’s post above, the retired German lung disease specialist, Wolfgang Wodarg, has claimed that the basic virological research, which would give definitive proof that the SARS CoV 2 virus is the real cause of the current epidemic, has not yet been done, due to the urgency of the situation and lack of time for the traditional method of culturing sufficient virus and testing for its effects on animals. This means SARS CoV 2 might simply be along for the ride and the real cause of the current epidemic has still to be found. This would explain the very poor, if any, correlation between positive PCR tests and serious lung disease.

    Wodarg has also claimed that SARS CoV 2 is not a new virus, but is most probably one among several which have been circulating in Asia and Europe since 2003, especially among bats. These viruses may have caused disease in humans before but have not been specifically identified, because there are over 100 different viruses known to affect the lungs, of which about 5 – 15% are coronaviruses, and because the identity of the virus does not alter the treatment. Previous experience of the virus could account for the quick development of immunity in many people infected in the current epidemic. Also the PCR test, used to identify the virus in China, was developed in Berlin and based on a test originally devised to identify the virus in European (Bulgarian) bats. There now seems to be a bitter dispute between Wodarg and the developers over whether this test is in fact specific to SARS Cov 2.

    As a former nurse, I remember that viral diseases in the 1980 s were usually treated blind, because by the time the virology results came back, the patient was usually no longer in the hospital. Acyclovir was then the new wonder drug: some patients responded brilliantly, others, with similar signs and symptoms, did not.

    I. like most people, have little understanding of the complexities of virology, so I hope I have represented the gist of the above arguments accurately. Wodarg appears to speak very good English: certainly the English subtitles of one of his YouTube talks are far more accurate than is normal. My account above also uses material from his other YouTube talks and interviews, which unfortunately are not available with English subtitles.

    Reply
  119. chris c

    News From The Middle Of Nowhere

    Last I looked there were about 120 cases of Covid 19 in Suffolk and 130 in Norfolk.

    The supermarket now has security guards who make you queue 2 metres apart until they let you in one at a time. A slight relaxation of some restrictions – Anchor butter back on the shelf. No 85% chocolate but some Lindt and Godiva 90%. I noticed most Fairtrade products are now nonexistent. Still no oatcakes. I don’t for a minute expect the Nairns factory closed down and switched to making ventilators. Obviously someone has decided we must only have biscuits containing wheat. Who is making these restrictions – the Government? Dieticians?

    I’ve heard of people elsewhere being told they cannot buy certain items even though they are on the shelf because they are “not essential”.

    The town shops have now been restricted to opening only in the morning. Yeah that’s going to help, making twice as many people go into town at the same time. The butcher made us stand outside and only go in one at a time. The veg shop permitted two people. There was an enormous queue all down the Thoroughfare to the Post Office, all dutifully standing two metres apart.

    The toilets in the supermarket are still closed, though strangely the public toilets in town have been reopened . . .for now.

    We are soon approaching the time when I would go round the garden centres and plant nurseries. By next year they will all have closed down. Later in the year I use a couple of retired farmers who grow runner beans and sell them and other veggies from roadside stalls. I suspect they will be gone too. At least the fish van is still delivering.

    Most of the Covid 19 deaths appear to have been in places with high levels of pollution. London definitely, how about the West Midlands? That was pretty polluted in parts when I went through in my truck on the M5/M6. By comparison we have particularly high air quality here, is that a factor in the low number of deaths, most in Essex? We also have a lot of high quality food, this week rump steak with purple sprouting broccoli, lamb chops with Brussels sprouts, lamb’s liver with bacon, mushrooms and one or other of the greens, salmon with frozen peas, prawns and cashew nuts fried in coconut oil with multicoloured peppers, chilles and garlic, etc. and of course going out in the sun every day. So far so good . . .

    Reply
  120. David Bailey

    This is an open Letter from Dr. Sucharit Bhakdi, Professor Emeritus of Medical Microbiology at the Johannes Gutenberg University Mainz, to the German Chancellor Dr. Angela Merkel.

    https://off-guardian.org/2020/03/31/open-letter-from-prof-sucharit-bhakdi-to-chancellor-merkel/

    He frames his text as a series of 5 questions, I’ll just quote the first two. I encourage everyone here to read the complete letter.

    1. Statistics

    In infectiology – founded by Robert Koch himself – a traditional distinction is made between infection and disease. An illness requires a clinical manifestation. [1] Therefore, only patients with symptoms such as fever or cough should be included in the statistics as new cases.

    In other words, a new infection – as measured by the COVID-19 test – does not necessarily mean that we are dealing with a newly ill patient who needs a hospital bed. However, it is currently assumed that five percent of all infected people become seriously ill and require ventilation. Projections based on this estimate suggest that the healthcare system could be overburdened.

    My question: Did the projections make a distinction between symptom-free infected people and actual, sick patients – i.e. people who develop symptoms?

    2. Dangerousness

    A number of coronaviruses have been circulating for a long time – largely unnoticed by the media. [2] If it should turn out that the COVID-19 virus should not be ascribed a significantly higher risk potential than the already circulating corona viruses, all countermeasures would obviously become unnecessary.

    The internationally recognized International Journal of Antimicrobial Agents will soon publish a paper that addresses exactly this question. Preliminary results of the study can already be seen today and lead to the conclusion that the new virus is NOT different from traditional corona viruses in terms of dangerousness. The authors express this in the title of their paper “SARS-CoV-2: Fear versus Data.” [3]

    My question: How does the current workload of intensive care units with patients with diagnosed COVID-19 compare to other coronavirus infections, and to what extent will this data be taken into account in further decision-making by the federal government? In addition: Has the above study been taken into account in the planning so far? Here too, of course, „diagnosed“ means that the virus plays a decisive role in the patient’s state of illness, and not that previous illnesses play a greater role.

    Reply
    1. markheller13

      Very interesting letter, thank you for sharing.

      The one thing that does seem to be missing here though is consideration of the rate of transmission.

      Even if COVID-19 turns out to be no more dangerous than other coronaviruses, it seems to have a much higher rate of transmission than other viruses (e.g. flu~1.3, COVID-19~2.5-3). Whilst this does not mean per se that it will kill more people, it does mean that infection spreads much more quickly, potentially overwhelming healthcare systems, leading to many more people (both with and without COVID-19) dying, who could otherwise have been saved.

      Based on this, the twin strategies of social distancing, and testing/isolating/tracing do seem sensible.

      Reply
      1. Martin Back

        Good point. Effectively the coronavirus is bringing forward the deaths. Later after the pandemic has passed the death rate should be below normal as those who would have died in the post-pandemic period would be already resting in an urn on the mantelpiece.

        Reply
      2. David Bailey

        I suspect even the transmission rate must be in doubt. The fact is, that the more testing that is done, the more cases are uncovered, so looking at the simple number of cases may be highly misleading. I’d guess this bug has been around for a lot longer than 6 months.

        There can be nothing sensible about social distancing, it must either be a measure of absolute last resort, or it is unjustified. I am sure that the stress from lost jobs etc will produce more heart attacks and more suicides. Those who simply stay at home, will also probably do much less exercise, and some will turn to drink. There will be an appalling cost from this action, not even including the financial cost!

        Reply
      3. markheller13

        David, I agree absolutely that more testing must be done, but in the UK at least, we don’t currently have the capacity to do that, so we’re left with social distancing as our main weapon against the virus.

        Of course, as you say, social distancing has significant harms, but you must compare those harms to the harms of NOT doing it, i.e. catastrophic, and unnecessary loss of life.

        You’re right that the number of diagnosed cases is not a good metric for the spread of the virus, but hospital admissions and deaths are, and these show exponential upward growth in most countries. I’m not sure how the virus could have been around undetected for a lot longer than 6 months, but I’d be interested if you have information/evidence supporting that?

        Reply
        1. Sasha

          I think that “catastrophic and unnecessary loss of life” is more of your impression rather than what’s actually happening on the ground. Talk to the docs who are in ICUs every day

          Reply
      4. andy

        Hi mark, re transmission
        Transmission must be high in New York city possibly resulting from congested living spaces. Locking down and isolating people by force in skyscraper condos could be easily achieved since there is only one main exit.

        Reply
      5. markheller13

        Sasha, that comment was my view of what would happen if the virus were left unchecked by the absence of social distancing… But I do accept that it’s very hypothetical!

        Reply
        1. Sasha

          Mark: I assumed it’s very hypothetical. That’s why I suggested you talk to the people on the frontlines. I do, however, think that when you talk of “catastrophic and unnecessary loss of life”, it might be useful to follow it up with: “this is all my very hypothetical point of view”. Or something to that effect… This also just my opinion, of course.

          Reply
      6. markheller13

        Sasha, thanks for taking the time to respond. I have to respectfully disagree though – while it’s hypothetical just how much worse things could become without social distancing, the situation is already catastrophic in many countries, including the UK. Please look at BBC reports like this one – ICU staff saying they’re fighting a war, and they’ve never seen anything like this before:
        https://www.bbc.co.uk/news/av/health-52190961/coronavirus-inside-an-icu-fighting-covid-19

        And this is being repeated around the world where frontline health workers are facing unimaginable conditions – in Italy alone, 5000 healthcare workers have been infected with COVID-19, with nearly 50 deaths, and two suicides.

        Reply
        1. Sasha

          Mark: thanks for the link. I don’t rely on mass media for information. I prefer to talk to people who are facing it every day. I spoke to two anesthesiologists so far and will probably talk to a third one. Covid is nasty but the solutions being advocated are quite insane, IMO. How much death and suffering social isolation will cause? You’re basing your analysis on hypothetical covid mortality numbers vs what?

          And if there’s ever a mandatory vaccine requirement that comes out of this, it will be quite a tragic development, I think.

          There are people trained to assess risk. It would be interesting if they ever do post-covid analysis but I wonder if it’s even possible. The amount of data may be simply too much.

          There’s a good book “Risk Savvy” written by a PhD who assesses risk for a living. It’s a very good book. He did post 9/11 analysis of 2002, the year many Americans were afraid of flying and chose to drive more instead. The problem is: most of us aren’t trained to assess risk properly and we don’t know that driving is a much more dangerous activity than flying. In that year 1,500 more people died from driving than would die otherwise, if people had maintained their regular driving habits. This number is approximately 50% of the total 9/11 casualties, by the way.

          Reply
      7. markheller13

        Sasha, thanks for your reply, and for the very interesting points you’ve made.

        I agree that we’re generally not very rational when it comes to risk management – people tend to be very good at working out the risks of taking a particular action, but not so good at assessing the competing risks of not taking the action (and then comparing the two).

        Your example about people choosing not to fly post 9/11 is interesting – on one level we could say that the decision to drive instead of flying was not rational. However, that would be based on the assumption that the objective was to minimise the chances of dying, which may not have been the case… For some people, avoiding highly stressful and potentially traumatic situations like flying may have been more important than the (slightly) higher chance of dying on the roads – in which case you could argue that the decision was (intentionally or unintentionally) quite rational.

        As for COVID-19, the damage caused by social isolation and lock-down is clearly huge, now and for many more years. But, the alternative of not doing it, is surely unacceptable, since we would end up in a situation where our healthcare system was overwhelmed, and many people – with and without COVID-19 – would die unnecessarily.

        I don’t think any country would tolerate such a situation, and so it seems to me that the only short-term option (in the absence of an effective vaccine, or widespread testing capability) is exactly what we’re doing – despite the heavy costs it will entail.

        Reply
  121. AhNotepad

    I’m accused of spreading BS by some who appear to find it difficult to have a reasoned (and polite) discussion. Well if I am spreading BS, so is the BBC (ok, ok, stop laughing, settle down).

    This from the BBC

    ”Google’s launch comes a day after EU justice chief Vera Jourova called on the tech giants to share more data with scientists trying to combat the virus.

    She also criticised them for not doing more to crack down on false information.

    “We still see that the major platforms continue to monetise and incentivise disinformation and harmful content about the pandemic by hosting online ads,” said the commissioner.

    “This should be stopped. The financial disincentives from clickbait disinformation and profiteering scams also should be stopped.””

    False information is that which does not agree with the official narrative.

    Reply
    1. Sasha

      RFK Jr recently posted that Mailchimp deactivated their account for “spamming” even though he is as far from spamming as you be. He runs Children Defense Fund and does a lot of work around the vaccine issue

      Reply
  122. Martin Back

    Remember that 40 tons of vitamin C shipped to Wuhan? The story seems to have vanished without a trace.

    I did a few sums. 1000 grams = 1 kilogram. 1000 kilograms = 1 ton.
    Therefore, 1 ton = 1000 x 1000 = 1 million grams
    So 40 tons of vitamin C is 40 million grams
    Now Wuhan has a population of 12 million.
    Let’s say 10% i.e. 1.2 million need vitamin C @ 10 grams per day
    So the vitamin C requirement is 1.2 million x 10 grams = 12 million grams / day
    So the 40 tons will last 40 million / 12 million = 3.3 days
    If they were doing 400 tons a month, every month, that would be impressive.
    40 tons? Not so much.

    Reply
    1. AhNotepad

      Yolanda, thank you for that very long read. It’s a pity it will be ignored by the dictators, er I mean, caring governments.

      Reply
      1. Yolanda

        Lol, caring governments? Isn’t that a contradiction in terms? Johnson doesn’t strike me as a chap who would actually care about my poor old nan, the dutch prime minister dito.

        Cheerio!

        Reply
  123. Umberto Ucelli

    “If you, or a loved one, is seriously ill, I would urge you to ask for – one or the other – to be used. Hydroxychloroquine has fewer side effects (drug related adverse effects)”

    Well ,

    First there is no evidence it works clinically.

    The latest randomized, unblinded study from China (31 + 31 patients) fails to show the two groups were matched for severity and comorbidities.

    Another short Chinese study finds no difference (small hence not sure it worketh not, but should it be a magic bullet it should’ve shown.

    There also was evidence chloroquine or OH-CLQ worked in vitro against Chikungunya , yet it made patients worse according to one study.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977261/

    30 severe side effects 10 ICU adlissions at least and 3 deaths reported in France with self or pirate treatment with hydroxychloroquine
    https://www.sudouest.fr/2020/03/30/automedication-a-l-hydroxychloroquine-des-effets-secondaires-tres-graves-voire-fatals-met-en-garde-l-ars-7373823-11000.php
    http://www.leparisien.fr/societe/covid-19-l-ansm-alerte-sur-les-effets-secondaires-graves-des-traitements-apres-3-deces-30-03-2020-8291049.php

    For a disease that is benign for most.

    ECG before and under treatment is a minimum especially adding another QT prolonging agent such as azithromycine ar raoult does.

    Reply
  124. Dr. John H

    The 2017/18 flu season was a bad one:

    From the CDC website:
    “The overall burden of influenza for the 2017-2018 season was an estimated 45 million influenza illnesses, 21 million influenza-associated medical visits, 810,000 influenza-related hospitalizations, and 61,000 influenza-associated deaths”
    https://www.cdc.gov/flu/about/burden/2017-2018.htm

    “In 2018 hospitals all across the United States were full to capacity with flu patients. Alabama declared a state of emergency. Elective surgeries were cancelled, patients were turned away. California hospitals were “war zones” where people were treated in hastily erected tents.”
    https://off-guardian.org/2020/04/02/coronavirus-fact-check-1-flu-doesnt-overwhelm-our-hospitals/

    Why is the Coronavirus supposed to be worse than that?

    Reply
    1. Umberto Ucelli

      Maybe the flu figures are overblown ?
      Tom Jefferson , authpor of many Cochrane (old style) reviews on Influenza vaccine and crookerymivir wrote somewhere that flu deaths numbers couldn’t be true

      Reply
  125. andy

    Who would have a better chance of surviving covid19: an optimist or a pessimist?
    Early mortality predictor = stress burden + virus
    Chronic stress suppresses immune response
    Chronic stressors: Biological + Psychological + Medical
    Old people have senescent immune system
    Some Biological stress factors: Age, heart disease, cancer, obesity, diabetes, malnutrition
    Some Psychological stress inducers: hopelessness, isolation, depression, medication, sickness

    Can’t blame everything on a virus.

    Reply
    1. AhNotepad

      andy, shock! horror! What do you mean “you can’t blame everything on the virus? Of course you can, if you are a epidemiologist/statistician/professor/have cocked it up on previous occasions. Did I mention NF? And you have a bunch of totally unquestioning ministers who are as gullible as they come, and have little or no ability to look at history. This is despite many of them whose only qualification is in history.

      Reply
      1. andy

        Hi AhN, politicians need a quick exit strategy from the lockdown and the solution could be to blame our own genes. People died because of bad genes. Opposition might come from companies betting on vaccines.

        https://www.medpagetoday.com/infectiousdisease/covid19/85783?xid=nl_mpt_DHE_2020-04-04&eun=g1182305d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202020-04-04&utm_term=NL_Daily_DHE_dual-gmail-definition
        “Why are some people with the SARS-CoV-2 coronavirus that causes COVID-19 so ill while others barely notice the infection?”
        “This observation, referred to as “differential susceptibility,” is known to be attributable not only to socioeconomic factors (which clearly play a role), but also to genetic differences (otherwise known as genetic polymorphisms) that together with environmental factors, human-virus interactions, gender, perhaps blood type, and age-related senescence determine the immune response and the likelihood of developing disease.”

        Reply
        1. AhNotepad

          Phew! Thank goodness it’s the patients fault, and if they went out shopping instead of starving at home (because i they had enough at home they must be hoarders), it was self inflicted. When the vaccine comes it will not be the vaccines fault if they die, did I mention the swine flu vaccine caused so many problems it was withdrawn? This one will be much safer, so safe in fact, that it will as you say, be the genes wot done it. I have a belief that it is the immune system that is the main factor, and particularly vitamin C, as that is the fuel source for white blood cells, and enough good quality sleep. Which is why you just don’t want health staff getting exhausted. But what do I know?

          Reply
      2. AhNotepad

        At the bottom of the greenmedinfo article is https://youtu.be/OrKzCQdgixs which explains the brainwashing to enforce the communist Stasi system of social shaming, reporting on neighbours to make people do as they are told. It is irrelevant if the consequences are worse than the disease.

        Reply
    2. chris c

      As we all know (!) all side effects from statins come from the Nocebo effect and not because they shut down the entire mevalonate pathway.

      I wonder how much of a nocebo effect there is from telling everyone we are all going to die . . .

      Reply
  126. mmec7

    Circle Bath Hospital
    March 23 at 4:09 PM ·
    We are proud to be supporting the fight against COVID-19. Circle Health and BMI Healthcare agreed a formal partnership with NHS England to support the national partnership with NHS England to support the national effort to tackle COVID-19 by offering all 2,500 beds, including specialised intensive care beds, across the Group’s 54 hospitals and clinics.

    This wide-ranging agreement provides additional capacity for urgent and important treatments that normally take place in NHS hospitals, makes the Group’s state of the art equipment available, and facilitates training programmes to broaden the services that can be undertaken in our hospitals.

    In addition, Circle has two hospitals in China and their team of clinicians there are providing shared learning and supplies with the UK team based on their experience of Covid-19 in China.

    Circle CEO Paolo Pieri and BMI CEO Karen Prins said: “Nothing matters more than getting vulnerable patients the treatment they need, and all sectors and industries have agreed to pull together in this national effort. We stand ready to support the NHS in any way we can at this time of national crisis.”
    (They have a terrific radiology department – )

    Reply
  127. Stuart Baggott

    I just came across this ….IN THE MIDST OF THE SARS-CoV-2 PANDEMIA, CAUTION IS NEEDED WITH COMMONLY USED DRUGS THAT INCREASE THE RISK OF PNEUMONIA. by Joan-Ramon Laporte, M.D. and David Healy MD FRCPsych and thought it worth sharing. I have no idea if the information included is good science and will leave it up to others who can look at the science to decide. Malcolm feel free to decide not to post.
    https://rxisk.org/medications-compromising-covid-infections/?fbclid=IwAR35KMoLmn-CA2NKcdHzQuLbXJvOpmriKs-pU8vxNPZC2ZI1SEBJV9DN4Is

    Reply