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Weekend reading: Stuck in the middle with you

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What caught my eye this week.

The lockdown continues, with the predictable result that the global economy has fallen off a cliff in barely a fortnight.

I’ll repeat again – we cannot take many months of this.

I continue to have doubts about how we’re approaching this crisis, whilst conceding most policy makers are striving to do the right thing with incomplete data and faced with horrible choices. It’s easy for pundits with blogs to speculate about alternative approaches. Rather different if you hold people’s lives in your hands.

Anyway, the links below – offering several different perspectives – cover where we’re at.

To be honest, social distancing rather suits me. I know others are finding it very tough going. Extroverts have owned the world for 30 years, and being asked to sit in a quiet room alone is alien. And nearly all of us could do with putting an arm around a friend again.

I thought the Farnham Street blog had a nice take on making the best of things:

What’s important is that you find an activity that lets you move past fear and panic, to reconnect with what gives your life meaning.

When you engage with an activity that gives you pleasure and releases negative emotions, it allows you to rediscover what is important to you.

Wouldn’t that be a wonderful dividend from disaster, even as cash dividends are cancelled?

The markets continue to do their thing. While the plunge was heart-stopping, I don’t think many shares are at bargain basement levels. With rates at zero and only a year’s worth of profits definitely set to be eviscerated, maybe they shouldn’t be? I’m not worried about most of my investments on even a medium-term view, let alone the long-term.1

This weekend will be hard. The sun will be out. Doctors and nurses will again be going into the trenches while most of us hide it out safe behind the lines.

Whatever one’s personal feelings about the universal lockdown strategy, it’s the path we’re on. Let’s hang tough.

I’m pretty confident in a year we will be talking about defusing capital gains tax and filling our ISAs, just so long as the economy isn’t utterly derailed.

Happy quarantine!

From Monevator

What has changed and what has not – Monevator

From the archive-ator: How talking about money is like French kissing – Monevator

News

Note: Some links are Google search results – in PC/desktop view you can click to read the piece without being a paid subscriber. Try privacy/incognito mode to avoid cookies. Consider subscribing if you read them a lot!2

Economists warn of ‘unprecedented’ recession as PMI hits record low [Search result]FT

950,000 apply for universal credit in first two weeks of UK lockdown – BBC

UK banks banned from requesting personal guarantees for loans – Guardian

One in 15 people in London may already be infected with the coronavirus [Search result]FT

Loan and credit card payments to be frozen for three months in UK – Guardian

Coronavirus crisis: your financial rights [Search result]FT

Global lay-offs surge as 6.6m Americans file jobless claims – FT

Products and services

Six things you need to know if you’re applying for Universal Credit – ThisIsMoney

Robo-adviser results: Nutmeg and Wealthify vs Vanguard year 2 – Much More With Less

Surge in investment account openings on UK platforms [Search results]FT

Beware of Google ads for ‘bonds’ touting mouth-watering returns – ThisIsMoney

Victorian gothic homes [Gallery]Guardian

Comment and opinion

When dollar-cost averaging matters the most – A Wealth of Common Sense

The majority of Vanguard investors are holding steady during the crisis [Data]Vanguard

Recovering from the coma – Investing Caffeine

Was that the bottom? – Of Dollars and Data

Barry Ritholtz: Maybe the coronavirus didn’t end the bull market? – Yahoo

This too shall pass – Humble Dollar

Rebalancing Vs taxes Vs expenses Vs life – Retirement Investing Today

Simon Lambert: Why are the airlines making it so difficult to get coronavirus refunds? – ThisIsMoney

Financial Independence and the virus mini special

They all retired before they hit 40. And then this happened – New York Times

The implausible millennial movement to save, invest, and quit the workplace – Vox

Naughty corner: Active antics

Dabbling with discounts – IT Investor

Which way now? [PDF]Howard Marks

Terry Smith: my scepticism of value stocks was proven correct in market sell-off – Money Observer

Developing a buying policy for the bear market – Simple Living in Somerset

The limits to lessons from past bear markets – Validea

COVID-19 corner

Just how deadly is the virus, really? – BBC

Why death and fatality rates differ – BBC

Test and trace with Apple and Google – TechCrunch

The math behind social distancing – Visual Capitalist

With this virus, a majority of ventilated patients are not coming off the machines / are dying – NPR

How NHS Nightingale was built in just nine days – BBC

The cost of compassion: Every life saved sees the US foregoing $1m in economic activity – Mr Money Mustache

Tim Harford: How do we value a statistical life? – FT

The real reason epidemiologists and economists keep arguing – Bloomberg

Why it’s so freaking hard to make a good COVID-19 model… – FiveThirtyEight

…although with that said… in praise of models – The Atlantic

We may be underestimating the COVID-19 death toll – Bloomberg

Will the economy ever get back to normal? – The Reformed Broker

Submariners likely unaware of global pandemic – Associated Press

Kindle book bargains

Remote: Office Not Required by David Heinemeier Hansson and Jason Fried – £0.99 on Kindle

Tin Can Cook: 75 Simple Store-cupboard Recipes by Jack Monro – £0.99 on Kindle

Side Hustle: Build a Side Business and Make Extra Money by Chris Guillebeau – £0.99 on Kindle

Elon Musk: How the Billionaire CEO of SpaceX and Tesla is Shaping our Future by Ashlee Vance – £1.99 on Kindle

Off our beat

Why time has slowed – Morgan Housel

Will the coronavirus kill AirBnB? – NY Mag

Live for today, plan for a better business tomorrow – Michael Katz

The Zoom privacy backlash is only just getting started – WIRED

And finally…

“Without us, Earth will abide and endure; without her, however, we could not even be.”
– Alan Weisman, The World Without Us

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  1. This future is unevenly distributed among different companies. Also you need to factor in some disruption impact for everyone. And if we get into a 3-6 month long lockdown like today’s and with it a depression, all bets are off. My belief is that politicians (and the public) will demand the economy is switched back on before that happens, rightly or wrongly from a medical point of view. []
  2. Note some articles can only be accessed through the search results if you’re using PC/desktop view (from mobile/tablet view they bring up the firewall/subscription page). To circumvent, switch your mobile browser to use the desktop view. On Chrome for Android: press the menu button followed by “Request Desktop Site”. []

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{ 194 comments… add one }
  • 101 Vanguardfan April 6, 2020, 11:50 am

    ‘The indefinite lockdown while waiting for vaccine supported by so many’ – I haven’t had the impression that this is a widely ‘supported’ strategy at all. More that people are desperately trying to find a way through that allows relaxation of the lockdown, as soon as proves possible. It’s just a recognition that the last five words there are the tricky bit. The last thing we want is to stop the distancing too soon and unleash a greater surge.

    I struggle to understand why you feel that the policy response is in danger of being balanced too far in favour of privileging lives over money. There are very very strong forces pushing to restart/renormalise the economy, everybody wants it, of course, so I think the risk is far greater that we will do it too soon than leave it too late (we were late to act precisely because people didn’t want to damage the economy unnecessarily). It’s proving hard enough to get some people to comply with things that are easy enough to comply with (don’t sit around sunbathing in a public park; and there a groups of young men roaming my town deliberately bumping in to people).

  • 102 Naeclue April 6, 2020, 12:09 pm

    A good article from the point of view that this is how the cost/benefit tradeoff should be done, but alas, hugely oversimplified. In addition to ZXSpectrum’s comments which I totally agree with, where are the QALY’s that will be gained from the lockdown? Reduced car accidents, fewer seasonal flu deaths, etc.

    But then he totally blows any credibility by agreeing with his 92 year old mother. I have elderly relatives who had a very similar attitude until I diplomatically pointed out the selfishness of their action. Flouting lockdown because you don’t value your own life is analogous to the difference between topping yourself by taking an overdose and driving down the motorway at 120mph then closing your eyes when you see you are approaching a large group of cars.

  • 103 The Investor April 6, 2020, 12:22 pm

    @Vanguardfan — Just quickly on this: “I struggle to understand why you feel that the policy response is in danger of being balanced too far in favour of privileging lives over money.”

    As I’ve repeatedly tried to stress and this article does again, it’s not *only* about lives over money. It’s about lives over lives.

    If as per the doctors’ (likely inflated) calculations the cost of lockdown is say 10x greater than NICE guidelines, this gives us an indication of how spending now on mostly getting a few more years for the very old will cost many more years for the very young. (And less dramatically less elective treatment on the NHS, money for things like psychiatric treatment for depression etc). As we’ve all agreed these numbers can be taken in any direction one wants to make one’s point and it’s all hugely subjective, but the point is it’s not just lives versus money.

    Again, as per the BBC article, the academic quoted in there put the cost of lockdown of *lives* lost as greater than his estimated lives saved from COVID at a GDP drawdown of c. 6.5%.

    @Naeclue — Fair points. On the other hand as I say he doesn’t account for permanently lost GDP. Also if you really want to go down the appalling QALY calculus rabbit hole (and I’m glad it’s not my job to 🙁 ) then say an 85-year in permanent hospital care dying a year early would release a lot of money to spend on a young person, so you would get massively more QALYs that way. (Based on, from memory, spending on the old on healthcare being 6-10x that spent on young).

    As @ZX has noted, we simplify this stuff at our peril from our armchairs.

    Perhaps I’m betraying my instinctively slightly socially left-wing bias / reading / friend circles as usual and this stuff is being discussed much more widely in the right-wing press than I’ve noted. A friend sent me a similar Tweet from Toby Young, who exists in a circle I don’t like to find myself.

    But anyway, this blog post from the doctor, imperfectly, is one of the only ones I’ve seen trying to publicly discuss these issues.

  • 104 Grumpy Old Paul April 6, 2020, 12:35 pm

    @ZXSpectrum48k,
    I don’t claim any particular expertise or intellectual firepower but as soon as I began reading Dr. Kendrick’s analysis, I immediately seized on his use of £350 billion as being absurd for the reasons that you state. What astonished me was that I didn’t notice any comments challenging it!
    So I’ll do a finger in the air job and say let’s assume that the actual net cost of the package is £35 billion then the good doctor’s revised estimates become:

    Best case: £9,720
    Most likely: £38,888
    Least case: £729,166

    Obviously, any digits following the most significant can be ignored and replaced by zero! Really appreciate your evidence-based comments.

    As always, to all who post, regardless of opinion, stay well!

  • 105 Vanguardfan April 6, 2020, 12:40 pm

    @TI ok sloppy wording (lives vs money), that was not the main thrust of my point, so let’s not get distracted. My main point is that it’s obvious that lockdown is undesirable, and that we need to get out of it when we can. So I see everywhere the pressure to get going rather than pressure to stop unnecessarily. I don’t think ignoring the virus would ultimate work for the economy either. But most of all I think that human life is not just about how we contribute to economic life. The economy should be there to support humanity, whereas I feel some people see it as the other way around, or at least as almost interchangeable.

  • 106 Snowman April 6, 2020, 12:52 pm

    What I liked about the Malcolm Kendrick article was that it was attempting to numerically quantify the situation. Rather than simply saying that you couldn’t put a cost on a human life, we should be saying you have to put a price on a human life. Government actions will have direct immediate affects on whether people live or die but if we concentrate on those, then we miss that the alternative actions will have indirect long term affects on whether people live or die. Putting a cost on life is in some way just a mechanism for balancing out the direct and indirect affects so that we can live full and fulfilling lives (whatever that means).

    I agree that there are major assumptions in the article. I didn’t really make any attempt to verify the numbers, I find the system is too complex for me to analyse.

    My analysis would be simplistic and wouldn’t particularly include costs to the economy etc.

    If we say the average loss of life expectancy for someone dying from covid-19 was 4 years (I’ve no intuition as to what that figure should be). And let’s say that loss of life expectancy applies to say 2% of the population that die through covid-19, who wouldn’t have died for 4 years on average had another strategy been followed (e.g. wait for a vaccine). Then the average reduction in life expectancy is about 28 days per member of the population (0.02 x 4 x 365).

    Then ask yourself this question. If you were put in the hypothetical situation, that the creator of the universe (imagined or real depending on your disbelief or belief) told you they could lift the lockdown, magic the virus away, but that you would with your fellow citizens all be docked 28 days of your future life. Would you or your fellow citizen take them up on that if the alternative was lockdown for 18 months and all the ramifications of that, some of which might in themselves reduce life expectancy?

    Looking at it that way the do nothing to slow the virus option appears quite attractive.

    What does that miss? It misses the social costs and ethical considerations of allowing 250,000 to die suddenly, rather than do something that meant those 250,000 could enjoy another 4 years of life on average.

    It would be totally inhumane to allow those 250,000 to die over a short period in my view, and I wouldn’t want to live in a society that allowed that to happen. Factor that revulsion into the calculation if you like and increase the 28 day number.

    But trying to cost in the social and ethical issues is very difficult numerically. The government does needs to act in a socially responsibly and ethical way (e.g. lockdown currently) but with some balance as to the long term ramifications going forward.

  • 107 Naeclue April 6, 2020, 2:51 pm

    Another aspect that really should be included in any quantitative cost/benefit analysis is the extent to which spending now may reduce spending in later, potentially far more dangerous, pandemics. Goodness only knows how valid any assumptions will be on including this, but it is reasonable to expect that part of current spending will result in reduced spending next time compared with just shrugging our shoulders now and saying “too expensive”.

  • 108 Naeclue April 6, 2020, 3:21 pm

    Another way that we can all help mitigate the cost (in lives and ££s) of this that I have not seen pushed by the government (other than saying exercise once per day) is to take extra care over our own health. Matthew Walker, sleep evangelist, would advise everyone to do their best to get a good night’s sleep as that would greatly benefit our sleep deprived immune systems and help us to avoid becoming obese. We could consume less alcohol and caffeine, which would help significantly with the sleep. Those of us with more time on our hands could prepare and eat more healthy meals. Those addicted to tobacco could make an extra effort to get off it. Quitting smoking would not only improve our collective health, but also improve our bank balances.

    Many would doubtless ignore the advice and complain of the “Nanny state” telling them what to do and do the opposite, but that makes it more important for the more responsible amongst us to make an extra effort to stay healthy.

    We are certainly eating better, assisted by our currently resident offspring and their partners who eat better than we used to by default, but I have also cut down on the alcohol and don’t touch anything with caffeine (including decaf tea/coffee) in it after about 4pm.

  • 109 MrOptimistic April 6, 2020, 4:34 pm

    When someone gets the chance, could they educate me on something ( helicopter money reminded me of my ignorance). All the talk about central banks buying up bonds and expanding their balance sheets. What stops them from just hitting the computer button and setting them to zero? Holders of bonds still get paid so no default, no new real money is injected into the economy so no inflation. I must be holding the wrong end of the stick but don’t see how.

  • 110 xxd09 April 6, 2020, 5:13 pm

    Re Mr Kendrick
    The stimulus is 350 bn not 3.5 bn-cost per qualy is not 97k is 97m
    Most of stimulus in Loan form so not expenditure. It’s providing liquidity-cannot use apples and pears in an analysis
    Maths aside -resources are finite even where saving life is concerned
    Doctors been doing it for years
    xxd09

  • 111 Grumpy Old Man April 6, 2020, 7:02 pm

    I think the good doctor erroneously put ‘3.5bn’ in brackets but performed the calculation using 350bn!

  • 112 Penelope April 6, 2020, 8:04 pm

    There seems to be a bit of an Imperial old boys network here dominating debate and shutting down valid questions. Makes you wonder…

  • 113 Passive Pete April 7, 2020, 8:29 am

    I learned a lot from reading Matthew Walker’s book too, I read it after @TI recommended it. However I think I lost sleep initially after reading it, as I was worrying about not getting enough!
    A couple of other fascinating books if anyone’s got some time on their hands; The Madness of Crowds by Douglas Murray and Sapiens by Yuval Noah Harari.

  • 114 The Investor April 7, 2020, 9:15 am

    @Penelope — No it doesn’t. Most of these commenters are regular readers and contributors below the line for several years. Not sure how serious you are but please don’t infect this site with nonsense conspiracy talk, further such will be deleted. Thank you!

  • 115 Jonathan April 7, 2020, 9:48 am

    The most relevant thing in that Kendrick piece is the illustration of how excess deaths are associated with economic problems. That is the balance that politicians need to be aware of.

    Clearly QALYs are something Dr Kendrick knows well from his own professional work. But actually they were invented for the very specific purpose of allowing a prospective analysis of whether introduction of a new drug (or other medical intervention) would be cost-effective in a resource-limited health service where they would reduce money available for something else. They were not devised for, or indeed appropriate for, individual patient decisions; or for that matter whether a non-medical action (partial salary for furloughed workers) will be effective.

  • 116 Indecisive April 7, 2020, 11:20 am

    @Investor, re #99:
    On putting a price on life, and the economic damage of the shutdown vs continuing, I found this article (in response to Toby Young’s comments) compelling – especially as Sam Bowman (https://twitter.com/s8mb) is a fellow at the Adam Smith Institute, so I (unfairly) was expecting the opposite conclusion.

    https://thecritic.co.uk/why-the-coronavirus-shutdown-is-worth-it/

    It introduced me to the concept of life tables, showing me where my “average life expectancy” fag packet calculations were wrong.

  • 117 ZXSpectrum48k April 7, 2020, 1:57 pm

    At opposite end of the viewpoint, another piece of research (http://www.healthdata.org/covid/updates) puts the UK as the worst country in Europe in terms of deaths. They see a central scenario where deaths in the first wave in the UK (66k+) are equal to Italy, Spain, France and Germany all combined. The reason: lack of hospital beds and ICU capacity.

    I haven’t read this research so it may be totally flawed. I have been on 75+ conference calls on SARS-CoV-2 in the past two months, and it does follow the broad consenus view (especially from Asian experts) who are hugely critical of the UK (even more so that the US). They think we will come out with one of the worst outcomes globally due to the inflexibility of PHE and brittleness of the NHS. Based on that view, they think the UK needs a longer lockdown that many other countries. We were late implementing the lockdown and didn’t see the vulnerability of London given the relevance of viral load to poor health outcomes. We may potentially pay a price in terms of both more deaths and needing a longer lockdown.

  • 118 Boltt April 7, 2020, 3:18 pm

    Wow. Those numbers for the U.K. seem very large.

    UK numbers expected to peak at about 4x current levels, but Spain, France Italy all passed their peak.

    I have little expertise and no facts to add – hopefully the actuals will fair lower than this scenario indicates. (How can I bet against their numbers?)

    B

  • 119 Jaygti April 7, 2020, 3:35 pm

    I haven’t read the above report yet, as I’m at work, but I have read a couple of comments on it, and it may be a dud.

    It says we have only 799 ICU spaces. This is taken from the pre virus total of 4000 total spaces which are generally 4/5ths full.

    It’s not taking into account the clear out of beds and all the extras from private hospitals etc.
    It doesn’t take into account the extra beds at NHS Nightingale etc either.

    So the 66000 deaths may be way off.
    I will read it properly when I get home.

  • 120 ermine April 7, 2020, 4:12 pm

    @ Penelope 112

    > There seems to be a bit of an Imperial old boys network here dominating debate and shutting down valid questions.

    Facts, please. We are in a troubled time at the moment. A disease is stalking the public health. The PM, whatever you think of his politics, in in a NHS hospital in living proof that there is a problem out there. There is insufficient data to draw clear conclusions of how to proceed, because this is new to us.

    You baselessly implied that Imperial, one of the institutions that is trying to bring the light of reason onto the situation was connected with a tobacco manufacturer, where a modicum of time spent with Google would have informed you this is not the case. Your claim was not shut down. It was refuted.

    Conspiracy theories are dangerous. There are morons attacking the mobile data infrastructure that is connecting many people together because of stupid assertions being made on social media. There may be all sorts of things wrong with 5G but it doesn’t spread coronavirus, which is mostly spreading where’s no 5G, because, guess what, there’s not that much 5G about! These twits trashing people’s bog-standard 3G and 4G connections that are their links with their livelihoods, friends and family and threatening people who are trying to do their jobs are antisocial berks and need to be stopped.

    It’s the easiest thing in the world to snarkily posit the the Deep State means things aren’t as they seem, “Makes you wonder…” Much harder to actually make a reasoned argument and subject it to the light of scrutiny, eh?

    FWIW I searched this thread for Imperial, because you claimed debate was being shut down. I did your claim the respect of trying to evaluate the assertion against the evidence, as one should do. Apart from me and others repudiating your baseless assertion about the tobacco industry establishing it, I was unable to detect any debate being shut down. Evidence of your incorrectness was presented from public sources of record. I actually agree with one of the other Imperial alumni that it would be good to have a plurality of modelling – to wit

    > wonder why we haven’t got a panel drawn from across the country’s expertise and more than one model ?

    Reason and intelligence will guide us out of this darkness into the light. Bullshit conspiracy theories seem to scream round the world before reason has got its boots on. They need to be shot down before they deprive necessary discussion of oxygen.

  • 121 ZXSpectrum48k April 7, 2020, 4:18 pm

    @Jaygti. As I said I didn’t read it. The numbers seem very high and, as you point out, may not incorporate the recent additional capacity that is being provided. What it does underline to me is what many foreign experts have said: that the UK was at least two weeks too late on the lockdown, didn’t clamp down hard enough on urban centres, especially London, and remain far too lax on air travel into the UK. We had an advantage of seeing what was going on in some Asian countries who were hit sooner and we blew it.

    It also underlines how we run the NHS with essentially no spare capacity, making it very brittle in any stress scenario. It reminds me of how we build Royal Navy warships these days, using a concept called FFBNW (Fitted for but not with) weapons capacity … because, of course, our enemies will always give us a good year of forewarning of the next war so we can pay for those weapons and fit them in time. Of course this time, our unseen enemy didn’t give us much forewarning and caught us with our pants down.

  • 122 Richard April 7, 2020, 4:29 pm

    I thought the UK lock down was roughly the same time as the Italy lock down in regards to position on the curve. At least from a BBC article. So, other than capacity issues, you would expect UK to have a similar result. And the original plan, as i understand it (and possibly still the plan), was to aim for herd immunity while staying below capacity rather than stamp it out and back to containtment.

  • 123 Matthew April 7, 2020, 4:35 pm

    @zxspec – its surprising though how empty theyve managed to get our (provincial) hospital by stopping all the normal stuff, most wards half empty – shows what can be done. On the other hand my dad who has pneumonia from flu (negative for covid) can’t go in for help when normally he would, and you have people at home with broken bones etc.

    I think if someone is in hospital for a different reason, and doesnt need access to oxygen, they could go to care homes. Hospitals by and large are a convenient place for doctors to visit patients and make sure they are obvserved and medicated, so potentially a lot of that can be done without the building – but of course access to oxygen is another thing.

    I think when london starts overflowing, theyll send them here, to the hick towns, we’re a few weeks behind london so hopefully when we’re overflowing london won’t be and we can ship them there

  • 124 Pendle Witch April 7, 2020, 5:26 pm

    @Penelope.

    Imperial old girl here. I think there were 3 “old boys” identifying above, so not really dominating.

    I’m not sure I saw a valid question from you, so don’t know how they can be shutting anything down. People here are very helpful, sane and logical for the most part, so please ask if you have something relevant!

  • 125 Snowman April 7, 2020, 9:38 pm

    No connection with Imperial at all but these weekly forecasts look interesting

    https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/covid-19-weekly-forecasts/

  • 126 The Investor April 7, 2020, 10:32 pm

    New BMJ study is suggesting 78% are asymptomatic. Note: It’s seemingly based on a very small sample size though:

    http://theconversation.com/coronavirus-bmj-study-suggests-78-dont-show-symptoms-heres-what-that-could-mean-135732

    I continue to infer from what I’ve read and as I’ve stated before that this disease is much more widespread than is commonly / was initially believed, FWIW.

  • 127 MrOptimistic April 7, 2020, 10:58 pm

    The UK national flu reports are worth keeping an eye on. Latest shows a sharp upturn in reports of respiratory incidents from care homes, and ‘ excess deaths’

    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877617/National_influenze_report_2_April_2020_week_14.pdf

  • 128 Richard April 8, 2020, 9:06 am

    @TI anecdotally i would agree it is more wide spread. I know someone who had all the symptoms back in early Feb. Two weeks with shortness of breath, fever etc. Doctors had no idea what it was. Doesn’t live or work in London, not been abroad etc. Good chance all friends and relatives and work colleagues were exposed as no self isolating back then. Could have been something else of course, but doctors couldn’t say and all symptoms in line with those described.

  • 129 Jonathan April 8, 2020, 10:00 am

    @TI, the question of how many asymptomatic cases is crucial but the margin of error seems enormous. Serious estimates have ranged from 25% to this one of nearer 80%. Put that in the context of estimating the total number in the UK affected: whatever you deduce the number of symptomatic cases to be, adding in different proportions of asymptomatic could give total numbers covering a 3-4 fold range. And numbers will at least double before the curve flattens. For anyone planning the exit from restrictions, that either leaves a pool of uninfected who need to be protected from a second peak, or the country already approaching the “herd immunity” point and the likelihood further infections will remain easily within health service capacity.

    Of course lots of us have speculated about possible mild symptoms – we can’t know without a test. My wife and I had a persistent cough without other cold symptoms back at the end of January/beginning of February. It was at the time when that British businessman returning from Singapore infected a chalet in the Alps before others in the UK. We had skiied in that same resort a week before symptoms, but a day or so before the businessman arrived there, and we inevitably asked ourselves if it was possible he had only picked up the virus there and we had done the same.

  • 130 ZXSpectrum48k April 8, 2020, 10:21 am

    We’re dealing with Knightian uncertainty. I’ve listened to 75+ conference call since mid Jan all from experts (WHO, academics, the heads of Covid response teams from many countries, PHE, CDC, economists galore etc). The dispersion of views is staggering. Moreover, the time variation of those views. Some who thought it was a minor issue in late Feb, declare it’s a major issue by late Mar etc. Their ideas of what the correct response is, pivots 180 degrees. Just not enough data and too many variables. A huge lack of quantifiable knowledge.

  • 131 Vanguardfan April 8, 2020, 11:32 am

    A small study from China on antibodies in recovered cases. Not positive news.
    https://www.scmp.com/news/china/science/article/3078840/coronavirus-low-antibody-levels-raise-questions-about

  • 132 Snowman April 8, 2020, 12:26 pm

    Thanks for that link Vanguardfan. Interesting but not encouraging.

    The following article talks about the American serological plans

    https://www.sciencemag.org/news/2020/04/unprecedented-nationwide-blood-studies-seek-track-us-coronavirus-spread#

    I’ve been wondering how they are able to measure the accuracy of tests both antigen and antibody tests, when they at the same time seem to be saying there is no accurate test at the moment even to do low number random testing. What test do you use to check that a proposed test is accurate? Unless you can apply separate independent tests you can’t really calculate the probability of false positives and false positives. And then if someone has had coronavirus symptoms, has travelled in a heavily infected area but tests negative for antibodies, how much less likely are they to have had coronavirus than someone who has had no symptoms, has remained in an area where the infection is limited but who tests positive for antibodies?

  • 133 Vanguardfan April 8, 2020, 12:39 pm

    @snowman. I don’t know enough about the science of the testing process to make sensible comment, although I believe that one of the issues with the antibody test is getting a test specific enough for the Covid19 antibodies (as opposed to antibodies for other antigens). Perhaps a proper scientist will reply.

    With the antigen test it relies on amplification of the viral rna, I think one reason why many false negs are because it’s quite easy to physically miss the viral particles during swabbing – will depend a lot on how much viral load.

    But in any case, I am sure the whole process of inventing reliable and scalable tests for novel pathogens is far from straightforward.

  • 134 Jonathan April 8, 2020, 1:16 pm

    @Vanguardfan, the advantage of the RT-PCR test for virus is that the specificity is due to short pieces of synthetic DNA which can be easily made. Any final year bioscience undergraduate would have been able to devise a test once the virus sequence was published, and most university labs would have been able to carry out small numbers of tests to order (probably several hundred a day; larger institutes and pharmaceutical companies would probably have managed several thousand) if a standard version of the test was agreed and they had been asked. The issue for them would have been the samples which depends on swabs, people who know how to use them reliably, and a good recipe for reliably getting the virus sample off the swab for testing.

    To test for antibodies in blood serum, the specificity would ideally be from having stabilised samples of virus protein for the antibodies to react with. In practice growing up large quantities of virus for that purpose would be difficult and risk big batch variation. So I imagine those working on tests are instead using bits of virus protein created by standard “genetic engineering” methods (using bacteria to produce them). They might have to try a range of viral protein fragments before coming up with a cocktail that will pick up antibodies produced by any individual, and then spend time optimising the test conditions so the tests can be rolled out to multiple laboratories. I am sure there are quite a few decent tests for research studies by now, but standardising them for medical diagnosis is a higher order challenge.

  • 135 WhiteSheep April 8, 2020, 6:46 pm

    The original WHO RT-PCR antigen test was actually put together within a week of the publication of the virus sequence by a team that did not have access to any SARS-CoV-2 samples themselves. They mostly tested on stored samples from the original SARS epidemic. As Jonathan says, technically the test is easy to perform by any molecular biology lab and there will be at least hundreds of labs across the country with the technical capabilities but not the clinical infrastructure. I work for an organisation who would have the technical capabilities (and like ZX I lost track of the number of technical conference calls I have had on Coronavirus in the last weeks). The difficulties are mostly around making the process repeatable, validating it and the handling and tracking of samples and data – no point in reporting accurate test results if I have mixed up which patient the sample came from.

    A key question about the lockdown is not just the cost (which everyone agrees is very high) but *how* to get out of it. I think this is where the conversation should be focused. TI gave a nice list, but as I and others tried to say earlier, a key component would likely be contact tracing (which the UK has abandoned prematurely. and it still does not seem to be discussed very much in the political news) combined with increased testing – even Neil Ferguson himself appears to think so [1].

    On the possibly good news front, here is another estimate (based mostly on data from the Ferguson group) that only 1.2% of cases were detected in the UK by the middle of March and a total case number of greater than 2 million by end of March [2]. Unfortunately still not enough for “herd immunity”.

    [1] https://www.nature.com/articles/d41586-020-01003-6, last paragraph
    [2] https://www.uni-goettingen.de/en/606540.html

  • 136 Sparschwein April 8, 2020, 7:33 pm

    The routine test for active infections is by PCR (actually, quantitative RT-PCR) that detects viral RNA, not an antibody test. Germany has been doing this at 500,000/week scale and the UK has been incapable of ramping it up, although these tests are desperately needed to manage the pandemic. Even NHS staff can hardly get tested.
    PCR is a standard method that has been around for over 2 decades and that is established in most research and diagnostics labs. The know-how and instrumentation is there; of course for a previously unknown virus like this, a new assay needs to be developed. SARS-CoV-2 sequence was published in January, and with that information it’s not very hard to develop a PCR test because the principles of this method are so well known and specific probes can easily be made.
    The method is reliable, sensitive and specific, as long as viral RNA is present (active infection) and captured during the sampling process. As I understand it (and I hope a medical doctor can confirm this), swabbing can miss the virus if the infection has moved deeper into the lungs, but such false negative tests are less problematic because lung infection leads to the characteristic severe symptoms. So most false negatives would be obvious from X-ray and other diagnostics.

    Antibody testing is an entirely different method, that detects a different thing and gives different information. Specificity is a very common problem with antibodies. Positive controls to see if an Ab test works can be simply patients who tested positive by PCR. The negative controls are a bit trickier because of the asymptomatic infections. I suppose there are enough blood samples taken pre-pandemic that could be used.
    Ab tests are no good for identifying those who are infectious. They can identify those who had an undiagnosed SARS-CoV-2 infection and can reasonably be presumed to be protected against the disease for a limited time (perhaps months). But *no one knows yet how long immunity lasts*, and if it entirely prevents re-infection.
    This was one of the fatal flaws in the UK government’s “herd immunity” debacle.

  • 137 Sparschwein April 8, 2020, 7:51 pm

    @Jonathan, you beat me to it. That’s spot-on. The antigens used are indeed recombinant virus proteins, e.g.
    https://doi.org/10.1093/cid/ciaa344

  • 138 Sparschwein April 8, 2020, 8:22 pm

    @WhiteSheep, we’ve heard of many such grassroots initiatives, research institutes working with local hospitals to implement testing. Someone invoked the “Dunkirk spirit”…
    Great initiative, all the best!

  • 139 Vanguardfan April 9, 2020, 9:46 am

    I thought this interesting, if somewhat anecdotal…some careful epidemiological studies of spread would be interesting (they won’t come from the UK though, given that we’ve abandoned contact tracing).
    https://www.theguardian.com/world/2020/apr/09/the-cluster-effect-how-social-gatherings-were-rocket-fuel-for-coronavirus
    I’ve been wondering whether travel restrictions might actually be one of the more effective control strategies. It’s all about separating infected and uninfected, as effectively as possible.

  • 140 Vanguardfan April 9, 2020, 9:48 am

    @sparchswein, that is certainly happening in my locality – local university contributing kit and people to the testing effort.

  • 141 The Investor April 9, 2020, 10:36 am

    @Vanguardfan — That is interesting. Appreciate you and I have different views about the pay-off from easing lockdown measures sooner rather than later, but if these clusters are more than easily spotted hotspots (i.e. if cluster-to-family is a much more important than say spreading via supermarkets and offices) we could find a halfway house.

    As I said in my article above, stopping kissing/handshakes/hugging and mandating more cleaning / handwashing (/masks) might go some distance to curbing spread while still allowing some element of location mobility.

    I suppose one big problem in London and other world cities though is public transport. It’s hard to avoid recreating a very dour party atmosphere on a crowded tube! (On the other hand, perhaps that also means as I suspect that very many Londoners have already got it so not such an issue).

    Could mean lockdown relief can come sooner to rural/car-based areas.

    Schools are another big issue. I had a day dream for a few moments of segregating playtimes by classes etc, but presumably that’s totally unrealistic.

    I still wouldn’t let the very old/vulnerable out for a couple of months, even if I eased. I appreciate there are still issues with carers mixing them and infecting them.

    Just thinking out loud. Fully appreciate this is one article with a lot of journalistic colour, and not enough to move anyone’s needle. 🙂

  • 142 Vanguardfan April 9, 2020, 10:57 am

    This is also interesting, modelling from China about the impact of relaxation of lockdown. Bear in mind that China lockdown is not the same as U.K. lockdown. Stricter, and likely more effective.

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30746-7/fulltext

  • 143 Vanguardfan April 9, 2020, 11:12 am

    @TI, the principle of control of any communicable disease, absent effective vaccines or treatments, rests entirely on breaking the chain of infection, and this can only be done by separating infected from uninfected. This principle has been the basis of outbreak control for centuries, and fundamentally this outbreak is just the same. Quarantine measure at individual and group level are essentially the only control tool we have.

    Of course the effectiveness of separation measures depends a lot on the type of contact that is needed to transmit disease, and crucially the role of asymptomatic spreaders. So with Ebola, very close contact is needed. And with the earlier SARS outbreak, only those with symptoms were infectious, making both of these easier to contain. Unfortunately with this agent, the ease of transmission means that more strenuous separation efforts are required to control it, which is why we are where we are.

    So really, the question is, how can we reintroduce economic activity while maintaining effective separation. (Bearing in mind we don’t quite know yet how effective our own separation measures have been).

  • 144 Snowman April 9, 2020, 12:19 pm

    https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt.pdf

    Interesting (mainly) serological study in Gangelt, a city in the German Heinsberg district where they did an antibody and antigen test on a representative sample of the roughly 12,500 population.

    About 14% tested positive under the antibody test and 2% tested positive under the antigen test, and 15% were estimated to have or had had the virus (due to crossover it’s not 16% I think).

    This is one of the worst affected areas of Germany, and not sure what date the conclusions apply to (given delay to get and detect antibodies and antigens etc) but interesting all the same.

    The mortality rate came in just under 0.4%, again not sure how indicative that is of the true mortality rate in that area.

  • 145 Vanguardfan April 9, 2020, 12:50 pm

    My German isn’t up to that I’m afraid, but that sounds pretty plausible. Are there any figures for proportion hospitalised or needing critical care?

    Serial antibody tests are of course needed to see the rate of infection.

  • 146 The Investor April 9, 2020, 12:52 pm

    @Vanguardfan — Well we’re just going to go around in circles discussing this. 🙂

    As I’ve debated with my own friends offline, if lockdown only works in ‘almost full lockdown mode’ then, effectively, it doesn’t work, at least in a Western democracy at this stage of the viruses spread. Because we simply cannot go on like this until we get a vaccine. (Possibly we could until we have a better treatment, as presumably that comes much sooner).

    If the virus is so easily spread that even near-but-distance measures don’t stop it (e.g. my suggestions above, or more medically informed ones) then we’re clearly just going to get waves of reinfection from just a handful of ongoing/undetected carriers again, assuming it doesn’t die back in summer etc (which I suspect it will to some extent) or that it isn’t far more widespread than @Snowman’s link suggests (so no herd immunity).

    And so indefinite lockdown. (Remember we got to this point from a handful of those who’d encountered Chinese carriers, initially).

    The only — and excellent — argument for ongoing on/off lockdown in that circumstance IMHO is to curb peak demand on the critical care capacity of the NHS.

    Leaving aside the very important NHS impact, in my view a 12-18 month full lockdown will probably cause far more loss of ‘life years’ than the virus, due to catastrophic economic collapse, as discussed multiple times in this thread, with its knock-on effects of direct health consequences (e.g. obesity and depression, people with other diseases not being diagnosed and treated) and funding consequences (i.e decades of future underfunding of NHS, more poverty etc).

    This isn’t just a pet theory of mine, it’s also being talked about more and more and numerated (very roughly indeed of course) by economists and even some medical professionals, as we saw in the link above.

    I still don’t think we’re seeing the full picture.

    E.g. I just heard the BBC say “7000+ deaths DUE TO coronavirus”. In reality as we all know these are people who tested positive for CV after death. What % were really “due to” coronavirus? What % would have die from some other horrible condition in the next fortnight?

    It makes a big difference if 80% are healthy-ish people dying due to the virus versus 20%. I don’t have the answer, but the average age of death being near-80 is surely a big clue.

    Again, this isn’t to dismiss those deaths. It’s that saving them (perhaps for a few weeks) will kill other people, perhaps to a limited degree in a short lockdown but certainly in a 12-18 month lockdown.

    In reality we will not do the latter, anyway. I am certain of that. Neither the government nor the public will stand for it. We are not going to go into a Great Depression to fight a virus with a likely fatality rate of well under 0.5%.

    Hence whether we like it or not we need to find some kind of exit route. Partially relieved lockdown, as I suggest, and a flattened curve, with ongoing deaths, may be the price we have to pay. Do you see an alternative?

    The other alternative perhaps is to go ‘full Singapore’ but it is surely far too late for that.

    Finally, for those who look to China and its exit, I say again you may not understand what their lockdown is/was like. Think 6-8 temperature checks a day (including whenever you leave your home community complex), scanning a bar code that logs who you are and your location and temperature when you enter/leave certain buildings, teams of half a dozen people contact tracing an individual infected person, and even removing infected people from their homes/communities to specialized facilities — basically imprisonment for a period.

    Yes, if we could click our fingers we might agree to it and hang the civil liberties. But could we assemble the infrastructure in any realistic time? Is there any sign that this is being done? If so they’re keeping very quiet.

    My personal big hope is this current lockdown is stopped in say 3-4 weeks. The virus abates because (a) it was far more widespread than understood in the first place (b) it hates summer (c) at least some of the most vulnerable have already unfortunately been claimed by it.

    It’s a hope though, not implausible but still I don’t pretend otherwise. 🙁

  • 147 The Investor April 9, 2020, 1:02 pm

    p.s. I forgot to add again (which I know some here have already pushed back against) that I believe age/vulnerability indicated self-isolation should be part of the picture. It beggars belief that the most vulnerable were wandering around and meeting up in the fuzzy are we/ aren’t we days before lockdown, not to mention going shopping now.

    What percentage of the critical care patients are over-65, say, and wouldn’t be there if they’d been self-isolated? I suspect a very high percentage.

    I’m not blaming them — they weren’t told to self-isolate (though my mum has been doing so for nearly a month now…) — and clearly the government will need to support them. Many will say it’s not fair. And yes, some young people will get ill and die. But clearly far, far fewer.

    In my view we will have to do something if it doesn’t abate in summer. If we’re sitting here next April still having this debate from our isolation chambers then I’ll concede defeat on an intellectual level, but it will be worse outside my front door. 🙁

  • 148 The Investor April 9, 2020, 1:23 pm

    p.p.s. Sorry, I appreciate this is bad form! But we’re now getting more estimates of the cost of the lockdown. For instance, the CEBR puts it at £2.4bn a day (so £876 billion a year), with UK GDP economic output down 31%.

    https://cebr.com/reports/the-telegraph-coronavirus-lockdown-costing-the-economy-2-4-billion-every-day-study-warns/

    If your response is “but this isn’t going to last for a year, it’s a temporary measure needed to flatten the curve” then I fully agree.

    However a temporary measure needs to be temporary. 😐

  • 149 Snowman April 9, 2020, 1:41 pm

    @Vanguardfan

    Very little information in that German article, other than what I posted. They appear to have also done written surveys for all those tested. So you’d assume they could estimate the proportion asymptomatic, by looking at the survey responses.

  • 150 Vanguardfan April 9, 2020, 1:53 pm

    I don’t think I’m particularly arguing for or against any particular stance – like everyone, I’m trying to make some sense of what is still very patchy data. I can certainly speculate what I think might happen, but the range of possibilities is incredibly wide, from the fairly hopeful to the really rather awful. I have, in reality, no idea how things will unfold, but I don’t think there are any easy/magical options (death rate would certainly not stay at 0.5% if health services did become overwhelmed, and there would be other consequences flowing from that too in terms of unrest and panic). We will have to wait and see.

    Everyone around the globe is facing the same problem, and we need to listen and learn from all of the cumulative experience. One of the failings so far is a lack of global coordination in the response. Too busy fire fighting I guess.

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