Tier 4 exercise limits

[Sweep]

The latest thing is some quarters will call for mask wearing outdoors. Mayor Khan is already proposing this in London.

Does he have any medical evidence for that proposal?

Before I answer...

1 Is this a serious question? i'm not missing irony or anything else...
2 Do you think that there is a new viral disease that has killed about 80,000 people in the UK?

Thanks

Jonathan

Yes it is a serious, and straight, question.
I realise the appalling seriousness of this virus from hell and have been acting accordingly throughout.
So now you can favour me with your serious answer.
Answers from others fine as well of course.
To my straight and honest question.

[Jdsk]

Thanks

Jonathan

[Sweep]

Thanks

Jonathan

Ta
I look forward to your answer.

[Psamathe]

it is too late to avoid the current situation but it isn't 'too late' to help stop things from getting (exponentially) worse.
....

So Johnson now planning some intensive finger crossing ...

...
FWIW the anecdotal evidence is that there are more people out and about now than in the lockdown nine months ago....

A member of a SAGE advisory committee on Radio 4 the other day said data show compliance is 90% (which is high). They said there are more people out and about and more traffic compared to spring lockdown but it's because this lockdown is somewhat less restrictive than the spring lockdown (which is presumably why the scientific advisors and experts have for some time been calling for the lockdown to be made more restrictive (but Johnson seems to prefer the finger crossing route).

Prior to hearing that interview I'd been critical of so many ignoring rules for their personal convenience but if one accepts what was said, I'd probably been being unfair and it's maybe more because of laxer aspects to Government rules.

Ian

[Psamathe]

The latest thing is some quarters will call for mask wearing outdoors. Mayor Khan is already proposing this in London.

Does he have any medical evidence for that proposal?

Is it one of those things where maybe the "precautionary principle" should be used? Getting people to wear a mask is not a big restriction but if it saves one life it would be justified.

I don't particularly like wearing a mask and for months our Government were telling us they were worse than useless. But I do because though uncomfortable and glasses steam-up those are really minor issues compared to C-19.

Sometimes we can get too wrapped-up in demanding "evidence" for every detail when low impact actions in advance of peer reviewed scientific research could have major benefits. Another example banning neonicotinoid pesticides where it looked like they were severely impacting bee and insect populations so on a precautionary basis (given how crucial those pollinator populations are to us) they were banned pending research (and research did confirm though UK has now used its "sovereignty" to allow the pesticides ...)

Ian

[Jdsk]

The latest thing is some quarters will call for mask wearing outdoors. Mayor Khan is already proposing this in London.

Does he have any medical evidence for that proposal?

There aren't any good randomised controlled trials and there probably never will be: it's just too difficult.

So the best evidence comes from observational studies, from extrapolation from other viruses and other settings, especially healthcare, and from laboratory studies.

It's then necessary to separate protection of the wearer from protection of others.

And to define "outdoors". Transmission is much more likely with prolonged close close contact in settings with poor ventilation, so "indoors" is much riskier than "outdoors", But "outdoors" includes cycling on your own in the countryside, being packed in a crowd at a racecourse or at a soccer match, and queueing for public transport. The variation in risk across those is enormous.

With those provisos I recommend the current CDC Scientific Brief and advice for the public:
https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
and this:
https://www.ox.ac.uk/news/2020-07-08-oxford-covid-19-study-face-masks-and-coverings-work-act-now/
https://royalsociety.org/-/media/policy/projects/set-c/set-c-facemasks.pdf?la=en-GB&hash=A22A87CB28F7D6AD9BD93BBCBFC2BB24

and on how policy should follow:
https://www.bmj.com/content/369/bmj.m1435
and subsequent correspondence, leading to:
https://onlinelibrary.wiley.com/doi/10.1111/jep.13415

Jonathan

[Jdsk]

The latest thing is some quarters will call for mask wearing outdoors. Mayor Khan is already proposing this in London.

Does he have any medical evidence for that proposal?

Is it one of those things where maybe the "precautionary principle" should be used? Getting people to wear a mask is not a big restriction but if it saves one life it would be justified.

I don't particularly like wearing a mask and for months our Government were telling us they were worse than useless. But I do because though uncomfortable and glasses steam-up those are really minor issues compared to C-19.

Sometimes we can get too wrapped-up in demanding "evidence" for every detail when low impact actions in advance of peer reviewed scientific research could have major benefits. Another example banning neonicotinoid pesticides where it looked like they were severely impacting bee and insect populations so on a precautionary basis (given how crucial those pollinator populations are to us) they were banned pending research (and research did confirm though UK has now used its "sovereignty" to allow the pesticides ...)

Yes it is, crossed posts, and see Greenhalgh's thoughts on policy when evidence isn't as good as we'd like, last two citations in my post.

Jonathan

[Stevek76]

Thus far in the UK about 3M people have had covid and (despite treatment) about 80K have died, which is about a 3% mortality rate. It isn't a big stretch to believe that the untreated mortality rate might be 10% or so.

That is a big overstatement of the mortality rate. The number of known cases is not the same as the total number of actual infections. The ONS infection survey estimated that 1.1m were infected with the disease just during the week up to 2nd Jan, the total estimate of non-overlapping info from that survey appears to be around 6.5m and it wasn't being undertaken until the tail end of the first wave. Actual mortality rates for COVID-19 are a tricky thing to estimate, but most attempts to do so seem to be around the 1% mark, some a bit higher, some as low as half that and most indications are that it is lower than it first was, probably as a result of better treatment of critical cases.

Obviously it becomes a major problem when NHS capacity is exceeded (not to mention the knock on deaths from all the regular NHS work that is delayed) and the government's approach to this has been dreadful to say the least, however I think your estimates are rather pessimistic, particularly given the vaccine rollout.

They said there are more people out and about and more traffic compared to spring lockdown but it's because this lockdown is somewhat less restrictive than the spring lockdown (which is presumably why the scientific advisors and experts have for some time been calling for the lockdown to be made more restrictive (but Johnson seems to prefer the finger crossing route).

It is considerably less restrictive, primarily on work. I recall the first lockdown was stay home unless the job was non essential. Now it's only stay home unless you cannot work from home, hence the considerably larger number of people out going to work. That said, early indications from both the government dashboard and the KCL zoe project are that the case rate is no longer exponential though clearly this government are not of the 'a stitch in time' inclination.

[LollyKat]

With those provisos I recommend the current CDC Scientific Brief and advice for the public:
https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
and this:
https://www.ox.ac.uk/news/2020-07-08-oxford-covid-19-study-face-masks-and-coverings-work-act-now/
https://royalsociety.org/-/media/policy/projects/set-c/set-c-facemasks.pdf?la=en-GB&hash=A22A87CB28F7D6AD9BD93BBCBFC2BB24

and on how policy should follow:
https://www.bmj.com/content/369/bmj.m1435
and subsequent correspondence, leading to:
https://onlinelibrary.wiley.com/doi/10.1111/jep.13415

Jonathan

Thanks for posting these links - most interesting, particularly the last two.

[Oldjohnw]

Way back in April the government promised laptops for children without their own so that they could study from home. About 1,000,000 were identified as needed but only half of that have been delivered.

Williamson now says those without can go into school.

As ever, the disadvantaged become the most exposed.

[robing]

The latest thing is some quarters will call for mask wearing outdoors. Mayor Khan is already proposing this in London.

Does he have any medical evidence for that proposal?

Is it one of those things where maybe the "precautionary principle" should be used? Getting people to wear a mask is not a big restriction but if it saves one life it would be justified.

I don't particularly like wearing a mask and for months our Government were telling us they were worse than useless. But I do because though uncomfortable and glasses steam-up those are really minor issues compared to C-19.

Sometimes we can get too wrapped-up in demanding "evidence" for every detail when low impact actions in advance of peer reviewed scientific research could have major benefits. Another example banning neonicotinoid pesticides where it looked like they were severely impacting bee and insect populations so on a precautionary basis (given how crucial those pollinator populations are to us) they were banned pending research (and research did confirm though UK has now used its "sovereignty" to allow the pesticides ...)

Ian

I have no problem in wearing a mask in shops, public transport etc. And I agree it's hard to provide evidence and as there is little or no harm I think it is perfectly acceptable for the government to advise or even mandate mask wearing in these circumstances. It would have made much more sense to have brought this in earlier during the first wave rather than in June when the virus had reduced to very low levels. And Khan to his credit, was asking for mask wearing to be mandatory on public transport in London back then.

But mandating mask wearing outside is the thin end of the wedge. You could argue it makes sense in crowded city centres, high streets etc. But I've seen on social media people being criticised for not wearing masks while walking in parks, joggers etc. Where do you draw the line?
We should be encouraging people to get outside and take exercise within the guidelines. We've already seen crazy policing with the current rules as it is.

[mjr]

The latest thing is some quarters will call for mask wearing outdoors. Mayor Khan is already proposing this in London.

Does he have any medical evidence for that proposal?

Is it one of those things where maybe the "precautionary principle" should be used? Getting people to wear a mask is not a big restriction but if it saves one life it would be justified.

No, it wouldn't necessarily be justified by that. You would have to estimate if more lives could be saved putting that effort into another measure instead. Available effort is not infinite.

[Jdsk]

Does he have any medical evidence for that proposal?

Is it one of those things where maybe the "precautionary principle" should be used? Getting people to wear a mask is not a big restriction but if it saves one life it would be justified.

No, it wouldn't necessarily be justified by that. You would have to estimate if more lives could be saved putting that effort into another measure instead. Available effort is not infinite.

The effort required to wear a mask is very low. I don't see it as competing with other non-pharmaceutical interventions.

Jonathan

[mjr]

The effort required to wear a mask is very low. I don't see it as competing with other non-pharmaceutical interventions.

But the effort required to get people to wear them is not low.

[Jdsk]

The effort required to wear a mask is very low. I don't see it as competing with other non-pharmaceutical interventions.

But the effort required to get people to wear them is not low.

Hard to tell, but a consistent message including all of the NPIs that had now been running for a year would have saved a lot of lives. I wouldn't expect separate messages for each NPI... one for masks, one for isolation, one for hand hygiene... to have been a smarter approach. I have no idea why this has never been delivered.

Jonathan