Which restrictions, if any, work? What's causing the drop in case numbers?

Solent&Wessex · 21 Jan 2021

I thought I would start a new thread for this as it covers across a broad base of some existing threads.

There has been much discussion across various threads on the effectiveness of various restrictions and measures in place, and also the desirability of those restrictions.

It is obviously going to be very difficult for official statistics to pick up exactly where the virus is being transmitted the most.

Some people suggest care homes, hospitals, workplaces or schools are big areas of transmission. The Government and SAGE always say the most transmission takes place in the home - but the virus has to get in to the home in the first place, by someone picking it up and bringing it in to the home from somewhere else. Recently the focus has been on supermarkets. For many months Hospitality has been blamed for being a super spreader, but what if any evidence suggests this?

Irrespective of anything else case numbers are dropping now, and have done so in the past, but what is causing the drop in case numbers we are experiencing now and have done in the past?

If we look at England as a whole we can see that there has been a drop since the start of this year. There was also a drop in November, but for England as a whole this wasn't as pronounced as in some regions.

If we look at some regions we can see marked differences:

Pictures show images of case numbers by specimen date rising and falling in England (first two images), The South East (third and forth images) and Yorkshire and The Humber (final two images)

Now, in the grand scheme of things, there wasn't much difference between the tiers that were in place later in the year.

I know there may be very little real evidence, but my questions are:

What restrictions and measures have been effective and have caused the fall in case rates nationally and regionally last year and that we are experiencing at the moment?

What is causing the regional differences in rise and fall? Are the regional variations due to the tier systems in place later in the year or other demographic reasons? If it is due to tiers, which measures in the relevant tiers are have caused the variations, as there wasn't a huge difference between them and every single industry (hospitality, hairdressers etc) or area (education) all say there is no evidence they are an area of transmission. But something was causing transmission and something has changed to cuase transmission to fall.

Obviously if there is any evidence showing which measures are effective or not then it aids in deciding which measures can be released first.

As a starter for 10 I would suggest that seeing as a considerable chunk of the country was in Tier 4 before we entered lockdown, and schools closed at least 2 weeks before the current lockdown, then it may be the case that closing schools (however undesirable that is) may be a significant factor in reducing spread. Is it a valid argument that it can't be blamed on hospitality as in some places, such as most of Yorkshire and The Humber it was closed or severely restricted anyway?

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philosopher · 21 Jan 2021

Solent&Wessex said:
Some people suggest care homes, hospitals, workplaces or schools are big areas of transmission. The Government and SAGE always say the most transmission takes place in the home - but the virus has to get in to the home in the first place, by someone picking it up and bringing it in to the home from somewhere else. Recently the focus has been on supermarkets. For many months Hospitality has been blamed for being a super spreader, but what if any evidence suggests this?

At the moment, as a supermarkets are one of the few things that are open, they are one of the few places people can get it, particularly if they working from home or do not work. That I reckon accounts for supermarkets being the issue at the moment.

My guess is that closing schools, particularly secondary schools has the biggest impact on reducing transmission. But that is just a guess.

DB · 21 Jan 2021

Given the complete lack of correlation across Europe between restrictive measures taken and the outcome, it does seem that most measures are of, at best, very limited effectiveness. If it can't spread in one place, it will do some somewhere else.

greyman42 · 21 Jan 2021

People are still visiting other peoples homes, having drinks etc but the government for whatever reason don't want to admit this. With hospitality long shut down they have now not much left to blame apart from the supermarkets.

DB · 21 Jan 2021

greyman42 said:
People are still visiting other peoples homes, having drinks etc but the government for whatever reason don't want to admit this. With hospitality long shut down they have now not much left to blame apart from the supermarkets.

Probably because they know that they can't stop it, and they won't want to admit that they have made a law which is effectively unenforceable in the majority of cases.

HSTEd · 21 Jan 2021

I'm not sure there is really much doubt lockdowns work.

I just don't think they achieve enough ot justify their enormous cost.

DB · 21 Jan 2021

HSTEd said:
I'm not sure there is really much doubt lockdowns work.

Do they?

How is the complete lack of correlation between levels of lockdown and cases/deaths across Europe explained then?

HSTEd · 21 Jan 2021

DavidB said:
Do they?

Well unless you have a reason to doubt that in any given country, lockdowns being imposed tends to make cases start dropping shortly after.
Maybe one correlation I could accept as coincidence but this has happened three times now in England.

DavidB said:
How is the complete lack of correlation between levels of lockdown and cases/deaths across Europe explained then?

Because ultimately epidemics are not deterministic phenomena, and there are many confounding factors comparing countries.

DB · 21 Jan 2021

HSTEd said:
Well unless you have a reason to doubt that in any given country, lockdowns being imposed tends to make cases start dropping shortly after.
Maybe one correlation I could accept as coincidence but this has happened three times now in England.

While cases may drop a bit, exponential growth kicks in as soon as restrictions are loosened and soon reaches the level it would have been anyway.

HSTEd said:
Because ultimately epidemics are not deterministic phenomena, and there are many confounding factors comparing countries.

I'm sure there are, which is why it is risky to compare just one country with another - but across a larger group, such as Europe, a pattern would be expected and there simply isn't one.

HSTEd · 21 Jan 2021

DavidB said:
While cases may drop a bit, exponential growth kicks in as soon as restrictions are loosened and soon reaches the level it would have been anyway.

Indeed, I don't think that really causes the lockdown to "not work" as such.
Cases do go down, just this is not actually that valuable because it just delays the inevitable by a few weeks.

The current situation is actually the best case I can think of for a lockdown, because every day of delay does actually save hundreds or thousands of lives by allowing vaccination to proceed.

You can't vaccinate dead people.

We aren't just locking down to delay the inevitable into the future by a few weeks any more.

Bantamzen · 21 Jan 2021

Solent&Wessex said:
I thought I would start a new thread for this as it covers across a broad base of some existing threads.

There has been much discussion across various threads on the effectiveness of various restrictions and measures in place, and also the desirability of those restrictions.

It is obviously going to be very difficult for official statistics to pick up exactly where the virus is being transmitted the most.

Some people suggest care homes, hospitals, workplaces or schools are big areas of transmission. The Government and SAGE always say the most transmission takes place in the home - but the virus has to get in to the home in the first place, by someone picking it up and bringing it in to the home from somewhere else. Recently the focus has been on supermarkets. For many months Hospitality has been blamed for being a super spreader, but what if any evidence suggests this?

Irrespective of anything else case numbers are dropping now, and have done so in the past, but what is causing the drop in case numbers we are experiencing now and have done in the past?

If we look at England as a whole we can see that there has been a drop since the start of this year. There was also a drop in November, but for England as a whole this wasn't as pronounced as in some regions.

View attachment 89046

View attachment 89049

If we look at some regions we can see marked differences:

View attachment 89047

View attachment 89050

View attachment 89048

View attachment 89051

Pictures show images of case numbers by specimen date rising and falling in England (first two images), The South East (third and forth images) and Yorkshire and The Humber (final two images)

Now, in the grand scheme of things, there wasn't much difference between the tiers that were in place later in the year.

I know there may be very little real evidence, but my questions are:

What restrictions and measures have been effective and have caused the fall in case rates nationally and regionally last year and that we are experiencing at the moment?

What is causing the regional differences in rise and fall? Are the regional variations due to the tier systems in place later in the year or other demographic reasons? If it is due to tiers, which measures in the relevant tiers are have caused the variations, as there wasn't a huge difference between them and every single industry (hospitality, hairdressers etc) or area (education) all say there is no evidence they are an area of transmission. But something was causing transmission and something has changed to cuase transmission to fall.

Obviously if there is any evidence showing which measures are effective or not then it aids in deciding which measures can be released first.

As a starter for 10 I would suggest that seeing as a considerable chunk of the country was in Tier 4 before we entered lockdown, and schools closed at least 2 weeks before the current lockdown, then it may be the case that closing schools (however undesirable that is) may be a significant factor in reducing spread. Is it a valid argument that it can't be blamed on hospitality as in some places, such as most of Yorkshire and The Humber it was closed or severely restricted anyway?

There is no suggestion that care homes are the main source of spread, they are statistically proven to be so. However they are also a sensitive area and that's why the discussion is rarely had. Clearly protecting residents and staff with vaccines is going to be the number one solution.

In terms of restrictions being effective, well clearly shutting down large parts of the economy and forcing people to stay at home is the most effective way of slowing the spread. However lockdowns don't stop the spread, merely contain it until they are relaxed. Its even possible that lockdowns could give new variants the upper hand in supressing previous ones. And of course there is the damage that lockdowns do, which makes them unsustainable in the long or even medium term. As for other restrictions, well most are simply political tinkering, attempts to be seen to be doing something without any real evidence they will have any meaningful effect. These include masks, one way systems, only allowing alcohol sales with meals in pubs etc. In short there are no real ways to stop the virus, it has only one purpose, to make copies of itself, and that is what it will do. All we can really hope to do is to treat & vaccine when & where we can. Messing around with the fabric of society isn't going to help in the long run, and may have unwanted consequences.

As for regional variations, well this is probably down to intensive testing. Right back at the start of the pandemic, it was clusters of cases in places like care home, factories etc that prompted area by area testing. And this has generally been the case ever since. If a new cluster comes up, politicians enter manic mode and demand intensive testing in those specific areas, which of course results in more cases being found, which leads to more testing. I suspect if the data were to be brought together you'd find that most areas, particularly built up ones would have very similar rates over time, and that it was the method of gathering data that would explain perceived differences.

DB · 21 Jan 2021

HSTEd said:
Indeed, I don't think that really causes the lockdown to "not work" as such.
Cases do go down, just this is not actually that valuable because it just delays the inevitable by a few weeks.

The current situation is actually the best case I can think of for a lockdown, because every day of delay does actually save hundreds or thousands of lives by allowing vaccination to proceed.

You can't vaccinate dead people.

We aren't just locking down to delay the inevitable into the future by a few weeks any more.

The argument against that is that targeted measures aimed at protecting those most at risk (e.g. care homes) may well achieve the same aim without anywhere near as much damage - but for some reason hardly any government seems interested in targeted measures - they seem to want to impose restrictions on everyone.

HSTEd · 21 Jan 2021

DavidB said:
The argument against that is that targeted measures aimed at protecting those most at risk (e.g. care homes) may well achieve the same aim without anywhere near as much damage - but for some reason hardly any government seems interested in targeted measures - they seem to want to impose restrictions on everyone.

From a strictly utilitarian perspective care homes are not actually that important, but that's because of the short life expectency of people who live there. In Britain many care homes end up taking on the characteristics of a hospice.

The real problem is how you target measures at people living in the community who represent the major loss of utility.

Cdd89 · 21 Jan 2021

My guess is that people meeting up with friends has the greatest effect on transmission (which includes people meeting up with friends in restaurants). Lockdowns limit that a bit; not completely though as people simply don’t respect it after a while.

HSTEd said:
lockdowns being imposed tends to make cases start dropping shortly after.
Maybe one correlation I could accept as coincidence but this has happened three times now in England.

I guess the counter argument would be that:

Restrictions get constantly tightened and tweaked as we move along the upward direction of the curve; when cases decrease, we credit the latest tweak to the restrictions when in fact it would have happened anyway, and ignore all the earlier tweaks (and tiers) that didn’t change the curve which could be submitted as evidence of lockdowns not having an impact.
Fear has a greater impact collectively than restrictions: when people are terrified of the virus, they limit illegally meeting up with friends (which lockdowns can’t prevent, other than to a degree by restricting travel) and that has a powerful effect.
Comparing the curves of places that did and didn’t lockdown - or locked down with different severity - shows they are quite similar. For example North vs South Dakota.
In places with almost no restrictions, what is the suggested explanation for why their curve decreases?

I think I agree with you that lockdowns “work” by the way, but those are just some counterpoints that occur to me. Especially because of the first point, it’s not as easy as saying “look at all the times it’s worked, they can’t be coincidence”, when we are effectively defining the “point” of success as when the curve decreases.

DB · 21 Jan 2021

HSTEd said:
From a strictly utilitarian perspective care homes are not actually that important, but that's because of the short life expectency of people who live there. In Britain many care homes end up taking on the characteristics of a hospice.

The real problem is how you target measures at people living in the community who represent the major loss of utility.

That's true, but care home account for a lot of the cases, so if the aim is to reduce cases they need to be targeted.

The majority of people at high risk aren't of working age, and for those measures such as guaranteed home delivery, etc, and advice to stay at home may well suffice. Similar for those who are working, plus ensuring no loss of income.

MikeWM · 21 Jan 2021

DavidB said:
That's true, but care home account for a lot of the cases, so if the aim is to reduce cases they need to be targeted.

The majority of people at high risk aren't of working age, and for those measures such as guaranteed home delivery, etc, and advice to stay at home may well suffice. Similar for those who are working, plus ensuring no loss of income.

The other issue there is that equalising the risk of exposure - trying to prevent the young and healthy from catching it to the same degree as the old and vulnerable - potentially makes things worse, even laying to one side for a moment discounting the appalling side-effects of these policies.

Making the whole thing last longer before we reach herd immunity just means there are fresh cohorts of vulnerable people coming along all the time. Some people who are dying now would have been able to shake off the virus if they'd been exposed to it earlier when they were healthier.

A Challenge · 25 Jan 2021

MikeWM said:
Some people who are dying now would have been able to shake off the virus if they'd been exposed to it earlier when they were healthier.

That is something I hadn't considered - but I can't imagine many people have become less vunrable to dying if they get the virus though (excluding any immunity)

Bikeman78 · 25 Jan 2021

greyman42 said:
People are still visiting other peoples homes, having drinks etc but the government for whatever reason don't want to admit this. With hospitality long shut down they have now not much left to blame apart from the supermarkets.

Also if track and trace ring you up and ask "where have you been in the last few days" people won't say they have been round to see friends or family, or whoever they just met on Tinder! They'll probably mention the shops and work, if they have to go out of the house to work. So inevitably supermarkets will be seen as a primary cause of spread.

SynthD · 25 Jan 2021

What’s causing the drop could be that people met at Christmas, not two weeks ago. This was predicted in early December.

kristiang85 · 25 Jan 2021

Or maybe we are just on the normal curve of a winter coronavirus in the population?

If you look at the red line on the right hand graph, from the summer onwards, the average curve fits quite in line with what we have experienced in the UK.

Although, given coronaviruses have not had a vaccination before, I expect our line to go down a bit steeper than the 'average' expectation. Let's see.

Freightmaster · 25 Jan 2021

Bikeman78 said:
Also if track and trace ring you up and ask "where have you been in the last few days" people won't say they have been round to see friends or family, or whoever they just met on Tinder!

Which is why track and trace is utterly pointless in a 'free' country like the UK - it only works in authoritarian
states such as South Korea and Singapore (and seemingly Australia these days!) where giving false or incomplete
information results in severe penalties.

MARK

DB · 25 Jan 2021

A Challenge said:
That is something I hadn't considered - but I can't imagine many people have become less vunrable to dying if they get the virus though (excluding any immunity)

Potentially people who were undergoing treatments such as chemotherapy would have been more at risk, but may have completed the treatment now.

SouthEastBuses · 25 Jan 2021

To me, it's the vaccine.

Let me explain why I think this. There is no scientific evidence that lockdown are actually successful. With 6.5 million now vaccinated so far, and with cases stating to go down since a few weeks ago (as well as people in hospital), I really have a feeling that the vaccine is helping drive the cases down.

Phil R · 25 Jan 2021

I too can't help thinking seasonality must be a factor in this, potentially outweighing many of the measures the government take. Had the initial lockdown been eased sooner then argubly the population would have been in a fitter state by mid-summer with raised Vitamin D levels and less time spent indoors to catch it too badly then (viral load), so better able to cope with the virus than was the case with the hand grenade of the schools going back being lobbed in at the start of winter.

MikeWM · 25 Jan 2021

DavidB said:
Potentially people who were undergoing treatments such as chemotherapy would have been more at risk, but may have completed the treatment now.

Yes, but then there's probably an equal number who need to undergo chemotherapy now and weren't then...

DB · 25 Jan 2021

MikeWM said:
Yes, but then there's probably an equal number who need to undergo chemotherapy now and weren't then...

Indeed - it's only going to be of relevance in terms of particular individuals, rather than altering the pattern to any significant extent.

Although of course there might be some who need chemotherapy but aren't getting it and will die as a result in due course.

WelshBluebird · 25 Jan 2021

SouthEastBuses said:
To me, it's the vaccine.

Let me explain why I think this. There is no scientific evidence that lockdown are actually successful. With 6.5 million now vaccinated so far, and with cases stating to go down since a few weeks ago (as well as people in hospital), I really have a feeling that the vaccine is helping drive the cases down.

So what caused the downtick in cases and deaths back in April and then again in November then?

The fact is that lockdowns "work" in the sense they stop people getting COVID at that specific time and so push case levels (and so death levels) down. Of course the problem with that, as this country has seen, is the trajectory just increases upwards again when you life restrictions. And that is exactly the pattern we have seen for each of the lockdowns we have had. They are basically just a delaying tactic until a vaccine - which again is exactly what most governments have done, to varying degrees.

Nicholas Lewis · 25 Jan 2021

Bikeman78 said:
Also if track and trace ring you up and ask "where have you been in the last few days" people won't say they have been round to see friends or family, or whoever they just met on Tinder! They'll probably mention the shops and work, if they have to go out of the house to work. So inevitably supermarkets will be seen as a primary cause of spread.

Good point but one does hope that privately you would notify anybody you consider to have been exposed to you and that person can then seek a test.

Phil R said:
I too can't help thinking seasonality must be a factor in this, potentially outweighing many of the measures the government take. Had the initial lockdown been eased sooner then argubly the population would have been in a fitter state by mid-summer with raised Vitamin D levels and less time spent indoors to catch it too badly then (viral load), so better able to cope with the virus than was the case with the hand grenade of the schools going back being lobbed in at the start of winter.

Respiratory virus are naturally attenuated in the Northern Hemisphere between April and September so its non unreasonable to assume Covid will react accordingly but govt can't rely upon that although one would have thought some analysis would have been done from last summer.

DB · 25 Jan 2021

WelshBluebird said:
So what caused the downtick in cases and deaths back in April and then again in November then?

The fact is that lockdowns "work" in the sense they stop people getting COVID at that specific time and so push case levels (and so death levels) down. Of course the problem with that, as this country has seen, is the trajectory just increases upwards again when you life restrictions. And that is exactly the pattern we have seen for each of the lockdowns we have had. They are basically just a delaying tactic until a vaccine - which again is exactly what most governments have done, to varying degrees.

The correlation=causation argument.

While lockdowns may or may not have some effect in reducing cases in the short term, it cannot be assumed that they are always the reason. Cases naturally fluctuate (as they have this time - numbers were already starting to fall before the latest lockdown or vaccine could have had any effect). In April the weather warmed up significantly - cases would be expected to drop significantly then.

Nicholas Lewis said:
Respiratory virus are naturally attenuated in the Northern Hemisphere between April and September so its non unreasonable to assume Covid will react accordingly but govt can't rely upon that although one would have thought some analysis would have been done from last summer.

It's pretty clear from looking at a graph that this is exactly what happened.

SouthEastBuses · 25 Jan 2021

WelshBluebird said:
So what caused the downtick in cases and deaths back in April and then again in November then?

The fact is that lockdowns "work" in the sense they stop people getting COVID at that specific time and so push case levels (and so death levels) down. Of course the problem with that, as this country has seen, is the trajectory just increases upwards again when you life restrictions. And that is exactly the pattern we have seen for each of the lockdowns we have had. They are basically just a delaying tactic until a vaccine - which again is exactly what most governments have done, to varying degrees.

Lockdowns may work, but there is not enough scientific evidence that they do so. That's why I'm no longer a pro lockdown person unlike back in March last year. Their disadvantages outweigh the advantages.

So maybe the lockdown might have worked (we don't know) in April and November, but I have the feeling that the vaccine will also factor the decrease in cases.

Which restrictions, if any, work? What's causing the drop in case numbers?

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