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David,

You bring to mind a question I have. I wrote a paper that appeared in Radstats journal last year about insurance risk transferring health care finance mechanisms, AKA capitation-like health care finance mechanisms

As an outsider, it appears to me that the community trust health care funding in the UK qualifies as such. The allocations of trust funds to communities would, I assume be based on epidemiological profiles, but a new disease process, that had a substantially different demographic impact would result in some trusts being over-funded, and others being under-funded for the new threat.

I am sort of wondering if anyone knows how adjustments would be made that would allow Community trusts to respond rapidly to a new health threat, whether that would occur in a timely manner, or if it would generate a lot of hand-wringing, studies, White Papers, and delays in the ability of some communities to be able to respond to the new threat?



Thomas Cox PhD RN
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On Saturday, March 7, 2020, 09:49:01 AM EST, David Gordon <[log in to unmask]> wrote:


Dear John

The data in your post are correct, but I think that to a certain degree they miss the point about the potential impact of a Covid-19 pandemic.

The latest WHO Situation Report (No 46 - see https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2) on Covid-19 makes the following points

"For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection,requiring oxygen and 5% are critical infections,requiring ventilation."

"The reproductive numberthe number of secondary infections generated from one infected individual isunderstood to be between 2 and 2.5 for COVID-19 virus, higher than for influenza."

"Mortality for COVID-19 appears higher than for influenza, especially seasonal influenza. While the true mortality ofCOVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (thenumber of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the numberof reported deaths divided by the number of infections) will be lower. For seasonal influenza, mortality is usuallywell below 0.1%. However, mortality is to a large extent determined by access to and quality of health care."

SEIR models of Covid-19 indicate that at the peak of the epidemic about half of all the infections will occur in about a one month period - if a significant proportion of the UK population is infected and 15% require oxygen and a further 5% require intensive care then bad things are likely to happen during the peak infection month,  even with all the efforts the NHS is making....In poorer countries, without the medical care infrastructure of the UK a large number of people may die for want of the necessary medical care to help them fight Acute Respiratory Infection (ARI) caused by Covid-19. Although ARI is not on your list, it kills many more people globally than many of the causes you have included, the Global Burden of Disease analyses estimate that 11–22% of deaths among children aged < 5 years and 3% of deaths among adults aged 15–49 years globally are due to ARI

Thus, I think that concerns about the potential impact of Covid-19 are not unwarranted.

Regards

David Gordon

___________________________________________
Dave Gordon
Bristol Poverty Institute
Townsend Centre for International Poverty Research
University of Bristol
10 Woodland Road
Bristol BS8 1TZ, UK

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Tel: +44-(0)117-954 6761
Fax: +44-(0)117-954 6756

From: email list for Radical Statistics <[log in to unmask]> on behalf of John Bibby <[log in to unmask]>
Sent: 06 March 2020 11:57
To: [log in to unmask] <[log in to unmask]>
Subject: Draft Blog:Coronavirus: Scare or emergency?
 

 I'd welcome your comments on the following draft blog.

Please also contribute a blog of your own. It should be sent to [log in to unmask]

Draft Blog: Coronavirus: Scare or emergency?

There’s nothing like a good emergency to improve people’s numeracy skills! Whether it is numbers of deaths and other disasters, wars and other worries, refugees, austerities and epidemics or pandemics – these things make people pay attention, and sometimes it can lead to good number learning.

Admittedly it can lead to bad learning too, as well as ‘bad facts’ and ‘false news’ – do people really pay attention when they are worried or stressed? Probably not. And journalists do not write good articles when their adrenaline gets going or they are worried or stressed – or when they are trying to engender worry or stress. (Bigger emergency = More newspaper sales!)

The ‘Coronavirus scare’ is a case in point. In calling it a ‘scare’ I am expressing some skepticism as to how disastrous Covid-19 will be on a world scale. It clearly is disastrous for many thousands of peoples in parts of China, and for large numbers elsewhere. Today I learn that part of occupied Palestine has been closed down by Israel, allegedly because of the virus: meanwhile, Israel has many more infections than Palestine.

Raw data often conceals countless personal tragedies. As Joseph Stalin allegedly said “One death is a tragedy; a million deaths is a statistic.

However at present Coronavirus seems to be claiming far fewer lives than many other everyday things which are rarely recognised as “emergencies” (although perhaps they should be). I am thinking here of road accidents, pollution, malaria, war, poverty, poor medicine, and many other things which kill and maim far more than coronavirus has done so far – and, I trust, more than it ever will unless it becomes a worldwide, years-long pandemic on the scale of the 1919 Spanish Flu.

Figure 1 gives some figures for comparison.

=======================

Figure 1: Deaths worldwide from coronavirus and other causes.
(As at 1st March 2020: much of this is taken from Wikipedia for convenience, and is probably of the right order of magnitude, albeit 10-20% or more away from the ‘true’ value.)

Deaths from coronavirus: 3000 in China; 66/29/26 in Iran/Italy/South Korea  respectively, 13 others outside China. Less than 100 per day.

Number of cases: 90,000, incl. 80,000 in China

Total number of deaths from all causes: approx. 150,000 per day or 55 million per year. Of these about 70% are due to senescence. (This figure rises to 90% in industrialised countries.)

Annual deaths from specific causes (2016, World):

Smoking: 8 million, incl. 1.2 million from secondary smoking
Suicide: 810k
Malaria: 710k
Influenza: 650k
Homicide: 390k
Drowning: 230k
Alcohol: 160k
Fire: 130k
Conflict: 120k
Terrorism: 30k
Coronavirus (as at 1/3/2020): 3k

=======================

So the impact of Coronavirus would have to increase 40 to 80 times before the number of deaths attributable can compare with deaths due to war, fire, alcohol or drowning. It would have to increase 30-300 times before the number of Coronavirus deaths was comparable with those who die due to suicide or smoking. Yet we frequently hear of the “Coronavirus emergency” or the “Coronavirus crisis” and very rarely about e.g. ‘Malaria Crises’ or ‘Malaria Emergencies’. As Table 2 shows, the number of “hits per death” is 6000 times or more greater for Coronavirus than for other causes. This is to ignore the non-death impact of smoking/suicide/war etc..

 

Table 2:
“Coronavirus crisis/emergency” is mentioned far more than other sorts of crisis or emergency.

Number of ‘hits’ from Google search on ‘crisis’ or ‘emergency’ when coupled with the following terms:

                                             Hits                                      Deaths                 Hits per death

               Coronavirus        18 million                           3k                          6000
               Suicide                 678,000                              810k                     0.837
               Malaria                12,000                                 710k                     0.017
               Smoking               12,000                                 8000k                   0.0015

 

Of course the language of “emergency” and “crisis” is very good at

               (a) creating anxiety, and
               (b) selling things.

Let’s not underestimate the clear commercial reasons why entrepreneurs might overstress dangers – sellers of bacterial gel, medical practitioners (not in the NHS surely?!), and people who want a good excuse for cancelling events which they wanted to cancel anyway. Anxiety sells!

Anxiety also damages health. The worry can cause more damage than the virus. We could end up with a pandemic of anxiety.

Could the BBC reduce the undue preponderance being given to Covid and the anxiety thus caused? A very simple possibility would be to announce e.g. “One more UK resident has died from Covid-19. This is to be compared with an estimated ?100? who died today from regular flu, ?500? who died from tobacco, and ?20? who died from traffic accidents and self-inflicted injuries.

 

====  

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