IOM Covid removing restrictions

[Roger Mexico]

49 minutes ago, jaymann said:

Also note this report which says how a 5 day testing regime can be up to 90% effective.

https://www.oxera.com/test-and-release-scheme

Also noteworthy - IOM follows PHE advice that single on-arrival test is 7% effective. Yet the evidence shows it is 54-76% effective.

Ah, those little words 'up to'.  Actually those figures don't seem that different from what we've seen elsewhere. but the problem is that you are still letting 1 in 8 infected people through on that basis.  And if you're only letting in say 800 people a week and the infection rate is about 1 in 100[1], then an infected person is going to be out in the community roughly one a week without any further restrictions. 

And because there are few in-community barriers to spread, just one person can infect a lot of others (and they in turn many more) before it's realised that an outbreak is taking place - as we saw in New Zealand in August.

I couldn't work out where the 7% that everyone keeps repeating comes from.  Luckily the Manx Radio piece discloses the source - a PHE modelling paper from August.  I think this is being misread as the 7% isn't based on any clinical evidence, but from modelling assumptions from which they calculate (I think) that 7% of people who were undetectable at the start of a 'medium haul' flight (by which they mean 7-9 hours) would test positive on arrival. 

It's not really relevant or based on reality.  It also wasn't really the point of the paper which was to point out how much more efficient a double testing regime was than just testing on arrival.  In practice a test on arrival will pick up a much higher percentage than 7%, but even 50% still means you are letting a lot of infected people in and need additional measures for the whole population - which still may not work as we see in Jersey at the moment.

 

[1]  This is without the additional fact that we know the sort of people who travel are more likely to be infectious that the population they come from as a whole.  We see that in the Jersey figures for testing on arrival - which will in turn underestimate the actual number infected.

[BenFairfax]

2 hours ago, Filippo said:

Candice Swanepoel does not need a ventilator or ambulance in standby because among the under 40s a Covid infection is less dangerous than a seasonal flu; a risk far too remote to worry about. Indeed, it is not a rational fear for most of us, if the concern has to be ramped up to the point of imposing drastic change to habits and lifestyle.

Here you are mixing risk to an individual with risks over an entire group. One of complexities of COVID is stratification of risk. Take two individuals of same age under the age of 65, after COVID infection of each the risk of death of one could be 1000x the risk to the other. Let just consider fatality rates of cancer patients from COVID, and as detailed in the Lancet review article:  https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30442-3/fulltext#seccestitle140

and by age we have following outcomes:

 

Naturally since all cancer patients have different prognosis, genetics; and not all people of a given age have same general overall health such results provide a back of envelop indication of the likely individual risks, and illustrate this group's average aggregate risk. Clearly for this group, risk from COVID meaningful higher than risk from seasonal flu.

The number of vulnerable groups with preexisting medical conditions in UK now being asked to shield again is roughly 4% population (2.2M people), which for IoM population of 84,077 equates to 3,363 people. These people live in social networks, and let's assume each has say 4 close contacts (1st degree family), and further 6 close contacts, so now talking about (after some overlap) over 30K on Island being drawn into this net. The choices are not black and white, but lot a grey and as Dr Whitty said no easy options. Just economically a significant outbreak on Island would see this group mitigate economic activity.... Shame Treasury do not tell us all models they have.... Also on related note be useful to understand why oncology, path lab, and other outpatients who deal with high-risk groups, are not using any PPE when conducting face-to-face consultations with patients (but that another matter).

Thanks Filippo for your post, and please do not take my above clarification in any way as a judgment on you.

  

 

Edited November 5, 2020 by BenFairfax
Put in a comma.

[jaymann]

3 minutes ago, Roger Mexico said:

 

I couldn't work out where the 7% that everyone keeps repeating comes from.  Luckily the Manx Radio piece discloses the source - a PHE modelling paper from August.  I think this is being misread as the 7% isn't based on any clinical evidence, but from modelling assumptions from which they calculate (I think) that 7% of people who were undetectable at the start of a 'medium haul' flight (by which they mean 7-9 hours) would test positive on arrival. 

It's not really relevant or based on reality.  It also wasn't really the point of the paper which was to point out how much more efficient a double testing regime was than just testing on arrival.  In practice a test on arrival will pick up a much higher percentage than 7%, but even 50% still means you are letting a lot of infected people in and need additional measures for the whole population - which still may not work as we see in Jersey at the moment.

 

How this data is being used politically is the problem here and you're absolutely right about context.

The Health Minister repeatedly uses the 7% PHE figure to write off the concept of border testing, without such context. The reality is that we need that middleground which will naturally carry a perceived degree of risk and ability to contain. Which would likely only come from multiple testing stages which collectively brings down the current 14 days isolation period requirement.

But as I covered in my post above, it needs a wider border framework that is actually effective.

[Utah 01]

2 hours ago, Nom de plume said:

I do wish we had people in the Keys who could

a. Read

b. Understand what they've read.

c. Make rational, thought-through decisions based upon a and b.

d. Worry about the big picture affecting the entire population rather than pandering to their innate sense of political self-preservation and covering their their publicly-funded fat arses.

Edited November 5, 2020 by Utah 01

[trmpton]

47 minutes ago, Roger Mexico said:

Ah, those little words 'up to'.  Actually those figures don't seem that different from what we've seen elsewhere. but the problem is that you are still letting 1 in 8 infected people through on that basis.  And if you're only letting in say 800 people a week and the infection rate is about 1 in 100[1], then an infected person is going to be out in the community roughly one a week without any further restrictions. 

And because there are few in-community barriers to spread, just one person can infect a lot of others (and they in turn many more) before it's realised that an outbreak is taking place - as we saw in New Zealand in August.

I couldn't work out where the 7% that everyone keeps repeating comes from.  Luckily the Manx Radio piece discloses the source - a PHE modelling paper from August.  I think this is being misread as the 7% isn't based on any clinical evidence, but from modelling assumptions from which they calculate (I think) that 7% of people who were undetectable at the start of a 'medium haul' flight (by which they mean 7-9 hours) would test positive on arrival. 

It's not really relevant or based on reality.  It also wasn't really the point of the paper which was to point out how much more efficient a double testing regime was than just testing on arrival.  In practice a test on arrival will pick up a much higher percentage than 7%, but even 50% still means you are letting a lot of infected people in and need additional measures for the whole population - which still may not work as we see in Jersey at the moment.

 

[1]  This is without the additional fact that we know the sort of people who travel are more likely to be infectious that the population they come from as a whole.  We see that in the Jersey figures for testing on arrival - which will in turn underestimate the actual number infected.

So you are completely adverse to any risk associated with the virus coming in, regardless of the impact on businesses and mental health and believe we should aim to keep the virus out completely?  Despite the fact we know it got into the community in Guernsey and caused no issues at all, because of testing.

You don’t see any merit at all to the ways that Denmark, San Marino etc have handled things with a balance of risk against reward?

Really not sure that’s a long term and viable proposition to be honest.

[Roger Mexico]

1 hour ago, jaymann said:

I appreciate we may have something 'special'. But having travelled at the end of Sept and seen first hand, Zurich no different to here really, yes people have masks on public transport and in busier spaces. But they accept and get on with life, it was as near to normal as possible. Denmark? A thorough inward and outward testing regime that produces results in <4hrs of testing. All done to facilitate movement and allow business to keep moving.

Well such policies don't seem to working out wonderfully well for Switzerland at the moment:

Though Denmark is doing a bit better, it has still seen a rise in cases recently.  There may be cultural and geographic reasons as well of course and Switzerland did quite badly and Denmark quite well in the first wave as well, but being 'open for business' will mean you are open for other things as well.   Which in turn means you end up being shut for everything.

[Nom de plume]

19 minutes ago, trmpton said:

So you are completely adverse to any risk associated with the virus coming in, regardless of the impact on businesses and mental health and believe we should aim to keep the virus out completely?  Despite the fact we know it got into the community in Guernsey and caused no issues at all, because of testing.

You don’t see any merit at all to the ways that Denmark, San Marino etc have handled things with a balance of risk against reward?

Really not sure that’s a long term and viable proposition to be honest.

This is what we are dealing with.

The narrative has shifted completely.

Quayle & Ashford told us it was inevitable the virus would circulate here & we would try to mitigate the risk whilst protecting the NHS.

Its clear after the Guernsey air bridge retraction they’ve gone into full hysterics & eradication mode.

[trmpton]

5 minutes ago, Nom de plume said:

This is what we are dealing with.

The narrative has shifted completely.

Quayle & Ashford told us it was inevitable the virus would circulate here & we would try to mitigate the risk whilst protecting the NHS.

Its clear after the Guernsey air bridge retraction they’ve gone into full hysterics & eradication mode.

Exactly that.

Eradication, and declaring us COVID free when the rest of the world are dealing with it (a few exceptions, like New Zealand, who have backed themselves into a similar corner) might prove to be the biggest balls up ever.

[x-in-man]

Bugger me, Quayle has become a news reader.   
 

pointless twat.

[trmpton]

HQ pinning his hopes on a vaccine ffs.  Completely lost the plot. 
 

Got a feeling he is heading up to isolation for the whole household!

 

”reasonably sure” lol 

[Banker]

6 minutes ago, trmpton said:

HQ pinning his hopes on a vaccine ffs.  Completely lost the plot. 
 

Got a feeling he is heading up to isolation for the whole household!

 

”reasonably sure” lol 

He has been losing the plot for a while! Why does he insist on giving the worldwide news on US election, Brexit , Scotland etc etc?

Edited November 5, 2020 by Banker

[Escape Artist]

1 hour ago, BenFairfax said:

Here you are mixing risk to an individual with risks over an entire group. One of complexities of COVID is stratification of risk. Take two individuals of same age under the age of 65, after COVID infection of each the risk of death of one could be 1000x the risk to the other. Let just consider fatality rates of cancer patients from COVID, and as detailed in the Lancet review article:  https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30442-3/fulltext#seccestitle140

and by age we have following outcomes:

 

Naturally since all cancer patients have different prognosis, genetics; and not all people of a given age have same general overall health such results provide a back of envelop indication of the likely individual risks, and illustrate this group's average aggregate risk. Clearly for this group, risk from COVID meaningful higher than risk from seasonal flu.

The number of vulnerable groups with preexisting medical conditions in UK now being asked to shield again is roughly 4% population (2.2M people), which for IoM population of 84,077 equates to 3,363 people. These people live in social networks, and let's assume each has say 4 close contacts (1st degree family), and further 6 close contacts, so now talking about (after some overlap) over 30K on Island being drawn into this net. The choices are not black and white, but lot a grey and as Dr Whitty said no easy options. Just economically a significant outbreak on Island would see this group mitigate economic activity.... Shame Treasury do not tell us all models they have.... Also on related note be useful to understand why oncology, path lab, and other outpatients who deal with high-risk groups, are not using any PPE when conducting face-to-face consultations with patients (but that another matter).

Thanks Filippo for your post, and please do not take my above clarification in any way as a judgment on you.

 

You are actually providing a truly convincing justification for "focused protection" rather than indiscriminate segregation of the whole population.

Your graph show negligible fatality risk for the under 40. Yes, some people may have specific health issues that need to be taken into account.

 

[Escape Artist]

2 hours ago, jaymann said:

We need a balance.

Personally I find our CoC to be ill-effective, self-important and a waste of money. But that's by the by... I was asked to comment off the back of that survey and here we are.

I appreciate we may have something 'special'. But having travelled at the end of Sept and seen first hand, Zurich no different to here really, yes people have masks on public transport and in busier spaces. But they accept and get on with life, it was as near to normal as possible. Denmark? A thorough inward and outward testing regime that produces results in <4hrs of testing. All done to facilitate movement and allow business to keep moving.

When I tell people overseas what we have here, they initially think it's amazing. Then I tell them about who we've sent to prison and why, then they think we've lost the plot.

Back to balance: I appreciate we have an aged population who are very nervous. This is why we need a regime that facilitates a 'best possible outcome'.

Our problem as an Island is that we are acting like nothing more than a devolved local council of England. We need a new border framework that does not align to the UK. Our view on 'on arrival testing' is derived from PHE, which studies from Jersey, Iceland and other places show that on-arrival testing is actually picking up of 76% of cases instead of 7% as PHE says.

We need to invest in testing and an affective track & trace system to allow people to start moving. A point I made clear in my interview is that as it stands, we have a border framework that relies on UK national average, or establishing reciprocal bubbles like with Guernsey. That isn't good enough. A ranking sytem would set clear paths that people can identify how close they may to being able to visit a country, say Ireland for example.

I have probably far too much to say on the matter but it's not exactly a selfish view. I needed to travel for business and to see unwell family in UK and I did, then completed my self-isolation. But three key issues;

1) We will supposedly hit Level 2 (I think) of our Border Framework when the UK reaches infection rate 20/100K of population. Yet when Guernsey had a small controlled outbreak reflecting 5/100K of population, the bridge was instantly shut down, rightly or wrongly.

2) Many smaller businesses with directors and staff on the Isle of Man use our great quality of life as a 'base' and typically rely on freedom to move around to conduct business.

3) Our financial services sector is leaking considerable amounts of business to Jersey, considerable amounts.

The economic ripples are coming, they will hit many sectors, impacting many jobs in the future. We should be preparing now and our borders form a key part of that.

 

3 hours ago, Filippo said:

[. . .] I think that the choices regarding Covid were always and inescapably political. But it is worth to ask how the kind of elected officials we would like to have would have dealt with the issue. They would have had the cognitive ability to figure out the viable options, and the honesty and communication skills to explain those to the public, so that policy aims and trade-offs were manifest. In case of the Isle of Man, I will describe in the following the three main alternatives.

The first option is what IOMG has done. Clear the virus from the island at huge cost; keep the border closed to prevent any resurgence of community spread; eradication, swift punishment of dissidents. Yes, I know the border is only closed up to a certain point. It is closed enough to prevent all routine back and forth travel. The winners are  those suffering from Covid phobia and the few parts of the hospitality industry (pubs and discos) that could have had some restrictions placed on them (minor restrictions in specific case of Jersey). The losers are all residents who needs to travel and, in various degrees, all businesses that are not entirely island-based.

The second option is what Jersey has done. Manage an open border through extensive testing and tracking. We know for sure, from the fact that Jersey has done it and we can observe the result, that the number of Covid fatalities adjusted for population size would have been the same. Winners and losers are swapped in respect to prior case.

It is worth asking what would have happened if IOMG had done much less: some initial mitigation effort followed by a nearly full reopening; no border closure; little or no testing of border crossings; that is the third option I am considering. San Marino, a land-locked micro-state of central Italy is one such example. I should have thought it by myself; I have been there a couple of times and I am aware of their history and system of governance. It was brought to my attention by a Daily Telegraph article a few days ago: “Tiny San Marino irks Italy with relaxed restaurant lockdown rules”. The article continues by saying that San Marino has provoked the ire of Italy’s policymakers by allowing bars and restaurants to stay open until late; unlike those across the border in Italy, which have to close by 6 pm and suffer from plenty of other restrictions. With no border controls of any description, Italians just drive across the border to have an evening pint with mates. Cheers.

San Marino covers a land area of 24 sq miles, has population of 33,5K and, unlike the Isle of Man, has sovereignty. It is relatively prosperous but with a run-of-the-mill kind of economy, which is not propped up by an influx of wealth residents with far away investments and business interests (what happens when you orbit a country like the UK with 0% corporation tax and 0% CGT). There is some offshore banking industry; tourism and hospitality are their most important source of revenue. Facing the choice between widespread bankruptcy/penury and tolerating more Covid deaths, it chose the latter. Initially there was lockdown-lite more similar to the Swiss than to the Italian one; then a full reopening with no border controls and it hasn’t looked back since. And more people died indeed. It has had the second in the world per-capita number of Covid cases and 42 deaths.

Adjusting for population size, the IOM equivalent would be 108 deaths. However, IOM is in the middle of the Irish Sea. We don’t, and can’t possibly have 1/3 of our population crossing our border every day. Nor we live into the multi-generational households that are typical of Southern Europe. Nor, most of us, have so many daily interactions by virtue of working in hospitality. I think, as a fair guess, we would have had half of that number of Covid fatalities. Somewhere between 40-60; at the bottom of that range if effort was put into testing incoming travellers and tracing the social connections of the infected. The looser of this freedom-fighter kind of policy would have been those who have irrational fears about Covid and want the illusion of an entirely Covid-free world. The winners would have been practically everyone else.

IOMG went for option 1 because it had an easier political justification and it knows the island can possibly afford the cost. But that cost is truly very high and it will result in meager pensions, reduced general welfare and poorer quality health care for many years to come; and certainly many more premature deaths along the line than the liberal third option on the above. Has there been any effort to quantify that and communicate it to the public? If the public had been aware of the options there would have been less blinkered support for the first option. Much less.

[. . .]

 

In reply to jaymann.

When you say “we need a balance” and “we've lost the plot” you are using far too polite and diplomatic language. Maybe because they know who you are. My own opinion about pitchfork-brigate-inspired IOMG policy is expressed by a list of four letter words.

The 7% figure quoted by PHE and some posters on this forums is based on having only one test on arrival and that’s it. There is nothing to stop having multiple tests of those who arrived recently, spaced a few days apart, and to submit them to an intermediate level of self-isolation in which one is asked to avoid offices/pubs/gyms etc but allowed out for physical exercise and shopping. That is what Switzerland is actually doing.

Some travellers will break the rules and get away with it. But most will behave responsibly and the experience of Jersey, Denmark, Iceland etc shows that it is enough to keep community spread under control. What we have at the moment is far from secure, because family members of those who have just arrived are not required to isolate. Testing with more freedom would actually be safer.

[Nom de plume]

Quayle waffling on about acceptable levels of risk (UK infection rates) before contemplating allowing family members back for Christmas.

He pulled the Guernsey air bridge on 7 cases ffs! Nobody is coming here whilst this man is calling the shots. 

[TheTeapot]

I have purposefully not tuned in today. Any letters read out saying how great they are?