The Wry Observer’s Covid-19 update (54)

Rather a long pause but I am confused again.

We returned from visiting mother-in-law in the West Country to find Rye teeming with unmasked, non-socially-distancing folk out and about.  The “rules” about masks seem to change daily, so it’s hardly a surprise that people are ignoring them.  We have not dared to visit the beach at Camber, but then if we tried we gather it’s impossible to get there (50 minute queues, cars dodging round the police telling them to go away) but it is even more impossible to get out again.

And then we learn that the dreaded Second Spike is coming!  Bits of the North are showing a rise in cases so lockdown is being resumed there.  Businesses that thought they were going to be able to open cannot.  The Spike in Spain is mainly on the plain (sorry, I mean the North-East) but overnight there is now 14 days of quarantine for returnees.  Much anger; we were given no notice, it’s only bits of Spain, so why penalise all of it, the Balearics and Canary Islands are better than the UK etc.  It is ironic that those protesting about the speed of imposition seem to be the same people who castigated the government for delaying a lockdown at the outset in March.  It’s a no-win situation, but sudden changes were always on the cards and were regularly telegraphed, so I don’t have a great deal of sympathy for people who didn’t listen.

But what is this second spike, or wave?  Is it just that we are picking up ever more cases (many asymptomatic) because we are testing more?  And does it matter?  I would have thought that trouble would be evident if in fact there was a spike in hospital admissions and ventilated cases.  But so far there isn’t.  Look at the figures for England from the official website:

 

Date Admitted Inpatient Ventilation bed % ventilated
29/03/2020 2817 8143 1494 18.35
29/04/2020 1227 11573 2045 17.67
29/05/2020 466 5589 630 11.27
29/06/2020 189 2780 228 8.20
29/07/2020 23 850 72 8.47

Or if you prefer a graph:

covd 19 graph

I see no spike.

Yet.

But as so many cases are asymptomatic I cannot see how you can either stop transmission unless you lock down until every last case has gone, which is impossible.  Maybe all the most susceptible have died already.  So is there really any point in continuing a lockdown if it doesn’t work?  Answers to me, please on one side of A4.

Meanwhile “The Times” reported that a tocilizumab trial failed to show benefit.  I can’t find this so far.  An Italian trial suggested there was some benefit (https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30173-9/fulltext).  Several others have conflicting results (see https://www.medscape.com/answers/2500114-197457/what-is-the-role-of-the-il-6-inhibitor-tocilizumab-actemra-in-the-treatment-of-coronavirus-disease-2019-covid-19).  So maybe my protocol for management is wrong.  On the other hand it’s not clear exactly when administration started in some of the trials, and with what other drugs.  And there is some evidence that my other recommendation, anakinra, may work (https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30164-8/fulltext) but there remain caveats (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316448/).

Life is not simple… time for lunch!

 

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