Thread: Throughout the pandemic there's been plenty of attention focused on #COVID19 deaths and on what’s happened in hospitals and in care homes - for obvious and understandable reasons. But for months there’s been another phenomenon which I find deeply unsettling.
Even after lockdown ended the number of people dying at home has stayed far, far above historic levels. There have been 28k excess deaths in people’s homes - more than in hospitals, care homes or other settings. Only a fraction of these deaths are officially put down to #COVID19.
I’ve been banging on about this since early on in the pandemic. It's not a new phenomenon. But it remains stubbornly unchanged even months on, even as excess deaths in other settings - care homes and hospitals - have dropped into normal or negative levels.
Is this something to worry about? Or is it (kind of) good news - in that lots of people would rather die at home than in a medical setting. Frustratingly there’s been v little research on this, so over the past few weeks we’ve been working on a short film looking beneath the data
It starts with Charlotte. Her mum, Caroline, died of ovarian cancer this summer. She had been in hospital but because of lockdown her family hadn’t been allowed to visit her, so they brought her home to try to care for her there. It was an ordeal, but they had little choice.
The family couldn’t get as much palliative care as they needed. Their home became a hospital. If she had gone into a hospice (as she might in normal times) they might not have been able to be with her, so she died with them at home. Her death is one of the thousands in this chart
Indeed, the most compelling theory about why excess deaths are up at home and down elsewhere is that these deaths are simply being displaced from other settings.
But these data can’t tell you anything about the QUALITY of death - something which matters enormously.
For many families the answer is remote hospice care (80% of hospice work is done in people’s homes).
Problem is those services have been overwhelmed during the pandemic. And like many, in the early days they struggled to get the PPE that would allow them to do their jobs
Selina says: “We can lose four patients just in one day. We can go off shift and have our two days off, come back to work and all our patients have changed because they’ve died. We’re getting our referrals in later and people are dying a lot sooner.”
And even as deaths at home remain so high, the hospice sector are struggling to keep up with the demand.
We’ve been shown numbers from an internal Hospice UK survey: 44% of hospices think they'll have to REDUCE their services. 93% fear people may miss out on the support they need
But there’s another likely explanation for high excess deaths at home:
some people are dying earlier than they would have because they've been unable or unwilling to go into hospital for the medical treatment they need. We know these cases are happening anecdotally.
Meet Amanda & Adrian. Adrian has stage 4 bowel cancer. He responded well to chemo - so well that his docs scheduled a life-saving operation to remove a large part of his liver. It was due in April. Then came lockdown, then the op was cancelled. Adrian’s cancer is now terminal
Adrian is one of potentially thousands of cancer patients whose care has been affected by lockdown. Doctors expect a surge in cancer deaths in the coming months and years. It is another dimension of what is happening beneath the surface of the data
We're still in the early stages of understanding this. Next week @ONS will produce further data breaking down home deaths by cause to see if there are any early patterns. But @d_spiegel told me it’s not impossible this is a permanent - or at least a long-lasting - change.
If you have time, do check out my long read on a disquieting phenomenon. For months I've been worried about the data showing thousands of excess deaths at home. This is my attempt to get beneath these numbers and understand what's going on news.sky.com/story/coronavi…
Here's our @SkyNews report about excess deaths at home, produced by the brilliant @maddylratcliffe.
As #COVID19 surges again and parts of the country go into another lockdown, this troubling phenomenon is likely to be with us for a while longer
Interesting @ONS deep dive into deaths at home.
Underlines point in my @SkyNews piece on this 👆, some of these deaths would have happened anyway.
Some may be happening sooner because of inability to access healthcare.
Eg see increases in causes of death: ons.gov.uk/peoplepopulati…
As of the latest data there have been more excess deaths happening in people’s homes this yr than any other place. Vast majority of the deaths were not from #COVID19.
This is one of the most important but least discussed phenomena of the pandemic.
More on it in the thread 👆
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The Chinese owners of British Steel say they are now considering shutting their blast furnaces and end steelmaking at Scunthorpe in early June - only a few months away.
It would mean an end of virgin steelmaking in the country that invented it during the industrial revolution
British Steel say the main question now is timing: whether the operations will close in June, in September or later.
It says tariffs are one of the reasons the blast furnaces are "no longer financially sustainable".
Press release 👇
The news means @jreynoldsMP faces two interlocking crises in the coming months: 1. The imposition of US tariffs on an ever growing segment of British exports 2. The end of virgin steelmaking (the UK would be the first G7 country to face this watershed moment).
This is big stuff
Donald Trump just announced 25% tariffs on anyone importing oil from Venezuela.
This is odd.
Because the country importing the most crude from Venezuela is... the US.
Capital Economics chart of Ven oil exports by Capital Economics via @rbrtrmstrng
But it raises a bigger point
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Why does the US import so much oil from Venezuela?
Mainly for the same reason it imports so much oil from Canada.
And no it's not just because they're close.
It's because most US refineries are set up to refine the kind of oil they have in Venezuela and Canada.
To understand this it helps to recall that crude oil is actually a broad term. There are LOTS of different varieties of crude - a function of the geology of where the oil formed and the organic ingredients that went into it millions of years ago.
It's called "crude" for a reason
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Here's a thread about ALUMINIUM.
Why this commonplace metal is actually pretty extraordinary.
How the process of making it is a modern miracle...
... which also teaches you some profound lessons about the trade war being waged by Donald Trump. And why it might be doomed.
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Aluminium is totally amazing.
It's strong but also very light, as metals go.
Essentially rust proof, highly electrically conductive. It is one of the foundations of modern civilisation.
No aluminium: no planes, no electricity grids.
A very different world.
Yet, commonplace as it is today, up until the 19th century no one had even set eyes on aluminium. Unlike most other major metals we didn't work out how to refine it until surprisingly recently.
The upshot is it used to be VERY precious. More than gold!
🚨TARIFFS🚨
Here's a story that tells you lots about the reality of tariffs both for those paying them & those hoping to benefit from them.
A story of ships, storms, bad luck and bad policy.
It begins a week and a bit ago, with a man frantically refreshing his web browser...
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That man is Liam Bates.
He runs the UK unit of a steel company called Marcegaglia. They make stainless steel - one of the most important varieties of this important alloy. The method of making it was invented in Sheffield. And this company traces its DNA back to that invention.
Watching the process is TOTALLY amazing.
They tip a massive amount of scrap: old car parts, sinks etc, into a kind of cauldron and then lower big glowing electrodes into it.
Then flip the switch.
⚡️Cue a massive thunder sound as a controlled lightning storm erupts inside it.
🧵Three years ago, when Russia invaded Ukraine, EU, UK and other nations vowed to wage economic war, via the toughest sanctions in history.
So... how's that going?
We've spent months documenting what ACTUALLY happened. Here's a thread of threads on the REAL story on sanctions...
1. Flows of dual use items, including radar parts, drone components and other parts used by Russia to kill Ukrainians, carried on from the UK and Europe to Russia, via the backdoor (eg the Caucasus & Central Asia)
2. Of all the goods sent by the UK to Russian neighbours, few were as significant as luxury cars.
Having sanctioned Russia (the idea being to starve Putin's cronies of luxuries) Britain (and Europe more widely) began sending those sanctioned cars in via the backdoor instead
If the main thing the US really wants out of a deal with Ukraine is "50% of its rare earth minerals" then I'm surprised this can't be wrapped up pretty quickly.
Why? Because Ukraine doesn't HAVE many rare earth resources.
Really. As far as anyone knows it's got barely any...
Yes, Ukraine has lots of coal and iron and manganese.
It also has some potential sizeable reserves of stuff like titanium, graphite and lithium. Not to mention some promising shale gas.
But of the 109 deposits identified by KSE only 3 are rare earth elements
Now in one respect I'm making a pedantic point: a lot of people say "rare earth elements" when they actually mean "critical minerals".
The two aren't the same thing.
Rare earth elements are a v specific bit of the periodic table: actually they're NOT all that rare.
More on them👇