Another quick update on Covid in Denmark. Cases and hospital admissions still rising, and first signs of an increase in ICU admissions, although numbers are so small that it could just be noise.

Hospital admissions now 2.5x what they were 4 weeks ago.

🧵 Wastewater surveillance suggests that cases are still rising quite strongly.

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The Danish RSV season is all over bar the shouting.

The conclusion?

It's been a pretty exceptional season, to say the least.

And not in a good way.

🧵 First cases/incidence.

I won't dwell too much on them, because they depend a lot on testing, which mainly takes place in conjunction with hospitalization.

It's clear the last couple of seasons have seen a lot more cases than in the past.

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Another week, another #EuroMOMO update.

And excess deaths are again very high.

🧵

https://twitter.com/BarclayBenedict/status/1613501932194209793

For all ages, the estimated number of deaths in week 51 is now just above the peak of the Alpha wave in early 2021.

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I can't find it now, but someone recently responded to one of my posts on Covid deaths in Denmark with this graph.

Implication: look, in the grand scheme of things, deaths aren't that high now.

But this is where the of/with argument works in reverse.

1/ Because of less testing, and other changes to how data is presented, most "with" deaths don't get counted these days.

During that big peak last year they did. If you look at just "of" deaths (the red ones on this graph) last year's peak shrinks significantly.

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I've finally had time to do a new Substack post.

Inspired by the breakthrough achieved by the Lawrence Livermore National Laboratory, it's on #fusion power.

And particularly how that relates to the energy transition and achieving net zero.

🧵

thegreentransition.substack.com/p/fusion-power When discussing breakthroughs in fusion power, it is worth remembering the running joke that “it’s the energy source of the future—always has been, always will be”.

Promising unlimited energy and delivering it are two different things.

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I've done a quick graph to show what's happening with Danish hospital admissions for RSV.

Each bar is a cohort, defined by the RSV season when they were 0-12 months old. So the left-hand bar shows hospital admissions for <1s in 2015/16 (blue), 1-2s in 16/17 (orange), etc.

1/3 The cohort that "missed out" on being exposed to RSV in 2020/21 was admitted to hospital in higher numbers than usual aged 12-24 months (orange), but that mainly reflected the size of the wave in 2021/22. Their *proportion* of admissions wasn't much higher than normal.

2/3

A few random thoughts.

Like other countries, Sweden had virtually no RSV cases in 2020/21, followed by a very big wave in 21/22.

If you use Sweden as an example of a country that didn't lock down, I'm not sure how you blame the current RSV waves on lockdowns. In many countries, the total number of RSV cases over the period 2019-22 has been higher than normal, not lower than normal.

So you can't explain the current high numbers of paediatric hospitalizations simply by a "lack" of cases in previous years.

RSV in Denmark.

First image is cases, second one hospital admissions. The last two seasons stand out as much higher than previous ones.

What's going on?

🧵 Here are the numbers for the past 4 seasons. As has been widely reported, there were virtually no cases and admissions in the 2020/21 season.

So you would expect more cases and admissions than normal in 2021/22. Call it "immunity debt" if you like (I don't much).

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Optimistic take:

It's hospital-acquired infections. (Obviously bad, but it's a *known* bad.)

Neutral:

Older people have fewer prior infections, so less immunity ATM. It will even out.

Pessimistic:

The older you are, the weaker the immune response, and the faster it wanes.

https://twitter.com/PaulMainwood/status/1580888171771965440

I don't really buy the optimistic take, as that steady gradient up the age groups doesn't match likelihood of spending time in hospital, which is high amongst the very young and, mainly, old to very old.

Covid update from Denmark.

TL;DR: Cases, hospital admissions, hospital occupancy, ICU and deaths have all risen. Nothing like Norway, in other words.

🧵 Reported cases have almost doubled over the past 5 weeks, and positivity has risen from 12.7% to 18.9% over that period.

By age group, there's a welcome dip in the over-80s, but with that exception cases are now on the way up in all age groups other than under-5s.

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I'd like to share the abstract of:

THE VENTILATION PROBLEM IN SCHOOLS: LITERATURE REVIEW

William J. Fisk

Indoor Environment Group

Lawrence Berkeley National Laboratory

[Note: LBNL is a U.S. DOE Office of Science national laboratory managed by the Univ of California]

1/ "Based on a review of literature published in refereed archival journals, ventilation rates in
classrooms often fall far short of the minimum ventilation rates specified in standards.

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As others have said, it's odd that indoor air quality (IAQ) has become a culture/Covid wars issue.

But less odd than many other things that have happened over the past couple of years, so whatever.

I've been a strong advocate for IAQ for a long while. Here's why.

1/ First, this isn't a new topic. There are countless pre-Covid reports and studies on why better IAQ is good for concentration in schools, offices and other workplaces.

Bad IAQ also potentially raises the risk of asthma, allergies and even cancers and cardiovascular disrase.

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Lots of people asking - quite reasonably - why can't we just put solar panels on commercial roofs like warehouses?

I've just read the UK warehousing association's report on rooftop solar in warehousing.

A fascinating read, which may feature in HIGNFY one day.

1/ They say you could install 15GW of solar on the 20% of warehouse roofs that are biggest.

That would roughly double current UK solar capacity.

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@timcolbourn @IndependentSage There is lots of CB analysis for IAQ.

Central HVAC systems should be replaced/significantly upgraded every 10-15 years, so C19-related improvements can be done in conjunction with that. These upgrades usually pay for themselves in terms of energy cost savings.

(cont.) @timcolbourn @IndependentSage Incremental costs of extra air changes/HEPAs are relatively small, and to some extent ongoing. Modern HVAC systems allow variable flow (demand controlled ventilation), so this can be adjusted.

Performance can be monitored, and if ventilation is not working, it can be reduced.

Fresh Covid update from Norway, for weeks 29/30.

For cases, Norway is past the peak of the summer wave, although there's not much testing going on, and "Symptometer" prevalence surveillance was not updated.

Wastewater also suggests cases are falling.

1/ Hospital admissions (top row) are falling, even bearing in mind the last couple of weeks will be revised upwards.

ICU admissions (second row) may be falling faster, but see above. Summer holidays may increase reporting delays.

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Monkeypox was the one we were going to get under control easily, because it "doesn't spread readily between humans".

Well, it doesn't spread anything like as readily as SARS-CoV-2 (or lots of other viruses), but we're still struggling.

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https://twitter.com/Monkeypoxtally/status/1554652532647026688

In terms of cumulative cases, Spain leads the way, with almost 100 cases per million people. That's one in every 10,000 people, and steadily rising.

A significant number of people infected already, and no signs of the epidemic slowing.

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Paper from 2020, so before the latest monkeypox scare, which means it hasn't just jumped on the bandwagon now:

"We conclude that circulation of smallpox, followed by worldwide smallpox vaccination, have previously protected human populations from monkeypox epidemics."

1/ "We combined historical data on smallpox and monkeypox with mathematical modelling to estimate the basic reproduction number of monkeypox, and found that monkeypox has epidemic potential."

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17 May, 1940 (Nordahl Grieg):

Today the flagpole stands naked,
among Eidsvoll's verdant trees.
But in this hour, more than ever,
we know what freedom is.
A song rises over the country,
triumphant in its words;
yet whispered through clenched lips,
under the foreign yoke.

1/6 A certainty grew within us,
freedom and life are one.
As simple, as all-important,
as breathing is to man.
We felt, when serfdom threatened,
our lungs did gasp for air,
as if in a sunken U-boat;
we will not die that death.

2/6

Using ONS daily incidence rates for England for the period 8 June 2020-23 April 2022, there were:

92.8 infections per 100 people in that period

If you add 6-7/100 for the first wave prior to that, and slightly more for the period since 23 April, you get ~105-110/100.

1/4 The ONS infection survey excludes some reinfections, so if anything that estimate is likely to be a bit on the low side.

So either:

1. Reinfections have historically been very low, in which case almost everyone has had Covid, and all cases are now reinfections.

2/4

*If* Covid is the primary cause, does anyone have a good explanation for why such a high proportion of the hepatitis cases have been discovered in the UK?

Looking at Covid case numbers, many other countries have seen similar levels to the UK.

1/4 I know lack of testing, etc. makes case numbers unreliable, but that's true in all countries, and anyway differences between most European countries aren't enormous.

Age-specific case rates may differ more, but a lot of young children have been infected everywhere.

2/4

There's a lot of Covid fatalism around - whatever we do (except vaccines) won't make any difference, is counterproductive or not cost-effective.

First, a quick look at cumulative excess mortality: clearly outcomes have varied greatly between rich countries.

🧵 Maybe that's just because some countries did better to start with, but they will gradually converge with the countries that did worse, or at least not continue to outperform them.

Comparing worst and best performers, that's not the case. Best are still doing better recently.

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