一本道理不卡一二三区

The ‘R’ rate: Is it reliable and how might reopening schools impact it?

Some scientists argue current method of measuring reproduction of virus does not provide an accurate picture

The Government is basing its lockdown release strategy on the reproduction, or ‘R’ rate, and has warned that if it goes above one, restrictions will remain in place.

But how is it calculated? Is it reliable? And will schools reopening一本道理不卡一二三区 have a significant impact?

Here is what we already know

The reproduction, or ‘R’ rate, is the number of people that a single infected person will go on to infect.

一本道理不卡一二三区Anything above one, means that each person will be passing the virus on to more than one person allowing the epidemic to grow exponentially. 

For example an ‘R’ rate of 1.5 would mean every 10 people who became infected, would infect 15 more people. Those 15, would, in turn, infect 22.5 people who would then pass the disease on to 33.7. 

The opposite is true if the ‘R’ rate is below one. The Government announced last week that it is somewhere between 0.7 and 1. Scientists cannot be completely accurate because different models are used to come up with the figures and they do not often agree.

一本道理不卡一二三区If it is at the lower end of the estimate, 0.7, then every 10 people will infect seven others. Those seven will infect 4.8, who will go on to infect 3.4.

If the ‘R’ rate is at the higher end of one, then the disease has plateaued, so 10 people would infect 10 others, and the epidemic would neither increase nor decline.

The ‘R’ rate is calculated by The Scientific Pandemic Influenza Group on Modelling (SPI-M), a sub-group of Scientific Advisory Group for Emergencies (Sage).

However it is only an estimation and it is usually out of date because it relies on testing, admissions and death data. So there will always be a 14 to 21 day lag because people are infected weeks before they enter hospital, or die. 

Contact pattern surveys are also used to calculate how much people move around but these also tend to have a lag of around a week and are open to bias because they rely on self-reported behaviour. 

Household longitudinal surveys — which sample the same people repeatedly — allow a direct estimate of the infection rates, but these have only recently started by the Office for National Statistics (ONS) and no long-term data is currently available.

Therefore the current ‘R’ rate reflects the situation in Britain at the end of April. 

It is also crucial to look at the ‘R’ value alongside the actual number of people infected. 

For example, although the countrywide ‘R’ rate is between 0.7 and 1, Public Health England (PHE) modelling suggests that in London it could be as low as 0.4, with daily infections down to fewer than 24 a day, and critically, halving every 3.5 days.

一本道理不卡一二三区In London’s case, the virus could potentially stop spreading within the capital by the end of May.

In contrast, the same study estimated that thousands of people are still being infected in the North East each day, where the ‘R’ rate could be at 0.8, and halving at a far slower rate, meaning that it will take longer to eliminate the disease in that area.

The other problem is that the ‘R’ rate can vary not just regionally, but also by subsections of the population. Government scientists now believe that the epidemic is largely confined to care homes and hospitals and there is very little community transmission at all.

“Nobody catches it by passing someone on the street,” said one Government expert. “That isn’t how you get it. This is now epidemic of care homes and hospitals.” 

There are fears that reopening schools will have a big impact on transmissions, potentially sending the ‘R’ rate above one again, but there is little evidence to show that will happen.

Research published in April, by University College London (UCL), suggested that schools only play a small role in transmission, perhaps accounting for two to four per cent of deaths and 10 per cent of the ‘R’-rate. 

一本道理不卡一二三区Those estimates were based on the entire school population without extra measures, such as social distancing, so the impact is likely to be even smaller with class sizes restricted to 15 and communal tables replaced by traditional single desks.

一本道理不卡一二三区There is also no evidence that those schools which stayed open for the children of key workers have seen extra infections in their communities.

The Chief Scientist of the World Health Organisation (WHO) Dr Soumya Swaminathan also said she did not think reopening schools would pose a threat of increased infections.

Speaking on the BBC’s Andrew Marr Show Dr Swaminathan, who specialises in paediatrics, said: “Children don’t seem to be getting seriously ill from this infection.

一本道理不卡一二三区“We do know that children are capable of getting the infection, but there’s less data on how effectively they are able to spread it to others. What we have seen in countries where schools have remained open is that there have not been big outbreaks in schools.

一本道理不卡一二三区“Where there have been it has been associated with events where a lot of people gather, not in regular classrooms and it’s often been associated with an adult, who has the infection and who has spread it. The risks to children are extremely low.”

Schools were closed in Britain on March 20 and a report published by Imperial College on March 30 suggested that might have taken the ‘R’ rate down from three to just above two.

However only nursery, Year 1 and Year 6 are going back to begin with which means the impact is likely to be far less.

一本道理不卡一二三区Prof Matt Keeling, Professor of Populations and Disease, at the University of Warwick, said: “Any form of additional mixing will inevitably lead to an increase in ‘R’, and hence more cases — however, all the current evidence suggests that children are not suffering substantially from this pandemic.  

一本道理不卡一二三区“This could be because they are less susceptible or because they show fewer symptoms when infected, there is no firm scientific data to determine which of these is true.  This means that opening some school classes is unlikely to push ‘R’ above one; a conclusion supported by our mathematical modelling studies.

一本道理不卡一二三区“The idea of only half the children being in school should mean that classes can be half the size, which will help with social distancing, further preventing a substantial rise in ‘R’.”

Some experts believe the ‘R’ rate should not be used at all to determine policy.

一本道理不卡一二三区Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, who also sits on Sage, said: “The ‘R’ rate shouldn’t be a policy objective. It’s not the direct measure of the public health burden, it’s not a direct measure of capacity. It restricts your options very substantially.

一本道理不卡一二三区“The R being below one for the whole country is meaningless when in fact when it can be different in different portions of the population,

“Particularly now we have a situation where it’s almost certainly below 1 for the whole country, but is around 1 or higher in care homes. Now if you think about it that’s the wrong way round.

一本道理不卡一二三区“The public health implications of ‘R’ greater than one are very different in hospitals than in the general population and the elderly and specific regions and having this single number directs policies.”

一本道理不卡一二三区Prof Woolhouse said that the regional lifting of lockdown had been discussed by those advising the Government.

一本道理不卡一二三区“It’s a discussion point, he said. “As I understand they prefer to move forward in the UK as one but the devolved administrations are doing things independently so there is an argument.

“There may be epidemiological circumstances where it would be justified to relax the region of the UK if the R value was lower.”

一本道理不卡一二三区A Government source said: “We have always been clear that loosening depends on ‘R’ being below 1. 

“Without that, we risk seeing the kind of exponential growth we faced at the height of the pandemic. R must be below 1 for further opening up of society.”

Prof Saul Faust, Professor of Paediatric Immunology & Infectious Diseases, University of Southampton, said: “Society has to reopen, children need to return to school as there are negatives for many of having to stay at home and we need to be able study transmission dynamics in all ages to help us learn how to manage this virus.” 

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