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Corona Virus + upcoming holiday

 Poster: A snowHead
Poster: A snowHead
Rather alarming news from the US this morning. A tiger in Bronx Zoo has tested positive:

https://www.bbc.co.uk/news/world-us-canada-52177586

Not only is this bad news for pet owners but the herd immunity solution just got a whole lot bigger.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Big numbers of cats in China have coronavirus - and pass it readily to each other.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Quote:


Because it is balancing deaths on the one side with jobs and GDP on the other, as if there was some trade-off to be had.

But NICE makes these trade-offs all the time - they are the stuff of health economics


With the decisions NICE make, they have clear, precise numeric inputs (e.g. treatment X will cost £100 000 per patient, and will be expected to provide 1 extra QOLY (Quality of Life Year)). This allows like for like comparison of different treatments (e.g. to compare X with treatment Y that costs £500 000 per patient, and gives 10 QOLY). That comparison is apolitical; there is then a political choice on where and how the line is drawn - e.g. is there a given pot of money, or do you provide treatments up to a given QOLY / £

However, with COVID19 there are no useful comparison numbers. There's huge uncertainty on the likely death toll per each option, and equally I can't see any way of usefully quantifying the economic hit for each option, at least not in any way that many people would agree on
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@altis, am I going to have to shoot all my tigers?

All nonsense.
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Anyway, snowHeads is much more fun if you do.
@LaForet,

Quote:

But NICE makes these trade-offs all the time - they are the stuff of health economics


This.

And some of those decisions have been made on the flimsiest of economic evidence - evidence rejected by Scotland and NI where drugs have been made available. So real-life treatment rationing purely on the basis of economics goes on day in day out
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@viv,

Quote:

With the decisions NICE make, they have clear, precise numeric inputs (e.g. treatment X will cost £100 000 per patient, and will be expected to provide 1 extra QOLY (Quality of Life Year)). This allows like for like comparison of different treatments (e.g. to compare X with treatment Y that costs £500 000 per patient, and gives 10 QOLY). That comparison is apolitical; there is then a political choice on where and how the line is drawn - e.g. is there a given pot of money, or do you provide treatments up to a given QOLY / £


That's a lovely soundbite, but when these panels convene and there is no recognized expert in the field present how is a considered judgement made.

And please don't suggest they use QOLY data appropriately
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Then you can post your own questions or snow reports...
QALYs (and for that matter VSLs and VOLYs Toofy Grin ) are economic measures of value best suited for decisions before an event (ex ante). They should not be used to after the stable door has opened and the horse bolted (ex post). Toofy Grin Toofy Grin Toofy Grin
Now back to thinking about skiing..
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
@abc why are you always looking for an argument? I clearly said I don't want the elderly to die. Did I say they haven't contributed? Did I say they don't deserve to enjoy a nice long retirement? The question was if we HAD to lose a section of society which would you prefer. While I obviously prefer nobody dies, the over 80s do cost the NHS a disproportionately high amount per person, they also are retired hence a net loss financially to society. It's simple logic, and brutal honesty. If you are so unhappy with my answer how about you answer the question yourself rather than just try and pick flaws? If we had to lose a section of society which would it be?

For what it's worth I have no plans for retirement, no pension plan. I am trying to enjoy my life right now. If I'm lucky enough to get to 70 and have to still work so be it. With younger people becoming less able to afford houses, work becoming far less manual, and the retirement age expected to go up I think the retirement outlook is changing.
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Quote:

why are you always looking for an argument?

@boarder2020, I believe this is exactly what we're doing here: picking arguments!

1) We don't have enough data to support good decisions, 2) We don't have the power to enact whatever theoretical "decision" we come to!

We're just a bunch of random folks passing time when we can't go out to ski. So stop being indignant when others argue the opposite view.

Quote:

If we had to lose a section of society which would it be?

Why do we have to pick a "section of society" to lose? I don't get the point.

But just to continue on the path of theoretical thought process, if we must pick, I'd argue hospitality industry itself is a "lessor" industry compared to manufacturing, agriculture, finance, communication, logistic... etc. So the pain of job loss might just be a re-balancing of different industry that is gradually going on, albeit squeezed into a short window of time!

Technology is already on the horizon that many manual jobs can be done without human. Or at least without human ON THE SCENE. It's happening rather slowly due to low demand. This pandemic may spur a rapid growth in automation.

So the economy, once back, may actually be stronger thanks to the lock down. rolling eyes
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I don't know enough detail on NICE judgements and processes to comment on them. I referenced them because they have quantifiable and agreed (to a reasonable extent) metrics that they can use to make judgements. This is in contrast to COVID19, where any metrics are based on huge amounts of unknowns, and much disagreement on how they'd be calculated / estimated
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@boarder2020 'They have been fortunate to already live a long life, most of them are now retired so not integral to society, most of them are a "burden" in terms of cost (increased cost to NHS, tax payers etc.)'

So basically, your life is worth more than theirs?

The logical end-point of your approach is to kill people off when they retire and stop working. In fact, the logical end-point is to kill people off who are unemployed for any length of time. Because they're a 'burden'. Oh, and children who are born with disabilities? They're a 'burden' too. So they should all go. Any anyone diagnosed with a probably terminal illness? Off to the crematorium for them, then - let's not waste NHS resources on the terminally ill.

And 'not integral'? What exactly does that mean? Who exactly is 'integral', then? Let's have a list then, and we can prioritise resources and medical treatment appropriately.
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And love to help out and answer questions and of course, read each other's snow reports.
@laforet the (very hypothetical!) question was "if large numbers of people die what section of our society would you prefer them to be from?" I answered the question making it clear that of course I would rather nobody dies. It really should go without saying but of course people want to jump on anything and misconstrue it to create argument so I made it very clear.

Quote:

The logical end-point of your approach is to kill people off when they retire and stop working. In fact, the logical end-point is to kill people off who are unemployed for any length of time. Because they're a 'burden'. Oh, and children who are born with disabilities? They're a 'burden' too. So they should all go. Any anyone diagnosed with a probably terminal illness? Off to the crematorium for them, then - let's not waste NHS resources on the terminally ill.


I never said anything like that. Simply if we HAD to lose a section of society the over 80s make the most sense to me. The NHS priorities young over old all the time, and we heard that ICU beds in Italy would be given to younger people over old if full, so it's not a new or unheard of opinion. From a health economics point we know younger people tend to have better outcomes to treatment, and also the same cost treatment is likely to provide many more years of quality of life or even life for a younger patient. Loss of working age people would have more impact on society in terms of skilled job force being lost and economically for the country as a whole. Losing a generation of children would create future problems.

You are welcome to disagree with my choice, but if you are going to criticise please answer the question yourself first - if we HAD to lose a section of society who would you pick?

Quote:

let's not waste NHS resources on the terminally ill.


Not something I said, or believe, and not really relevant to the current conversation. But in a lot of cases we don't! There are many medications that are not available on the NHS because they are not considered cost-effective (<£20,000 per QALY is considered cost effective, with anything more going to review where it could be approved or not in some cases).
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
'please answer the question yourself first - if we HAD to lose a section of society who would you pick? '

I am not God.

And as a very famous politician once said "I can't answer hypothetical questions."

I know this sounds evasive, but what she meant was that such simple questions have inadequate context for a meaningful reply. Or they come with a whole raft of assumptions that one doesn't necessarily agree with.
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 You know it makes sense.
You know it makes sense.
boarder2020 wrote:


You are welcome to disagree with my choice, but if you are going to criticise please answer the question yourself first - if we HAD to lose a section of society who would you pick?
.


Man United fans?
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Medical ethics are crucially individual based. Not about the expendability of a "section of society".
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Poster: A snowHead
But yeah, football fans..... Puzzled
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
boarder2020 wrote:

You are welcome to disagree with my choice, but if you are going to criticise please answer the question yourself first - if we HAD to lose a section of society who would you pick?


Lefties
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
@boarder2020,
I think I would pick all those who take to twatter and so on to spout any form of hate.
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boarder2020 wrote:
You are welcome to disagree with my choice, but if you are going to criticise please answer the question yourself first - if we HAD to lose a section of society who would you pick?
.

LaForet wrote:
'
such simple questions have inadequate context for a meaningful reply. Or they come with a whole raft of assumptions that one doesn't necessarily agree with.

+1

This is getting silly. But play along...

Candidate "section of society" that are more expendable: disabled, prisoners, chronically sick, jobless, chronically lazy...

Quote:
Lefties

Quote:
Man United fans?

blacks, yellow, homos, ... JEWS

You know where this is going...
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Anyway, snowHeads is much more fun if you do.
@abc, you missed out the Bankers who, don't forget caused all the problems in 2008 which resulted in the years of austerity to pay off the debt.

They lost practically nothing, but then made millions in commission re-selling the shares.

The overall cost was in the region of £8,000 per person in the UK

How much of the money used to prop up the Banks could have been diverted into the NHS over the last 10 years?
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@brianatab, you're telling me you don't own any bank shares in all of your savings/investments?

And yeah, I forgot the professional footballers too. (https://snowheads.com/ski-forum/viewtopic.php?t=152439)
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Somewhere in these pages (least I think it was this thread) I stated that my daughters school ski holiday at Easter had been cancelled, as it was in Italy, in Lombardy & the flights were to Bergamo. It was quite early on in the whole Covid in Europe saga.

Anyway, this evening I received a full refund on the cost of the trip (which we had been paying for over the whole of the last year, with the final 10% only going out on DD last month, after the cancellation).

So full credit due to whomever the trip was arranged through. I will try to get the name of the company and post it up on the various relevant snowHeads threads.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Not sure where to post this but managed to get a refund for from BA for an overseas flight scheduled for May which they cancelled today. As some may know BA are trying to force people down the route of accepting a credit voucher to get around their lawful requirement to provide a refund (for cancelled flights) by making ticket holders call a number that is always busy - replacing the usualsimple online process of cleaning refunds . The way around this is for anyone to call the executive gold line on ‭0800 123111‬ and choosing the last option in all menus and there will be a less than 5 minute wait to connect with an agent who can process a refund. This only works once the flight is cancelled by BA and therefore you need to sweat it out before claiming the pre-cancellation voucher.
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"Spare a thought for members of the Flat Earth Society.

They fear that social distancing will push them over the edge... "
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Just had the word from our insurance that they will not pay a bean because no-one was ill, or was burgled etc:
Quote:
The Insurer will pay up to the amount shown in the Schedule of Benefits for an Insured Person’s loss of the proportionate unused and irrecoverable travel and accommodation costs paid in advance or contracted to be paid that cannot be recovered from any other source, as a result of Curtailment of that Insured Person’s Trip.

THE FOLLOWING SPECIFIC DEFINITIONS APPLY TO SECTION 8 (IN ADDITION TO GENERAL DEFINITIONS)

Curtailment

Means the necessary and unavoidable abandonment of a Trip after the Insured Person has departed on the Trip, as a result of one of the following circumstances:

(a) written medical advice by a registered medical practitioner requiring the Insured Person to either:
i) return to their Country of Residence due to Bodily Injury or Illness of that Insured Person, or
ii) attend a hospital overseas as an In-Patient;

(b) Written medical certification by a registered medical practitioner confirming the necessity for the Insured Person to return to their Country of Residence due to the death, Bodily Injury or Illness of a Close Relative or Close Business Colleague;

(c) the Insured Person’s presence being requested by the Police following their Home or business premises being rendered uninhabitable during the Trip or in the 7 days prior to their departure on a Trip;

(d) the Insured Person’s presence being requested by the Police following burglary or attempted burglary at their Home or business premises;

(e) the Insured Person being called to be a witness or for jury service where postponement has been denied by the Court;

(f) official requirements for the Insured Person to attend emergency duty in British Military, Medical or Public Service.

That's nearly 2K we laid out for two days in Chamonix. Ah well, at least we're still healthy.
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altis wrote:
Rather alarming news from the US this morning. A tiger in Bronx Zoo has tested positive:


Unless he's planning on skiing Saalbach next January, I'm not too worried.
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
Everyone knows the answer to ‘who dies’. The poor
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 So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
@altis, go on, name and shame!

Did you cancel pre the FCO banning overseas travel? Mine (AXA) has told me it expects to pay everyone out where the FCO ban was relevant.
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 You know it makes sense.
You know it makes sense.
We set off on Friday, 13th March (unlucky!) for a week in Cham then another in Champagny. We were pushing the boat out for our 40th anniversary.

Lifts closed on Saturday evening and France went into full lockdown at midday on Tuesday - when we were half way home again.

Under “catastrophe” Axis will pay for extra costs incurred through travelling home but, since we drove, there weren’t any. They will only pay under “curtailment” in the limited circumstances listed above.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Dave of the Marmottes wrote:
boarder2020 wrote:


You are welcome to disagree with my choice, but if we HAD to lose a section of society who would you pick?
.


Man United fans?


Very Happy Very Happy
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the BBC seem to be reporting of hope for some summer holidays, I reckon everywhere has it now so its not like your going to me visiting an infected area.
I am feeling hopeful but it will be a driving break & I won't be getting on a plane anytime soon.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@Jonny996, I'd love to believe you and I know we share a "glass half full" mentality (including "if it isn't, get another round"). But in the UK I suspect you could plausibly argue for anywhere between 5% and 40% of the population having had it - and that number biased towards London.

At one level though, there will be a point where the risk of not opening up travel might outweigh the risk of not being totally on top of the virus. Not sure how that will work out in practice though, opening hotels is a different story and for those of us not within a day's drive plus Eurotunnel/ferry of our destination getting there might be tough. (I assume when you drive from Edinburgh you stay over somewhere).
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Rather depressingly, this (proper scientific, not self published/journo reported etc.) preprint https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article shows that in one very detailed contact-tracing exercise, only 4% of people were asymptomatic.

On a positive note, it also shows that there was negligible transmission from presymptomatic and asymptomatic people.

This would suggest that the hope that many of us have had COVID but not noticed, and are thus immune, may be more hope than reality. Prof Neil Ferguson has admirably demonstrated the dangers of people thinking they've had COVID and are therefore immune...

It also shows what is being done, in Korea, to get on top of this. Every person who spent more than 5 minutes in the vicinity of the office block where the infection broke out (identified by mobile phone location data from the network, no "please install an app that might not work" nonsense) was notified and invited for testing. All the people involved who tested negative were repeatedly tested during their 14 day quarantine. Over 16,000 people were notified/traced, and over 1,100 of those were tested directly.

On a similar and travel-related note there's a paper from IATA (arguably a bit self-serving, and more PR than a scientific study) that suggests out of 1,100 known COVID cases on board aircraft, there have been only 2 secondary infections. https://www.iata.org/contentassets/f1163430bba94512a583eb6d6b24aa56/covid-medical-evidence-for-strategies-200504.pdf
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@snowdave, Rather than there being large numbers of asymptomatic people my hunch is that many people had the virus in December and January and it was spreading unchecked for months whilst the focus was only on people who had travelled to China and Italy. Our family had a very unusual viral illness in December including terrible coughs and large numbers of people were off at my kid's school at the time. One of my son's classmates had pneumonia. I am certainly not taking any chances though and we are following the lockdown rules.
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@snowymum, it's possible but _extremely_ unlikely. There are lots of seasonal illnesses that present similarly to COVID. UK testing in the early days was focused heavily on people who had extremely strong symptons, yet even so most were coming back negative even when COVID had been symptomatically diagnosed.

Once COVID hits, it's pretty obvious in hospital admissions and behaviour, and since the infectiousness is understood (within bounds) if it had been circulating in December, by Feb UK hospitals would have been overwhelmed. We know (approximately) how long it takes to get infected, how many more people get infected by an index case, what proportion of symptomatic patients end up in hospital, subsequent mortality rates etc. and thus I suspect it's wishful thinking to hope that it was in widespread circulation in the UK in December.
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snowdave wrote:
@snowymum, it's possible but _extremely_ unlikely. There are lots of seasonal illnesses that present similarly to COVID. UK testing in the early days was focused heavily on people who had extremely strong symptons, yet even so most were coming back negative even when COVID had been symptomatically diagnosed.

Once COVID hits, it's pretty obvious in hospital admissions and behaviour, and since the infectiousness is understood (within bounds) if it had been circulating in December, by Feb UK hospitals would have been overwhelmed. We know (approximately) how long it takes to get infected, how many more people get infected by an index case, what proportion of symptomatic patients end up in hospital, subsequent mortality rates etc. and thus I suspect it's wishful thinking to hope that it was in widespread circulation in the UK in December.


A week ago I would have agreed with you, but France had now tested a sample from Dec which has tested positive so it was in Europe then, also there are now reports the virus has mutated between 7 and 20 times so it is entirely possible that the bug that most people we know had in Dec was a mild version of covid19, of course its entirely possible it wasnt.
There have been plenty of reports on how many dont show symptoms too from 10% up to 90%
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@snowdave, They have already found in France (in the last week) that it was starting to circulate in December and it took months from that time for large numbers of people to be dying in France. I have also read elsewhere the suggestion there were at least three strains so possibly Europe initially got a milder version and then the more serious or more contagious version started circulating in Italy and then spread. However I agree with you that this might be wishful thinking...until we get reliable antibody tests we won't know.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
robs1 wrote:
A week ago I would have agreed with you, but France had now tested a sample from Dec which has tested positive so it was in Europe then, also there are now reports the virus has mutated between 7 and 20 times so it is entirely possible that the bug that most people we know had in Dec was a mild version of covid19, of course its entirely possible it wasnt.
There have been plenty of reports on how many dont show symptoms too from 10% up to 90%
I've heard a few times that studies of the mutation rate of SARS-CoV-2 virus point very strongly to its genesis at the end of November / beginning of December (which would tie in with the first hospitalisations in Wuhan). Given that we have seen the rate at which it travels from country to country and the time it takes to get established, I think the cases in Europe in late December than we are now concluding were Covid-19 are likely to be isolated examples, perhaps with an easy to establish direct link to China, rather than evidence of widespread community transmission in European countries.
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@rob@rar, that is my interpretation of it too, although our surgery reception staff are still convinced most of them had it in January, and none of them have actually had Covid-19 symptoms more recently. Potential source from Chinese students, and we are the student medical practice.
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@rob@rar, +1

My recollection of the French case is that researchers went back through the records to look for anyone who'd died of COVID-like symptoms, and then tested the blood samples to find one patient who died of COVID. This, based on what we currently know, means either a) that they were a bit of a one-off (e.g. had come back from China recently or similar) or b) that there were a few hundred to a few thousand cases in France at that point.

Research to date suggest a doubling time of 2-3 days in an "uncontrolled" situation (i.e. no social distancing etc.) see https://www.medrxiv.org/content/10.1101/2020.02.05.20020750v5 . That would mean that if a few thousand people had COVID in December, by Feb, the entire population of the UK/France etc. would all have been infected.

Whilst all these things are possible (as are theories around mutation, albeit they are inconsistent with the data which has symptoms in early cases in China relatively consistent with European cases today), they are unlikely. The most likely scenario is that it hasn't been circulating in the population widely for months, most people have not already had it, and there is limited herd immunity.

The problem is that's not what we want to believe, nor is it what some segments of the media (particularly those pushing for early release of the lockdown) want us to believe, but it is the most likely scenario based on the data to hand. Happy to see any contradictory published scientific papers (of which there will be some).
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