Archive for the ‘COVID-19’ Category

COVID-19: My insights have become irrelevant.

March 27, 2022

Click Image for a larger version. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. Numbers in panels highlight the numbers at the peak of Wave#2 in January 2021 and the peak of Wave#3 in January 2022. This pandemic has been going on for a long time and my ability to say anything useful about it is declining.

Friends, it has been just over two years since the UK locked-down in order to minimise the harm caused by the first wave of COVID-19.

Then…

In the following months I retired from my job, and devoted some of my new-found time to charting the development of the pandemic.

Since then I have intermittently deployed my scientific superpower to try to understand what was happening.

My ‘superpower’ was the ability to plot data on logarithmic graphs and spot exponential growth and decline in disease indicators: cases, hospital admissions, and deaths.

In the early data, the number of positive COVID tests was a good predictor for the number of COVID hospital admissions about 10 days later. And admissions were in turn a a good predictor for the number of COVID deaths about two weeks later still.

As the pandemic dragged on through 2020, I felt that what I was doing was helpful. At least, one or two people told me so.

Now… 

But two years on, things are more complicated.

After multiple vaccinations, multiple variants and strains, the different partial immunity that people have acquired from vaccination or prior infection, and very wide variation in people’s behaviour, there is no longer a simple story to tell about the dynamics of the disease.

For example, the disease is now as prevalent in the UK as it is has ever been – roughly 1 in 25 people are currently infected. Hospital admissions have been rising for roughly 3 weeks and are now around 2,000 people per day.

And finally, after a long delay, the rate at which people are dying is increasing: currently roughly 130 people are dying from the disease each day.

The new flu?… 

A few weeks ago, I asked if COVID had become ‘like flu’. And concluded that in terms of deaths it had. The death rate from COVID is around 10% of the roughly 10,000 people that die each week from all causes.

But at this time of year, we would expect flu cases to be reducing.

And flu does not cause ‘long flu’ in the way that COVID gives rise to Long-COVID. I have not studied Long-COVID statistics, but post-viral ‘syndromes’ are actually not unusual.

For example, I had not understood that when people are infected with polio virus, around 70% of infections are asymptomatic. And in those with symptoms, the disease is usually mild. The paralytic complications which in my understanding defined the disease, arise in just a small percentage of cases, when the viral infection finds a way out of the intestines into the central nervous system.

Similarly, I had not understood that infection with the Epstein Barr virus is usually harmless, but in certain circumstances can give rise to glandular fever, and has now been identified as one of the causal factors in Multiple Sclerosis.

So, the idea that a viral infection which primarily affects the airways can, in a small percentage of cases, affect other parts of the body is actually not unusual.

So… 

Friends, I just don’t know what to make of what is happening now.

The Government seem to have yet again abandoned their public health responsibilities, and by ending free-testing, is obliging us all to manage our own risks – and our risks to those around us – by nothing more than guesswork.

I can’t see what will happen in the coming months, but in the last two years infections have fallen from a winter peak only with the aid of severe lockdowns. But I sense no public appetite for the re-introduction of strong restrictions. And I too am enjoying visiting the folk club and other music venues.

In both 2020 and 2021 cases, admissions and deaths all began to rise again after restrictions were lifted. The rises started in June or July indicating that COVID (unlike most flu strains) can still thrive in a British summer. And in both years, the prevalence grew through the summer and autumn and went on to cause serious winter crises.

So viral prevalence may rise, or it may eventually begin to recede.

The situation with re-infection of previously infected or vaccinated people is complex. but recent evidence seems to point towards vaccination being much more effective than prior infection. And so we will likely rely on boosters to minimise deaths and hospital admissions.

I will keep monitoring things, and if I can think of something helpful to say I will. But for the time being, I will just try to say as little as I can.

Stay Safe.

Tee Shirt available here

 

COVID-19: Is it really like flu now?

January 22, 2022

Friends, I hope you are well.

In case you’ve been tuning out of the news and relying solely on this blog for information, I feel obliged to inform you that the COVID-19 pandemic is still here. But I think things are getting better!

I last wrote about the pandemic over a month ago on December 14, and there I commented that I didn’t have much to say. And since then I have frankly just not wanted to think about it!

I was prompted to look again at the situation, as the government seems to be moving to a stance that COVID is now ‘like flu’, and we just need to live with it.

I felt rather distrustful of this assertion, so I thought I would see if there really was any justification for this laissez-faire approach.

To my surprise, I have concluded that there is actually a fair amount of justification.

What?

In this article I compare current death rates in Wave#3 with what used to happen in ‘normal’ years. Can you remember normal years?

My conclusion is that death rates from COVID in its omicron variant, spreading in our heavily-vaccinated population seem to be similar to – or less than – winter death rates seen in ‘normal’ years between 2000 and 2017.

So it may be thatwith some caveats that I will discuss at the end – yes, COVID is becoming like flu.

Really? Yes. Let me explain.

COVID deaths so far

Click the image for a larger version. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. Numbers in panels highlight the numbers at the peak of Wave#2 in January 2021 and the peak of Wave#3 in January 2022. Also shown are the average values through the months of September, October and November 2021.

Even the most cursory glance at the graph shows that the pandemic is still with us, killing around 270 people per day (1,890 people per week) at the moment.

Infections, hospitalisations and deaths have been at a high level through the last 4 months of 2021, and rose strongly at the start of the new year.

Comparing peaks of the curves in January 2021 and 2022:

  • Cases in 2022 (omicron) are around 3 times higher than in 2021 (delta).
  • Hospitalisations in 2022 are around half the numbers in 2021.
  • Deaths in 2022 are around a fifth of the numbers in 2021.

So back in 2021, around 2% of people testing positive died. Now the equivalent figure is 0.1%.

These simple figures mask many complications.

  • In 2021 the death rate was for an almost unvaccinated population and the virus was controlled by severe social distancing: a lockdown.
  • Now the most vulnerable parts of the population are multiply vaccinated and there is a great deal of immunity acquired through prior infection.
  • In 2021 we were dealing with the delta variant and now we have omicron.
  • In recent months schools seem to have been the focus of transmission, and that is likely to stay that way for a little while.

So how does this level of COVID infection and death compare to influenza?

As far as I can tell, and rather to my surprise, the death rates from this third wave are similar to those seen in earlier winter flu episodes.

Let me explain how I have come to his conclusion.

I downloaded the weekly rate of deaths in England and Wales from the Office for National Statistics (ONS). The data shown below are extracted from Figure 4 of this document.

Click the image for a larger version. Weekly deaths in England and Wales from mid-1999 to mid-2017. Typically 8,000 to 9,000 people die each week in the summer, but the figure rises in the winter peaking between 1,000 and 3,000 deaths per week above the summer death rate.

Typically 8,000 to 9,000 people die each week in the summer, but the figure rises in the winter, peaking between 1,000 and 3,000 deaths per week above the summer death rate.

A significant fraction of this is due to flu – it correlates well with what the ONS call an index of “influenza-like illness (ILI) consultation rates”.

So I suppose we can consider that this is ‘normal’ for the UK.

The large peak in the winter of 1999/2000 is (I think) caused by flu, because the ONS note elsewhere (this document just after Figure 3) that in 2000, flu vaccination became commonplace.

So in all the years shown except the first, flu is being controlled by mass vaccination of the vulnerable population.

How does the COVID 19 death data look if overlaid on this graph? This is shown below.

Click the image for a larger version. Weekly deaths in England and Wales from mid-1999 to mid-2017. Also shown are the weekly deaths from COVID plotted above a nominal baseline of 9000 deaths per week. This is the same data plotted on the logarithmic graph at the head of the article. The three waves can be clearly seen.

The graph above shows weekly deaths from COVID plotted above a nominal baseline of 9,000 deaths per week. This is the same data plotted in black on the logarithmic graph at the head of the article, but scaled ‘per week’ rather than ‘per day’.

The three waves of the pandemic can be clearly seen.

The data are broadly comparable to what happens in normal years between 2000 and 2017, but larger. And remember, these are deaths from just a single cause.

Additionally we must remember that the peaks from Wave#1 and Wave #2 are only this small because of national lockdowns which wreaked immense disruption to all our lives.

If we had not had lockdowns, then the scale would likely have been something on the order of 10 times this size – quite comparable with the 1918 influenza pandemic. Things would have been truly catastrophic.

However the death rate in Wave#3 – the wave we are currently experiencing – is much smaller than the previous waves and this has been achieved mainly (but not entirely) by vaccinations.

From this, I conclude that deaths from COVID in Wave#3 do appear to be at a level similar to deaths from “Influenza-like illnesses” over the years 2000 to 2017.

Caveats

Before concluding that ‘it’s all over’, we need to remember that the situation is still serious. People are still becoming seriously ill and dying.

What I am pointing out is that this is now occurring at a rate that is similar to previous ‘normal’ winters.

We should also recall that COVID is a completely new disease and may have other mutations which may surprise us still.

Given this, it seems to unwise to throw out all mitigations against transmission while viral prevalence is so high.

For example, I will continue to mask up in shops and I would feel comfortable if other people did too.

However, I can understand that other people may disagree.

Conclusion

But is COVID really on its way to being ‘like flu’.

Yes. Amongst vaccinated populations, that’s how it looks to me.

======================

P.S. As pointed out in a comment: I did not consider the impact of Long COVID – or the disease burden on hospitals.

COVID 19: Wave#3: Omicron Dawn

December 14, 2021

Friends, I have been keeping quiet about pandemical developments recently because – frankly – I couldn’t think of anything to say.

Looking back at my most recent comments, I realise that I have felt this way for a while.

In October I wrote:

“The UK seems to be living out a form of collective cognitive dissonance, with the scale of infection and death very high from a global perspective. And yet there is widespread behaviour as if it were all over.”

“My guess is that if the death rate and hospitalisation rates remain similar to current rates, then ‘people’ will accept almost any level of infection rates – no matter what the eventual harm from Long COVID, or the risk of generating further variants.

And in November I added:

As we stare into the coming winter, I find it very hard to see how the epidemic will evolve; how the government will respond or how people will respond.

Since then, the disease has continued to kill just over 100 people per day and the third-wave death toll is currently approximately 18,431.

My latest data collation is shown below:

Click the image for a larger version. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The blue arrows show the dates of 2021’s ‘opening’ events. The green dotted line shows an extrapolation from the first week of June. The blue dotted lines show an extrapolation of trends, doubling every 41 days. Also highlighted in purple are the Euro finals, and the dates of returns to school and university in 2020 and 2021. Growth with a doubling time of ~3 days is shown by dotted arrows on the right-hand side of the graph.

The last few months

Very roughly since August we have experienced (in rounded numbers):

  • Roughly 40,000 cases per day
  • Just less than 1000 admissions per day (~0.25 % of cases)
  • More than 100 deaths per day(~15 % of admissions and ~0.04% of reported cases)

There are periods of 2 to 3 weeks where the epidemic grows exponentially, but at a relatively slow rate – doubling every 6 weeks or so. But these growth periods, while concerning, are not sustained.

And we seemed to be set for a long and miserable COVID winter. But a winter in which the NHS was not overwhelmed and in which a tolerable level of social activities could take place.

Omicron Dawn

Although current data show trends continuing as before, genomic analysis indicates that a rapidly increasing fraction of the cases are caused by the so-called omicron variant of COVID-19.

Omicron appears to spreading rapidly with an estimated doubling time of just 3 days or so. This is similar to the doubling rate when the original viral strain hit the UK back in March 2020 – before we had any mitigations in place.

The fact that omicron can spread at this rate amongst a population in which the vast majority have immunity from either vaccination or prior infection is worrying.

The significance of the short doubling time is hard to over-emphasise.

Over a period of 2 weeks during which prevalence of the current delta variant might hardly change, prevalence of the omicron variant might grow by a factor ~16 – all other things remaining constant.

So there is the potential for significant harm.

  • Positive cases could exceed 100,000/day – off the top of the graph at the head of the page. Many people would be ill and isolating. And mixing at Christmas could easily lead to super-spreading events.
  • Even if omicron is less harmful than delta, and even if the growth is not quite so explosive as anticipated, hospital admissions – particularly in certain areas – could rise rapidly to high levels.
  • And if cases and admissions rise, then an increased rate of death would inevitably follow a couple of weeks later.

Please notice the words in blue above. Among European countries, omicron seems to be hitting the UK first, and so there is still considerable uncertainty about how the epidemic will evolve.

So…

We are expecting:

  • A sharp rise in cases in the couple of weeks leading up to Christmas.
  • A delayed rise in admissions to hospital around the start of the New Year.
  • And a rise in the rate of death in January 2022.

But the magnitude of all these effects is very hard to anticipate.

Please take care.

COVID 19: Wave#3:12,000 deaths

November 2, 2021

Friends, I last wrote about the pandemic death toll a couple of weeks ago on October 14th (link). At that point the COVID third wave had killed around 10,00 people.

Since then, the disease has continued to kill just over 100 people per day. And as the death toll ticks over the 12,000 mark, it’s probably a good time to look and ask again: what is happening?

Click the image for a larger versions. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The bold horizontal dotted lines are to help reference the situation 1 year ago. The blue arrows show the dates of recent ‘opening’ events. The green dotted line shows an extrapolation from the first week of June. The blue dotted line shows an extrapolation of trends, doubling every 41 days. Also highlighted in purple are the Euro finals, and the dates of returns to school and university in 2020 and 2021.

However I find it difficult to write about this topic at the moment. The UK seems living out a form of collective cognitive dissonance, with the scale of infection and death very high from a global perspective. And yet there is widespread behaviour as if it were all over.

Anyway. Let’s see how things are going.

Compared with a year ago…

There are currently:

  • Almost 40,000 cases per day (x 2 compared with ~ 20,000 per day at this time last year).
  • Around 1000 admissions per day (roughly the same as this time last year).
  • Just over 100 deaths per day (roughly the same as this time last year)

So nominally everything continues to be the same or worse than this time last year! But the dynamics – the way viral prevalence is changing – is different.

Last year the epidemic was in a phase of exponential growth, doubling every 11 days or so.

This year, things are more-or-less stable. There are periods of 2 to 3 weeks where the epidemic grows exponentially, but at a relatively slow rate. But these growth periods, while concerning, are not sustained.

The viral prevalence has been over 1% for roughly 10 weeks. But there is substantial acquired immunity amongst the unvaccinated (younger) population from having caught COVID, and amongst the vaccinated (older) population, from vaccines. However, this immunity is not perfect.

So what is happening?

As I mentioned, I have been struggling to summarise the COVID situation in the UK.

But on Monday morning I received a précis from New York Times who – although I never write to them – kindly write me a daily newsletter.

Click on image for larger version. Excerpt from the New York Times newsletter today.

In the UK we are months into the ‘living with COVID‘ post-pandemic world.

Of course ‘living with COVID’ actually involves around 3,000 people each month dying with COVID.

And merely designating this era ‘post-pandemic’, does not actually make it so.

In my last article I wrote:

My guess is that if the death rate and hospitalisation rates remain similar to current rates, then ‘people’ will accept almost any level of infection rates. – no matter what the eventual harm from Long COVID, or the risk of generating further variants.

As we stare into the coming winter, I find it very hard to see how the epidemic will evolve; how the government will respond or how people will respond.

I just hope that the winter will be kind to us all.

COVID-19: Wave#3: The Effect of Vaccines

October 16, 2021

Click on the figure for a larger version. Charts showing the rates of cases, hospitalisations and deaths across different age groups – with categorisation according to vaccination status: Double-Vaccinated (blue) or Not-Vaccinated  (orange). Individual charts are also shown below.

Friends, as I mentioned in my previous blog, I have been puzzled about “what is going on” in the pandemic right now.

The data I have seen seem complex and difficult to interpret. The statistics involve different age groups, geographical locations, and vaccination status.

But I came across some graphs on-line that seemed significant. So I tracked the data to a regularly-updated Public Health England (PHE) surveillance report for the 4 weeks up to 10th October 2021 (Link). I then reproduced the graphs from the tables therein.

The charts show rates of…

  • positive COVID-19 cases,
  • hospitalisations, and
  • deaths,

…versus age group, categorised according to vaccination status. Note that these are rates per 100,000 people, not absolute numbers.

CLARIFICATION added on 17 October.

In each age group, the two rates shown are:

  • the number of cases, admissions or deaths per 100,000 vaccinated people and
  • the number of cases, admissions or deaths per 100,000 unvaccinated people.

They are NOT the number of cases, admissions or deaths per 100,000 members of the population in that age group.

I think they tell a story.

Click on the figure for a larger version.

Deaths

As has been the case throughout the pandemic, age is the primary risk factor.

This data tells us that in any age group, being un-vaccinated is typically 4 times more dangerous.

The risk ratio is worst in the 50-59 year-old age group where the rates of death amongst the un-vaccinated are more than 8 times higher.

Note: this death rate is affected by both the number of people infected in each age group and their risk of death. The high risk ratio in this age group is likely to be because these people are more likely to be still working, unlike people aged over 60. 

It’s also important to note that amongst the older age groups most people are double-vaccinated – more than 80% of the over 50’s are double-vaccinated.

Actual deaths in the under 18 age group are sadly not zero. Over the four weeks of coverage, the tables record the deaths of 3 unvaccinated youths, and 1 who had only recently had a single shot.

Hospitalisations

Click on the figure for a larger version.

Hospitalisation data show that age is again the primary risk factor – but now even younger people are being affected.

Actual admissions in the under 18 age group were 408, of whom all but 12 were un-vaccinated.

Taking the over-50’s all together, there were 3360 hospitalisations – 660 of whom had not received a double dose. So around 2700 had been double-vaccinated. This ratio (2700/660) is around 4.1, not far off the ratio of the number of double-vaccinated people to unvaccinated people.

This seems to indicate that the vaccines have only a partial ability to prevent illness serious enough to warrant hospitalisation.

Cases

Click on the figure for a larger version.

The ‘case data’ show a striking contrast with the hospitalisation and death data. This data shows that the epidemic is spreading predominantly amongst young people.

It is also striking that amongst those older than 30, the case rates-per-100,000, are higher amongst the doubly-vaccinated than amongst the un-vaccinated.

This effect arises because (a) even double-vaccination does not fully protect against infection and (b) there are many more doubly-vaccinated people than un-vaccinated people.

This seems to indicate that the vaccines do not offer strong protection against catching COVID-19.

And so the story is…

I think the COVID-19 epidemic is being kept going by high infection rates amongst younger people – presumably in schools.

Schools – presumably – form infection hotspots through which pupils and support staff infect people in the wider community.

Double-vaccination does not protect against infection, but it does seem to reduce the rates at which infections warrant hospitalisation, and is highly – but not perfectly – effective at preventing death.

So what will happen next?

The future is amongst the most difficult things to predict. But given the Government’s laissez-faire policy, it is hard to imagine that they will not allow the epidemic to continue to infect everyone it can possibly infect.

And some fraction of those people – between 0.1% and 1% – will die. This probably amounts to tens of thousands more deaths over the coming winter.

The only thing which I can see that might cause the Government to think otherwise would be if the Health Service became overwhelmed.

Personally

Personally, I find this data deeply depressing.

This data speaks of an ongoing crisis, killing more than 100 people each day. But a crisis which the Government seems to refuse to acknowledge.

Having reflected on this data, I (double-vaccinated and aged 61) will be taking even more care than I have been up to this point.

And if you have not yet been vaccinated…

COVID 19: Wave#3. 10,000 deaths

October 14, 2021

Friends, I last wrote about the pandemic six and half weeks ago on August 29th. At that point the COVID third wave had killed around 4,300 people.

Since then, the disease has been killing just over 100 people per day. And as the death toll ticks over the 10,000 mark, it’s probably a good time to look and ask: what is happening?

Click the image for a larger versions. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The bold horizontal dotted lines are to help one reference the situation 1 year ago. The blue arrows show the dates of recent ‘opening’ events. The green dotted line shows an extrapolation from the first week of June. The blue dotted line shows an extrapolation of trends at the start of September, doubling every 42 days. Also highlighted in purple are the Euro finals, and the dates of returns to school and university in 2020 and 2021.

Compared with a year ago…

There are currently:

  • Almost 40,000 cases per day (x 3 compared with ~ 15,000 per day at this time last year).
  • Around 800 admissions per day (roughly the same as this time last year).
  • Just over 100 deaths per day (roughly the same as this time last year)

So nominally everything is the same or worse than last year!

But last year the epidemic was in a phase of exponential growth doubling every 11 days or so.

This year, things are more-or-less stable.

What does ‘stable’ mean?

  • The epidemic is still with us– more than 30,000 people per day are being infected.
  • The prevalence of infected people has been roughly constant for roughly 10 weeks.

By ‘stable’, I mean that the epidemic overall, is not in a phase of exponential growth or exponential decline. But these ‘stable’ statistics reflect a dynamic balance between different factors.

By this I mean that the factors which reduce transmission (masks, social distancing, vaccination, acquired immunity) are collectively sufficient to prevent increasing numbers of cases. But not sufficient to reduce prevalence.

The disease prevalence is high – more than 1% among many sub-populations – so anything which affects this balance could cause the epidemic to rapidly shift into a phase with exponential growth.

This could be an increase in indoor gatherings, a decline in the percentage of people wearing masks, or other small changes in behaviour.

I was happily surprised that the return to school in September did not have a large effect – despite many infections in schools.

And similarly I have been surprised that we have not seen (or at least not yet seen) a signal from the return to Universities in October.

However, the autumn has been mild so far, and it could be that the onset of winter coupled with ever more ‘normal’ activities could tip the dynamic balance in favour of exponential growth.

Factors against this would be the slowly-growing vaccination rate among young people, and the large number of previously-infected people with acquired immunity.

My expectation – for what it is worth – is that the prevalence (as evidenced by the number of cases per day) will grow as we go into winter. And there is the potential for exponential growth.

What to do?

Back in August I said “I don’t know!“. And I still don’t know. And indeed, what is ‘advisable’ doesn’t seem to matter to this government.

My guess is that if the death rate and hospitalisation rates remain similar to current rates, then ‘people’ will accept almost any level of infection rates. – no matter what the eventual harm from Long COVID, or the risk of generating further variants.

But if death and hospitalisation rates rise to the point where the health service is even more critically stressed than it is now. Or if the death rate rises much above 170 per day – 10% of normal death rates. Then further restrictions will become inevitable, even if the doubling time of the epidemic is very slow.

However my recent experiences – some of them traumatic – have led me to believe that large groups of people are extraordinarily and aggressively unsympathetic to other people’s caution, and would disregard any restrictions.

As we stare into the coming winter, I find it very hard to see how the epidemic will evolve; how the government will respond or how people will respond.

Let’s hope that the winter is kind to us all.

COVID 19: Wave#3. How its going.

August 29, 2021

Click for a larger image. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The blue arrows show the dates of recent ‘opening’ events. The green dotted line shows an extrapolation from the first week of June. The blue dotted line shows an extrapolation of current trends, doubling every 42 days. Also highlighted in purple are the Euro finals, and the dates of returns to school and university in 2020 and 2021.

Friends, I last wrote about the pandemic three weeks ago on August 7th. At that point it had just become clear (to me at least) that the late July peak in cases was associated with the Euros.

In the UK we are now experiencing the third wave of the epidemic which was happening ‘underneath’ the ‘Euro surge’. Viral prevalence is high and showing slow exponential growth – with cases, admissions, and deaths doubling roughly every 42 days.

There are currently:

  • More than 30,000 cases per day (x 30 compared with ~ 1000 per day at this time last year).
  • Almost 1000 admissions per day (x10 compared with ~ 100 per day at this time last year).
  • Over 100 deaths per day (x 10 compared with ~ 10 per day at this time last year).

In the weeks ahead we have the return to Schools and Universities in England. Based on last year (when prevalence was about 10 times lower) we might reasonably expect an increase in the number of cases admissions and deaths over and above the current trend. See the purple arrows on the graph above.

In the face of these facts, it might surprise many readers to know that life in the UK for many non-immunocompromised people has become very normal.

Are we all OK with this?

The Daily Mail points out that current death rates from COVID are no longer the greatest cause of death in the UK. The gist of their suggestion is that we should just get used to this.

[Note: as detailed in the figure caption, their numbers are out of date]

Click for a larger version. Article from the Daily Mail on Sunday 29th August 2021. The graphic is misleading because it uses older data on deaths and the death rate has been increasing. COVID Deaths are now over 700 per week and if current trends continue will exceed 1400 deaths per week at the end of September.

I understand and sympathise with this argument. But the argument is based on numbers now.

Being an epidemic, the prevalence of COVID will continue to increase and – as we have seen repeatedly – we can make decisions which seem reasonable now, but which commit us later to large numbers of cases, hospital admissions and deaths.

One lesson of the epidemic might be that modest precautionary steps taken early can avoid the need for drastic lockdowns – the only tool for dealing with a widespread lethal epidemic in its later stages.

Recall that roughly 1700 people die each day ‘normally’. So 100 people dying each day (6% of normal) may be considered ‘acceptable’.

But if things continue on current trends, then by the end of September 2021 we may be looking at 200 people dying each day (12% of normal), alongside 60,000 daily cases and 2,000 hospital admissions per day. The death toll from Wave#3 might be have reached 8,000.

And if things continue to continue on current trends for a further month, then by the end of October 2021 we may be looking at almost 400 people dying each day (24% of normal). The death toll from Wave#3 might have reached almost 15,000. This is probably not acceptable to most people – and certainly not me.

What to do?

I don’t know!

The Government appear to be in denial about these likely projections, which are similar to predictions by much more eminent people than I.

As I look at these figures  it is clear that the growth rate of the epidemic is being limited by vaccines, but it is still growing, albeit slowly.

Vaccination of children may help, but I suspect that any program started now will be too late to prevent a ‘back-to-school’ boost in cases and further growth through the autumn. Vaccination of 18 year-olds may well be sufficient to slow viral spread at Universities.

So unless we re-introduce some additional social distancing, it seems cases and hospital admissions and eventually deaths will all continue to grow. This is not to mention any risks of other variants or ‘long Covid’.

However the government seem indifferent to these harms, and all the associated suffering.

So it seems likely that things will continue on trend until – frankly – something politically embarrassing causes the government to act.

Or have I missed something?

COVID 19 Wave#3: Trends become clearer

August 7, 2021

Click for a larger image. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The blue arrows show the dates of recent ‘opening’ events. The green dotted line shows an extrapolation from the first week of June. The purple area shows the period of the Euros finals.

Friends, I last wrote about the pandemic 11 days ago on July 27th. Then I said:

… [the] decline in daily cases is really welcome. However since I don’t know why it has happened I can’t really imagine what will happen next.

If I had to guess, I think I would expect the rapid decline to be temporary. I think daily cases  will fall to a still high level, perhaps 10,000 cases per day, but hopefully less.

And then I would expect daily cases to either increase again or decrease, but much more gradually. But that is just a guess.

So in the coming weeks I will be looking to see if the hospitalisations and deaths show the same peak in  cases, and then trying to discern the ongoing trend in cases.

Things have now become clearer, and the rapid decline in daily cases was indeed temporary and the timing indicates that it was associated with the Euro 2021 championship.

Click for a larger image. Logarithmic graph showing positive cases, since the start of 2021. The blue arrows show the dates of recent ‘opening’ events.  The green dotted lines show (a) an extrapolation from the first week of June, and (b) a guess for the ‘underlying’ spread showing the ‘Euros Effect’.

The peak in daily cases occurred on 21 July and daily hospital  admissions  peaked 10 days later on 31 July. This correlated peak in admissions indicates that the peak in cases was not a measurement effect but arose from a real increase in viral prevalence.

As I write (7 August) the number of deaths per day has not yet reached its peak but the 7-day retrospective average is currently 90 deaths per day.

Ratios

By looking at the data at the peaks (7-day retrospective averages) we can estimate how many cases result in hospital admissions and how many hospital admissions result in deaths.

  • Around 47,700 cases per day resulted in about 930 admissions to hospital per day i.e. a ratio of roughly 2%
  • Around 930 admissions resulted in at least 90 deaths per day i.e. a ratio of roughly 10%
  • So 47,700 cases per day results in at least 90 deaths per day i.e. a fatality ratio of roughly 0.2%

These figures are much lower than earlier in the pandemic, but they are still – in my opinion – worryingly high. For comparison, in the UK we normally expect about 1700 deaths per day from ‘non-pandemical’ causes.

Ongoing Trends

Recently daily cases have fallen to around 27,000 cases per day – a very high level by either a historical or an international comparison.

Worryingly daily cases still appear to be slowly increasing. Measures to restrict viral spread appear to be ad hoc at best and so we might reasonably expect Wave#3 to continue for several weeks – or even months – at a similar level.

Based on the ratios above, 27,000 cases per day will result in roughly 55 deaths per day or around 1600 deaths per month.

27,000 cases day probably corresponds to very roughly 1 million infections per month which is similar to the rate at which first doses of vaccine are being administered.

Click for a larger image. The progress of vaccination amongst the UK population. The left-hand axis shows the population in millions and the right-hand axis shows the fraction of the entire population – not just adults. The dark blue line shows first doses and the light blue line shows second doses.

What do I think about this?

I don’t know!

I hate to say it – and readers in New Zealand and Australia and South Korea and Taiwan may find this extraordinary – but in the UK at the moment, this level of infection and death is ‘politically acceptable’.

The alternative – re-imposing restrictions and re-doubling vaccination efforts – is not being considered.

  • If we are lucky, then the death rate will remain at 50 or so people per day for just a month or two – perhaps increasing when schools and universities restart – and then slowly reducing as the long-sought ‘herd immunity’ is achieved. The death toll from Wave#3 might be below 10,000.
  • If we are unlucky, then this death rate will continue for several months, and the widespread prevalence amongst the several million immunocompromised people might result in a new variant against which vaccines are not as effective.

This is not the policy I would have chosen – I would have been less inclined to rely on ‘luck’ as an ally. But given where we are, if the death rates and hospitalisations rates remain low enough then I can’t see this policy being changed.

On the plus side – for the non-immunocompromised – a reasonably normal life is possible.

In contrast with the UK’s ‘Total COVID’ strategy, countries which have adopted a zero-COVID strategy – such as China, New Zealand or Australia – will have to retain strict border controls until their populations are fully vaccinated.

But since no border controls are perfect, they will probably have to periodically impose lockdowns as new infections are imported: And in democracies, there is a limit to the amount of restrictions citizens are prepared to accept – and colloquially – many people seem to feel we are close to that limit. For example restrictions on Australians leaving Australia seem extraordinary!

Over the coming year or so, COVID might become endemic in the UK, and so there might not be too many restrictions for entering the UK – but countries worldwide might retain especially tight restrictions for passengers from the UK.

As many people have said until COVID vaccination becomes available world-wide, COVID will remain a threat everywhere in one way or another.

Good luck wherever you are.

 

COVID 19 Wave#3: How is it going?

July 27, 2021

Click for a larger image. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The blue arrows show the dates of recent ‘opening’ events. See text for further details. The green dotted line shows an extrapolation from the first week of June.

Friends, I last wrote about the pandemic almost a month ago on 29th June 2021. There I quoted myself from 4th June as saying that

I don’t think [Wave#3] can kill ‘hundreds of thousands’, but it could easily kill ‘thousands‘ and cause serious illness in many more.

I estimated that

by the end of June we would exceed 10,000 new cases per day and approach 40,000 per day at the end of the school term“.

I then pointed out that aside from more death and serious illness and we would be rolling the variant dice. I then concluded:

“the recommendations [on what to do] were … obvious, but that writing them down was pointless, because the Government just doesn’t care!

Today

Today (26th July) I see that at the start of July cases exceeded my estimates. Using a retrospective 7 day average cases peaked on 21st July with 47,000 cases per day.

But since then, the number of positive cases has been falling.

Click for a larger image. Logarithmic graph showing positive cases since the start of the 2021. The blue arrows show the dates of recent ‘opening’ events. See text for further details. The green dotted line shows an extrapolation from the first week of June.

Daily hospitalisations and deaths have continued to rise, but if this data really indicates a meaningful decline in viral transmission, then they too will peak shortly.

I am puzzled.

This is great news, but it is not what I expected. And it lifts my spirits to know that something – anything – appears to be spontaneously improving!

Sudden changes in number of daily cases like this have previously coincided with distinct changes in behaviour: lockdowns or similar. But this recent fall coincided with the calendar date of the nominal ending of pandemic restrictions!

The cause of this change in the trend of the number of daily cases would have happened a few days prior to that. But what could that cause be?  Well I don’t know, but here are six thoughts.

  • Thought#1: Could we have reached something close to herd immunity? At least in the key groups amongst whom the pandemic is spreading. I don’t think this is the case, because if it were, I would have expected a much more gradual change in the number of daily infections.
  • Thought#2: Could this be an effect of the ‘pingdemic’? After such a pedigree of failure, could it be possible that the number of people requested to isolate has become so large that viral transmission is really being restricted? Well it ought to be having some effect, but again I would not have expected such a sharp change.
  • Thought#3: Could a substantial part of the rise have arisen during the Euro 2020 matches? The final was on July 11th and so we might perhaps expect that cases arising from that might peak about a week later (July 18th) and then decline sharply.
  • Thought#4: Could it be something to do with the hot weather?
  • Thought#5: Could it be something to do with changes in Schools?
  • Thought#6: Could it be that people are avoiding taking a test even if they think they might be ill? Since all retractions have (nominally) been lifted, perhaps people’s sense of civic duty has changed?

Or could it be some combination of these things?

What next?

It is worth pointing out that the number of daily cases is still high based either on either an international or a historical comparison. So the UK part of the pandemic is not over, and there is a continuing risk of new variants. And a continuing threat to the millions of immuno-compromised people.

But this decline in daily cases is really welcome. However since I don’t know why it has happened I can’t really imagine what will happen next.

If I had to guess, I think I would expect the rapid decline to be temporary. I think daily cases  will fall to a still high level, perhaps a 10,000 cases per day, but hopefully less. And then I would expect daily cases to either increase again or decrease, but much more gradually. But that is just a guess.

So in the coming weeks I will be looking to see if the hospitalisations and deaths show the same peak in  cases, and then trying to discern the ongoing trend in cases.

Anyway, I hope you enjoy summer (or winter) safely wherever you are.

COVID 19: Wave#3

June 29, 2021

Click for a larger image. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. The blue arrows show the dates of ‘opening’ events. See text for further details. The red and blue dotted – – – lines show similarities and differences between the start of Wave#3 and Wave#2.

Friends, do you remember the good old days when the control of deadly infectious diseases was considered a matter of public health? Sadly, we are not living in those times.

25 days ago

On 4th June I wrote:

“I am reluctantly concluding that – as they did last summer – the government are about to screw things up.

I don’t think [Wave#3] can kill ‘hundreds of thousands’, but it could easily kill ‘thousands‘ and cause serious illness in many more.

I estimated that

by the end of June we would exceed 10,000 new cases per day and approach 40,000 per day at the end of the school term“.

I then pointed out that aside from more death and serious illness and we would be rolling the variant dice. I then concluded:

“the recommendations [on what to do] were … obvious, but that writing them down was pointless, because the Government just doesn’t care!

Today

Today (29th June) my spreadsheet tells me that the weekly averaged figure for new cases is 17,877 rather than 10,000. And it looks like at the end of the school term (~20th July) the figure could approach 100,000 positive cases per day rather than 40,000.

Currently cases are rising as rapidly as they did last summer which indicates that the virus is spreading easily in the non-vaccinated population.

The data on hospital admissions do not yet show a strong rise. But if we reach 100,000 positive cases per day it seems inconceivable that there will not be a significant extra burden on the health service.

The death rate is currently 17 people per day and rising at the same rate as it did last summer. The vulnerable population is probably not large enough to allow rates of 1000 deaths per day as in Wave#2. But it could plausibly reach 100 per day – i.e. 3000 deaths per month.

So should we abandon all restrictions on July 19th?

The normal death rate in the UK is about 1% of the population per year, or roughly 1700 people per day.

So death rates from COVID-19 of 10 or 20 people per day are not a great societal strain in themselves.

But being an infectious disease, COVID-19 has the capability to increase exponentially in prevalence and cause harm – sometimes in unforeseen ways.

Vaccination of 66% of the total population (1 dose) has limited the harm which can be done, but the virus is currently spreading freely amongst the 33% of the population (around 20 million people) who are unvaccinated. That is a lot of people.

I think removing restrictions in July will make almost no difference to the growth rate of viral prevalence, because I don’t think current restrictions are having very much effect. I could be wrong.

For me the question is whether there should be extra restrictions now because we are unsure of the harm to which are committing ourselves.

The government’s proposal that their policies are irreversible is truly Cnutian, implying that somehow they have dominion over the virus. I wonder if it knows.

Personally

I think we should take action now to avoid death rates of 100 people per day i.e. 3000 people per month, together with an unknown burden of long-term ill health.

In two months, vaccination levels could reach 90% and this point – when the viral prevalence was decreasing rather than increasing – would be a suitable point to remove restrictions.

Damaged as we all are by the pandemic, and impoverished as many people and businesses have been, I think think keeping mask-wearing and social distancing for a couple more months would be reasonable.

Allowing unrestricted mixing in the UK will create a viral breeding ground which could easily create new variants which could potentially allow viral escape from the vaccine. This is something we have seen often enough to know that it is not just a theoretical possibility.

And while 66% vaccination may reduce harm in the UK, there are many countries with a lower vaccination rate. For those countries it would be madness to allow unrestricted travel from the UK while the viral prevalence was approaching the same levels seen at the height of Wave#2.

But I know the government are not listening to me, or sadly their advisors. Individually they appear to be utterly venal, incompetent and corrupt, and collectively they appear to be in hock to a group of right-wing ideologues who are in denial about the harms caused by the virus. Despair is always an option.


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