Coronavirus outbreak

[kingrollo]

It looks as though the 21st will be delayed and I must say I am surprised, Boris had perhaps learnt something from the past events.

I did note that numbers in hospital decreased as you suggested or even more quickly - at the time you made the prediction I was sceptical.

What if we delay a month and the numbers keep increasing - a not unprobable scenario IMO.

Surprised vaccine passports was dumped as an idea tbh.

 

[Ajax Bay]

What if we delay a month and the numbers keep increasing - a not unprobable scenario IMO.
Surprised vaccine passports was dumped as an idea tbh.

If a new date is set as 'no earlier than' 19 July that will coincide with schools breaking up as well.
Numbers of cases are going to increase for a month: leave the 'not unprobable' out of it: but key is the effect on hospital admissions and bed occupancy. I see a delay as offering two things: more certainty on the effect of the Delta VoC (compared to the dominant Alpha VoC when the relaxation plan was shared on 22 Feb); and another 2.5M each week first vaccinations and 1M a week second doses.
I note that the Government's '4 tests' have stood the test of time, with the fourth one pointing up the uncertainty of what new variants might throw at us, just as the more transmissible Alpha VoC emergence created uncertainty and derailled the plans last autumn.
Two weeks might be 'enough'.
There is some jeopardy, getting minimal airing, that delaying the final relaxation much longer risks pushing the 'exit wave', albeit one with a lower hospitalisation peak, into the autumn. Let's get this done, to parody a phrase ringing around a year ago.
Certificates of vaccination for overseas travel seem an entirely reasonable proposition and doubt they have been 'dumped'. The idea of certification for use within UK has profound liberty issues, not least because half the population haven't access to vaccination (yet) - but maybe one for the 'vaccine' thread.

 

[Wobblers]

I doubt there's much public appetite for an inquiry - except among those who want another stick with which to beat Boris.

The public understands we never attempted to 100% follow the science, which in any case was far from perfect.

The public also understands the many and various reasons why we didn't follow that science.

Better to focus resources and where we are and where we might be going, rather then endlessly raking over what's done.

We have been extraordinarily lucky: CV19 is a moderately transmittable disease with a low (below 1%) fatality rate. There are microbes out there which are considerably worse: bird flu for example. Rather than being a false alarm, it's still causing sporadic cases in SE Asia. It kills over half of those it infects. Fortunately it's not significantly transmittable. So far. Because the part of the flu genome that controls transmittability is different from that part controlling virulence. We're one small mutation away from something far worse.

It is inevitable that there will be future pandemics. There is a very good chance that the next one will be worse than CV19. Sadly, the performance of the UK in the last 18 months suggests that we'd end up with millions dead. This is an existential threat. Next time, we have to do better.

An inquiry of some sort is not merely desirable, it is essential. This is something that is beyond petty party point scoring. I want to see something that is not focussed on blame but rather to determine what mistakes were made and what successes were achieved - including the experience of other countries. The thrust should be to answer the question "How might we best preapre for ,and deal with, a future pandemic?".

We can't afford to let that goal be buried by a desire to dish out blame for political motives. But neither can we afford to brush it under the carpet - which is also politically motivated.

 

[Wobblers]

Variants_of_Concern_VOC_Technical_Briefing
Table 6 (p15) suggests that around 1% of Delta cases result in hospitalisation with an overnight stay (taking an average of the last two rows) and seems to be regardless of vaccination status.
Table 18 (p51) vaccine effectiveness against symptomatic disease: Alpha 1 dose 50%, 2 doses 88%; Delta 33% and 81%.
Let's assume no one with a second dose goes to hospital (81% true) and no children go to hospital either (the latter is mostly the case).
About 12M adults O/16, haven't had their first jab yet. A further 12M have only had one so far and of those, 67% are susceptible, so 8M. Take away from that 20M (12M + 8M) say 40% or 8M who've been previously infected so total 12M susceptible pool. 10% catch it and 1% of those go to hospital = 12,000. Spread over (say) 30 days either side of peak that'd suggest (planning figures) = 400pd, peaking at less than 800pd. (NB Latest figure is 187 on 8 Jun.)
Put it this way, it's not going to be in the thousands, and the NHS can handle it (see Test 2).
If the government chose to delay Phase 4 relaxation this would reduce the numbers (because R would stay lower longer for NPI reasons and in the same period another 6M (in a fortnight) would get a first dose, thus reducing the susceptible population).
Note that if any relaxation is delayed too long, there's a danger that the subsequent 'exit wave' will be pushed into the autumn, cooler conditions and autumn snuffle months.
Here's another treatment (note this is hospital admissions per week):
View attachment 593504

You've made a critical error in one rather large assumption:

Let's assume no one with a second dose goes to hospital (81% true)

This is to ignore a very large population: over 30 million. From these figures, 19% will get the delta variant. That's 6 million people catching CV19. 1% of those will go on to require hospitalisation: 60,000. Added to the 12,000 you calculated above, we can expect 72,000 hospitalsations - 6 times your figures. The rates will therefore also be 6 times greater. Again, using your planning assumptions, that suggests a peak of 4,800 per day.

You note that the hospitalsation rate is currently below 200 pd. True, but we're only in the beginnings of this third wave. We are some way off the peak.

 

[Ajax Bay]

You've made a critical error in one rather large assumption:
This is to ignore a very large population: over 30 million. From these figures, 19% will get the delta variant. That's 6 million people catching CV19. 1% of those will go on to require hospitalisation: 60,000. Added to the 12,000 you calculated above, we can expect 72,000 hospitalsations - 6 times your figures. The rates will therefore also be 6 times greater. Again, using your planning assumptions, that suggests a peak of 4,800 per day.

Thank you for having a look at that. Perhaps I might just rework your figures and see how many I should add (your figures are awry and I've emboldened the fallacy). So far there are less than 5M cumulative/total UK cases shown on the gov.uk dashboard. Separate ONS survey data suggests that the actual figure (which includes asymptomatic infection) is twice that so say total 10M (in 15 months). So suggesting 6M will catch it in the next few months is a clear flag that maybe your observation has itself included a "critical error".
Including the fully vaccinated, then.
28.2M (which I had not included in my figures by my stated assumption) have been fully vaccinated (+14 days by 21 Jun).
That vaccine double dose gives them 81% protection against symptomatic disease (against the Delta VoC). So 19% are 'unprotected' = 5.4M.
There's only a 10% chance that that fifth will catch it (another assumption that @lane pointed out), so = 540k. The average fraction of those that catch it who end up in hospital is 1% (another assumption which I'm not certain is robust, but I've seen quoted), so = 5,400. Spread over 30 days (see previous 'model') 30 days either side of peak that'd suggest (planning figures) = 580pd (400+180), peaking at (estimate) 1160pd. (NB Latest figure is 187pd on 8 Jun and the peak in January was 4,232pd (7-day average).)
Hope I've got that right @McWobble
Average time in hospital is also reduced (assume because the average age is lower, maybe continuing improved therapeutics and also the beneficial effect of one or both doses for very many) which further reduces the admissions > occupancy multiplyer.
To reiterate: "Put it this way, it's not going to be in the thousands, and the NHS can handle it (see Test 2)."
Recently issued Warwick Uni modelling paper which will go through SPI-M to SAGE and inform this evening's No 10 decision meeting.

 

[Bromptonaut]

The latter risks yet more critics using nothing other than hindsight.

What is your point?

Even if it's only hindsight that makes last Summer's easings look like mistakes (and there's evidence they were not) they represent learning points.

 

[classic33]

Thank you for having a look at that. Perhaps I might just rework your figures and see how many I should add (your figures are awry and I've emboldened the fallacy). So far there are less than 5M cumulative/total UK cases shown on the gov.uk dashboard. Separate ONS survey data suggests that the actual figure (which includes asymptomatic infection) is twice that so say total 10M (in 15 months). So suggesting 6M will catch it in the next few months is a clear flag that maybe your observation has itself included a "critical error".
Including the fully vaccinated, then.
28.2M (which I had not included in my figures by my stated assumption) have been fully vaccinated (+14 days by 21 Jun).
That vaccine double dose gives them 81% protection against symptomatic disease (against the Delta VoC). So 19% are 'unprotected' = 5.4M.
There's only a 10% chance that that fifth will catch it (another assumption that @lane pointed out), so = 540k. The average fraction of those that catch it who end up in hospital is 1% (another assumption which I'm not certain is robust, but I've seen quoted), so = 5,400. Spread over 30 days (see previous 'model') 30 days either side of peak that'd suggest (planning figures) = 580pd (400+180), peaking at (estimate) 1160pd. (NB Latest figure is 187pd on 8 Jun and the peak in January was 4,232pd (7-day average).)
Hope I've got that right @McWobble
Average time in hospital is also reduced (assume because the average age is lower, maybe continuing improved therapeutics and also the beneficial effect of one or both doses for very many) which further reduces the admissions > occupancy multiplyer.
To reiterate: "Put it this way, it's not going to be in the thousands, and the NHS can handle it (see Test 2)."
Recently issued Warwick Uni modelling paper which will go through SPI-M to SAGE and inform this evening's No 10 decision meeting.

Local hospital are bothered in case they don't have the staff, able to work, if things get worse.

On paper they're fine for staff, but that doesn't seem to take into account that they are at the same risk as everyone else. Reducing their numbers.

 

[Ajax Bay]

I hope that all hospital staff are fully vaccinated, so not "at the same risk as everyone else" imo: bit more because infectious bods will be coming in, a lot less than all those unvaccinated. And you have a nice low case rate: 32 per 100,000 so less risk than maybe 75% of English/Scottish areas/hospitals. I can understand all hospitals will not welcome (to put it mildly) the third wave: let's hope the peak will stay entirely manageable (for the sake of the staff and the patients with other competing healthcare needs).
The spread of the Delta VoC to Northern Ireland is, thankfully, a lot slower than to Wales and Scotland so vaccination against the Alpha VoC should give an average 88% protection (Pfizer a bit more, AZ a bit less; but most H&SC will have had Pfizer). Against Delta VoC than (only) drops to 81%: still good.

 

[mjr]

I hope that all hospital staff are fully vaccinated,

Some people cannot be vaccinated.

 

[neil_merseyside]

Or how about we half open up on June 21st but only to those with 2nd jab +14 days, slightly discriminatory as yoofs (relative term) haven't had the option yet, but it would allow theatres and other venues to open (OK so nightclubs only to the oldest swinger in town (no not that type of swinger)). This option bridges concern for those in the hostility industry and those of us at lesser risk wanting to get into big crowds in small venues - I'm not selling this well am I...

 

[classic33]

I hope that all hospital staff are fully vaccinated, so not "at the same risk as everyone else" imo: bit more because infectious bods will be coming in, a lot less than all those unvaccinated.

Some people cannot be vaccinated.

Even if fully vaccinated, it doesn't guarantee not being able to catch it. And in a team of of nurses should one test positive, the others still have to isolate. A much bigger impact than one team member going ill.

As I said on paper, they're fine, they can handle it. Real life is different. And that's what concerns local staff. They're only human after all. People who come into contact with more than most on here.

 

[Deleted User]

Be it this month, next month or the month after things will open soon enough and all this speculation and assumption will be immaterial.

 

[newfhouse]

Be it this month, next month or the month after things will open soon enough and all this speculation and assumption will be immaterial.

If you own or work in a business that is currently restricted you are probably keener than most for some certainty. “Soon enough” may be too late. For the rest of us, I think you’re right, we can wait.

 

[Wobblers]

There's only a 10% chance that that fifth will catch it (another assumption that @lane pointed out), so = 540k.

This is worse than an assumption, this 10% factor is an arbitrary fudge factor. Worse, it has no basis on reality.

So far there are less than 5M cumulative/total UK cases shown on the gov.uk dashboard. Separate ONS survey data suggests that the actual figure (which includes asymptomatic infection) is twice that so say total 10M (in 15 months). So suggesting 6M will catch it in the next few months is a clear flag that maybe your observation has itself included a "critical error".

I assume your 10% is derived from this? This not merely ignores the significant under-reporting known to have taken place, it ignores the fact that the numbers infected are this low due to three lockdowns - two of them being considerably extended. And this, too, with variants that were substantially less transmittable than delta!

The delta variant has a R0 of at least 6, and modelling suggests it may be as high as 8. 85-90% of the population need to have been infected or vaccinated in order to reach herd immunity. With vaccine efficacy of 81% vacination alone cannot achieve this. Moreover, at the moment with 25% of the adult population not being vaccinated and a further 25% still being vulnerable to an extent. Roughly speaking, that means about 45% (minimum) of the UK population is vulnerable [1] - and that's more than sufficient for exponential growth to take place. Which is exactly what we are seeing.

The delta variant will only die out when the vulnerable population falls below 10-15%. It will not simply stop when it has infected 10% of those vulnerable to infection. There is no mechanism that will do so! Making the hidden assumption that there is, as you've done, unfortunately has the effect of invalidating any conclusion you might make from your analysis.

Overall, if the hospitalisation fractiion for the vaccinated really is 1% of those who become ill, I'd expect total numbers to be 10-15% lower than my above figure, as the infection rate dies away as herd immunity is reached. However, hosptialisations from those who're unvaccinated or only have had one jab will be significantly higher than your estimate.


[1] Note that I've excluded transmission via breakthrough infections in the vaccinated population here. As I've said, this will be significant.

 

[neil_merseyside]

If you own or work in a business that is currently restricted you are probably keener than most for some certainty. “Soon enough” may be too late. For the rest of us, I think you’re right, we can wait.

What price is someone's life [1] and I know what I think matters, but then again I have no sympathy for people/businesses borrowing to the hilt. I've always had a contingency fund from when I first started work, hell Mum insisted I could always pay my way for 6 months without work - rather hard from day one of employment...

[1] be that Covid directly or that hospitals can't do 'usual' stuff.