There follows a guest post by the Daily Sceptic’s in-house doctor, a former NHS consultant now in private practice. He’s looked at the latest NHS England data and points out that there are fewer than half as many Covid patients in English hospitals than there were this time last year, not 14 times as many, as was claimed recently.
On Friday November 26th, the South African Institute for Communicable Disease released a statement in relation to the Covid variant now referred to as Omicron.
The variant had been first detected on November 12th from specimens collected in Gauteng Province and the molecular structure was characterised by November 22nd. The statement from the South African Institute on November 26th considered that the Omicron variant did not meet the WHO criteria for being either a ‘variant of interest’ (VOI) or a ‘variant of concern’ (VOC). Yet less than 24 hours later, the WHO had classified the Omicron variant as a ‘variant of concern’.
The definitions of variant classification are clearly laid out by the WHO. Classification of a ‘variant’ usually proceeds stepwise, from VOI to VOC. Classification of a VOI requires data collection to verify different effects of the specific variant and upgrading it to a VOC requires evidence that the variant is definitely evading prior immunity or making humans more severely unwell than previously.
I cannot find any evidence in the open sources to date that shows infection with the Omicron variant carries any greater risk of hospitalisation or death than the currently dominant Delta variant. One obvious possible reason for this absence of evidence is that the variant was only identified very recently. Given the known time lag between infection, the development of severe disease and hospitalisation, there has not been sufficient time to assess whether this particular new strain is clinically significant or not. It might be, but we just don’t know.
Simply put, it is not yet clear whether this new variant is a bad one (more infectious and more lethal) or a good one (more infectious but less severe). Opinion is clearly divided on how this situation will develop. Dr. Angelique Coetzee, the Chair of the South African Medical Association, speaking on Marr on Sunday 28th said that so far all the known patients infected with Omicron had very mild symptoms and none of them had been admitted to hospital.
Looking at the ‘charts that matter’ this week, we see a continual reduction in Covid admissions to hospitals (graph one). It’s important to note that all of these admissions are likely to be the Delta variant rather than the Omicron variant.
Graph two shows that the total number of Covid positive patients in hospitals also continues to fall – from this we can reasonably infer daily discharges are higher than daily admissions.
The Pritchard ratio (the number of patients in hospital with Covid divided by the number at the same date in 2020) is approximately 0.43 – so there are currently fewer than half the number of Covid inpatients compared to this time last year – not 14 times as many. Covid positive patients occupy approximately 4% of NHS hospital beds.
ICU numbers show a similar pattern (graph three).
I was encouraged to see in last week’s report from the Intensive Care National Audit and Research Centre (ICNARC) that vaccination status has now been included in the data. The absence of this important information from such a reliable and credible audit has puzzled me for months.
Table 16 of the report shows that overall, 75% of patients in ICU with severe Covid are unvaccinated and there is a gradient of incidence with increasing age – 90% of admissions in the youngest age group (18-29 years-old) were unvaccinated compared to 39.3% in the over 70s.
Nevertheless, the data presented only refers to the period from May 1st to July 31st. I find it surprising that there isn’t more up to date information available. Clearly, the proportion of the population double vaccinated at the end of November is likely to be higher than it was at the beginning of May and that may have a significant bearing on the ICU admission figures. Further, a casual glance at graph three above shows that the incidence of ICU cases between May 1st and July 31st is very different to the period from September 1st to November 26th. Surely, there must be more up to date information about vaccination status of ICU patients available? Why not publish it, unless it tells a different story to the one the NHS wants to tell?
Overall, the trends as we go into winter are fairly stable or on a gradual downslope. The numbers are substantially better than this time last year. Professor Chris Whitty acknowledged as much at the Downing Street press conference on November 27th. The widely predicted resurgence of influenza has so far failed to materialise. The National Influenza and Covid Surveillance report shows extremely low levels of both flu and Respiratory Syncitial Virus (a common winter respiratory infection in children) – both far lower than at this stage in prior years.
In politics, as increasingly in clinical medicine, decision makers are fixated on blame – as in who gets it when things go wrong.
The reimposition of travel restrictions and mask mandates in England in response to the identification of the Omicron variant marks the crossing of a new threshold in ‘non pharmaceutical interventions’. At the start of the pandemic, the WHO stated that societal restrictions should be regarded as a last resort – mainly because of the known economic and wider adverse public health consequences.
We have now come to a situation where societal restrictions are imposed on the basis of fear about what might happen, rather than a rational analysis of what has happened and is currently happening. Patrick Vallance acknowledged in the Downing Street press conference that, as yet, there is still no clear data suggesting Omicron is more dangerous than the Delta variant.
Simply put, the Government now reaches for societal interventions as the first resort to a perceived public health threat, rather than as a last resort. This is a worrying precedent as it opens the door to arbitrary restrictions by the executive on the population based on opinion rather than quantifiable facts. I’m sure the implications of that shift are obvious to readers.
Stop Press: According to the Telegraph, backbench Conservative MPs who are sceptical about the effectiveness of NPIs are asking for a House of Commons vote about the new restrictions on Tuesday. Read more on that story here.