Day: 20 December 2021

News Round-Up

A Doctor Writes… Here We Go Again

The following is a guest post from our in-house doctor, previously a senior NHS medic. In addition to looking at the latest Omicron data from the U.K. and South Africa, he touches upon the politicised and corrupted nature of SAGE and attempts to uncover why its models are so routinely incorrect and hysterical.

“Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly and one by one.” So wrote Charles MacKay in Extraordinary popular delusions and the Madness of Crowds (1841). MacKay’s classic analysis will require substantial revision if the Covid delusion ever subsides.

I’m coming to the view that my role as medical analyst for the Daily Sceptic is no longer relevant, because there is such a discordance between publicly available data and decision making that factors other than medicine must be at play. We have moved out of the realm of scientific rationality and squarely into the sphere of medical politics, a game at which I am atrociously inept and not qualified to comment on.

Here is an excerpt from a post I wrote exactly one year ago: “The NERVTAG meeting notes of December 18th which seem to have sparked off the latest panic are relatively muted about its significance, but do record ‘It was noted that VUI-202012/01 (later referred to as the Alpha variant) has demonstrated exponential growth during a period when national lockdown measures were in place.'”

This brings me back to my key point: ‘the illusion of control’. In the spring the rationale for lockdown was to ‘flatten the sombrero’ – a temporary measure to delay viral transmission and prevent the NHS from being overwhelmed by a sudden surge in cases. Since the autumn, that message has mutated to a new variant – the Government and their associated advisors have become obsessed with the need to ‘control the virus’ – yet the evidence shows that they have about as much chance of controlling the weather. So many of the ‘experts’ have invested their entire professional credibility on the premise that more stringent lockdowns are the only way to ‘beat the virus’ and to achieve ‘zero covid’. Yet both of these goals are manifestly unattainable.

Yet here we are again – on the verge of legally enforced societal restrictions which will have the predictable effects of damaging the economy and other areas of healthcare while having minimal effect on viral spread. Readers will remember that lockdown enforcements in January of 2021 were not lifted until mid July – and even then there was substantial opposition to removal of social curbs with hysterical predictions of imminent calamity, all of which failed to materialise.

Another point I have noted over the last year is measurement shift. At first, the reportage was on daily deaths. When these subsided, the quoted figures changed to hospitalisation rates. When those fell off, the focus shifted to ‘cases’ – positive community tests irrespective of whether these caused illness or not.

To quote one of the TV Dragons: “Turnover is vanity, profit is sanity”. In other words, positive tests in the community are irrelevant unless they cause sufficiently severe disease to put patients in hospital for extended periods. Further, as has already been recently exposed in these pages, the more testing is done, the greater the number of positive findings. It is instructive that the percentage of positive tests in the community has not changed over several months – so by increasing testing we are uncovering greater viral spread but this may well be irrelevant to the overall burden of disease.

Although I have substantial reservations about the accuracy of officially released figures, I will go through what we are permitted to see on the only metrics which are currently relevant: hospitalisations. I’m going to firstly look at the situation in London as the capital is regarded as the epicentre of the Omicron outbreak. Mayor Sadiq Khan has declared a ‘major incident’ because 4,900 London healthcare workers are off sick with Covid. It is unclear what proportion are actually sick and what percentage are completely asymptomatic but have been ordered to self-isolate due to contact tracing after staff Christmas parties.

I firstly present the data from the ‘primary diagnosis’ spreadsheet in graph one. Readers may recall this distinguishes between patients in hospital because of severe Covid (blue line) versus those in hospital for other reasons with co-incidentally positive tests (orange line). This data had to be forced out of the Department of Health by Mark Harper MP when he challenged the newly appointed Sajid Javid on the point in the summer. Up to that point the NHS had denied that there was any distinction between ‘with Covid’ and ‘because of Covid’. But for Harper’s intervention, we would probably not be aware of the distinction.

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Graph One

The ratio of genuine Covid patients to incidental Covid patients in London has reduced from 0.84 on October 1st to 0.77 on December 15th. My interpretation of this graph is that the modest rise in Covid inpatients to December 15th is more due to incidental tests than genuine Covid illness. This is important information but sadly only released on a weekly basis.

To put this rise in admissions into context, we can examine graph two. This shows daily admissions in London since the start of the pandemic.

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Graph Two

SAGE hypothesise that due to the lag effect between infection and hospitalisation, the blue line on the right hand side (currently 210 admissions per day in London) will shortly exceed the second wave peak of 977 admissions.

SAGE minutes from the 99th meeting on December 16th predict a peak of 3,000 hospital admissions per day in England as a whole by the end of December. As things stand at the moment, across England as a whole, daily admissions have been flat or falling for two months. They have increased recently in London but have fallen off in other parts of the country.

Is this really a plausible analysis given the huge difference in vaccination rates between December 2020 and December 2021? I note that the December 19th Omicron daily overview from the U.K. Health Security Agency gives a figure of 104 hospitalisations in the entire U.K. due to Omicron as of 17th December, although SAGE think that this is about 10% of the real figure due to reporting lags.

It is observable that London has a higher percentage of unvaccinated people than the rest of the U.K. – official estimates suggest that up to 30% of Londoners are not vaccinated.

Lack of vaccination is particularly high in specific ethnic groupings which form a larger proportion of London’s population than in the wider country. Could this be a possible reason why cases are rising more rapidly in London than the rest of the kingdom? Given this disparity, is it reasonable to assume data from London is applicable to the whole of the U.K.?

Fortunately, we do have some real world data from South Africa, which in Omicron terms is about a month ahead of the U.K.

The insurer Discovery Health examined 211,000 positive Covid tests and followed up their clinical course between November 15th and December 7th. Of these tests, 78,000 were from the Omicron variant, the remainder being Delta. About 41% of the tested patients had had two doses of the Pfizer vaccine.

After adjusting for vaccination status, the risk of hospital admission for newly diagnosed adults is 29% lower than in the first wave, said Shirley Collie, a statistician at Discovery Health, presenting the findings. “Furthermore,” she said, “adults admitted to hospital currently have a lower propensity to be admitted to high care and intensive care units, relative to prior waves”.

More recent data published by the South African institute for communicable diseases suggests that the Omicron peak has already passed in Gauteng, and there has been no surge in deaths.

Naturally there are differences between the South African and British population. Their median population age is 27.6 years-old. Ours is 40.5 years-old. They have a lower vaccination rate (26.3% double vaccinated versus close to 90% in the U.K. and over 40% of our population have had booster doses). So, this study does not directly read across into what will happen in the U.K. Nevertheless, it is an important piece of information and I’m puzzled as to why SAGE apparently have not referred to this in their recent meetings, nor have they referred to recent data from Denmark suggesting that hospital admissions from Omicron are about 60% of those from Delta.

Another anomaly caught my eye this week in graph three. This maps positive community tests (blue) against Covid inpatients in England (orange) since the beginning of the pandemic. Note there are two separate ‘y’ axes – test numbers on the left of the graph and hospital inpatients on the right.

On the left hand side of the graph we can see in March 2020, there was virtually no testing going on but plenty of admissions in the first wave. By the end of 2020 testing was happening but still not highly developed, so inpatients were front running testing until the end of December 2020 (Zoe app data was much more predictive).

The interesting point is in July 2021. There is a clear peak of positive tests in mid-July, widely attributed to increased mixing at summer sporting events which was not followed by a hospital admission peak. A second smaller testing peak in October similarly failed to cause a surge in hospital admissions.  We believe this demonstrates protective natural immunity due to prior infections and vaccine effects.

SAGE now predict that the right hand peak in tests will be followed by a surge in hospitalisations on the basis that Omicron will both evade both vaccine protection and natural immunity and cause illness severity at least as bad as Delta. I don’t understand this assumption, given that all the open-source real world data available suggests the opposite. Neither by the way do analysts from JP Morgan who have commented publicly on this specific point.

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Graph Three

Even if SAGE are correct in their apocalyptic predictions, as Professor Heneghan observed this morning on Radio 4: “this is as good as it gets”. If we can’t manage to live with Covid with the vast majority of the population double or triple vaccinated plus substantial natural immunity from prior infections, then we are destined to repeat the cycle of lockdowns for the foreseeable future – possibly running into decades. Do any readers want to live like that?

An insight into why this consistent extrapolation to catastrophe may be occurring can be gleaned from Fraser Nelson’s twitter exchange with Professor Graham Medley, the chair of the SAGE modelling committee. It is an astonishing conversation in which Medley appears to say that SAGE only consider the worst case scenarios because presenting more plausible real-world assumptions would not “help” decision makers. I urge readers to follow the link for themselves. As Nelson puts it, this is “policy led evidence making”.

I can provide no better comment than a contribution to the discussion by ‘Reg@ratboy101203’: “This entire exchange has left me open mouthed. To think of all the livelihoods at stake here, mainly because they don’t see the need to model accurate outcomes as it will not make the Government take any action. Scandalous.” Reg is right. It is scandalous.

Finally, today, I turn to the subject of the politicisation of medicine. We have seen this occur in a number of critical areas in the last 18 months – from a complete inversion of our understanding around informed consent, to blatant biases and selective referencing of data. Professor Mark Woolhouse a member of SPI-M said on the Radio 4 Today programme on December 20th “we are not starting from a baseline of zero, we are starting from a considerable burden of illness due to Delta… so there is less headroom than there was”.

A casual examination of the Office for National Statistics data shows that there are 60% fewer Covid cases in hospitals than at this time last year – a Pritchard ratio of 0.4. (15,741 vs 6,321). Doesn’t this mean that there is actually more ‘headroom’ than this time last year – not to mention the 12 month lead time to prepare for a predictable winter surge of a respiratory pathogen? Woolhouse’s remark supports an assertion I have made previously – that the medical establishment is not urging politicians to cage citizens in their own homes to protect the population, but to conceal the inability of the NHS to function correctly. What do you make of that, Reg?

Debbie Hicks Cleared of Breaching Lockdown Restrictions

Debbie Hicks, the anti-lockdown activist who is facing a number of attempts to prosecute her for protesting in various ways, was found not guilty earlier today in Cheltenham Magistrates Court. BBC News has more.

A woman who helped to organise a rally during lockdown has been found not guilty of breaching Covid regulations.

Debbie Hicks attended the Freedom Rally in Stroud, Gloucestershire, in November 2020.

The free speech activist was arrested on the day and faced two charges relating to lockdown regulations.

A district judge has found her not guilty and said police were incorrect to act as though there was a blanket ban on protests at the time.

Cheltenham Magistrates Court was told the Freedom Rally took place in Stratford Park on November 7th, two days after the latest round of lockdown regulations had come into effect.

Those regulations banned gatherings of more than two people.

More than 50 people attended the rally and police, who identified Ms. Hicks as an organiser – something she denied – approached her and told her she might be arrested if she did not leave.

Ms Hicks, who said she was not against vaccinations but wanted to take part in the rally to support “freedom to protest”, remained at the scene and was eventually arrested.

PC Tim Burch, from Gloucestershire Police, told the hearing that officers had been briefed that the rally was “not reasonable” because of the lockdown restrictions coming in.

Ms Hicks, of Stratford Road, Stroud, faced two charges; holding or being involved in a gathering of more than 30 people, and participating in a gathering of more than two people.

She said she was exercising her rights under the European Convention of Human Rights articles 10 and 11 – that deal with freedom of expression and freedom of assembly.

“I felt human rights superseded that [lockdown] and it was my right to be there to protest,” she told the court, adding that she was “shocked” by the level of policing on the day.

Clearing her of both charges, District Judge Nicholas Wattam said while the evidence proved she was one of the event organisers, he found the police response to the rally was “not proportionate”.

“I’m concerned that the understanding of police officers on the ground was flawed,” he said, adding that it was not the fault of the police at the event as they were taking their instructions from senior officers.

The judge added that a blanket ban on public gatherings was not in place at the time, and if it had been it would have been a breach of human rights.

Debbie was only able to fight this case because readers of the Daily Sceptic generously contributed to her crowdfunder, meaning she could afford a crack legal team from Murrays Partnership. Wish Debbie luck – she still has four more cases to fight.

Swedish Company Creates Vaccine Passport Microchip Implant

Taking advantage of the same technology used for contactless payments, a company based in Sweden has developed a microchip – placed under the skin in either the arm or hand – that can store information relating to an individual’s vaccination status. The firm’s Chief Distribution Officer praised the accessibility and convenience of the implant, as it removes the need to carry specific documents or digital QR codes. The Mail has more.

Epicentre, a Stockholm-based start-up, unveiled a new way of carrying around a Covid vaccine passport – in a microchip implanted under your skin.

The implant can be read by any device using the near-field communication (NFC) protocol – technology used for contactless payments and keyless entry systems.

In a video shared by Epicentre, Hannes Sjöblad, Chief Distribution Officer, has the chip in his arm and simply waves a smartphone over it to pull up his vaccination status.

“Implants are very versatile technology that can be used for many different things, and right now it is very convenient to have COVID passport always accessible on your implant,” he said in a statement…

Many venues, restaurants, bars, concert halls and museums, across the U.S. are requiring visitors present their vaccination status in order to enter the building.

Epicentre wants to make presenting this information as easy as possible.

“In case your phone runs out of battery, it’s always accessible to you. So of course, that’s how we use this technology today, next year we are going to use it for something else,” said Sjöblad.

The microchip sits directly beneath the skin, either in the arm or between the thumb and forefinger.

According to Sjöblad, the procedure is “completely reversible” and does not require a special phone app.

Worth reading in full.

Dominic Raab Refuses to Rule Out Imposing Further Restrictions before Christmas Day

Although Dominic Raab has insisted that Brits will experience a “much better Christmas than last year”, he also mentioned that there are no “hard, fast guarantees” that additional Covid restrictions won’t arrive before Christmas Day. Meanwhile, Government advisers have said that “significant action” needs to be taken to curb the spread of the Omicron variant and save the NHS from “real collapse”. Sky News has more.

Raab told Kay Burley: “I think we will have a much better Christmas than last year because of the vaccination level – both the overall vaccination level and particularly the impact of the booster campaign.

“People will need to be careful and cautious.

“But I do think, again subject to the data – and it’s always under review – that we’re in a better position to enjoy Christmas with loved ones this year.”

Asked if more restrictions would be imposed between now and Christmas Day, Raab said: “I just can’t make hard, fast guarantees.”

Twelve people infected with Omicron have died – Raab said 104 people with the variant are in hospital.

He added he did not anticipate parliament being recalled to vote on new restrictions before Christmas.

The Cabinet Minister said there was a time lag in the data and “we don’t yet know the severity” of the Omicron variant, adding that “it comes through day-by-day”.

He said regardless of modelling by scientific advisers, the government would “test the data in real-time against real cases”.

Professor Ravi Gupta, a member of NERVTAG which advises the Government on the threat posed by new and emerging respiratory viruses, said “significant” action needs to be taken to tackle the growing number of Covid cases.

He said: “It is of serious concern. We have an escalating number of cases that really has reached levels that we haven’t seen before in terms of the rate of increase.

“The action that’s needed really is going to be quite significant.”

Dr. Gupta added: “The sheer numbers that are going to be infected because of the increased transmissibility of this virus is going to potentially overwhelm our health service.

“So that’s a really critical situation that we’re facing.”

Worth reading in full.

Free Speech Union Welcomes Court of Appeal Judgment in Landmark Free Speech Case

Harry Miller, the ex-copper who refused to take it lying down when he was told by Humberside Police that retweeting a comic verse about transgendered people would be recorded against his name on the police database as a ‘non-crime hate incident’, has won a tremendous victory today in the Court of Appeal today. (Full judgment here.) The Free Speech Union, which has been supporting Harry, has just issued a press release about the judgment.

The Free Speech Union welcomes today’s landmark judgement from the Court of Appeal that the recording of non-crime hate incidents is an unlawful interference with freedom of expression. As the Court says, the knowledge that such matters are being recorded and stored in a police database is likely to have had a serious “chilling effect” on public debate.

Not only does the recording of non-crime hate incidents violate Article 10 of the European Convention on Human Rights, as the Court said, but it is a huge waste of the police’s time.

Between 2014 and 2019, 34 police forces in England and Wales recorded a total of 119,134 non-crime hate incidents, an average of 65 a day. What possible justification can there be for the investigation and recording of ‘non-crimes’ when so many actual crimes go unsolved? Between 2015 and 2021, 964,197 domestic burglary investigations ended without a suspect being identified.

Toby Young, the Free Speech Union’s General Secretary, said: “The Free Speech Union is proud to have played a part in winning this landmark victory, but the lion’s share of the credit must go to Harry Miller. Thanks to his courage and tenacity, we can all rest a little easier in our beds tonight, knowing the police are not about to knock on our doors because we’ve made an inappropriate joke on Twitter. They should be policing our streets, not our tweets.”

A welcome bit of good news in an otherwise bleak pre-Christmas period. If you haven’t already joined the Free Speech Union, you can do so here. And if you want to see Harry talking about why the police have been so eager to follow guidance which, thanks to him, has been declared unlawful, see this clip from a panel discussion hosted by the FSU at this year’s Battle of Ideas.

Stop Press: I further explain the significance of this ruling in a piece for Mail Plus.

Both the Young and the Old Have Been Disorientated by Covid Restrictions

We’re publishing an original essay today by regular Daily Sceptic contributor Dr. Sinéad Murphy, an Associate Researcher in Philosophy at Newcastle University, arguing that Covid restrictions have left both the young and the old feeling profoundly disorientated. Here is an extract:

Of all descriptions of the condition of autism, a want of orientation may be the most accurate. Children with autism cannot find their place in the world by the usual landmarks. Words and objects that would normally be salient and around which meaningful experience would cluster do not stand out for them even in familiar interactions and environments; there really could be an elephant in the room.

The world, it seems, is not for children with autism; they cannot make themselves at home in it.

This lack of orientation of those with autism is sadly echoed in a condition that is also remarkably on the rise and into whose terminal fog so many of our old people now wander and get lost: Alzheimer’s Disease, and the other forms of dementia.

Indeed, life now is increasingly book-ended by these conditions of disorientation, by autism and by dementia; the one affecting those youngest amongst us who cannot get a foothold on the world; the other affecting those oldest amongst us whose fingertips are losing their grasp.

It is uncertain which condition is the sadder; whether a child’s struggle to be at home in the world is more affecting than an old person’s struggle to stay at home in it. Either way, they describe a growing phenomenon of disorientation in our young and old people, a rising tide of bewilderment.

Worth reading in full.

Downing Street Garden Party Picture Captures Prime Minister and Staff Violating Covid Rules

A photo (pictured) has emerged revealing that Boris Johnson and members of his staff attended a close-contact social gathering in the Downing Street garden during May 2020. The image appears to show the attendees violating numerous Covid restrictions that were in place at the time, such as rules relating to social distancing and household mixing, with the photographic evidence also challenging the Government’s original claim that this was, in fact, a work meeting. The Guardian has the story.

Johnson has been pictured with wine and cheese alongside his wife and up to 17 staff in the Downing Street garden during lockdown, raising questions over No. 10’s insistence a “work meeting” was taking place.

The photograph was shared with the Guardian following No 10’s denial last week that there was a social event on Friday May 15th 2020 including wine, spirits and pizza inside and outside the building. Johnson’s Spokesman said Downing Street staff were working in the garden in the afternoon and evening.

However, the picture raises questions over that assertion. Bottles of wine are in evidence, there is a lack of social distancing and 19 people are gathered in groups across the Downing Street terrace and lawn.

At the time social mixing between households was limited to two people, who could only meet outdoors and at a distance of at least two metres. In workplaces, guidance said in-person meetings should only take place if “absolutely necessary”.

Angela Rayner, the Deputy Leader of the Labour party, described the picture as “a slap in the face of the British public”, adding: “The Prime Minister consistently shows us he has no regard for the rules he puts in place for the rest of us. Alleged drinking and partying late into the evening [at No. 10] when the rest of us were only recently getting one daily walk.”

The Prime Minister has faced a string of allegations of partying and socialising in No. 10 while Covid restrictions were in place. He was forced to order a civil service inquiry, though its head stepped down on Friday over allegations of his own Christmas party.

The past week has been described as the worst of the prime minister’s premiership, with a major rebellion by Conservative MPs over Covid regulations followed by a historic byelection defeat and the shock departure of the Brexit Minister, David Frost.

In the new image shared with the Guardian, Boris Johnson and Carrie, who appears to be holding their newborn baby, are seen sitting around a table with a cheeseboard and wine, along with two people believed to be a civil servant and an aide. Last week No. 10 said Johnson was working in the garden before retiring to his flat at 7pm.

On that day Matt Hancock, then Health Secretary, had given a 5pm press conference urging people to stick to the rules and not take advantage of the good weather over the May weekend to socialise in groups.

At the time schools were still shut and pubs and restaurants were closed, with strict controls on social mixing. More people had been allowed to return to their workplaces, but guidance said social distancing of two metres should be followed at all times and “only absolutely necessary participants should attend meetings and should maintain two metre separation throughout”.

The Guardian reported last week, as part of a joint investigation with the Independent, that Johnson had been present for an alleged social gathering in Downing Street on 15 May 2020. Sources said the Prime Minister had spent about 15 minutes with staff, telling an aide inside No. 10 that they deserved a drink for “beating back” Covid.

Insiders claimed about 20 staff drank wine and spirits and ate pizza following a press conference on that day, some in offices inside No. 10 and others going into the garden. Some staff stayed drinking until late into the evening, they alleged. The sources described the event as having a “celebratory” feel given the initial loosening of some restrictions and the good weather in London that day.

Worth reading in full.

Touch Christmas and the Blond Gets It

Furious Tory MPs have warned Boris that if any more Covid restrictions are brought in over the festive season it will cost him his job. MailOnline has more.

Boris Johnson was under growing pressure last night not to impose lockdown restrictions that will ruin Christmas for the second year in a row.

The Prime Minister is considering curbs on mixing indoors in England that could be announced within days.

And Health Secretary Sajid Javid yesterday refused to rule out Covid measures coming into force before Christmas Day.

Tory MPs last night said any attempt to toughen rules before Christmas will provoke letters seeking to oust Mr. Johnson as party leader.

And ministers indicated they will not back new curbs. Rishi Sunak is understood to be arguing that they need to plot a clear route out of restrictions before they are imposed, while Liz Truss says she is “uncomfortable” with the current curbs.

It comes as the official number of confirmed cases of the Omicron variant rose by nearly 50% to 37,000 in just 24 hours.

Families are desperate to spend Christmas together after last year’s Covid lockdown rules meant millions were forced to be apart or severely scale back their celebrations.

It is understood Mr. Johnson is resisting calls for restrictions ahead of December 25th, but there are mounting fears they will be imposed after that, spoiling New Year plans for millions.

Scientists are urging the Prime Minister to bring in restrictions quickly, amid warnings that hospitals will struggle to cope with rising infection numbers.

Mr Javid repeatedly declined to rule out imposing tough restrictions before Christmas as he warned there are “no guarantees” Christmas Day will go ahead without a lockdown. The Health Secretary acknowledged that data about the Omicron variant remained incomplete – but suggested it might be necessary to make decisions before a full picture is available.

“If you wait until data is absolutely perfect it may well be too late,” he said.

The Health Secretary admitted “everything is under review” after SAGE delivered a grim assessment that the number of infections could reach two million by the end of the month without tougher restrictions – floating a “circuit breaker” ban on households mixing and closure of non-essential shops.

Worth reading in full.

Delta is Holding its Own Against Omicron. Why This Shows Us Natural Immunity at Work

The Omicron variant is known to have a relatively high number of mutations, including in the spike protein, and is therefore better than previous variants at escaping vaccine immunity, especially, and also natural immunity. As a new pre-print study from South Africa explains:

The Omicron variant is characterised by between 26 and 32 mutations in the spike protein many of which are located within the receptor binding domain (RBD). In addition Omicron has three deletions and one insertion in the spike protein, and mutations outside of the spike protein. Many of the mutations are either known or predicted to contribute to escape from neutralising antibodies, and work on earlier variants of concern has demonstrated that such variants can be antigenically very distinct.

The study looks at the reinfection rate in successive waves in South Africa and finds that the recent Omicron surge was characterised by a reinfection risk over twice as high as in the original wave – though it should be noted that this is from a low base, as studies have found natural immunity to confer 85-90% protection from reinfection (pre-Omicron).

As far as vaccines are concerned, the UKHSA recently acknowledged the weak protection from two doses of the vaccines against Omicron, even publishing a graph showing negative effectiveness for the AstraZeneca vaccine, albeit with very wide confidence intervals.

Nonetheless, there is good evidence that previous infection will continue to provide robust protection against the variant, albeit at a slightly reduced level. Further evidence of this enduring protection comes in the UKHSA’s latest daily Omicron report from December 19th. It shows that Omicron is partially replacing Delta to different degrees in different regions, suggesting the two variants are largely competing for the same pool of susceptible people.