There follows a guest post from our in-house doctor, formerly a senior medic in the NHS, who says the widely trailed tsunami of hospitalisations has not only failed to arrive after ‘Freedom Day’, but we seem to be on the downslope of the ‘third wave’.
The philosopher Soren Kierkegaard once remarked: “Life can only be understood backwards, but must be lived forwards.” I have been reflecting on that comment, now we are three weeks since the inappropriately named July 19th ‘Freedom Day’. Readers will remember the cacophony of shrieking from assorted ‘health experts’ prophesying certain doom and a tidal wave of acute Covid admissions that would overwhelm our beleaguered NHS within a fortnight. Representatives from the World Health Organisation described the approach as “epidemiologically stupid”. A letter signed by 1,200 self-defined experts was published in the Lancet predicting imminent catastrophe.
Accordingly, this week I thought I should take a look at how the apocalypse is developing and then make some general observations on the centrality of trust and honesty in medical matters.
Let’s start with daily admissions to hospitals from the community in Graph One. Daily totals on the blue bars, seven-day rolling average on the orange line. Surprisingly the numbers are lower than on July 19th. How can that be?
Perhaps there are more patients stacking up in hospitals – sicker patients tend to stay longer and are hard to discharge, so the overall numbers can build up rather quickly. So, Graph Two shows Covid inpatients up to August 5th. Readers should note that Graph Two includes patients suffering from acute Covid (about 75% of the total) plus patients in hospital for non-Covid related illness, but testing positive for Covid (the remaining 25%). How strange – numbers seem to be falling, not rising. This does not fit with the hypothesis – what might explain this anomalous finding?
Maybe the numbers of patients in ICU might be on the increase – after all, both the Beta variant and the Delta variant were said to be both more transmissible and more deadly than the Alpha variant. Graph Three shows patients in ICU in English Hospitals up to August 5th. It shows a similar pattern to Graph Two – a small fall in overall patient numbers in the last two weeks. I looked into the Intensive Care National Audit and Research Centre ICU audit report up to July 30th. This confirms the overall impression from the top line figures. Older patients do not seem to be getting ill with Covid. Over half the admissions to ICU with Covid have body mass indices over 30. Severe illness is heavily skewed to patients with co-morbidities and the unvaccinated. Generally speaking, the patients have slightly less severe illness, shorter stays and lower mortality so far.
Finally, we look at Covid related deaths since January 1st, 2021, in Graph Four. A barely discernable increase since the beginning of April.
So, whatever is going on with respect to the progress of the pandemic, the widely trailed tsunami of hospitalisations has not arrived yet – in fact, we seem to be on the downslope of the ‘third wave’.
The report from round 13 of Imperial College’s REACT-1 Covid infection survey was published yesterday, covering the period from June 24th to July 12th, broadly corresponding to the Delta surge.
The press release led with the claim that “double vaccinated people were three times less likely than unvaccinated people to test positive for the coronavirus” (0.4% vs 1.2%). This is clearly misleading as an indication of vaccine effectiveness, however, as younger people were both less likely to be vaccinated and more likely to test positive. As the report itself admits: “These estimates conflate the effect of vaccination with other correlated variables such as age, which is strongly associated with the likelihood of having been vaccinated and also acts as a proxy for differences in behaviour across the age groups.”
Presumably, the headline was chosen by a politically savvy communications officer who did not want to draw attention to the fact that the study found a lower vaccine effectiveness than other studies such as those of Public Health England.
It found a vaccine effectiveness (vaccine type unspecified) among 18-64 year-olds of 49%. However, the 95% confidence interval ran from 22% to 67%, meaning the authors didn’t have enough positive test results to be very sure of their estimate (despite testing nearly 100,000 people, only 527 results or 0.54% came back positive). They couldn’t even be very confident it wasn’t as low as 22%.
The number of new daily Covid cases in the U.K. fell to 21,952 today, the lowest it’s been in five weeks. Meanwhile, deaths are up slightly compared to last Monday and hospitalisations are down. MailOnlinehas more.
Covid cases are lower today than they have been since June 29th, according to the official figures released today.
But the number of virus tests conducted also fell to their lowest levels since June 26, suggesting there are cases that have not been picked up.
The new figures follow data published on Friday, which suggested cases are still on the rise and as many as one in 65 people in England are currently infected.
Some experts think fewer people are coming forward for Covid tests to avoid isolation.
The figures also signal a slow in the week-on-week drop in infections, with cases dropping by 12% on seven days earlier.
Last Monday, cases had dropped by 37.5% compared to the previous week.
Meanwhile, there were just 24 deaths within 28 days of a positive Covid tests were recorded, down from 65 yesterday, but an increase of 71.4% compared to last Monday.
Covid death figures released on Monday often lag, due to a delay in recording deaths over the weekend.
Updated hospitalisation figures for last Tuesday show a further 911 patients were admitted to hospital who tested positive for the virus, a drop of 1.6% compared to one week earlier.
The Telegraphreported on Monday that more than half of patients counted in the COVID hospitalisation numbers did not test positive until they were admitted. (Everyone must take a COVID test before entering a hospital in England.) Only 44% tested positive prior to being admitted.
The data seen by The Telegraph correspond to 22nd July. On that date, 827 “COVID-19 patients” were admitted to hospital, according to the Government’s coronavirus dashboard. However, the true number of people hospitalised because of COVID-19 may be far lower.
Crucially, the hospitalisations numbers do not exclude people who were admitted for non-COVID reasons (say, a broken leg) but simply happened to test positive upon admission.
Given that tests are now widely available, it seems likely that someone who had symptoms resembling those of COVID-19 would take one before going to hospital. Consequently, many of those who only test positive upon arrival may be suffering from other ailments. The true number of “COVID-19 patients” admitted to hospital last Thursday could be as low as 363 (i.e., 44% of 827).
The Telegraph story highlights an important point, which lockdown sceptics have made over and over again during the pandemic. Testing positive on a PCR or lateral flow test is not the same thing as having the disease COVID-19. (It would be more accurate to describe a positive test result as “an instance of SARS-Cov-2”.)
One important implication is that the number of hospitalisations and deaths – indicators that supposedly capture the impact of the pandemic on public health – can increase simply due to higher transmission.
According to the ONS’s Coronavirus Infection Survey, the percentage of people in England infected with the virus went from 0.22% in the week ending 19th June to 1.36% in the week ending 17th July – an increase of 1.1 percentage points.
In July of 2019, there were 1.3 million inpatients admissions, or 42,000 per day. If the percentage of inpatients testing positive rose by 1.1 percentage points due to a general increase in transmission, that would yield an additional 462 “COVID-19 patients” by the end of the month.
Now this calculation isn’t an exact representation of what’s going on at the moment. We know that infections are concentrated among people in their 20s and 30s, who are unlikely to be hospitalised for any reason. But it illustrates the point that even the hospitalisation numbers have to be taken with a grain of salt.
As I’ve noted many times, the only truly reliable indicator of the pandemic’s impact is excess mortality. And going by that measure, the pandemic has been over since March.
There follows a guest post by the academic economist who wrote a short post a few days ago about the apparent failure of the vaccine roll-out to reduce the number of over-60s being admitted to hospital with COVID-19 as a percentage of the number of over-60s testing positive rate. It generated a lively discussion in the comments so I asked the author to expand on it.
In the following short essay, I am going to examine whether the vaccines are preventing hospitalisations. We already know that the vaccines are not proving very effective at suppressing cases – which appear to be soaring in many countries, and notably the United Kingdom, in spite of the successful vaccine roll out and even though we are in summer and last summer cases remained suppressed. Some of us expected this to happen. The vaccine trials were rushed, the studies were of dubious quality, and they were released by drug companies who had a vested commercial interest in claiming high efficacy for the vaccines.
In addition to this, it should be obvious to anyone who gives it any thought that vaccines do not suppress highly contagious respiratory illnesses; more than half of Americans get flu shots every year, yet the United States has a flu season that is every bit as bad as Europe – which does not have high rates of annual flu vaccinations. A cynic might say that the flu vaccine business is much like the cosmetic business: a hustle by pharmaceutical companies to sell medicine to people who are not ill thereby massively expanding their market.
Now that it has become obvious that the vaccines are not preventing the spread of the virus, the public health clown show is doing what it does best: moving the goalposts. They are acting as if we knew all along that the vaccines did not prevent transmission. Instead, they tell us, the vaccines are there to prevent serious illness and death. We are supposed to ignore the fact that they are also insisting that groups that are not at-risk take the vaccine, but no matter – water under the bridge and if hundreds of young people die from blood clots or heart inflammation, so be it, better than Whitty and Vallance having to (gasp!) admit they were wrong.
Okay, well let us do what these clods never do: let’s test their hypothesis against the data. We are going to use data from Scotland (see here, here and here). Why? Because Scotland has had an outbreak that rivals previous outbreaks. The U.K. has not. It may appear the U.K. has had a full-on outbreak if you simply look at case data, but this is misleading. Testing has increased due to the proliferation of lateral flow testing. When we control for testing and look at the percent of tests that are positive rather than cases, we see this clearly.
Okay, so Scotland has a verified outbreak. How do we check whether the vaccines are preventing serious illness? Well, we know that serious illness only really occurs in older groups. We also know that older groups are more heavily vaccinated than younger groups. In fact, in Scotland almost 100% of over-60s are fully vaccinated. This provides us with a very nice natural experiment.
What we need to check is whether the correlation between positive cases among the over-60s and hospitalisations has broken down. In the pre-vaccination period we know that a certain percentage of positive cases among the over-60s would go on to become hospital patients. Well, if the public health boffins are correct and the vaccine prevents hospitalisations then fewer people should be being hospitalised relative to the number of cases. Do we see this?
Maybe. Squint and you will miss is. Hospitalisations do not appear to be rising quite as fast as cases in the over-60s. But let us not forget that testing has increased. So, what we really need to do is construct a positive test rate for the over-60s. With a bit of digging and applying a few statistical tricks, we can do this.
No squinting required this time around. The link has not been broken at all. The slight break between hospitalisations and cases in the over-60s is fully explained by the rise in testing. Control for this and the break disappears. Just as many people over the age of 60 are being hospitalised today in Scotland relative to the number of over-60s testing positive as they were before the vaccine roll-out began. The real-world evidence suggests that the vaccines are not, in fact, preventing serious illness. This confirms the impression we get reading the Scottish press. The Herald reports ‘Covid hospital admissions triple in over-60s — and nearly half of patients fully vaccinated’ – in fact, half is probably an understatement.
What about the link between hospitalisations and deaths? Perhaps the vaccines aren’t preventing serious illness, but maybe they’re preventing people with serious illness from dying?
Again, squint and you will miss it. Deaths are rising together with hospitalisations. If there are slightly fewer deaths relative to hospitalisations this could well be due to the better treatments for Covid that we know have been developed. Anyway, the notion that the vaccines will stop our hospitals from being overwhelmed – (were they ever really overwhelmed?) – is nonsense.
But we do not live in a rational society. We live in a society gripped by hysteria and fear; a society where control at both a governmental level and in day-to-day interactions has been handed over to the most neurotic and stupid among us. What will likely happen then is that these people double down. Rather than admit they were wrong they will get angry and project that anger on the people who doubted them. Those who have chosen not to get vaccinated will become increasingly vilified. They will be blamed for the hospitals stuffed full of fully vaccinated elderly people. Boosters will be insisted upon – and the dodgy pharmaceutical companies will continue to rake it in as they peddle untested drugs.
Either that, or our leaders grow spines and put a stop to this madness.
Stop Press: Covid hospital admissions among over-65s are a third of the level they would be if Britain didn’t have vaccines, according to PHE. MailOnlinehas more.
Stop Press 2: The Swiss Doctor has weighed in on this subject with a typically measured and erudite post.
A reader (an academic economist) has analysed the Scottish Covid data and reached a depressing conclusion: Covid vaccination seems to offer the over-60s little protection from severe illness.
Wasn’t busy today so I decided to collect all the Scottish data and do a bit of mining. Many of the datasets are not properly organised and are downloaded from separate parts of the Government website, so I wondered if they were missing something.
Lo and behold, they were – something big. The reason it was hard to track down was because the government does not publish positive test results by age. This is a problem because testing in Scotland – and across the UK – is far higher this summer than it was last year. Lateral flow tests are everywhere now and people upload their results to the Government app. Only neurotics were doing this last year, but now everyone is doing it.
Okay, so I managed to construct a positive test rate for the over-60s. This can then be compared to hospitalisations. If hospitalisations are low relative to the positive test rate in over-60s then we can have some confidence that the vaccines are protecting this group. This means that even if they seem borderline useless at preventing case growth, they would at least be a prophylactic against severe cases of the virus.
But as you can see from the table above, there is no evidence that hospitalisations are lower for the over-60s that are testing positive and so no evidence that the vaccines protect the over-60s from severe illness.
Researchers in Israel have found that Vitamin D deficiency increases the risk of a hospitalised Covid patient dying more than seven-fold.
Looking retrospectively at the pre-infection Vitamin D levels of the 253 Covid patients for whom such records exist admitted to the Galilee Medical Centre up to February 4th 2021, the researchers found that the mortality rate among the Vitamin D deficient (under 20 nanograms per millilitre) was 25.6% (34 out of 133) compared to 3.4% (4 out of 116) of the non-deficient. That’s an increase in mortality risk of over seven and a half times, or 653%.
The study (which is not yet peer-reviewed) also found that more than half the hospitalised patients (52.5%) were Vitamin D deficient, suggesting Vitamin D deficiency contributed to the patients’ hospitalisation in the first place.
It also found that patients who suffered severe or critical disease were more than 14 times more likely to be Vitamin D deficient than those who suffered mild or moderate disease, once confounding factors had been controlled for.
The figure below shows the Vitamin D levels of the patients and the severity of their illness, broken down by age; the lines indicate the strong correlations.
The researchers noted there is no evidence that using Vitamin D to treat hospitalised Covid patients improves outcomes (seems it’s too late by that point). However, there is some evidence that Vitamin D supplements reduce risk of acute respiratory infection in general, though not yet specifically for COVID-19.
The researchers recommended that further study of the potential benefits of protective Vitamin D supplementation for the Vitamin D deficient is warranted. Sixteen months into the pandemic, you have to say there doesn’t appear to be a hurry to investigate what seems to be a key factor in Covid risk and may provide a cheap way to save many lives.
Compared to the other U.K. nations, Scotland’s third wave of infections appears to be more advanced. On June 22nd, 3,253 cases were recorded (going by date of specimen) which is the highest daily total since the start of mass testing. See the chart below, taken from the government’s COVID-19 dashboard:
However, as even Nicola Sturgeon has acknowledged, “Most cases are now in younger, yet to be vaccinated groups, so fewer are becoming v ill.” In fact, the recent surge appears to be related to Euro 2020.
A dramatic gender gap has opened up in the last two weeks, with men aged 15–44 substantially more likely to test positive than their female counterparts. The BBC quotes behavioural scientist Stephen Reicher as saying “the obvious explanation is that people were getting together for the football”.
Compare the chart above with the one below, which shows the number of patients admitted to hospital with COVID-19:
The first time there were over 3,000 cases recorded in a single day, on 29th December, the number of patients admitted to hospital with COVID-19 was 153. Yet on 22nd June, the number was only 35 (roughly four and a half times lower).
As Fraser Nelson noted in a tweet yesterday, the number of hospitalisations per 1,000 cases 10 days earlier (for the whole of the U.K.) has been trending downward for the past four months. At the end of February, the number was about 100. It has since fallen to less than 30.
There follows a guest post by the Lockdown Sceptics’ in-house medic, a former NHS doctor.
Alice laughed. “There’s no use trying,” she said. “One can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was your age, I always did it for half-an-hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”
I hope the readers will forgive a little self-indulgence on my part if I relate an anecdote from the tail end of my 12 years as a junior doctor in the early years of the first Blair government. At the time, the Health Secretary Alan Milburn (advised by the youthful Simon Stevens) had issued strict waiting time targets to all hospitals.
I was tasked with sorting out the numbers of patients on the surgical waiting lists at a large teaching hospital. It became apparent that if a patient had a date for surgery, they were no longer counted as ‘waiting’, even if that date was many months in the future. Accordingly, I issued dozens of patients dates for surgery and achieved compliance with the waiting time targets at a stroke.
There was just one problem. Both the managers and I knew that all those patients had virtually no chance of getting into the hospital on their designated dates. Due to lack of available beds, they would all be cancelled a couple of days before admission. At a meeting with the CEO of the Trust, I pointed this out. He looked me in the eye and said, “Let me make one thing clear to you. There is no problem with beds in this hospital.”
I briefly considered debating the assertion, but realised it was a pointless endeavour. The facts did not fit the Chief Executive’s preferred narrative – so the facts had to change. He was subsequently awarded a Knighthood for services to healthcare.
And so, here we are twenty years later – still believing six impossible things before breakfast. We might call it the ‘rule of six’!
Here is my first example where a target failed to be matched by real world data. When considering facts there are three basic components. Understanding the collection process and the inherent errors and bias within that, the interpretation process, during which there will be a range of opinion, (although currently only one viewpoint is permitted) and finally presentation of the data which is open to the greatest amount of bias.
Graph 1 shows the actual number of patients admitted with COVID from the community in June (orange bars). The blue line indicates where SAGE predicted it would be as a consequence of easing lockdown restrictions. How annoying – the data does not correlate with the prediction. In fact, hospital admissions are stubbornly refusing to increase significantly.
Never mind. If we simply state loudly that something nasty ‘could happen’ in the future that will cover just about every situation where the observable data do not support the required conclusion. And we can also show Graph 2 – which records the number of positive ‘cases’ in May-June 2021. The public won’t realise that most of these cases were asymptomatic and they may well think that they are the same as people being admitted to hospital.
It’s not two weeks since Lockdown Sceptics was casting doubt on Public Health England’s alarming claim that the Delta (Indian) variant had more than double the risk of hospitalisation of the Alpha (British) variant. How long will they take to backtrack after the panic has done its damage, we asked?
Well, it turns out that even before Boris took to the podium on Monday PHE had already released a new study claiming that vaccines after all are more effective at preventing hospitalisation against the Delta variant than the Alpha variant. Here’s the story in the Telegraph:
Vaccines are more effective at preventing hospitalisation against the Indian/delta variant than they were against previous types, once people are double-jabbed, new data shows.
Real world data shows the Pfizer/BioNTech vaccine is 94% effective against hospital admission from the variant after one dose, rising to 96% after two jabs.
The Oxford/AstraZeneca vaccine was found to be 71% effective against hospital admission after one dose, rising to 92% after two jabs.
In both cases, two doses had a greater impact preventing hospitalisations than was the case with the Kent variant.
The new study and the earlier study aren’t quite showing the same thing. The earlier study showed the risk of hospitalisation with the Delta versus Alpha variant for all those testing positive, not just the vaccinated, though subsequently adjusted the results for “vaccination status”. The new study specifically looks at the hospitalisation risk in those vaccinated with respect to the Alpha and Delta variants and compares them. However, the two studies should come to broadly the same conclusion, as they are both looking at how much more serious disease is with the Delta variant. At any rate, given that a large proportion of the vulnerable population is now fully vaccinated, we certainly shouldn’t see a doubling in the hospitalisation rate with the Delta variant if, as is claimed in the new study, the vaccines are better at preventing serious disease from that variant.
Ross Clark suggests the problem with the earlier data was that the sample size was small and biased. As he notes, PHE’s modelling misses the most obvious data point, that the rate of hospitalisations per case has not increased as the Indian variant has become dominant (see graph below). How then can the Indian variant have twice the risk of hospitalisation?
Is the new study any more reliable than the earlier one? As usual with a PHE observational study, it’s hard to tell, as much of the method is hidden behind opaque statistical techniques with working that is not set out. All the reader knows is that raw data is taken and transformed by some statistical process into hazard ratios and vaccine effectiveness estimates that are all but impossibly to verify. What we can do, though, is look at the results of this largely concealed data-processing and see if it makes sense.
Below is the table from the study (there’s only one, it’s a very short paper), and it shows something very curious.
