Indian variant

India Confounds the Modellers

What happened to India’s summer and autumn waves? After suffering a large surge with the emergent Indian variant (i.e., Delta) in the spring, India has defied modellers’ predictions by remaining very quiet since.

In August, Rajib Dasgupta, Chair of the Centre of Social Medicine and Community Health at Jawaharlal Nehru University, wrote for the Conversation about the “likely” imminent new autumn surge.

With about 40,000 cases and 400 deaths each day as of mid August, a new uptick is likely in the cards. The Indian states experiencing most of these new cases are those with relatively lower sero-prevalence, ranging between 50% and 70%. The 400 million sero-negative pool – that is people who have not been infected or had the vaccine – continues to be a large vulnerable group.

Forecasting by modellers indicates a third wave beginning in August and peaking at 100,000 to 150,000 infections a day by October. An alternative projection expects the peak in cases going until November.

It’s October now and the reality, of course, is a low level of infections since June and no new surge throughout summer and autumn so far. Below is the graph showing the predictions from the modelling of Mathukumalli Vidyasagar and Manindra Agrawal of the Indian Institute of Technology that Rajib Dasgupta cites above. I have added in the line of actual ‘cases’, which shows that they have trended well below the ‘optimistic’ scenario since the moment the prediction was made.

Councils in Virus “Hotspots” Ignoring National Guidelines on Not Giving Children Covid Vaccines

Councils in variant “hotspots” have begun vaccinating children against Covid ahead of an official decision on the matter from the Government, with one inviting thousands of 16 and 17 year-olds to “drop into one of our vaccine clinics” without the need of an appointment. It is not clear whether these clinics only vaccinate children whose parents have given their consent. The Telegraph has the story.

On Friday, Rochdale Borough Council invited “anyone aged 16 and over” to have a first dose of the Pfizer jab without the need for an appointment. Another drive-through clinic for teenagers is due to take place in the town on Saturday.

On Friday night, a spokesman for the council and local NHS clinical commissioning group said a “multi-agency decision” had been taken to expand the criteria to 16 and 17 year-olds because Rochdale was “again in a desperate race to stay ahead of the virus”.

The spokesman said: “Our borough is one of the areas of the country worst affected by coronavirus and our infection rate is now approaching that seen in Bolton a few weeks ago. Among our younger age groups, the rate is almost 1,000 cases per 100,000 people.

“Many 16 and 17 year-olds with underlying health conditions have already been vaccinated but many other younger adults who are at risk for different reasons are falling outside national protocols.

“On that basis, and to avoid any vaccine wastage, a multi-agency decision was taken with clinical leads to temporarily expand the qualifying criteria for at-risk 16 and 17-year-olds for our clinics this weekend, but following discussions we have now revised our plans.”

GPs in west London and other parts of the country have also given the vaccine to healthy under-18s in recent weeks, it is understood.

A senior NHS source said on Friday that action would be taken against GPs and local authorities who “go rogue” by ignoring national guidelines. …

Yet in a leaflet seen by the Telegraph, Rochdale Borough Council invited thousands of under-18s to come forward for their first Pfizer jab. It said: “If you’re aged 16 or over and have not got an existing appointment, please drop into one of the extra vaccine clinics.”

In an accompanying video posted online, Dr Mo Jiva, the Chief Executive Officer of the Rochdale and Bury Local Medical Committee, invited anyone aged 16 or above to “come down and receive their first or second vaccine” at a drive-through clinic in a gym car park. “We hope to see you tomorrow,” Dr Jiva said. …

A source at Rochdale Borough Council said the move to vaccinate under-18s was a “clinical decision”.

Worth reading in full.

People Who Have Had One or Zero Doses of a Covid Vaccine to be Barred from Indoor Hospitality When it Reopens in Ireland

The Irish Government is delaying the reopening of indoor hospitality, along with other indoor activities, due to fears over the Indian Delta variant. To add insult to injury, only those who have been fully vaccinated against Covid, and who have a pass to prove it, will be allowed into indoor venues when restrictions are finally eased. People who have only received one dose of a vaccine, or who – for medical or other personal reasons – are unvaccinated, will be forced to stay outside. BBC News has more.

Indoor hospitality was due to reopen on July 5th.

When it reopens, indoor hospitality will be limited to those who are fully vaccinated against Covid, Taoiseach (Irish PM) Micheál Martin has said.

The recommendation had been made by the National Public Health Emergency Team (NPHET). …

Mr Martin said while there will be an increase in the number of people who can attend outdoor events and the number who can attend weddings will be increased to 50 as planned, “the return to other indoor activities including hospitality will be delayed”.

“NPHET’s clear advice based on the modelling it has done is that given the increased transmissibility of the Delta variant, the safest way to now proceed with the return of indoor hospitality is to limit access to those who have been fully vaccinated or who have recovered from Covid infection,” he said. …

“The simple truth is that we are in a race between the variants and the vaccines and we want to do everything we can to ensure that the vaccine wins.” …

The Taoiseach gave no date as to when indoor dining and drinking in pubs and restaurants will resume.

Restaurateurs and publicans have expressed their anger and frustration at Mr Martin’s comments…

The plans have been criticised by the Restaurants Association of Ireland, which said it was “astounded” that indoor hospitality will face a further delay.

In a statement, the group said it believed the policy is discriminatory and unworkable. 

“Restaurant, pub and café owners will now be placed in the unenviable, complex and difficult position of allowing vaccinated customers enter indoors and restricting non-vaccinated customers to outdoor dining,” its Chief Executive Adrian Cummins said. 

“Such a practice of refusing access to goods and services in currently illegal under equality acts.”

He added that many people working in the hospitality sector are in the unvaccinated age groups, and could potentially be asked to refuse service to their peers.

Worth reading in full.

Claims the Indian Variant is “Hyper-Transmissible” are Nonsense – And Here’s the Graph that Proves It

Yesterday I wrote about the latest Public Health England (PHE) report claiming that the Delta (Indian) variant is much more infectious than the Alpha (British) variant. I noted that the main measure of transmissibility – the secondary attack rate (i.e., the proportion of contacts that an infected person infects) – has varied over time.

It occurred to me that it would be useful to plot these attack rate values to show them graphically. So I went through the 15 technical briefings released by PHE so far and extracted the secondary attack data for the three variants (Wuhan, Alpha, Delta) and plotted them in the graph above.

There are a few points worth making from this about the infectiousness of the Covid variants.

First, between 85% and 92% of the contacts of all those infected with any of the COVID-19 variants do not get infected. This is an indication of the high level of immunity (i.e., low level of susceptibility) in the population and the low absolute infectiousness of the virus.

Second, new variants appear to start off with – or quickly acquire – a high attack rate compared to established variants, a rate which then declines. The decline for the Alpha variant occurred prior to any significant vaccine coverage meaning it cannot all be attributed to the vaccines. Conversely, despite the high vaccine coverage in April and May the Delta attack rate spiked. Nonetheless, it has already sharply declined. (The reason for the sudden drop in the Alpha attack rate from 10% to 8% at the end of April is unclear.)

Third, the Alpha variant was once more transmissible than the Delta variant at its recent peak, but is now much less transmissible.

While more data from more variants would help to confirm the patterns here, the data so far suggest that new variants will often be more infectious than established variants to begin with, but this will not last. Further, the degree of infectiousness appears to arise more from factors such as the epidemic phase or the season than inherent properties of the variant, save insofar as the new variant is slightly better at evading our immune defences for a time. And I mean slightly. Only 3% more contacts of those infected with the Delta variant are being infected compared to the Alpha variant, a difference that is dropping week on week.

The upshot is we should stop being frightened by claims that the latest new variant is “50% more infectious”, which are a distraction, and focus on levels of serious disease and how best to cope with them.

Government Adviser Says the Prevalence of Covid Variants Means “There’s a Very Strong Argument” for Vaccinating Children

Despite warnings from a wide range of health experts against giving children Covid vaccines, including from a member of the Government’s Joint Committee on Vaccination and Immunisation, it seems increasingly likely that Government’s across the U.K. will decide to include children in their vaccine roll-outs in the near future.

On Saturday, Professor Peter Openshaw, a member of the Government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) and Professor of Experimental Medicine at Imperial College London, said that the prevalence of Covid variants means “there’s a very strong argument” for the vaccination of children. The MailOnline has more.

He told BBC Radio 4’s Today programme: “A lot of people are sitting on the fence about this but I think on balance I’m coming to the view that vaccination of children – there’s a very strong argument there.”

He said the vaccine was safe for children, while prolonged symptoms of coronavirus meant one in 10 sufferers have not fully recovered.   

He added: “Originally with the Wuhan strain it didn’t seem there was very much amplification of the epidemic going on amongst people who were at school in contrast to what we know about influenza, where schools are often the major driver of spread. 

“But with these more transmissible variants it is evident that they are being transmitted much more amongst young adults and school children and even younger children and that seems perhaps to be a change in the biological quality of the infection. 

“It’s still fortunately not causing very high disease rates amongst those kids but it does strengthen the argument against vaccination.”

He said the Government “absolutely needs to have the discussion” as research proves the “safety and efficacy in terms of generating an antibody response in children”…

Meanwhile, the Medicines and Healthcare products Regulatory Agency (MHRA) last week approved Pfizer’s Covid vaccine for 12 to 15 year-olds.

But no decision has yet been taken on whether to extend the rollout to under-18s once all adults have been offered a jab.

And there are now concerns in the U.S. that the Pfizer jab might have health risks for children that outweigh the benefits, with officials there fearing around 200 cases of heart damage among under-30s could have been linked to the jab.

The MHRA said it has not seen any such cases in the U.K. but the JCVI has advised that young adults or children should not be given the AstraZeneca jab unless it’s the only option because of a small blood clot risk.

The JCVI is expected to tell ministers the move to give jabs to children would be a “political decision”.

Worth reading in full.

If the Indian Variant Really is 60% More Infectious, Why is it So Tame in Other Countries?

The Government’s favoured modellers appear to have settled on a figure for the greater infectiousness of the Delta (Indian) variant: a spanking 60%. Reuters reports.

Neil Ferguson of Imperial College London told reporters that estimates of Delta’s transmission edge over Alpha had narrowed, and “we think 60% is probably the best estimate”.

Ferguson said that modelling suggested any third wave of infections could rival Britain’s second wave in the winter – which was fuelled by the Alpha variant first identified in Kent, south east England.

But it was unclear how any spike in hospitalisations would translate into a rise in deaths, as more detail was needed on how well the vaccine protects against serious illness from Delta.

“It’s well within possibility that we could see another third wave at least comparable in terms of hospitalisations,” he said.

“I think deaths probably would be lower, the vaccines are having a highly protective effect… still it could be quite worrying. But there is a lot of uncertainty.”

Ferguson isn’t the only one making such doom-laden predictions. The usually more sanguine Philip Thomas of Bristol University is also predicting an “enormous” third wave in the summer. It will be “far bigger than the second”, he says, because of the Delta variant. “There is no hiding place. Either you’ve had the virus or been vaccinated, or you are pretty likely to get Covid this summer.” Ah, so another model that doesn’t factor in prior immunity or T-cells. Professor Thomas writes:

Link Between Positive Covid Tests and Covid Deaths Has Been Broken, Says NHS Leader

The vaccine has broken the link between positive Covid tests and Covid deaths, according to the Chief Executive of NHS Providers, Chris Hopson, who last week criticised the scientific modelling seen by the Government through much of the pandemic as “crude” and unreliable. Chris says that viewed alone, the raw number of positive tests does not tell the full story: “It is a much younger population that is coming in [for hospital treatment now], they are less clinically vulnerable” and much easier to treat. The MailOnline has the story.

Chris Hopson… said today that the surge in cases and hospital admissions in the Greater Manchester town was manageable for its hospitals.

Patients were generally younger and less sick, he suggested, than in the crippling second wave over the winter, and the numbers of people coming in were lower and significantly fewer of them are dying.

Vaccines appear to be doing a lot of the heavy lifting, Mr Hopson said, adding that they have broken the link between infections and “very high” levels of hospital admissions and deaths in earlier waves of the virus…

Bolton has been overtaken by nearby Blackburn as the country’s Covid hotspot after cases surged there driven by the Indian variant, which accounts for almost all infections in the town. Hospital admissions rose shortly after, to a peak of 49 people on wards with Covid and 14 admitted in a day, but these appear to be falling now, too, with 42 reported in patients on June 1st.

Mr Hopson said: “If – and it is a big if – if Bolton has gone through its complete cycle and if other areas follow Bolton, the view from the hospital there was that they were able to cope with the level of infections.”

His comments come as pressure is building towards Boris Johnson’s speech next Monday when he is expected reveal whether June 21st’s “Freedom Day” end of social distancing will go ahead. Current trends look as though he will prolong lockdown laws for a few more weeks or until the summer holidays to buy more time for vaccinations.

Mr Hopson told Times Radio: “It’s important not to just focus on the raw numbers here… you also do need to look at who’s being admitted into hospital and how clinically vulnerable and what level of acuity [illness] they’ve got.

“What chief executives are consistently telling us is that it is a much younger population that is coming in, they are less clinically vulnerable, they are less in need of critical care and therefore they’re seeing what they believe is a significantly lower mortality rate which is, you know, borne out by the figures.

“So it’s not just the numbers of people who are coming in, it’s actually the level of harm and clinical risk.”

Worth reading in full.

“Minimise Travel” Advice Extended to Cover Millions More Brits

All people living in Greater Manchester and Lancashire are now advised to “minimise travel” due to fears over the Indian Delta Covid variant, though Greater Manchester Mayor Andy Burnham has told people not to cancel trips because of the new guidelines. The Government hopes to tackle the Delta strain with a “strengthened package of support”, focusing particularly on additional Covid testing. The Mirror has the story.

The Government’s Covid advice was updated today, to expand the areas advised to only travel in and out of the area if necessary.

At the end of May, the Government faced criticism after it updated guidance for people in Bedford, Blackburn and Darwen, Bolton, Burnley, Kirklees, Leicester, Hounslow, and North Tyneside, where the India variant had started to surge.

The information was posted in an online update at Gov.uk on May 21st but it was not accompanied by an official announcement. 

Today, the areas covered by the guidance were updated to include the Greater Manchester Combined Authority… and Lancashire County Council…

Asked about the change, the Prime Minister’s official spokesman said: “The Health Secretary has talked about that in the House. 

“He wants to provide the package of support that has been effective in Bolton to a wider area, so that’s Greater Manchester and all of Lancashire County Council, to tackle the cases of the Delta variant.”

After the advice was updated, Health Secretary Matt Hancock told MPs: “I can tell the House that today working with local authorities, we are providing a strengthened package of support based on what’s working in Bolton, to help Greater Manchester and Lancashire tackle the rise in the Delta variant that we’re seeing there.

“This includes rapid response teams, putting in extra testing, military support and supervised in-school testing. I want to encourage everyone in Manchester and Lancashire to get the tests on offer.”…

Greater Manchester Mayor Andy Burnham told locals not to cancel trips because of the new guidance. 

“It’s very important to keep a sense of proportion,” he told a press conference today. 

“This is guidance… it is not a lockdown, it is not a ban.”

Worth reading in full.

Matt Hancock Reveals Hospitalisation Rate of Indian Variant is Just 1% – Half that of the British Variant

Health Secretary Matt Hancock revealed some statistics in the Commons yesterday about the Delta (Indian) variant: out of 12,383 Delta variant positive tests in the U.K. up to June 3rd, 464 went to emergency care and 126 were admitted to hospital. Of those admitted to hospital, 83 were unvaccinated, 28 had had one jab and three had had both doses.

Keen-eyed readers will spot that 83+28+3 is not 126 – there are 12 hospital admissions unaccounted for. A Department of Health source told the Financial Times‘s Sebastian Payne that nine of these “don’t match to a vaccine status at present” while three were within 21 days of their first dose so didn’t count in any category.

Can we use these figures to make some crude calculations of the severity of the Delta variant?

126 hospital admissions out of 12,383 positive tests gives a 1% hospitalisation rate, or 99% not needing hospital. How does this compare to the Alpha (British) variant?

Last week Public Health England (PHE) released a study claiming the Delta variant had around double the risk of serious disease or hospitalisation compared with the Alpha variant. However, according to the ONS, during the winter peak when the Alpha variant was dominant, around 2% of the population of England was infected with COVID-19 and around 0.04% of the population was being admitted to hospital with the virus each week, giving around 2% of British variant infections leading to hospital admission. This is double the rate for the Indian variant on Hancock’s figures – and furthermore, Hancock’s figures use positive cases, not an ONS population infection estimate, which would reduce the hospitalisation rate for the Indian variant further.

However, what we don’t know, because these are just statistics delivered verbally in Parliament not a proper report (more science-by-press-release), is how many of the 12,383 positive cases are too recent to have led yet to hospital admission. We also don’t know how elderly or vulnerable those in the sample of 12,383 are, or what impact the vaccines are making on the hospitalisation rate.

The figures are of limited use as well in estimating the effectiveness of the vaccines against hospital admission with the Delta variant. That’s because we don’t know what proportion of the 12,383 infected were vaccinated, so we can’t control for that key factor. Having said that, the three versus 83 hospital admissions for fully vaccinated versus unvaccinated seems encouraging.

Overall, this data is very limited. Nonetheless, the fact that the hospitalisation rate even among positive cases is so much lower with the Delta variant now than with the Alpha variant in winter is further evidence that the latest scariant is nothing to fear.

Hospital Admissions For Covid Continue to Fall in Scariant “Hotspot” Bolton

The number of people being admitted to hospital to be treated for Covid continues to fall in the former Indian Delta variant “hotspot” Bolton. The MailOnline has the story.

[The] latest NHS figures show there were 42 people in hospital in the Royal Bolton Hospital with the virus on June 1st, last Tuesday, down from 49 at the peak of the new variant scare a week earlier.

The number of people being admitted to hospital each day has tumbled, too, to just three on May 30 compared to 14 five days before. The numbers are trailing a decline in cases which appears to show a spike in new variant cases has come under control.

The same pattern is hopefully beginning to unfold in neighbouring Blackburn, the U.K.’s current hotspot which has also been hit by the Indian “Delta” strain, where infection numbers among over-60s have started to fall following a rise.

Although the borough’s infection rate was still rising at the end of May, a decline in infections among older people should help officials to keep hospital admissions and deaths under control.

More than 12,000 cases of the B.1.617.2 variant have been spotted so far in the U.K. and Public Health England last week admitted for the first time that it has become the most common variant in Britain. Almost one in five officially recorded cases – 2,149 – have been in Bolton, with another 724 in Blackburn with Darwen.

But the fact that Bolton has turned the tide of the super-infectious strain suggests it can be successfully controlled without lockdowns, instead using testing, contact tracing and vaccinations.

Covid hospital admissions started rising in Bolton in the first week of May around 10 days after cases began to rise – it can take several weeks for infected patients to become ill enough to need medical care…

Its coronavirus infection rate spiked 10-fold from just 44 cases per 100,000 people in the week ending April 22nd to a peak of 453 per 100,000 a month later on May 21st.

Cases have been most common in under-55s, who are least likely to have had two doses of a vaccine, but hospital admissions rose in the wake of the rocketing cases. Only a small fraction of patients had been fully vaccinated.

Health Secretary Matt Hancock last week admitted the link between infections and hospital admissions, which vaccines should separate, has so far been “broken but not completely severed”.

Worth reading in full.

Stop Press: According to the Prime Minister’s spokesman, quoted in the Guardian, “[it] still remains that there is nothing in the data currently to suggest step four [of the lockdown roadmap] can’t go ahead at the earliest date”.

But we do need to look very closely at the data over this coming week, which will be crucial to decide and really to get a sense of the data, particularly on hospitalisations and whether or not the excellent vaccine rollout programme has sufficiently severed that link between the increase in cases, which we always expected to happen, particularly after step three, and that subsequently leading to hospitalisations and deaths.

Worth reading in full.