Third wave

The SAGE Models are Already Wrong

In a recent article, we considered the implications of the U.K.’s spring rise in infections, given that before now the assumption has been that coronaviruses are seasonal at northern temperate latitudes. Do we have to dismiss that hypothesis in light of the ‘Third Wave’?

Here we argue that, contrary to Government claims, the British summer is indeed finally impacting viral transmission, with sharp falls in positives reported across the U.K. In England, reported cases have more-or-less halved in a week, from 50,955 to 25,434.

This sharp fall runs counter to all three of the most recent SAGE models driving Government policy, which predict rising infections leading to peaks in hospital admissions in high summer – and by implication falsifies the assumptions upon which these models are based.

Parsimony predicts the summer troughs and winter peaks evident for SARS-CoV-2

In spring and summer 2020 and winter 2020-1, SARS-CoV-2 infections parsimoniously followed the pattern of seasonal respiratory viruses, falling away in the summer months and rising again in the autumn, with peaks in deaths occurring between mid-November 2020 and mid-April 2021 in different northern temperate countries.

Although falling infection levels were sometimes prolonged into early summer or began to rise again in late summer, there were no peaks in fatalities in summer or early autumn 2020. 

Most notably, while cases in Sweden rose in a pattern close to the European average in early 2020, they persisted much later, continuing to a plateau in late spring and early summer, before falling away sharply from the end of June. Hospitalisations and deaths fell more smoothly from the mid-April peak, however, and showed no corresponding rise in late spring and early summer.

Similarly, while infections began to rise in late summer in some countries – such as France – there was no substantial increase in deaths before mid-autumn. Summer 2020 appears to have broken the link between infections and serious illness in the absence of vaccination. 

Sweden has so far emerged relatively unaffected by the Delta variant. Although this variant was detected in Sweden – as it was in most other European countries – infections in Sweden nevertheless fell with the onset of summer. As Sweden’s State Epidemiologist Anders Tegnell remarked in an interview on June 18th, 2021 (at about 8 minutes 25 seconds), “the number of cases in Sweden are falling rapidly, very rapidly I would say, much more rapidly than we ever thought was possible”. Tegnell also makes some sceptical points about asymptomatic transmission and mass testing, so beloved of the U.K.’s SAGE committees.

Recent peaks attributable to the Delta variant have occurred in countries such as Denmark, Belgium and the Netherlands, but these outbreaks too may have peaked as they appear to have in the U.K.

SAGE scenarios – anything can happen in the next eight weeks…?

Turning to the latest (July 6th) scenarios of the SAGE’s SPI-M-O modelling groups, we find hospitalisations could be between 50 and 10,000 per day by August 31st depending on the R value. SPI-M-O note these scenarios are not forecasts or predictions, leaving open to question their purpose with regard to Government formulation of policy. 

Previous over-estimations of hospitalisations are attributed to: 1) the cancellation of ‘Freedom Day’ on June 21st permitting more vaccinations to be administered and transmission to be delayed due to restrictions; 2) less than anticipated mixing between adults since late April to mid-May; and 3) the effectiveness of vaccines against the Delta variant.

There appears to be no suggestion of an emphatic effect of spring and summer on behaviour, the virus or viral transmission, which would have been considered conventional wisdom until mid-March 2020.

Warwick University

The Warwick models predict the current rise in hospitalisations will persist to peak in late summer or early autumn, which may or may not be accompanied by a small wave – based on the mean estimates – from late December 2021 or early February 2022 depending on supposed “precautionary behaviour”.

None of the Warwick models predict a fall in hospitalisations in summer 2021 nor – by implication – a fall in infections.

Imperial College London

Imperial College offers two models, based on optimistic (upper figure) and central (lower figure) estimates of vaccine effectiveness, adjusted according to estimates of the speed of change in behaviour and the R value. 

Both models predict peaks in the early autumn, possibly delayed to mid-autumn if changes in behaviour are slow. Using these assumptions, the mean estimates presented for hospitalisations are higher than in the Imperial models. 

Central estimates of vaccine effectiveness with sudden relaxation in precautionary behaviour appears to predict mean daily hospitalisations of about 2,500 to about 12,000 per day by the end of September depending on the R value. Imperial have produced a further model based on pessimistic estimates of vaccine effectiveness (not shown).

Of the Imperial models, only the gradual relaxation of restrictive behaviour scenarios indicate a fall in hospitalisations, but in both instances this simply delays a peak in hospitalisations and – by implication – infections until the early autumn. Neither model anticipates an imminent fall continuing into summer, nor a winter peak between December and February.

London School of Hygiene and Tropical Medicine (LSHTM)

LSHTM present similar models based on a further set of assumptions and predict a peak in hospitalisations in mid-summer, varying in size according to the extent of reduction in transmission (five to 20% reduction at medium mobility is shown in the figure).

Again, the LSHTM model precludes the current reduction to a baseline as in summer 2020.

The ZOE Symptom Study, which provides invaluable independent comparator to reported positives figures, appears to show infections to be rising to July 20th, but only since the method of estimation was revised. Comparators such as ONS and REACT-1 are out of date.

Implications of the models

None of the SAGE models predict a sharp fall and summer lull in infections. Rather, the SAGE report states “the prevalence of infection will almost certainly remain extremely high for at least the rest of the summer”.

We are left with two competing hypotheses:

SAGE predict a continued rise in infections, accompanied by hospitalisations and deaths, peaking in mid-summer or early autumn. There may be a further small wave from late December or early February, or none at all.

Parsimony predicts cases will fall to baseline as summer advances, much as occurred in Sweden last year – a late spring or early summer cold that does not cause significant morbidity or mortality. The summer disappearance will be followed by a resumption in the autumn rising to a peak in infections and deaths in winter proper.

Are the SAGE models already wrong?

Although summer peaks in infections in seasonal respiratory viruses are rare, they are not unknown, particularly in novel varieties and, it may be noted that – unlike in Sweden in 2020 – the spring rise in infections in the U.K. arose from a low base and involved a new variant – the Delta variant – and was preceded by the vaccine roll-out.

While vaccination is argued to be the key factor in keeping hospitalisations and deaths figures low, these measures were also low in the late spring 2020 wave of infections in Sweden. It is possible that nosocomial and care-home outbreaks have also been prevented, in part due to the seasonal fall in general demand for hospital beds in the spring and summer. The most recent ONS report shows overall excess deaths in England and Wales to be higher at home than in care homes or hospitals. Nevertheless, it is striking that reported positives in Scotland have been falling since the end of June.

Hospitalisations in Scotland are also falling from a peak approximately a week later.

The rest of the U.K. is now following the trend in Scotland, which showed a rapid fall in infections from the end of spring and beginning of summer, as Sweden did in 2020. Are we simply experiencing a late impact of seasonality on suppression of spread, which has finally taken effect?

Reported positives peaked just prior to ‘Freedom Day’ in England and about three weeks earlier in Scotland. There is no sign of any stall in the falling trajectory of infections in either country, as could be attributed to the relaxation of restrictions on ‘Freedom Day’. This would be not at all surprising to those who observed the lack of impact of ‘opening up’ in Texas and Florida some months ago.

On the basis of current infection data, the SAGE models are already wrong.

So must be the assumptions of virus transmission and effects of Non-Pharmaceutical Interventions – and lack of effect of nature – on which they are based.

It begs the question as to why the Government and media have again so enthusiastically engaged with consistently disappointing predictions leading to such damaging public health policy.

None of this should be a distraction from the point that lockdowns cause a good deal of harm to physical and mental health and to the economy, far outweighing any presumed benefit – if any can be shown. The models, NPIs and lockdowns are about politics, not science.

The co-authors are a PhD epidemiologist trained at a Russell Group University and a retired former Professor of Forensic Science and Biological Anthropology.

Chris Whitty Warns of Summer AND Winter Waves as Neil Ferguson Raises Prospect of New Lockdowns – But Data Show the Third Ripple is Already Peaking

The doom-mongers of SAGE were out in force again yesterday, building on their recent victory in Downing Street to keep stoking the fear. The Independent brings us the latest wisdom from Imperial College’s Professor Neil Ferguson.

The third wave of COVID-19 cases in the UK has already began, according to Government advisers – who said it was possible strict lockdown curbs would have to reintroduced at some point this year.

It comes as a new study commissioned by the Government found Covid infections have increased 50% since the start of May – as the country struggles to combat the rise of the highly-transmissible Delta variant first detected in India.

“We’re at the beginning of [the third wave] now,” said Professor Neil Ferguson, the Imperial epidemiologist dubbed “Professor Lockdown” by the tabloid press.

Ferguson told a media briefing that his latest modelling predicts between 100 and 1,200 deaths a day at the peak of the summer “third wave”, before raising the possibility that restrictions may need to be introduced.

I’m very much hoping we won’t need to reverse course [on the easing of restrictions] – and I suspect we won’t. We will inevitably see cases and hospitalisations rise. But the key is [how] manageable the level is.

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:

Boris Tells Commons that Pandemic is Currently at Peak and U.K. Should Expect New Surge in Autumn

Speaking in the House of Commons, Prime Minister Boris Johnson has said the Indian coronavirus variant is of “increasing concern” as outbreaks have been detected across the country. 

He said that despite increasingly encouraging data in the U.K, the threat of the virus remains “real” and new variants “pose a potential lethal danger”.

The end of lockdown is not the end of the pandemic. The World Health Organisation has said the pandemic has reached its global peak and will last throughout this year. The persistent threat of new variants, should these prove highly transmissible and elude the protection of vaccines, would have the potential to cause greater suffering than we had in January.

He added there is “high likelihood” of a new surge in infections and hospitalisations this autumn when “the weather helps the transmission of respiratory diseases, when pressure on the NHS is at its highest”.

Earlier today, junior minister George Eustice said that local lockdowns and tiers could make a comeback in response to local outbreaks.

What happened to the lifting of restrictions being irreversible? Wasn’t that supposed to be the reason it was happening so cautiously and slowly?

Despite the fast vaccine rollout and the example of states like Florida and Spain that have ended the state of emergency, the noises coming from the U.K. Government increasingly suggest they have no intention of returning the country to a normal footing any time soon. Perhaps a permanent state of emergency, and a posture as saviour, is good for elections?

Pro-Lockdown MPs Tell Government to Discourage Holidays Abroad After May 17th

The All-Party Parliamentary Group on Coronavirus (APPG) – a zealously pro-lockdown group of opposition MPs – has urged the Government to discourage holidays abroad even when they’re legal so as to keep Covid variants out of the U.K. and prevent a third wave of infections. The Group said that, if implemented, this approach should only be reviewed every three months. The Guardian has the story.

Holidays abroad should be discouraged even once legal, a cross-party group of MPs have said as part of a suite of recommendations to prevent a third wave of coronavirus and further lockdowns.

Under the U.K. Government’s roadmap to relax coronavirus restrictions, international travel for leisure purposes could resume from May 17th.

Ministers have confirmed that a traffic light system is to be put in place in which countries will be added to green, amber and red lists, with different rules regarding issues such as quarantine of returning travellers for each list…

But on Monday the APPG issued a report recommending that holidays abroad should be discouraged in light of experts’ concerns about international travel.

“The U.K. Government should discourage all international leisure travel to prevent the importation of new variants into the U.K., in order to reduce the risk of a third wave and further lockdowns,” the report states, adding that financial support must be given to the travel industry. “This recommendation should be implemented immediately and reviewed on a quarterly basis.”

The SNP MP Dr Philippa Whitford, the Group’s Vice-Chair, said: “Our cross-party inquiry has heard how the U.K.’s border management is acting more like a sieve than a shield in the fight against coronavirus. Ministers must act on these recommendations and learn from the mistakes made last year, when the premature reopening of international travel contributed to a second wave. With the threat of importing dangerous new Covid variants, we must not throw away recent hard-won progress made through the sacrifices and efforts of the public.”

Worth reading in full.

Stop Press: Even if holidaymakers are allowed to travel abroad from May 17th, only a “tiny handful” of countries are expected to be included on the “green list”. Travellers to countries in this category will not have to quarantine upon their return to the U.K. but will have to pay for PCR tests. The Telegraph has the story.

The “green” list for quarantine-free travel, to be unveiled on Thursday or Friday, is expected to be limited to a “tiny handful” of countries including Gibraltar, Israel, Iceland and Malta. Most European nations will be on the “amber” list requiring 10-day home quarantine on arrival back in the U.K..

Amber-rated countries are expected to include Spain, Greece, France and Italy, as well as their islands. Portugal is the only big European holiday destination with a chance of making the green list from May 17th.

Also worth reading in full.

Stop Press: Boris Johnson poured cold water this morning on hopes of an extensive green list being announced shortly. “We do want to do some opening up on May 17th but I don’t think that the people of this country want to see an influx of disease from anywhere else,” he told reporters on an early morning visit to Hartlepool where a by-election is taking place on Thursday. “I certainly don’t and we have got to be very, very tough, and we have got to be as cautious as we can, whilst we continue to open up.”

Boris Warns of Third Wave – as He Finally Gets Round to Looking at Treatments for Covid

Boris told the country yesterday that, despite the vaccines, there is going be “another wave of Covid” at some point this year. Speaking at a Downing Street press briefing, he said:

As we look at what is happening in other countries with cases now at record numbers around the world, we cannot delude ourselves that Covid has gone away. I see nothing in the data now that makes me think we are going to have to deviate in any way from the roadmap, cautious but irreversible, that we have set out. But the majority of scientific opinion in this country is still firmly of the view that there will be another wave of Covid at some stage this year and so we must – as far as possible – learn to live with this disease, as we live with other diseases.

The warning came as he announced a task force to find new ways of treating COVID-19 before winter, with the aim of developing a tablet that can be taken at home to provide crucial early treatment. He said:

This means for example that if you test positive for the virus that there might be a tablet you could take at home to stop the virus in its tracks and significantly reduce the chance of infection turning into more serious disease.

The task force is welcome, of course, but the question is why is it only just being set up, when we first knew of this virus in January of 2020? Why wasn’t finding effective treatments a priority from the start? Why did none of the journalists at the press conference ask this question? Treatment should always be the first solution reached for when faced with a disease, as unlike lockdowns and vaccines they provide a way of making sick people better.

While the idea of learning to live with the disease, including through the use of treatments, should be reassuring, what the politicians mean by the phrase in the past year has typically turned out to be quite different to what most of us mean by it. We mean getting back to normal. They mean setting up a new “normal” of vaccine coercion, biometric ID passes, permanent screening programmes, face masks, closed borders, and restrictions on social contact and basic freedoms that loosen and tighten depending on the questionable results of mass testing. No thanks.

So why now? Is the Government only turning to treatments at this point because its fears are growing about variants that can escape the vaccines (for which there is some evidence)? Is this a further sign that the Government and its scientists are losing confidence in the vaccines?

In fact, as Professor Philip Thomas argues, there is unlikely to be a “third wave” now that we have the vaccines to top up our acquired and pre-existing immunity (and I doubt there would be a “third wave” without the vaccines). The remarkably low Covid hospitalisation rate for people who’ve been vaccinated that was reported yesterday adds to that hope. However, there is always going to be a winter flu season, and Covid and its potentially immunity-stretching variants are always going to be around. Who knows what the future will bring? Certainly not SAGE and its discredited modelling teams, whose alarmist predictions have consistently fallen flat. (Even in winter they predicted a much bigger surge and failed to anticipate that it would peak before lockdown.)

The question that has never been answered in this crisis is how safe do we need to be from Covid before we can go back to normal? Actually, it was answered once. In the Government’s original Pandemic Preparedness Strategy we know that a death toll of up to 315,000 within a few months from a pandemic virus was envisaged as being acceptable – still far more than we have seen with the (PCR-inflated) Covid death toll of the past year. That scale of mortality was not deemed to warrant any of the unprecedented measures we have experienced since March 2020 (which in any case were, correctly, judged not to be effective).

But since that sensible, science-based plan was ditched, the key question of when we can return to normal – the old normal, not the new normal – has never been answered. Is it because to do so would mean the politicians and scientists would have to grow a spine and endorse an acceptable level of risk and bring the emergency – and their status in it – to an end?

PM “Under No Illusion” That Europe’s “Third Wave” Will Hit UK

Boris Johnson has stressed the importance of keeping the vaccine rollout at its current pace due to the risk that the ‘third wave’ of Covid infections across Europe will hit the UK as well. Sky News has the story.

Boris Johnson has been “reassured” EU leaders “don’t want to see blockades” on the export of Covid vaccines – as he warned a third wave of infections in Europe would likely hit the UK as well.

Amid a dispute over a possible block on exports of coronavirus jabs to the UK, the Prime Minister said he had been “reassured by talking to EU partners over the last few months that they don’t want to see blockades”.

He stressed the UK was “on course” to vaccinate the top nine priority groups – including all over-50s – by April 15th, while the Government would “bash on” with its roadmap for lifting lockdown restrictions.

Mr Johnson said he had talked to EU leaders “repeatedly over the period”, adding: “We’re all facing the same pandemic, we all have the same problems.

“I think one thing worth stressing is that on the continent right now, you can see sadly there is a third wave under way.

“And people in this country should be under no illusions that previous experience has taught us that when a wave hits our friends, I’m afraid it washes up on our shores as well.”

That last sentence is poorly constructed. If a person is “under no illusions” that “previous experience has taught” them a particular lesson, that implies “previous experience” hasn’t taught them that lesson, when Boris clearly means the opposite. Tsk, tsk.

The Prime Minister’s garbled statement follows recent warnings that an increase in Covid cases on the Continent could prevent Brits from holidaying abroad this summer.

Worth reading in full.

Tory MPs Urge Boris Not to Extend Lockdown Restrictions

Mounting pressure is being put on the Prime Minister by his backbenchers not to deviate from his roadmap timetable or impose a blanket ban on foreign travel in response to the resurgence of the virus on the Continent. The Observer has more.

With scientific advisers warning of the risks of overseas holidays in the late spring and summer, figures from across the Conservative party demanded that the prime minister reject an “excess of caution” in reacting to an apparent third Covid wave across the continent.

It comes with cases rising in countries including France, Italy, Spain, Germany and Turkey. Italy has recorded a near-doubling in the past month, while Paris has entered a new month-long lockdown to curb the spread. The government’s roadmap says that overseas travel from England could resume from May 17th at the earliest, should a series of conditions be satisfied. …

With tensions building in the party, a series of Tories said on Saturday that Britain’s successful vaccine programme should allow the government to deploy testing and stricter rules for high-risk countries, rather than prolonging a blanket travel ban. Graham Brady, chairman of the powerful 1922 Committee of backbench Tory MPs, said: “The success of the British vaccination programme should allow international travel to resume safely. It is very likely that Covid is now an endemic virus – there may be variants for years to come. We need to focus on rational mitigation and not keep resorting to disastrous lockdowns.”

Worth reading in full.

Is There a Third Wave in Europe?

Europe shared in the worldwide fall-off in coronavirus infections in January and February but, unlike in the UK, that trend has reversed in the past few weeks and the continent, especially in the east, is beginning to see sharp rises again.

The World Health Organisation’s Emergencies Lead in Europe, Dr Catherine Smallwood, has said she is “particularly worried” about the situation in the Balkans, the Baltic States and Central Europe, where hospitalisation and death rates are now among the highest in the world. The Telegraph has more.

The numbers of new cases per million people are also rising so fast that in some countries – notably Estonia, Bosnia, Hungary and Poland – the graphs tracking the virus point almost vertically upwards. 

Experts said that the combination of the spread of the more transmissible UK variant coupled with slow Government reactions, as well as a lack of vaccinations in some countries, could all be contributing to the spiking numbers and Europe’s looming third wave. 

The jury is still out on how much more transmissible the UK variant really is. As Dr Clare Craig notes in relation to the UK: “The ONS Survey had it falling before Lockdown 3 was announced. At peak cases ONS reckoned 61% of COVID cases in England were new variant, 33% in Northern Ireland, 22% in Scotland and only 5% in Wales – yet all had a winter wave.” The assumption that “slow Government reactions” make a difference is also not in line with the findings of most studies, which find no association between restrictions and spread.

The WHO said that the situation was “most acute” in areas that had been successful “in controlling the disease [sic] in the first six months of 2020”, suggesting for many of the countries this is more an extended first wave than a second or third.

Nonetheless, it looks like the region may be in for a rough ride over the next few weeks.

Positive rates from Our World in Data

Government’s Long, Slow Walk to Freedom is Costing Billions and Makes No Sense

This afternoon’s No 10 Press Conference

Today Boris Johnson held a press conference to mark what he described as an “emotional” moment in the lifting of lockdown as children return to school. Encouragingly, he said that the “greater risk now is keeping them out of school for a day longer”. 

Deputy Chief Medical Officer Dr Jenny Harries told the press conference that she didn’t expect schools to be forced to close again.

Less welcome was that she said it would take some families time to get used to the wearing of masks and regular testing, as though this was to be part of an ongoing normality.

On the plus side, she said the vaccination programme meant the R number was no longer so important.

The whole issue about vaccination of course is we have now protected the most vulnerable individuals as we come down the age groups into those with underlying health conditions. And so the impact on our hospitals going forward is likely to be significantly less.

She noted that cases, hospital admissions and deaths continue to fall, and that infections are now below 100 per 100,000 of population in every part of the country and are back to where they were in September.

She then reverted to alarmist nonsense, saying: “This is a level at which a new wave could easily take off from again”, and there is still “substantial strain” on the NHS.

In other words, everything’s going down – but don’t think that means you can resume your liberties, as it could reverse at any moment. On that logic, we’ll never be free.

As for the NHS being under “substantial strain” – Covid patient levels are back to where they were in October, when hospitals were running at normal levels, and dropping quickly.