Variants

The Figures Don’t Match Up To the Fear, a Doctor Writes

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 Figures Don’t Match Up To the Fear, a Doctor WritesRead More

By Michael Curzon  /  7 August 2021 • 20.49
                   
43 comments

What the Modellers Still Don’t Understand About Herd Immunity

Bristol’s Professor Philip Thomas has a new piece in the Spectator this week. Readers may recall that I criticised his previous pieces for what seemed in my view to be wildly over-the-top predictions of the likely scale of the Delta surge.

In June, he predicted “an enormous final wave“, in which the virus “would quickly seek out the one-in-three Britons who are still susceptible: mainly the not-yet-vaccinated” and peak in the middle of July (the bit he got right) “at anywhere between two million and four million active infections“. According to the ONS, around 951,700 people in the U.K. were PCR positive in the week ending July 24th, and that appears to be the peak, which is less than half of Professor Thomas’s lower estimate.

He now admits: “The situation is better than I bargained for at the beginning of June and also better than my estimates a month later.” In fact, it’s so much better, that he thinks “the decline in active infections can only mean that England is about to reach the herd immunity threshold for the Delta variant”. By which he means that “around 86% of England’s adults and children must now be immune”. On this basis he argues that it is “extremely unlikely” that there will be a new Covid surge in the coming winter.

The problem with this analysis is it is still based on the SAGE assumption that herd immunity is a once-for-all-time thing, that was made harder to reach by the more transmissible Delta variant, but which we have now just achieved, mostly through vaccination, and it will now keep us safe.

What the Modellers Still Don’t Understand About Herd ImmunityRead More

By Will Jones  /  6 August 2021 • 01.05
           
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Covid Vaccine Could Become Mandatory for Troops in U.S. Military

U.S. Defence Secretary Lloyd Austin is expected to recommend that vaccination against Covid should be mandated for all 1.3 million active-duty military troops, with the final decision lying with President Joe Biden. The shift in position is believed to have occurred because of fears over the Delta variant. The New York Times has the story.

Biden announced last week that all federal employees and on-site contractors must be vaccinated against Covid, or be required to submit to regular testing and other measures. The requirement extended to the 766,372 civilians working for the Defense Department, but not active-duty service members.

That could soon change, administration and military officials said on Tuesday. Austin, who recently returned to the United States from a trip to Asia, has asked the military services to report on how and when they would go about putting a mandate in place. Mr Austin has previously said that he would not be comfortable with a mandate until the vaccines are fully approved by the Food and Drug Administration (FDA), but officials and executives across the board are rethinking their position as the Delta variant surges.

The FDA plans to fully approve the Pfizer Covid vaccine, one of the most widely used vaccinations, by early next month, people familiar with the effort have said. The move will lead to more vaccination mandates across the country, but officials say Mr Austin is not expected to wait for final approval before making his recommendation. …

About 64% of active-duty military members are fully vaccinated, above the 60% of Americans over 18 who are fully vaccinated. But for the military, the rate is unacceptably low, raising issues of readiness should cases rise among service members. It is also difficult to deploy troops who have not been vaccinated to countries with stringent local restrictions.

Beyond readiness, a big part of the push for a mandate for the military centers on the belief that service members could set an example for their families and friends in states where vaccine hesitancy has been higher.

“When people see that these guys got the vaccine and nothing happened to them, that could be decisive,” said Dr Ezekiel J Emanuel, a Bioethicist at the University of Pennsylvania who advised Mr Biden during his transition.

“People admire our military,” he said. “They can serve as a positive example.”

Worth reading in full.

By Michael Curzon  /  5 August 2021 • 11.27
           
76 comments

CDC U-Turns on Face Masks – Tells Vaccinated Americans to Put Coverings Back On

“Look, we’ve gotten this far. Please protect yourself until you get to the finish line.” With these words, spoken in May, President Joe Biden instructed unvaccinated Americans to continue wearing face masks indoors but echoed advice from the Centers for Disease Control and Prevention (CDC) that fully vaccinated Americans could ditch their coverings. On Twitter, he said: “The rule is now simple: get vaccinated or wear a mask until you do.”

It turns out the rule wasn’t as simple as he made out.

The CDC has told vaccinated Americans that they must put their face masks back on when indoors, less than three months after announcing that it was safe to remove them, citing fears over the Delta Covid variant. CDC Director Rochelle Walensky told reporters: “The Delta variant is showing every day its willingness to outsmart us and to be an opportunist in areas where we have not shown a fortified response against it.” The Washington Post has more.

On Tuesday… the CDC announced it had again changed its guidance on masks, recommending once more that all Americans wear masks indoors in public spaces. The game-changer for the agency was data showing that vaccinated people infected with the highly infectious delta variant carry the same viral load as unvaccinated people who are infected, the Washington Post reported.

Whiplash recommendations carry downsides. “Once you’ve let the genie out of the bottle, it’s really hard to put it back in,” said Lawrence Gostin, a Professor of Global Health Law at Georgetown University. Americans who have set aside their masks might not be persuaded to don them again.

Last year, the CDC was not alone in its scepticism. The World Health Organisation (WHO) did not publish global guidance supporting masks until June 5th, more than two months after the United States did. The lack of mask availability early in the pandemic made recommending them difficult.

The WHO currently advises all people, vaccinated or not, to continue wearing masks when around others.

WHO spokesman Tarik Jasarevic said Tuesday that the global health body advises governments to continue emphasising proven public health and social measures, including masks, “as long as there is community spread”.

There was community spread when the CDC issued its May 13th guidance. The United States that day recorded almost 50,000 new Covid cases. But vaccination rates were dipping. The message about masks appeared to be an attempt to incentivise the shots.

That gambit may have failed: the number of Covid vaccine doses given out this week across the United States is less than half of what it was the week of May 13th. Many unvaccinated Americans appear to have ditched their masks anyway. …

Reinstating mask rules that have been lifted can be difficult. Israel has struggled with mask compliance since June 25th [when the mask mandate was reimposed just 10 days after it was lifted].

Worth reading in full.

Stop Press: Reporters had to be handed face masks at a White House event on Tuesday evening, minutes after the CDC updated its advice, according to MailOnline.

By Michael Curzon  /  28 July 2021 • 10.09
             
187 comments

A Doctor Asks: The Data Is Looking Good, So Why the Doom-Mongering?

There follows a guest post from our in-house doctor, formally a senior medic in the NHS, analysing the latest NHS England data packet.

Once a month, the NHS releases a more detailed summary of COVID-19 related data than provided in the regular daily updates. Although the data set is far from complete, the monthly packets provide a better impression of what is really happening in hospitals than the daily snapshot. I find this month’s information particularly interesting. Apologies in advance to readers for reverting to a more data-driven ‘chart fest’ format for my latest contribution – but stick with it, because there are some important messages here which have not been widely reported so far.

Take a look at Graph One. This rather complicated graphic shows daily admissions in the vertical orange bars and paired daily discharges in the vertical blue bars. Readers will notice that on every day between April 7th and June 30th, there were more discharges than admissions.

The grey line with the secondary y-axis to the right of the chart shows the total number of ‘COVID-19’ patients in hospital on each given day. For the first period from April 7th to May 25th, this was on a falling trend – that’s what one would expect if there were more discharges than admissions each day.

From May 26th to the end of June, however, the total number of patients in hospital ‘with COVID-19’ was on an upward trend – but on each day of the series, there were still more discharges than admissions. How can that be?

I’ve discussed this issue with colleagues and there are only three interpretations we can think of. One is that there are a very large number of patients contracting COVID-19 in hospital who came into hospital without the virus. The second is that some of the ‘discharges’ are in fact patients who were never admitted to hospital at all, but seen in A&E and then sent home. The other is that the data quality is very poor and gives a misleading impression of the true picture.

A Doctor Asks: The Data Is Looking Good, So Why the Doom-Mongering?Read More

By Michael Curzon  /  10 July 2021 • 11.14
         
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Sydney Extends Lockdown Due to Fears Over Delta Covid Variant

Australia’s largest city, Sydney, will remain locked down until at least mid-July, with restrictions having been extended by a week due to fears over the Indian Delta Covid variant. Empty Sydney beaches suggest that locals broadly support the extension of lockdown measures. One city resident told BBC News: “We have to knock [Covid] on the head so you have to go along with [lockdown].” BBC News has the story.

The New South Wales Government said it had made the “difficult decision” as it battles the highly transmissible Delta strain.

A stay-at-home order was issued on June 26th.

Australia has recorded 910 deaths and fewer than 31,000 cases since the pandemic began. 

Clusters have emerged after some people who were later found to be infected left their homes for essentials.

The outbreak of around 330 cases is the worst in the city this year.

A stay-at-home order covering more than five million residents in the Greater Sydney, Wollongong and Central Coast areas was due to be lifted on Friday. It has now been extended to July 16th. Schools will also be closed next week.

The New South Wales Government said it recognised the “pain and stress” that lockdown was causing families and businesses.

Yet officials said the daily case rate – with 27 new cases recorded on Wednesday – and low levels of vaccination meant the restrictions needed to be extended.

Less than 10% of Australians are fully vaccinated. A lack of supplies, specifically of the Pfizer vaccine, means many Australians will not be able to get a jab until the final months of the year.

“What we want to do is give us our best chance of making sure this is the only lockdown we have until the vast majority of our citizens are vaccinated,” said Premier Gladys Berejiklian on Wednesday.

“We don’t want to be in a situation where we are constantly having to move between lockdown and no lockdown.”

Worth reading in full.

By Michael Curzon  /  7 July 2021 • 10.52
       
74 comments

Restrictions Could be Reintroduced Locally After “Freedom Day” to Deal With New Variants, Says Sajid Javid

We have been assured that our unlocking will be “irreversible” – that July 19th is the “terminus date” for Covid restrictions (in England, at least). These words would be comforting if only they were matched by Government action. Alas, laws allowing local authorities to bring back restrictions on businesses and social contact in case of Covid outbreaks or – of course – new variants are being kept at least until the end of September, Sajid Javid has confirmed. The i has the story.

Ministers will retain laws that allow local authorities to shut down businesses, prohibit certain events, or close outdoor public spaces “in case of a local breakout” or in case a new dangerous variant emerges, the Health Secretary told MPs.

“We will be keeping in place contingency measures, particularly for local authorities, the so-called Number Three regulations, at least until the end of September, in case those powers are needed in the case of a local breakout,” Mr Javid told the Commons.

He added: “Of course there’s no intention at this point that those powers will be used but we believe it is necessary to have powers in place just in case.

“You would have heard me earlier talk about the risk that still exists from new variants and that is the plan.”

The so-called Number Three laws were first introduced in July 2020 to give local authorities the power to respond to “a serious and imminent threat” to public health by managing Covid transmission.

They form a patchwork of legislation that was used to govern local lockdowns in the second half of 2020.

But Boris Johnson decided to scrap the approach and impose another national lockdown in England in January after a series of painful negotiations over restrictions with local leaders like Greater Manchester mayor Andy Burnham.

Worth reading in full.

By Michael Curzon  /  6 July 2021 • 09.40
       
105 comments

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.

By Michael Curzon  /  2 July 2021 • 23.24
       
47 comments

Does This Explain Why COVID-19 is Normally so Puny But Occasionally Goes Bang?

I wanted to come back to the question of what causes COVID-19 occasionally to have explosive outbreaks. We’ve had two in England so far. Using the graph below (produced by Imperial’s REACT study using symptom-onset reports from their antibody survey, so no PCR tests involved) we can see when they occurred. The first occurred from around February 25th to March 19th 2020, ending after about three and a half weeks, as abruptly as it began. The second got going around December 2nd, and ended – once again abruptly after three and a half weeks – on December 25th. As the lines below indicate, these starts and stops bear no relation to when lockdowns were imposed or lifted (the red and blue lines respectively).

REACT

Given that (as we can see) Covid was around in England throughout the winter of 2019-20 (arriving in November according to this graph) and was also simmering away in the autumn of 2020 without taking off, a key question is what triggers the beginning and end of the more explosive outbreaks?

Another way of putting the same question is: why does COVID-19 occasionally, Jekyll and Hyde-like, transform from a relatively gentle, not very infectious disease into a super-infectious disease for a few weeks, before suddenly returning once more to its largely benign form?

Perhaps surprisingly, Covid in England has only been in ‘Hyde’ form for about seven weeks in total so far, with the R rate (the speed at which the epidemic is growing) only going significantly above one (indicating an exponentially growing epidemic) for around three and a half weeks in February/March 2020 and three and a half weeks in December 2020. The rest of the time it’s been up and down in different regions, particularly in the autumn, but there’s been no nationwide surge. What, then, on those two occasions triggered the disease to become briefly so much more infectious across the country?

Does This Explain Why COVID-19 is Normally so Puny But Occasionally Goes Bang?Read More

By Will Jones  /  30 June 2021 • 01.58
         
44 comments

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.

By Michael Curzon  /  29 June 2021 • 14.29
             
72 comments