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.

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.

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.

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.

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).

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?

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.

Mask-Wearing and Social Distancing Rules Should Stay in Place Due to Covid Variants, Says WHO Official

Mask-wearing and social distancing should become part of “the life to come”, says a Special Envoy on Covid for the World Health Organisation (WHO). Dr David Nabarro told Sky News that restrictive measures should stay in place because it is “inevitable” that new Covid variants will be able to “break through the vaccine-related protection in a few people”.

Sky News has more.

[Dr Nabarro’s comments come] as India said on Tuesday that the new “Delta plus” variant recently discovered in the country is of concern and that nearly two dozen cases had been detected in three states.

Speaking to Sky News, Dr Nabarro said the “issue of variants is what we are watching all over the world” and they “are going to go on coming”.

“We will go from Delta to Lambda and then on to the other Greek letters, that’s inevitable, and some of these variants will be troublesome,” he said.

“They will be able to break through the vaccine-related protection in a few people and that will cause problems.”

He added: “I’m basically saying variants are going to go on coming. That’s part of life, we need to pick them up fast, we need to move quickly if we see them in a certain location, we need to build the management of variants into what we call our Covid-ready strategy, which is going to be the pattern for the foreseeable future.”

Due to new strains, Mr Nabarro suggested that mask-wearing and keeping apart would still be necessary for areas of high infection.

He said there was a need to “maintain defences against the virus to stop it welling up more and more, and that’s going to be the life to come, at least until there’s enough vaccine, and enough certainty, to be sure that vaccination will protect us. Right now we can’t say that.”

Dr Nabarro said we will have to continue social distancing as well as using vaccines “as part of our defence” against Covid, particularly in virus hotspots.

Reports this morning suggest that guidelines on face masks and distancing could be dropped on July 19th because of the slowdown in Covid infections. Earlier this month, however, a top Government adviser and long-time member of the Communist Party of Britain said they should stay in place “forever”, not only for Covid but also “to reduce other [diseases]”.

The Sky News report is worth reading in full.

Boris Announces Extension of Lockdown by Four “Crucial Weeks” – Noting “Possibility” That a “Far More Dangerous” New Variant Could Cause Further Delays After July 19th

Boris Johnson has announced that lockdown will be extended until July 19th. At a Downing Street briefing, the Prime Minister said that four more “crucial weeks” of restrictions were needed to prevent the virus from “outrunning” the vaccine and to prevent “thousands more deaths that could otherwise have been avoided”.

The PM hopes that “easing off the accelerator” will allow enough time for two-thirds of the adult population to be fully vaccinated against Covid, but warned that “a proportion of the elderly and vulnerable may still succumb [to the virus] even if they have had two jabs”.

Weddings and wakes with over 30 guests will be permitted after June 21st, so long as social distancing guidelines are followed, and there is a possibility that restrictions could end after a two-week extension on July 5th. The chances of this are, however, very slim. Boris said:

[We must] wait another four weeks – or maybe as little as two weeks. But let’s be realistic, [it’s] probably more likely [to be] four weeks.

Whereas June 21st was a “not-before date”, the PM is “pretty confident that July 19th will be, as it were, a terminus date”. That is unless yet another “new variant” emerges.

At that stage [when, by July 19th, the vaccine roll-out has created a “wall of immunity”]… I am confident that we will be able to go forward with the full… opening. That, of course, doesn’t exclude the possibility… that there is some new variant that is far more dangerous – that kills people in a way that we currently cannot foresee or understand. That’s obviously the case.

As before, Boris maintains that the roadmap to freedom should be “cautious” but “irreversible”. You can watch the full briefing here.

Stop Press: Sam Coates of Sky News says that “Labour will back the four-week delay to lockdown lifting step four”.

They will characterise it as a consequence of Boris Johnson’s mishandling and criticise [the] lack of economic support.

Stop Press 2: According to YouGov, 71% of English adults support the unlocking delay.

Stop Press 3: GB News has reported on the lockdown protesters marching outside Downing Street today.

The people are really angry. “Enough is enough” was the message that [came] from there – people wanting to just have the choice now to get out there and live their lives again.

Lockdown Could Continue Past July 19th, Says Health Minister

The Prime Minister has yet to formally announce a four-week delay to the end of lockdown in England, but Government figures have already hinted that the imposition of restrictions could be extended beyond July 19th and even into the month of August. The Sun has the story.

Health Minister Ed Argar said it is “of course possible” that a longer delay will be needed to get the Indian variant under control.

But he said the hope is to use the month-long window to get 10 million second jabs into arms, extending full protection to 75% of Brits.

The PM is set to announce Freedom Day is being pushed back by four weeks to July 19th during a Downing Street press conference at 6pm.

He’ll include a break clause, meaning the lifting of restrictions could go ahead on July 5th if hospitalisations don’t significantly rise.

But some ministers fear that with cases spiralling the health situation could go the other way and curbs will need to stay in place for longer.

Asked about that possibility, Mr Argar said: “Were there to be a delay of course that’s possible.

“But I and the PM and the Health Secretary want to see restrictions removed as soon as it’s safe to do so, and any delay as short as possible.

“We’ve got to recognise vaccination is the key. This disease will become endemic and we’ve got to learn to live with it.

“We will not get to a zero Covid. Vaccination is the way to get to the point where we can live with this disease.”

Foreign Secretary Dominic Raab also warned he couldn’t provide an “absolute guarantee” restrictions will definitely be lifted on July 19th.

But Mr Argar was adamant that there will be no rolling back of the roadmap and return to the previous lockdown.

He said: “The key thing the PM has always said throughout is the dates set out in the roadmap were the earliest possible date it could happen.

“He’s been clear each step is irreversible, that is why he’s considering now whether or not to delay step four.

“The reason the gaps between stages are five weeks and the reason it’s staggered over a number of months – I know people would’ve wished it to be faster – is because he believes on the basis of the advice he’s received that means it can be irreversible.”

Worth reading in full.

“We Are Seeing Some Worrying Stuff in the Data,” Says PM

Boris Johnson has “all but confirmed” that the June 21st “Freedom Day” will be delayed, saying that “we are seeing some worrying stuff in the data”. The PM is particularly concerned about an increase in hospitalisations – only too late have NHS hospitals been told to change the way they collect data on patients who test positive for Covid by differentiating between those who are actually sick with Covid symptoms and those who test positive but are actually ill with something else. The fact that there is unlikely to be much of a backlash to the extension of lockdown from the public appears also to have bolstered the Government’s decision to delay. The MailOnline has more.

The PM delivered a downbeat assessment of the dangers posed by the Indian “Delta” variant amid growing expectations he will announce a four-week delay to the unlocking roadmap at a press conference on Monday…

In a round of broadcast interviews at the G7 summit in Cornwall, Mr Johnson insisted no final decision will be taken until Monday.  

“We are seeing some worrying stuff in the data, clearly. We are seeing the Delta variant causing an increase in cases, we are seeing an increase in hospitalisations,” he told Channel 5 News.

“The whole point of having an irreversible roadmap is to do it cautiously and that’s what we are going to do. I know people are impatient to hear more but you will be hearing the full picture on Monday.”

Ministers believe the backlash from Tory MPs and the public should be limited as long as the timetable does not slip beyond the school holidays. 

A poll today suggested that just a third of Britons want the total lifting of restrictions to go ahead as originally laid out. 

Worth reading in full.

Stop Press: A poll for Opinium published last night showed that a majority of Britons are now in favour of postponing the June 21st lifting of restrictions. Over half (54%) think the date should be postponed (up from 43% two weeks ago), with just 37% thinking it should go ahead as planned or even be moved forward (down from 44% two weeks ago). The majority of those in favour of postponing are among the older age groups with almost two thirds (65%) of over-65s in favour of postponing and only 28% in favour of going ahead as planned or earlier. Young people are more evenly split as 45% of 18-34 year olds think it should be postponed and 46% think it should go ahead as planned or earlier.

More specifically, people are most in favour of not removing the restrictions on:

  • Wearing masks (62% vs 31%)
  • Keeping nightclubs closed (60% vs 28%)
  • Limiting large outdoor events (60% vs 31%)
  • Having a maximum of 30 people can gather outdoors (57% vs 31%)
  • Having a rule of six and table service in hospitality venues (50% vs 42%)
  • Having up to 30 people at weddings (48% vs 41%)
  • Having up to six people in people’s homes (47% vs 43%)

It’s official. We’ve become a nation of chin wobblers.