UKH

Brief interpretation this week as I’d not left much time this week - spent most of the day outside for obvious reasons….  Then found that the demographic download I was using is gone, and it’s I’ve used most of my allotted time to sort out using the alternate format…

Interpretation is getting harder; the pandemic has always been highly variable over demographics and geography, but now there’s vaccination status to consider as well it’s getting harder to pull it all together in to a snappy analysis. 

SAGE and PHE documents discussed over the last couple of threads suggest gaps in vaccination are a contributor of the recent English outbreaks; I haven’t looked in the same detail for Scotland and don’t think the same level of local authority demographic data is available, but similar processes seem to be at work.   The latest weekly update from PHE on variant data analysis [1] suggests that the Indian variant reduces efficacy of the vaccine against catching this virus, particularity for people with just their first dose.  This does not translate directly in to an equivalent reduction in efficacy against serious illness or death, and it seems reasonable to me to hope that reduction will be quite a lot smaller, but until the longitudinal data is published, we don't know.  This can't be easily inferred from the top level data published on the dashboard.    I made a super-noddy plot (Plot V) of the data from table 12 in the report - the blue squares represent, by area, the fraction of people protected from either variant by each of 1 and 2 doses, and the grey boxes are the confidence intervals (range unspecified) from the table.

Some new plots for this week to look at the situation in England.

Plot A, B - Stylistic Cases.

• This shows cases / 100k people / day for the English UTLAs over the last 5 weeks or so.
• Areas with the biggest rises are coloured red as “outbreak areas”.  Kirkless has joined the others this week.  The initial sub-week doubling times have abated from all these areas - some unknown combination of surge testing (after initial delays to test-and-trace that made the news) and local interventions taking effect.  So, hopefully closer to “flash in the pan” than “here we go again”, but none of them have closed out yet, and the provisional data on the dashboard doesn’t look great.  
• All other UTLAs have had their data replaced with a straight line from their initial value to their final to simplify the plot.  Some are falling, some are rising.  When added together, the falling ones no longer have the numbers to mask the rising ones. 
  • The average of these are shown on Plot B. 
  • It seems the two sets of regions parted way around May 10th. 
  • If this is secondary seeding of the Indian variant from the outbreak areas where primary importations were focused then those outbreak areas give us a general idea about what’s going to happen - although hopefully now test and trace is working properly, which will help compared to the initial loss of control in Bolton, and most of these areas started from a position of more vaccine uptake than the worst outbreak parts within Bolton, and a lot more vaccines have been given since.
  • Some of this growth is likely also the effect of May 17th dropping of restrictions on indoors activities; that'll just be staring to show through in the data.

Plot C - Outbreak Demographics 

• This plots the probability distribution of cases for the “3 Bs” outbreak areas around their previous peak at the start of 2021 (blue) and during their current outbreak (red). 
• As its a probability distribution each curve is normalised to an area of 100% so it doesn’t tell us about the difference in total number of cases between the times, but about how the relative distribution across ages changes.
• There's a massive demographic shift in the cases towards younger ages.  This does not imply that the variant has more affinity for younger people, although it also does not rule it out.  It's likely heavily influenced by more people towards the older ages having had both their doses and the high level of protection against developing symptomatic illness that this confers. 
• Given that hospitalisation and death probabilities seem to scale almost exponentially with age, this is a big development in that the hospitalisations and deaths resulting from these outbreaks should be much lower as a proportion of cases.  As some of the infected people will have had at least one dose of the vaccine, their health outcomes will be improved by their partial immunity as well, making outcomes better still than just the demographic shift.
• (All this is assuming the Indian variant is no more lethal - too soon I think to actually determine that from UK data; it looks months for the evidence to firm up on the Kent variant)

Plot D - English PCR rate constants

• My new preferred method of comparing cases 7 days apart, with a highly filtered trendline.  
• There's no doubt that English PCR cases (interpret as a proxy for symptomatic infections) are rising and have been for a couple of weeks; the initial "oh crap" doubling times were I think from the surge testing of outbreak areas; now the rise is being driven by the many low rate but rising UTLAs orange in plots A and B.  

So - brave new world - we're starting to see rising cases and as later posts will show rising hospitalisations and deaths.  I suppose the hope in government is that the vaccines will bound the amount cases can rise by, and hold the rise to slower doubling times, and that the hospitalisations and deaths are going to double much more slowly than cases as a result of various mechanisms and protections of vaccination.  If it goes well, hopefully this process will update immunity - especially in the gaps in vaccine uptake - as it goes, without killing many people or putting healthcare into overload/proximal collapse, and moving this ******* virus in to the list of many others that pester the human race without disrupting it catastrophically.  Not an easy step for many of us to welcome, and I could give a bunch of reasons why I think it's a bit too soon, but there you go.  It's clear form the various SAGE and PHE documentation being released weekly that there's a real cadence and structure to the collation, analysis and presentation of data that was lacking when this all kicked off, and that all the information government need to put the brakes on if things look bad is being presented to them consistently and cogently, and there's signs from of leadership responding in advance of the next unlock to what this cadence of information is telling them.   So, lots of reasons to be cautiously positive about the months ahead...

Link to previous thread: https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_27-...

[1] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/...

In reply to wintertree:

The four nations plots for cases (including LFDs)

• As with last week, cases in England and Scotland are clearly in growth. 
  • The initial, rapid doubling time for Scotland is backing off; I think the Glasgow (G41/G42, Indian variant prominent) outbreak was a larger fraction of total national cases than Bolton was for England so it's growth started to dominate the national level doubling times.
• Last week NI was ambiguous about growth or not, lost in the noise.  Now it looks like the trend is still towards gradual decay.
• Wales continues to see cases decay.  Go Wales - although perhaps there is more to the story than cases; we'll see in another post...

In reply to wintertree:

I don't normally show the individual curves for Wales, but this week there's a curious discrepancy.

Cases are still falling but hospital admissions look to be rising.

What's really curious is that the daily number of cases is currently around 30/day and the number of admissions is around 25/day.  I'd not really looked at the absolute numbers for a long time and this is odd - only a minority of cases would be expected to be admitted to hospital, but here it's almost all cases.  I can see two basic interpretations:

• Community testing is not being engaged with, and only people being admitted to hospital are being tested
• Community prevalence is incredibly low, with almost all cases being confined to the clinically very vulnerable (e.g. care home outbreak)

There seems to me more Scottish interest and input on these threads then Welsh, but perhaps someone has more insight than I...

The deaths plot looks a bit odd as there are lots of days with 0 deaths/day, which can't be shown on a log-y axis plot so those markers are missing, but the trend line bobs down towards them.

In reply to wintertree:

The plots for Scotland.  

• Cases look set in exponential rise
• Hospital admissions look perhaps sub-exponential; an initial rising phase (importations into less vaccinated community?) followed by a possible levelling off (infection spreading beyond importation areas to younger people not yet offered a vaccine in other areas?)
• I'd normally be more cautious about interpreting the admissions as levelling off given they they're quite noisy, but the hospital occupancy shows a similar trend.  It could all change by next week; we'll see.

So - interesting things afoot north of the border; are we seeing hospital admissions becoming decoupled from rising cases - initially masked by local effects around the initial outbreak sites south of the Clyde?  There's some data watchers north of the border better informed than I...

In reply to wintertree:

The plots for England

• Cases - rising, lots.
• Hospital Admissions - rising, much less.  Doubling time is twice as long in plot 9 for admissions as for cases.  Demographic shift caused by vaccine preventing some older people from getting infected, and better health outcomes for vaccinated older people who do get infected? (The later particularly relevant to people with their first jab only)
• Hospital occupancy - they're no longer emptying out with the rise in admissions, but so far it's around break-even and they're not filling up.  
  • This is the one to watch - if it starts rising, and if the longitudinal data (presented via SAGE documents, not the gov dashboard I use) shows vaccinated people to be part of this, that's the absolute red line for hitting the panic button on control measures IMO.
• Deaths - may or may not be rising; dominated by the statistical noise of low numbers.  Give it another week to see.  I am hopeful we won't see much of a signal in deaths from this.

In reply to wintertree:

Plot 16 - UTLA Watch Plot

• Bolton has dropped a bit from last week
• Blackburn with Darwen has gone up
• A few other places are rising up a bit and have passed my arbitrary 12 cases / 100k / day threshold for annotation; for convenience, URLs to their dashboard pages are below.

Plot 16 Crop - UTLA Watch Plot 

• Zooming in on the y-axis to a limit of 12 cases/day
• This  annotates all UTLAs in growth that are not in the main Plot 16.  These and a few of the smaller ones from the main plot make up the orange curves in plots A and B in my first post.  
• This is the very beginning of rises in many areas; some combination of the chunk added to R by partial vaccine evasion of the Indian variant (in terms of efficacy against developing symptomatic infection, particularly with one vaccine dose only) and the ongoing relaxation of restrictions.
• As I said in my first post, lots of reasons to think these are going to have less explosive growth than the outbreak areas - several more weeks of vaccination has happened, less gaps in vaccine uptake in many of these areas etc, test and trace out of its recent troubled phase.  Half term is going to help as well for a limited period, and the weather is improving.

Edit:  Forgot the UTLs

https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Bo... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Bl... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Be... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Ki... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Ma... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Sa... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Ol... https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=La...

In reply to wintertree:

The Welsh question piqued my interest.

I looked a couple of things up and this BBC article and graph reminded me that Welsh hospital figures include suspected cases awaiting test results, not just confirmed. As you can see, that is where all the rise is - so it's not actually people who have yet tested positive for covid. I think there are a few possibilities that leads to.

BBC News - Covid in Wales: What do the stats tell us?
https://www.bbc.co.uk/news/uk-wales-52380643

In reply to wintertree:

The demographic rate constant plots.  

Plot D1.c - Outbreak areas:

• This is where the data for the probability distribution plot in my first post came from.
• You can really see the shift towards younger ages in cases
• Is ongoing vaccination going to keep squeezing the cases down to younger ages?
• The top right of the rate constant plot is dominated by noise form the low numbers involved.
• Thankfully the initial, very fast doubling times were not maintained.  They never have been in any UTLA across the waves for which we have good data.  Some interesting phenomenology there.  
  • Perhaps it's turning towards decay shortly - we'll see next week.

Plot D1.c -Non-Outbreak areas:

• The rate constants sub-plot is now turning to growth across most ages on the far right hand side of the rate constants sub-plot.
• Still looks like there's been a significant care home outbreak, still haven't narrowed it down in the data to a UTLA or two.

Plot 18 - Regional Rate Constants

• Most regions are turning to growth in cases - the South East is standing out and the provisional data on the dashboard (not used in my analysis) confirms this. 
• Hospitalisations - very noisy, but signs of rises here and there
• Deaths - not enough data to measure rate constants anywhere (a good kind of problem to have!)

Next week I'll try and assemble a matching hospitalisations dataset for corresponding NHS Trusts to the outbreak areas; thanks to Si dH for the list of trusts to use on Plotting #27.  

In reply to wintertree:

Grab bag plots.

Vaccine plot

• The big surge of second doses is now due, to match the busy week from mid-March
• I've added a trend-line for the rolling average doses/7 days; we're at joint highest rate ever this week.  I've also put the estimate of lag between doses on there - it's been reducing and is at ~10.5 week.
  • So, lots of capacity and some slack in the system to death with the surge of second doses needed.
• In other two weeks, there won't be many second doses coming due any longer, and first doses can surge ahead.
  • Not that there's many first doses left to do by that point unless one ore more vaccines are authorised for older children as has happened recently in the USA [1].
  • It feels like focusing on gaps in coverage once the main process is complete will be the next logical step.  
• Wednesday just gone looks like "Big Wednesday" - the highest number of doses for a Wednesday yet.   Gary Bussey and I have been waiting for this for some time.

Variants plot (text lifted from my update on Thursday on Plotting #27)

• The latest update for the Indian variant has fallen well below the 5.1 day doubling time trendline it had been on.
• The doubling time measured over the whole dataset is now 6.1 days; the change over the last week represents a doubling time closer to 7 days.
•  Even through we're pretty sure there's a lot of lag between the pillar 1 and 2 cases and these numbers, it's a relief to see the initial fast rise starting to slack off here too.
  •  7 days isn't great, but I hope there's going to be another slackening off next week.

[1] https://arstechnica.com/science/2021/05/fda-authorizes-pfizers-covid-19-vac...

In reply to Si dH:

Nice one, thanks.  That's ringing a feint bell but if I had known this I'd totally forgotten.

I wonder why suspected hospitalisations are rising?  One question answered opens another..

In reply to wintertree:

Further to this, in rUK does the hospital admissions figure count all people who are admitted to hospital who have tested positive? e.g. went in with broken leg, have covid? If they count that then in a world with excess testing capacity you'd expect the rise to track cases, but outcomes be a lot better and people in ICU stay low.

Or am I talking crap?

In reply to wintertree:

Hounslow are running a vaccination event at Twickenham stadium tomorrow, 15k doses available, book on Eventbrite rather than the NHS website (although that may also be a possibility) or just turn up.  Understand it is open to all anyone over 18. 

In reply to wintertree:

Bloody BBC news still talking about Gupta when discussing the 21st June. Why the hell are they even mentioning this discredited charlatan?

Oh god, now they're just reading tweets from uninformed idiots on twitter...

In reply to captain paranoia:

Only seen the Guardian, but the top piece concerns Ravi Gupta's caution. Is the BBC really going on about Sunetra still? 

In reply to David Alcock:

Ah. I was reading the subtitles, and had audio off. I saw 'Gupta' flit through. Maybe I missed the message in triggered state...

[edit: checks BBC website; yes, it would have been Ravi Gupta warning about the need for caution. Phew. Stand down on the BBC rant...]

In reply to wintertree:

What's the admissions policy for UK hospitals at present?  Over here during our outbreaks they were stopping all elective procedures. The example given was colonoscopy presenting a significant risk due to inflation of the patient and subsequent deflation <instert picolax thread link here :-D >.  Even assuming the NHS isn't overwhelmed, is there going to be a hit on admissions and more backlog problems?

In reply to wintertree:

I ventured a train journey on Sunday; my first since lockdown (and first non-work trip), for a significant family event. Tested myself the night before. Station full of signs warning of £6400 fine for not wearing a mask. Regular announcements that mask wearing was mandatory without medical exemption.

And yet each leg of my journey had a large group of people, chatting loudly and laughing, with no masks. One group speaking an Indian sub continent language (but also fluent in English), and one Italian.

All a bit depressing, really. Compliance in shops has been very good for months.

First available train of the day, and it was packed... I came home early yesterday to avoid the BH crowds.

In reply to captain paranoia:

Recent experience showed London Underground compliance was high (one maskless person in the carriage on 4 northern line trips) but almost non-existent on overground trains.

In reply to wintertree:

Vaccines plot  got me thinking. 

Second jabs (priority groups 1-9) started to outnumber first jabs in week beginning 29/3/21 which that is 9 weeks ago.

Notional delay from first to second jabs is 10.5 weeks. 

The reduction in first jabs 9 weeks ago should mean high demand for second jabs will end or start to decline in a week or two.

This should free up (double) vaccine supply for 18-49 age group greatly speeding up their first/second jabs.

Reserving Pfizer-Biontech for under 40s should mean there is quickly more AZ-Oxford than we can use so 40-49 age group with get second jab in June or early July (bigger supply and smaller age range so delay to second jab reduced to 3 weeks?).

18-39 is bigger age group and Pfizer-Biontech supply is more limited so not as quick as age 40-49.

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_28-... 

PS thanks for graphs & analysis

In reply to elsewhere:

Are there any thoughts on whether the guidance on giving AZ to under 40s might change if cases keep going up?

The objective risk still seems basically tiny, and the benefit of getting more people vaccinated more quickly seems to be getting more significant than it was a month or so ago.

In reply to elsewhere:

Impressive effort yesterday  https://www.standard.co.uk/news/uk/twickenham-queues-covid-vaccine-b938120....

Although looking at the pics  it appears most people were from the leafier middle-class areas and not the postcodes getting hit at the moment.  (As far as I know it was Pfizer on offer) 

In reply to Ramblin dave:

The vaccine programme is delivering incredibly high vaccine uptake (99-100% in some age groups) so even vaccine sceptics must be getting vaccinated. 

Therefore a justifiable and good policy change that unjustifiably undermined vaccine confidence amongst highly subjective vaccine sceptics is an objectively bad policy if it makes vaccine sceptics less likely to get vaccinated!

The vaccine uptake is so high and so successful that psychology of a fringe few percent of the population is the key to the difference between 98% and 100% uptake.

Hence I can understand why the government might be reluctant to change policy.

Only after all over 40's have had two jabs and there is no longer demand for AZ might it be worth offering AZ to the 18-39 age group with the alternative (default) of a short wait for Pfizer-Bionetech. We are not there yet.

In reply to wintertree:

Zero deaths reported today. Think that is the first time since the whole thing started. A big symbolic moment, and let’s hope it doesn’t make folk drop their guard too much. 

In reply to elsewhere:

It seems very variable. Reading is 54/29% first/second. Bournemouth is 68/49%. I dont think the age demographics will be that different; whilst BCP has a large retired population, there is also a large young population. Vaccination rates might explain why the incidence in Reading is ten times that in Bomo, and has doubled in the last week; it's not a good picture. Not as bad as Bolton, Blackburn, etc, but doubling in a week isn't good.  

In reply to elsewhere:

Yes, but comes down to a few things:
i) How many jabs can we deliver in a day? No good having >40s and piles of AZ lined up but no capacity to administer. (But there is likely more AZ than we need piling up somewhere now)
ii) How much Moderna have delivered
iii) Whether the follow up Pfizer order can be pulled forward. I.e. if you go all-in and jab all the <40s asap, we end up in a situation where the initial 40m pfizer order runs out (this will happen anyway) and second doses are due before the first of the follow on order gets delivered (August/Sept?). As I've said before, we may see a slow down in first doses for <40s to push some of the 2nd dose demand back a bit. We might not. The answer to that probably tells us how much Moderna have delivered.
Loads of twitterists are all over this. Start with Paul Mainwood and, if you can work out how to navigate the obtuse tangle of twitter, follow some links.

In reply to captain paranoia:

Vaccination rates are very variable but Covid rates are even more so.

Current figures for two adjacent areas of Glasgow
Crookston North ZERO cases per 100k in last 7 days
Pollockshaws 246 cases per 100k in last 7 days

However Crookston North and Pollockshaws had 0 and 11 cases in the last week for populations of 3106 and 4462 respectively.

I wonder if the wildly high infection rates quoted for some postcodes represent half a dozen outbreaks of 10 people.

Unfortunately they can't be ignored because the alternative to exponential decline is exponential growth.

In reply to Longsufferingropeholder:

There is at least capacity to consistently administer about 600,000 jabs per day as that is what has been done for a sustained period. Everything I've read/heard suggests the limit is vaccine supply and not jabbing capacity. 

Almost negligible unless you happen to be the person injected with it.
Scotland publishes vaccine breakdown. In last 7 days 2% of vaccinations were Morderna.
I don't think there is a substantial Moderna stock because Jonathan Van-Tam has previously said “vaccines don’t save lives if they’re in fridges”

Very good points. I've just been assuming mostly consistent supplies slowly creeping up as suggested by the number of jabs administered.

Ha! The first image of his I see suggests first doses outnumber second doses in as suggested by wintertree's graph and his calculated nominal delay between doses. Unfortunately looks like supply is declining so not as rosy as I thought.

In reply to elsewhere:

Not sure about that any more. There's a lot of stock somewhere. Whether it's jabbing capacity or strategy isn't clear, but there aren't many logical strategies that would explain it.

Edit - there's the nuance that each centre seems to lock in to one flavour on any given day, be it e.g. 2nd doses of AZ, 1st doses pfz, 2nd doses of Pfz, and doesn't deviate.

Where have you found this? Is it definitely official??
Edit again - https://public.tableau.com/app/profile/phs.covid.19/viz/COVID-19DailyDashbo...
Not sure where you've found the 2% figure. Not disputing it, but it's worth noting that it's more like 1:10 moderna:pfizer first doses the last few days.

It's not intuitive but that's very much non-negligible. It's sort of making all the difference in a weird kind of way, because the numbers are touch and go.

You don't need to think or assume these things - supply is published by wales and scotland and it's in proportion to population. You can also kind of infer the split from yellow card data. Mainwood does all this and he's good at citing his sources for those who want to follow along. He's always pointing out that there is a massive stash somewhere that keeps getting publicly denied.

They will soon, but not yet. As you say, second dose debt from those few massive weeks will be paid soon. Issues then become more subtle than working out who had a jab 10 weeks ago.

In reply to Longsufferingropeholder:

I'm not a great believer in secret stocks, nuance and subtlety. The roughly linear total jabs versus time suggests a consistent slightly increasing supply is a good enough model.

I reckon 24 million Pfizer jabs given by scaling up Scotland numbers to whole UK.

I've just got numbers from travelling tabby. What is vaccine split by type on an official dashboard?

In reply to elsewhere:

People have done these maths and shown their working so you don't have to reckon and guess. You might not believe in nuance and subtlety but unfortunately we need to suck it up and apply some to figure out how far we get with the remaining 16m and whether moderna deliveries bridge the gap and allow us to keep up the pace or not. That's where I'm watching

Link above.

In reply to wintertree:

I see C4 are showing a 90-minute documentary "The Anti-Vax Conspiracy" tonight...

"Who are the people behind the international anti-covid vaccine movement, and why are they doing it?"

Could be interesting if they've done a decent investigative job...

In reply to Longsufferingropeholder:

I think right now, the Venn diagram of “people going to hospital for non-covid reasons” and “people with covid” has very little overlap, as both are small and independent sub-sets of a large population, so I don’t think it’s very relevant now.  But if we successfully break the link between infection and hospitalisation, and it’s decided that high levels of circulating cases can be tolerated (or perhaps even beneficial in the long run) then I think this becomes an excellent point - the report measures for hospitalisation and death may need to be re-visited as the distinction of "with" vs "of" becomes significant.

In reply to Kirsten:

Excellent.  

One notable part of the recent response in Bolton was taking vaccination in to work places where people felt unable to take the time off; that people should feel that way says a lot - none of it good - about where were are as a nation and a society, but I was glad to see the issue recognised in the response,  I wonder if that can be opened up to more places?

In reply to captain paranoia:

Glad that was cleared up; the other Gutpa is a very sensible person who, rumour has it, can divide two round numbers without being out by a factor of a hundred.  Most confusing.

Was it any good?  We abandoned broadcast TV a long time ago, but I could be prepared to use C4s catch up service for this.  Hopefully part 2 is “Who are the people behind the misleading minority of academics”….   Someone recommended this book to me recently [1] - it’s gone on my list and I think may need updating.  I’m reading a lot of fiction at the moment though; working through my complete Asimov before the Foundation TV series lands.

[1]  https://en.wikipedia.org/wiki/Merchants_of_Doubt

In reply to Toerag:

I don’t know what the policy is, but it looks like we’ve started playing catch-up on the backlog.  There was a BBC article recently with a graph showing the number of procedures queued up for hospitals.  Covid was a big effect but what was shocking was how that buffer has been growing for at least a decade.  Oddly, despite having a public health focused crisis of generational magnitude, there's been very little talk about the benefits more funding across healthcare in general would have.  

In reply to elsewhere:

Yes, on first glance it looks like first doses are going to surge ahead in under a week (now).  However, - as you note - there’s the issue off which vaccines are used for the <40s going forwards; not a trivial decision as the risk of a significant further wave of cases lies ahead which whilst not drastically worrying for that age group changes dramatically the risk calculation vs vaccine side effects.  The known knows vs the known unknowns... JCVI have a lot of weight on their shoulders I think.

Perhaps - the longer gap is well evidenced now as giving better protection in terms of health; with the Indian variant there’s now a more pressing need to limit transmission which suggests a shorter gap given the big change to immunity from one dose; I can’t see the gap coming down much below 8 weeks myself.  A different possibility is to start offering a 3rd dose to the most clinically vulnerable; I think I recall skimming a news story on trials beginning for this.

Thanks; hopefully won't be long now before I can do something else on my Saturday evenings!

The other alternative to exponential growth is ever slower growth towards saturation (inverted exponential decay if you like).  It’s easy to forget after the last year, but a new disease spreading - if resulting in enduring immunity -  results not in endless exponential growth but a logistic function, where the exponential growth rate eventually gives way to slower and slower growth until herd immunity is reached; with current restrictions many sub populations are close to that point I think, meaning that there’s very little scope for more exponential growth.  Where we have had exponential growth recently it seems to have been areas with less vaccination; as infection grants immunity and also attracted more focused vaccination campaigns and more focused control measures this is all hopefully contained and containable.

Of course, we still don't know how long naturally acquired or vaccine acquired immunity will last; long enough to get us out of "only bad choices", but long enough that things can go back to how they were indefinitely?  Only time will tell.  

In reply to thread:

I forgot to mention in my first post - thanks to someone for their email pointing out a typo on one of the plots, now fixed.  Updates to some of the plots below.  

It looks to me like the effects of the May 17th unlocking step are showing through in the data now with a much more widespread return to growth beyond the Indian variant outbreak areas.  I haven't dived down in to the data to try and understand more but it's not unexpected that we see the doubling time on cases heading towards 10 - by late last summer as indoor dining and drinking reopened (for example), regions were hitting ~8 day doubling times for a bit.  

The cropped update to plot 22 shows that both hospital and ITU occupancy is up at the national level, but considering the crop it's not even a blip yet.

The critical thing now and over the next couple of weeks is to see how much that blip does, or does not, respond to the rise in cases.   

It would be really nice if the dashboard cases data was broken down in to categories based on vaccination status (> 2 weeks post second dose, > 2 weeks post first dose, remainder).  Then we'd have a much more direct, evidenced basis for trying to feel relaxed about control over cases being relinquished; as it is there's scattered evidence from snippets from ministers and various documents released via SAGE.  

With vaccinations ongoing in adults and rising, mostly sub-clinical infections in the young unvaccinated and the partially vaccinated middle aged folks, it might not be long before this burns out now.  All things considered I'd rather we'd delayed the May 21st step for another month to get the vaccine out across all adults, but considering pretty much all of 2020 I'm really very pleased with where we are now and how much more cautious the approach has been in 2021, and with the level of scrutiny the longitudinal data is getting from multiple groups of experts reporting on to government.  We wait now and see what happens with hospitalisation - it seems like most of my updates for the last two months boil down to waiting...

In reply to wintertree:

I was looking at the figures for Scotland. At the rate of AZ usage and how many over 40's have had 1st/2nd jabs and hence how many still to be done (1.1M for ages 40-64, 65+ pretty much fully vaccinated).

To complete 100% of 1st/2nd jabs at current rate of AZ usage (245k per week) will take 4.5 weeks, so completion determined by desired delay to 2nd jab. Either way a surplus of AZ supply soon.

To complete 100% of 1st/2nd jabs for under 40s (2.2M required) will take 30 weeks at current jab usage (Pfizer+ Moderna 80k per week).

This (under 40s) is where I was wrong and Longsufferingropeholder is right. Either Pfizer 40M delivery (3.3M for Scotland) is not yet complete or there is a Scottish stock of 2.1M Pfizer (1.2M Pfizer already used in Scotland).

Currently few Pfizer+Moderna second jabs and Pfizer+Moderna usage corresponds to 1st jabs for under 40.

I don't know why such a stock would exist rather than being now for under 40s. Maybe staff/venue capacity is a limit but that's not the impression I get. That would be resolved in a few weeks when demand for 2nd AZ jabs for over 50's and 1st AZ jab for over over 40s will cease.

When I say "complete" or "cease" I mean demand for vaccination will be much reduced as uptake approaches some saturation level which so far have been close to 100%. That already applies to ages 65+ who are only getting 6k jabs per week as 96-98% have had their second jab.

In reply to wintertree:

More so in Bolton etc though? It was those that I had in mind. If you test everyone admitted to hospital in an outbreak region, then say "our town has n covid patients in hospital", that would not mean what you could easily think it means.

In reply to wintertree:

Just a quick thank you, again - I don't know enough, nor have the analytical muscle, to contribute much to these threads, but I am SO grateful.

In reply to Longsufferingropeholder:

Actually, that said, is it not a universal point that *if* positive test on admission is reported as a covid admission*, then the doubling time of hospitalisations would necessarily track the doubling time of cases if the two were fully decoupled? In the extreme situation where every case was a mild case, that's what you'd see, just with less of a lag than when covid is causing the hospitalisations. Waters muddied. You're welcome. Need a different Venn diagram to tell whether the if is true or not when the numbers get small.

* -  I checked the wording and it's not super clear, but my interpretation is that this is the definition they're reporting to in England.

In reply to Longsufferingropeholder:

The more I think about it, the harder to understand it gets.  

ITU admissions and occupancy is probably a better measure, and thinking about it, that’s where I’d focus efforts on implementing a new reporting criteria that makes the situation clear “Covid related ITU admission”.  That feels achievable and useful as we move in to a situation where a lot of people could be going to hospital “with covid” not “because of covid”.

In reply to BusyLizzie:

At some point I’m going to start a thread called “Leaving academia” and I hope you can contribute plenty there!  Been interesting to see how many happy and surviving ex academics there are posting on here...

In reply to elsewhere:

Looks like you’ve gone down the Twitter rabbit hole on vaccine stocks...

Several possible interpretations for what’s going on if that analysis is on the ball, perhaps a switch in focus and supplier once the big push through the bumper week of second doses is done (assuming it’s a bumper week due in Scotland based on UK level data).

In reply to wintertree:

I have occasional sorties back in; had a surreal day yesterday helping to examine a Dutch PhD, where as you probs know the viva is also the graduation. The examiners were on zoom but the essential academics were present and there were several processions with robes and funny hats, made even funnier by masks - the first time masks have made me laugh. (Discretely).

In reply to wintertree:

Not aware of that happening, but looks like over 18s are being accepted as walk ins at the regular vaccination centres, and some surgeries are calling up 20+. Also, not sure if it’s just round here but all second doses are available from 8 weeks, not just over 50s. 

In reply to wintertree:

I still think "Pfizer deliveries are on schedule" means Pfizer 40M order not yet complete so there is no huge stock on shelves rather than in arms. That seems more likely than a secret and cunning plan.

I think other countries just publish what has been delivered.

In reply to elsewhere:

You're entitled to think this but I'm not sure why you would. The only part of the UK where number injected is anywhere close to number delivered is Wales. The other areas all have a lot of doses in the system somewhere.

No idea why that's the case, and I offer no opinion on whether it's bad or not, but if you ran the numbers on the little freely available data there is (or read more Mainwood - he's written all this up) you might not think what you think.

Edit to clarify: none of this contradicts the statement that Pfizer deliveries are on schedule. Seems still to be coming in steadily.

In reply to Longsufferingropeholder:

The stated policy is to get jabs into arm rather than keep them on shelves.

What's the estimate of the size of this stock? What is the composition of this stock? Are there any hard facts? If it is AZ it is irrelevant to ages 18-40 and AZ requirement for 40+ will tail off soon. If Wales has used significantly more Pfizer/Moderna per head that will be hard data that England, Scotland & NI might have unused stocks.

"Seems still to be coming in steadily" -  that's exactly what I assume when extrapolating from current vaccination rates.

I don't think Mainwood knows how many Pfizer or Moderna delivered either and without that it's as well informed as possible but still very speculative.

In reply to Longsufferingropeholder:

https://gov.wales/covid-19-vaccination-programme-stock-and-distribution - unfortunately no breakdown of manufacturer

Wales has been allocated 3.7M doses and has administered 3.1M doses.
Therefore Wales may have a stock of 0.6M doses held in Wales (already delivered) or in UK central stock and Wales has used 84% of its allocation.

Scaling by population from Welsh allocation, Scotland has been allocated 6.4 doses. Scotland has administered 5.4M doses. Therefore Scotland may have a stock of 1M doses held in Scotland (already delivered) or in UK central stock and Scotland has also used 84% of its allocation.

It looks like Scotland has stock for 3 weeks at current usage but we have no good information (see quote below) on whether the composition of the stock is suitable for ages 18-40.

"My vaccine supply numbers are built by scrabbling around in the data equivalent of a rubbish tip and inferring from the scraps I can find."

https://twitter.com/PaulMainwood/status/1400227931310411776

In reply to elsewhere:

Pretty sure this isn't how the numbers work. It would be double accounting. The Wales/Scotland allocations are published when it's given over, and those are the numbers he uses to infer (by population) and cross-check the UK total.

You don't need to do this. Scotland publishes too. Every Tuesday (except BH weeks) at 2pm. If you READ MAINWOOD he explains how he uses both independently to get a UK number, and they never disagree.

Just keep reading. Stick with it. All the stuff you're thinking, postulating, mulling over, it's all there. Feeling a bit like I can lead a horse to water..... but I can't make it scroll through twitter.

In reply to Longsufferingropeholder:

Yes but it doesn't give me much more than thinking of the vaccine delivery chain from raw materials to jabs in arm is a slow moving tanker without rapid course changes resulting in the roughly straight line of jabs administered versus time over the last few months. Hence extrapolating from one week's jabs in arms for the following few weeks has been a good predictor.

I feel little need for nuance, subtlety & twitter when there's a roughly straight line of jabs in arms to look at.

In reply to elsewhere:

Mainwood's points have been picked up and agreed by others (including More or Less). Wales IS very slick in the logistics of getting jabs done, from country delivery into arms. Scotland a bit less so but they did more of the hard to get to cases earlier. England are worse but don't give the numbers (but can be extrapolated and haven't contradicted any official data yet..... unlike much of what Boris and Hancock say). It's not just moving jabs to the right place, it's ensuring the people will be there as well (the English booking systems have crashed multiple times and sometimes gave appointments to groups not yet due to be scheduled; amongst other problems).

More or Less this week looked at Bolton, as Hancock claimed the success of tens of thousands of daily jabs there, in response to the Indian variant (as a distraction from the politics around all his blame from Dom). It turned out to be 17,000 in the week, following on from 25,000 the previous week, which was no real difference from similar areas without the variant:  there was no significant protective extra surge in vaccinations in Bolton (probably mainly because enough people didn't turn up).

In reply to Offwidth:

There definitely was a surge:
https://coronavirus.data.gov.uk/details/vaccinations?areaType=ltla%26areaNa...

Whether it was significant or protective, I'll leave open.

In reply to Offwidth:

Comparing Wales & Scotland with up to date figures, you are right Wales is looking very slick (106 jabs per 100 population vs 97 jabs per hundred population) so they will have smaller stock (0.4M rather than 0.6M) and have actually used 89% (rather than Scotland's 84%) of their allocated jabs. 

In reply to thread:

The next variant update is out (No. 14).

https://www.gov.uk/government/publications/investigation-of-novel-sars-cov-...

Some worrying data briefly reported on hospitalisations in the second half. From preliminary data in England and Scotland looks like the new variant (Delta - anyone else dislike this naming convention?) causes more hospitalisations than Alpha after correcting for confounding factors, including vaccination status (ie, this effect is believed to be independent of any reduction in vaccine efficacy).

Also an updated table in the first half showing the numbers of Delta cases, admissions to A&E with and without overnight stays, and deaths, presented as a function of vaccination status. They present the A&E data both including and excluding people who tested positive on the same day they were admitted - presumably this is to try to exclude people like longsufferingropeholder was talking about the other day who might go to A&E with a broken leg and just happen to have covid.

There is no new analysis or interpretation of this data provided. Two deaths so far in people who had had two doses of vaccine. 3-7 A&E overnight admissions in people with two doses, depending whether you include people who tested positive on the same day of admission. There are a lot more hospitalisations in people who are >21 days past their first dose but not yet had their second, than in people who are < 21 days past their first dose. So if I were in my 50s I'd be having my second dose as fast as possible...

In reply to Si dH:

...and copied from the other channel, in case anyone lives in the right place and wants to help out:

Vaccination clinic volunteers needed at a bunch of places in England:

https://nhsvolunteerresponders.org.uk/i-want-to-volunteer/volunteer-roles/s...

Possible indication that they want to ramp up vaccination rates further soon?

In reply to Si dH:

Four problems with it for me:

1. I find it harder to recall and tie them to specific variants.
2. Seems wildly optimistic about the number of variants they're going to end up tracking; 24 letters in the Greek alphabet?
3. Totally puts me in mind of Red vs Blue.  Lets hope they don't end up with a Meta after exhausting the alphabet.
4. Saying "Delta cases" puts me in mind of a change in cases.

> The next variant update is out (No. 14).

This has fast become the document to watch, hasn't it...  Reassuring in terms of the cadence of analysis and passing up the food chain that the document keeps the same basic format and analysis week-to-week.

That data has been a bit confusing for me, to say the least.  One factor to consider:

• For a constant rate of vaccinations, and an 11-week gap between doses, there are 11/3 = 3.67× as many people who are single dose and > 21 days post first dose than those who are single dose and ≤ 21 days post first dose
•  The row "Delta cases since 1 Feb 2021 ¥" can I think be used to normalise for this, doing so gives less concerning results than the headline numbers suggest.

A quirk of where we are right now, the hospitalisation rate is similar for the vaccinated and unvaccinated rows in the table.  Given the demographics (very crudely: young=unvaccinated, old=vaccinated), this is a massive success for the vaccination, as previously older people were orders of magnitude more likely to be hospitalised.  

It's all small numbers so quite noise prone for now - they don't seem to consider it appropriate yet to start measuring rates or putting CIs on them; still, hints that this is not looking good for healthcare if uncontrolled spread of this new variant is allowed to continue indefinitely at anything like the current doubling times until most adults have had two doses to seriously shrink the size of the susceptible pool.    

There really wasn't much space in the plan for a variant with rising vaccine evasion and worse healthcare consequences.  Re: your second post on volunteers and vaccination, I can see a push towards a 3rd booster jab for older folks sooner rather than later, and at this point I presume AstroZeneca and Novovax are being asked "Say, just how fast can you change variants for your vaccine production".  Speaking of Novovax, it seems their approval request has slipped to at least July - https://www.theguardian.com/society/2021/may/21/novavax-volunteers-in-uk-th... 

That footnote ¥ is interesting:

• [...] unlinked sequences (sequenced samples that could not be matched to individuals) are excluded from this table
• It seems mad that fully one quarter of the sequences can't be matched to an individual; I wonder what that's all about...?

I wish they'd not put a CFR for "Delta" in Table 2; they qualify it in a footnote: "*Delta (VOC-21APR-02) includes a high proportion of recent cases who have not completed 28 days of follow up and therefore CFR is likely to be an underestimate." but this is how misinformation is born with a semblance of credibility.  Certainly at least one Oxford professor has been quite confused about this specific class of mistake in the past...  Better not to give a meaningless number than to give it and qualify it elsewhere, context is easily separated.

In reply to wintertree:

This. This needs a big lit up arrow pointing at it.

N.B. demographic of hospital occupancy in "normal" times is another circle on our with-not-of venn diagrams *if* that's mixed into the reporting. Would indicate even bigger success for vaccination.
Slight aside: really would be useful to clarify if those 2 deaths within 28 days were 'with' or 'of'. With such low stats it could easily be either.

Been asked and answered. They're already on it. Tl;dr - much quicker than the approval process.

Waste water etc??? Are they sequencing any of that other off-pilar stuff? If so, is it reported separately?

In reply to Si dH:

Having mine tomorrow...

In reply to Si dH:

Interesting that they're after volunteers in Bomo; as I mentioned elsewhere, its vaccine rollout is significantly better than near me, and prevalence is currently very low (one tenth that near me), which, considering how many people pour into the resort from all over the country, is quite remarkable...

In reply to elsewhere:

More on that not-a-stockpile https://twitter.com/PaulMainwood/status/1400573134198214662

In reply to Longsufferingropeholder and WT:

I realised after posting that I had probably mis- or over-interpreted that table's data a bit as the number of cases is also quite different for groups <21 and >21 days post first dose. Good on ukc to pick me up though! 

I do wish they would provide a few words of interpretation to go with it though.

Re: Paul Mainwood. I haven't seen an obvious error in his work, but as elsewhere pointed out, he acknowledges it is the best he can do with scraps. There is certainly potential for errors or misinterpretation of the data sources he is using, especially the ones that weren't intended for public use. So I think it's an interesting counterpoint to the usual story of supply constraints but I don't consider it completely reliable. A sensible approach in life in my experience is that if you see some surprising data and there is nothing to corroborate it, then you should maintain a healthy suspicion. The 'sense check' to me is that if it was true, vaccination rates should be at least holding flat at the moment, but they aren't - in the last week there has been a noticeable drop off in both first and second doses, which makes me more sceptical still. If that's a bank holiday effect (hopefully) then rates should start to rise back towards the previous trend this week.

There is certainly a valid point that Wales has done a noticeably better job of vaccine rollout than the other nations. The rest of us are fairly similar but with England ahead of Scotland or NI despite what Offwidth said above. It would be good to see learning adopted from Wales' approach by the rest, but that would require politicians to accept their approach isn't the best, so is probably a pipe dream.

In reply to Si dH:

Re changing approach to mirror wales - probably hard to change horse now, more of a lessons for the future thing?
All of the home nations are doing well, just wales slightly better.

(44, North Somerset, invited for second dose on Sunday by my GP, about 3 weeks sooner than expected)

In reply to Si dH:

I've gone a bit further and checked his sources and working for a lot of it. The bits I keep ranting about definitely stack up. There's not much based on unofficial sources; that's only really an issue when it comes to inferring the split of suppliers.

Wales opened up to younger ages sooner. Scotland tried to mop up all the outliers before moving on. England, somewhere in between. There's not a huge amount in it between nations, a month at most depending on what you call the finish line, but the puzzle is these millions of doses that are floating around somewhere. The people running this campaign have been making good decisions all along so there must be a reason/plan for them.

In reply to Longsufferingropeholder:

That difference puts Wales a few weeks further ahead in the virus Vs vaccine race so it is significant.

In reply to Longsufferingropeholder:

It would be interesting to see someone intelligent in the Press pick up his analysis and ask some direct questions of the government or their advisors on the vaccine rollout.  The directness of the answer would be informative.

In reply to Longsufferingropeholder:

More or Less know their onions: their point was there was nothing special about the number of extra Bolton jabs (there was a small surge elsewhere), whereas Hancock used the wrong number and implied special success for jabs in arms in Bolton. They did say there was extra capacity (handled differently) in Bolton. In the news today Blackburn claim they are being left without any extra vaccine help.

Latest data from PHE and Scotland looks like the Indian variant has doubled in a week again and is about twice as likely to cause hospitalisations.

In reply to wintertree:

I was startled to hear from my student son that he had his first jab this morning. He's 21, at Cambridge, no health problems.

In reply to captain paranoia:

Perhaps some of their current volunteers are going back to work in the hospitality/tourist industry now the summer's coming?

In reply to Offwidth:

From the variants table on the gov webgage, sequencing shows an 78% increase in a week, corresponding to a doubling time of 8.4 days, which is an improvement over the previous week's 100% and 7 days.

This is worrying; again very conflated data as the initial importation and outbreaks I think will have had a lot of overlap with minority factors known to have worse health outcomes for Covid; but how much of that is down to chance of catching the disease, and how much is down progression of the disease I don't know.

I've banged on about harder borders a lot in the past.  A red listing two weeks earlier would not have kept this out, but it would have kept us perhaps 3-4 weeks behind on the exponential growth curve, which would have put vaccination further ahead, resulting in slower exponential growth of the variant once established - giving a better chance at containing it and blunting the worst case consequences.

Until vaccination is complete, we can't afford the risk of a yet-worse variant coming in.  They keep getting measurably worse.

Household quarantine is ineffective against the "Kent" variant when some members of the household are non-travelling and so non quarantined.  Amber listing is a dangerous illusion of security and should be dropped immediately and all amber list destinations moved to the red list.

In reply to Si dH:

I don't think there is much need to be sceptical about the data in Mainwood's work, just the wider conclusions need care. The bigger question is why the UK government still don't release their data (and why they tried to block the release in the devolved nations). I was referring to comparison of lean delivery, not numbers of jabs, where Wales are well ahead of the clumped others. Scotland are worse than England on total numbers jabbed as they initially targeted the harder to jab (but most vulnerable) to try to save more lives and cut hospitalisations, given that they are not far behind England on numbers now, the indications are their delivery systems are probably a bit leaner than England's. More or Less talked through the fact that the Welsh success in lean delivery had some potential big risks in a supply shock situation. This was at the start of the show two weeks back:

https://www.bbc.co.uk/programmes/m000wc4t

In reply to wintertree:

Oddly enough I'm still mainly optimistic as I think we are far enough into vaccination that hospitals probably won't be widely overwhelmed this summer even with this government in charge. The Boris bullshit is falling apart again and some shift from the plan to fully open in early summer seems neccesary and almost inevitable, but the risks of any Boris delay this time seem to me to be way lower (assuming new even nastier variants don't arrive). Risks of infection outdoors are tiny and with the average better summer ventilation are reduced indoors. Vaccination scepticism seems to be struggling in the face of large percentages being jabbed, irrespective of the fact I don't trust the government percentage data (I've met too many sceptics to believe anything like 100% in any age cohort). Short term I also worry about long covid in the young...I really don't think the health risks of this are being pushed enough. In particular I know young women worried about unproven vaccine impact on fertility when overall risks from covid are maybe orders of magnitude higher.

I agree on your points...in particular I always thought amber listing was too high a risk for leakage for too little economic benefit and that mixed messages from the cabinet made that situation even worse.

In reply to Offwidth:

I'm not worried that we're going to see anything like the same number of deaths again, but I am worried that we're going to end up back in a place where we either have much tighter restrictions or where it just generally doesn't seem safe to do stuff anyway, and I'm bloody livid that the government once again seem to be hell-bent on making that situation worse for longer by holding off on taking any serious action until things are obviously and undeniably going pear-shaped, as if they haven't learnt anything at all from the previous three times that they've done the same thing.

In reply to Offwidth:

Any delay in Scotland due to doing difficult cases first is long past and they could have caught up. I reckon we will soon run out of over 40s to jab with AZ as 2nd jabs for 50+ and 1st jabs for 40-49 approach completion. Little risk in a splurge of AZ.

Moderna usage creeping up so that is a hopeful sign about supply and speed of vaccination of 18-40. In the absence of hard data on supply I look at the hard data on usage (jabs in arms).

Unless a third jab program instigated, at some point mass vaccination will have to close and re-open as sports centres and concert venues etc.  We will have to attempt to mop up the remainder with ultra-convenient vaccination, GP appointments, small marquee on the high street or whatever is where people are and gets jabs in arms.

I suppose a free vaccination taxi at pub closing time for the pissed up to take you home would be considered unethical...

In reply to elsewhere:

Scotland did catch up a bit. The initial 'slowness' in Scotland was headline news in England, the catch up wasn't. Yet comparing per-capita deaths since January the Scottish approach seemed to have worked better.

In reply to elsewhere:

Or the school nurse:

BBC News - UK approves Pfizer jab for use in 12-15-year-olds

https://www.bbc.co.uk/news/health-57358446

In reply to Longsufferingropeholder:

Indeed.

Since we are in the business of sharing Twitter threads, I found this perspective on yesterday's PHE report to be worth reading:

https://mobile.twitter.com/JamesWard73/status/1400721177774018561

In reply to Si dH:

The latest ONS reports on long covid. Scary numbers.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/con...

In reply to Ramblin dave:

I think at this point we need to have concrete goals to determine if, and for how long, we delay full re-opening. It can't be this continuing amalgam of open-ended fears.

What exactly are we trying to achieve? A bit of extra time for more vaccination to take place? How long to delay for this exactly? Reduction in case numbers? Reduction in deaths? By how much? Obviously trying to prevent any and all new variants spreading is an exercise in futility and as yet none are vaccine dodging. 

If we cannot define and agree on exact, logical objectives at this stage we should not be delaying any further, lest we always have a justification to not get on with it. For example; if we said we must delay full re-opening for 10 years to ensure no new variants emerge and we are completely covered by an advanced vaccination program, we would have to say that is too much and we cannot delay on that justification surely?

In reply to wintertree:

Just pumped case data into my noddy spreadsheet back to April when I'd given up updating it. Currently ~40k live cases in the UK by my '14 day recovery' reckoning. Same as ~18th September 2020(rising) and 8th April 2021 (reducing). September rate of live case increase was ~5% per day, it's currently 2.7%.

It took 31 days to get to those 40k cases in September from a low of 9k, it's taken 19 to get there today from a low of 28k. That same 28->40 rise only took 7 days in September, so a very rough calculation says current levels of vaccination have reduced the spread down to 1/3rd <-> 2/3rds of last autumn's rate.  I think levels of restriction are about the same?

That would give 4 months until the working population experiences the same numbers in self-isolation/hospital as it did in November assuming hospitalisation rates are the same as in the autumn...... but if the Delta variant does prove to be twice as debilitating as the pre-kent variant we had in the autumn, then things could be pretty bad from an economic perspective.

In reply to TomD89:

Basically yes. The more we vaccinate, the less we need to do to contain the spread. It seems fairly feasible to get to a place where cases are basically zero and we've vaccinated enough people that we can contain any new outbreaks with test and trace, surge testing, testing of travellers etc or maybe in extreme cases partial local lockdowns.

This isn't without costs, but it seems like a better option than just opening everything up, having huge numbers of people hospitalized, huge numbers of people suffering long-term health problems and a massively increased risk of vaccine evading variants springing up. Or, what seems to be the government's favourite option, sitting on our hands for a bit hoping the problem will go away, having quite a lot of people hospitalized, a lot of people suffering long-term health problems and some risk of new variants emerging, and then locking down again harder and for longer than we would have had to if the country wasn't being run by a bunch of halfwits who're either too thick to think through or too psychopathic to care about the consequences of their gung-ho posturing.

In reply to TomD89:

Exactly.

Getting towards completion on the vaccination makes the difference between uncontrollable exponential spread (*) and hopefully containable outbreaks that don't threaten to tear all the progress back down.

(*) Uncontrolled exponential spread is currently a risk even with 75% of adults having had a 1st dose of vaccine, because of the Indian variant being better at beating a single dose, which is a problem because we opened up too fast too soon undermining the progress made with a previously quite effective 1st dose.  It looks like uncontrolled exponential spread could take us back to healthcare overload, at which point the only option is lockdown, again.  Which I think nobody wants.

So, I for one am content for the current mild restrictions to remain for an extra month or so if it helps guarantee that we continue moving in the right direction.

More haste, less speed.

It's not a complicated guiding principle, and it's one that if followed results in a net total reduction in infringements on our liberties.  

In reply to Toerag:

I think your approach would work if you could ignore demographics, but in practice cases have reduced more than you estimate in older people and less than you estimate in younger people. The effect of vaccinating older people first will also change hospitalisation rates as a function of demographics when compared to last September. So I think overall we should expect much lower hospitalisation numbers than November over the next few months if the case numbers go up in the way you describe. Short of another new variant that evades the vaccine, I think the bigger risk is that case numbers explode much faster than you predicted, especially if further relaxations are made. On the positive side, numbers in Bolton have flattened off so maybe (maybe?) we are reaching some sort of herd immunity in the groups most likely to get infected. Probably not.

In reply to Si dH:

I think the confounding factors around the initial outbreak zones are significant and things like estimates of the SAR from the outbreak dominated period remain of limited predictive value; as with the initial ~5 day doubling times there're sensible reasons to think these values are localised to the initial outbreak and that won't carry forwards.  

I certainly hope so.  Having the SAR estimate come down in the latest report certainly doesn't contradict my hopes...

In reply to Longsufferingropeholder:

Big news; not unexpected after the US moved that way, but big.  I expect we'll see a significantly renewed push from the pro-death / anti-vax brigade with this news, but I think any vaccination here could make a material difference to spread.

In reply to wintertree:

I think a lot of parents outside of the usual anti-vaxx brigade will push back if JCVI recommend 12-15yos get vaccinated (they haven't yet but presumably might do soon.) There simply isn't an obvious reason to do it for an *individual* in an age group who mostly get no or very mild symptoms from covid but who have the longest to suffer from any unknown side effects. The obvious exception is for kids with conditions that make them especially vulnerable to covid, and for them this is great news. Personally I hope it doesn't go further than that at the moment. I would want to see a few years of longitudinal data first if I had a healthy 12 yo. I don't think any of us should be in the business of vaccinating kids if it is not in their personal interest, other alternatives to control spread are much better. It would also be unethical in my view to vaccinate kids here rather than donating doses elsewhere.

In reply to Si dH:

I agree that it’s a difficult issue and that’s why I expect those with an agenda to undermine all covid control measures are going to pile in with gusto.

Its very complicated; if for example being vaccinated in that age group helps to avoid another lockdown imposing home schooling, many children are going to benefit clearly and directly from vaccination within their cohort.  This is the first time in a long while that the loop on benefit from vaccines has been closed in such an immediate and “social” way.

In terms of longitudinal data, there’s more by the day, and there’s much more time for which we’ve been able to get longitudinal data on the virus and it’s effects; with the Pfizer vaccine being a strict subset of the viruses genome I think it’s reasonable to bound it’s effects on a secondary age child as a subset of those of the virus, and it wouldn’t concern me to go ahead had I a child of that age and an alternative looked like more home schooling, given that - in isolation of wonder consequences and given the copious medical data - I wouldn’t be too concerned if my child caught the virus itself.  Then again I’d probably saw a leg off, or at least a little toe, to avoid home schooling again - more for Jr’s sakes than mine.  However, it’s not an area where I feel I have any right to tell anyone else what to do, nor would I judge them for the choices they make for their children.  None what so ever.  However, there’s a distinction between that and those who have been seeking to use every option open to them to undermine buy in to vaccination and I think this step is going to be weaponised by them, and i do not have time for those people.  

I strongly agree.  Vaccines should not be the driving force for reducing cases, they should help with the mop up and suppression once that is achieved.  However, the current relaxed restrictions in the UK hinge entirely on the vaccinations.  I for one am still only eating outdoors.  I worry that opposed to the anti vaccination brigade, if vaccinating children is shown to let other people go night clubbing or on foreign holidays, by curbing R at a societal level, there is going to be another toxic push to incentivise vaccinating children, pressuring parents out of an area I feel they should have free choice.  

>  It would also be unethical in my view to vaccinate kids here rather than donating doses elsewhere.

It could also be argued unethical to run cases hot amidst partial vaccination, as this optimises conditions for forcing vaccine evasion which could kill far more people globally than the donated doses could ever save. It’s very hard to find a single morally proper point on so much of this.  I look forwards to the day it’s all in the past and the subject of debate by what ever kind of scholars take interest in such things.

In reply to wintertree:

The other one is holidays - if places ban un-vaccinated kids then there'll be a big drive to vaccinate them by parents that want to go on holiday.

In reply to wintertree:

I think the same will happen as before - people in low prevalence areas will be feeling like 'it's only a problem in towns in the north beginning with B' and be lax in their precautions until it's too late. There's plenty of areas yet to have their 'initial high rate of rise' until people realise it's in their community.  Does anyone have any idea if behaviours have changed in the current outbreak zones (other than people going for jabs)? Has social distancing and mask used increased? Or are people ignoring the fact they're in an outbreak zone?

With the current prevalence and rate of rise, the UK will have a prevalence rate of 60+ per 100k by the 1st of July - that's going to put travellers from the UK in 'red zones' for many other countries and decimate the chances of overseas summer hols.

In reply to Si dH:

I read this earlier, was going to write a reply after work, wintertree has said everything I was going to say better than I could have. 

Only additions here 

We don't really have any more longitudinal data on covid than on the vaccines. If you had to give your kid one or other (and you kinda do) which would you choose? Not offering an opinion, just making clear that in the absence of perpetual restrictions on society, those are your options.

I tend to agree with the moral sentiment, with the caveat that the heartlessly objective scientist in me sees this as the most effective variant breeding programme still available to us.

In reply to Longsufferingropeholder:

I don't want to get into a long discussion about this but I long ago decided the risk of covid to my son (who is nearly 4 so not up for vaccination) was low enough that I was going to keep sending him to preschool regardless. We did so, he (and probably we, as he was in bed with us every night for the period) got covid, it was still the right decision and I'd do the same again. Wintertree made a point that he thinks the possible side effects of the Pfizer vaccine should be bounded by the effects of the disease even if there is something we don't know about yet. This isn't something I'd considered, and it feels like a key point. It obviously wasn't true for other vaccine types (you don't get blood clots from covid) and I'm sceptical for mRNA purely because it's novel and the regulators felt the need to do a proper assessment, but if his argument is true it obviously makes the decision far easier.

I don't want to fuel any general vaccine scepticism here, but if parents are reluctant to vaccinate their kids against a disease that poses minimal risk to them on the basis of emergency authorisations then I think we should be sympathetic rather than critical.

As per my post though, there are much better ways of avoiding such a big breeding ground, like keeping masks and not opening nightclubs (or, frankly, any indoor hospitality if it came to it) until more people are vaccinated.

In reply to Offwidth:

I think there should be clearer categories than "long covid".  Feeling off for a few weeks after a virus is quite common and a drag but nothing more. Feeling ill a year later is another matter.

In reply to Si dH:

There are very rare allergy issues with (presumably?) the phospholipid membrane used for Pfizer as well - I should have mentioned those - they’re dealt with for adults by using a different vaccine in cases where people are known to suffer from anaphylaxes.  The clotting issue removes that option for children so anaphylaxis in children perhaps contra indicates vaccination for now - and at least until after a long time has passed for Novovax in use to encompass feedback from mass vaccination and longitudinal studies.  For much younger children, the risk of bad allergic responses is likely unknown as well.  I don’t imagine we’ll see the age getting pushed much lower than 12.

Yes please.  Plenty of people disagree more’s the pity. 

In reply to Si dH:

"Research begins to pick apart the mechanisms behind a deadly COVID-19 complication."

https://www.nature.com/articles/d41586-020-01403-8

In reply to elsewhere:

You got me there. I think the point I was making is sound though.

In reply to Si dH:

Yeah, I can understand all that. It's a difficult choice to ask people to make. It's far from obvious and I'm not going to take sides when people are making informed choices on it.

(Possibly not relevant to the children debate but covid definitely does cause clots though. I mean, it really, really does. Maybe not so much in kids, but as we've heard plenty of times it carries an order of magnitude more risk of thrombosis than the AZ vaccine)

In reply to Si dH:

This can't happen though, because as we've seen there's always enough dicks who think they're Jesus carrying the cross because they can't freely go and pick up some new variant in benidorm after they've had a bad year (and obviously it's been a picnic for everyone else) and their mental health will be just irreparable if they can only go on holiday in Cornwall this year. Yes, I mean you, Kerry, a photographer from the Wirral and Rachel Richmond, from Edinburgh. What was it that made this year so bad again? What's that sooty? Something to do with a virus being spread around the world by international travel? Well shit. Maybe don't do that then??

In reply to Offwidth:

"Figure 1: Since March 2021, there has been a marked increase in the number of people with self-reported long COVID of at least a year in duration"

Well, since the pandemic only really got going in the UK in March 2020, it would have been hard for people to report long COVID of more than a year before March 2021. So that's a bit of poor phrasing...

Meanwhile chaos reigns in Hounslow: vaccination centre says if you’re over 18 come be vaccinated, no appointment necessary; council tweets that is fake news, stay away.  Local interweb kicking off between parents of <20s that turned up anyway and got jabbed and those that listened to the council and stayed at home. Still all at the leafy end of the borough though rather than where it actually matters!   Maybe this is why Blackburn can’t get doses…. 
 

In reply to Šljiva:

I think encouraging as many as possible in Hounslow to get vaccinated would be a good idea; it's not all 'leafy end'....

In reply to captain paranoia:

Just looking at the surrounding ULTAs:

Reading: 55/30%
Wokingham 74/45%
South Oxfordshire 75/51%
West Berkshire 74/49%

Dorset is now 80/60%

Reading UTLA has experienced 110% growth on the last week. My MSOA is 500%.

Time to email my MP again and ask why the f*ck Reading's vaccination is going so slowly, compared to the surrounding UTLAs.

In reply to captain paranoia:

Hey, Cambridge is 45 / 28! But South Cambs is 74 / 51.

I suspect that part of it is a demographics thing - the actual city has loads of students and young professionals who are further down the list, the surrounding countryside has a more normal proportion of retired folk and older adults with families.

In reply to captain paranoia:

We're all travelling from miles around to Reading for our jabs, and they're insanely efficient, so I wouldn't be too harsh on your MP.

In reply to Offwidth:

The lower deaths in scotland predate the vaccine and I doubt you'll find any evidence to back up your (assumed) claim that this was based on vaccine differences. "The initial 'slowness' in Scotland was headline news in England, the catch up wasn't. Yet comparing per-capita deaths since January the Scottish approach seemed to have worked better." It could be just as likely to do with international travel frequency (think london and nearby) and population density IMO.

Scotland is also a bit behind England on jabs overall including both doses something like 2.5% or so and mostly on second jabs. But looking at the graph we never really had much of a lead there. I think much of the difference in this regard has been jabbing the older population more effectively in scotland. But again the death differences predate the vaccine.

https://coronavirus.data.gov.uk/details/vaccinations

In reply to Longsufferingropeholder:

I route marched 4k in 35 minutes to get there today; had to go back home as I'd forgotten my mask...

Ten minutes in and out.

The Madejski operation is slick, but the question is why our numbers are so low. Maybe it's all you bastards from the surrounding areas. Bloody West Berkshires  coming here, taking our vaccines...

My MP is Labour...

In reply to TomD89:

We don’t have any fully vaccine evading variants *yet*.

I think we need to keep certain restrictions (SD, masks, no mass indoor events, very limited international travel, etc) as long as Covid is a significant threat - which it will be until most countries with which we have significant links have reached hers immunity. That will take another year or so. 

In reply to Si dH:

Seem to recall reading that Covid does cause blood clots but the ones they were seeing from AZ were particularly unusual. I’m not actually sure if anyone has managed to prove that these clots were caused by the vaccine. Not seen anything in the news anyway. 

In reply to captain paranoia:

They took our jaaaaaaabs

In reply to wintertree:

Ferguson saying Delta is around 60% more transmissible, with a CI of 30% to 100%. That’s pretty bad news if that’s how it turns out. The papers are suggesting that a two week delay to the 21st is being contemplated, which is not sufficient to get everyone first jabs plus 3 weeks, never mind second jabs plus 3 weeks. Madness. 

In reply to Misha:

Serological study out too - https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01290-3/...

The weakening of antibody responses from Pfizer-BioNTech vaccine against the India variant is worse than for the Kent variant.

This tallies with what the PHE technical reports have been saying in recent weeks, as inferred from healthcare data; so bottom up and top down estimates are in agreement thats there’s significantly more single dose vaccine evasion with this variant.

x 2 with the serology results.

Amber listing seems even more pointless as the data on transmissivity and increased single dose immune evasion stacks up. 

In reply to CurlyStevo:

Since I specifically said deaths since Jan you really need to think on what your posting. Feel free to prove me wrong with data, as I've been watching scottish briefings and expert comment on that carefully and regularly, being retired. I just said something has clearly worked: I'd agree its complex causation. On the border influence and overall policy setting, my view is Scotland has lost out way more due to Boris's idiocy than vice-versa.

We discussed the benefits of the English approach of going fast and picking up the vulnerable later on here from January. My view was the much greater targetting on the vulnerable approach of Scotland (especially in care homes where fast spread was a risk)  would work better given it's more likely to reducing hospitalisations and deaths than jabbing those at much lower risk, providing the main population efforts were not delayed too much. It was also the human approach: I have someone in my family who is very high vulnerability and very old and know quite a few others...all with large daily contact numbers due to care requirements  (from care staff who were not jabbed).  Relatives and friends were worried sick. They were only getting vaccination at the same time as healthy people in safe environments who were 20 years younger.

In reply to Longsufferingropeholder:

Oh, you are West Berkshire...

In reply to captain paranoia:

Yeah. Had the choice of refreshing constantly for ages to get a rare appointment somewhere in a town centre where I'd have to either walk miles or dick around trying to park, or could have basically any time I like a few yards off J11. So sorry, not sorry.