UKH

Another week - this update almost didn't happen because I spent all the time I had put aside for it walking around local meadows admiring the wildflowers - in the North East this seems to be an absolute stand out year for the wildflower season.  Perhaps we can get out to the Langdon Beck Inn for lunch on Wednesday and see what the next valley over looks like.  I made time for this by letting the washing up pile up until tomorrow...

Plot A - Stylistic cases

This is a way of categorising the English local authorities (UTLAs) to let us try and look at the different behaviours going on right now.   Those with the greatest rises are coded red for “outbreak”.  Of the remainder, those that rise over the period of the plot are coded orange and those that fall are coded blue.  These are entirely arbitrary classifications but I have found them useful over the last few weeks; I think their utility comes to an end this week as all turn to growth.

Orange and blue cases are simplified to a straight line joining their start and end points on the plot.   The number of blue areas has been falling each week as more tip over in to growth.  Last week there were 63 blue areas whose combined cases had just about stalled in decay; this week there are only 18 and they have just tipped over in to growth. 

Plot E is a stacked plot of all the UTLA cases grouped by colour code; remember my arbitrary assignment is based on the whole duration of the plot.  The legend also gives the characteristic time measured over the last week only.  By this measure, all three colour bands are now growing.  The orange band is growing the fastest in exponential terms, doubling every 9.8 days.  The red “outbreak” band is growing more slowly doubling every 12.6 days, and the remaining blue areas have finally just tipped over in to growth.

The good news is that none of the early outbreak areas remained in the fastest exponential growth they saw at the start - as seen in plot A, although some of them (e.g. Blackburn with Darwen) are experiencing ever larger “boom and bust” events - outbreak after outbreak in the area?  It almost looks weekly in cadence but too large in scale to be day-of-week sampling effects (which should be improved with recent changes to the lab protocols on around the recording of dates).  Are there some events that go on once a week driving spread? 

I say this is good news because it means we know we can hold the line against cases in the areas likely most susceptible to outbreaks, so we know we can hold the line in the orange areas; but we typically see a few weeks of sustained high rate exponential growth before local responses kick in to limit this.

The possibly bad news is the orange areas being in such high rate growth mean there’s a lot of new cases likely coming our way in the next couple of weeks.

The plots I’m making have been well suited to following past waves, but the doubling time is not such a good lens to use when looking for changes in the hospitalisation rate.  I’m going to try and work up some plots like my old CFR plots using a variable lag to look at the “Case hospitalisation rate” and to eyeball the most appropriate lag, to look at changes in rates in the outbreak areas.  As of this week I think there’s enough data to make a sensible stab at that.  It’s clear though that far fewer people are going to hospital proportionally speaking.  It occurs to me that the doubling time of hospital occupancy is a useful measure as this includes information on the average length of stay as well as the admissions rate - with direct (better immune response) and indirect (infections now on average in younger people, plot C shows this clearly) effects of the vaccine will act to reduce the length of hospital stays.

Plot D shows that we’ve been holding a ~9 day doubling time on cases in England for a week or so; this fast rate of growth was last seen late last summer when cases were also low.  In the past, daily case rates have always moderated in response to rising local prevalence - I think both as a result of targeted interventions and rising local awareness and caution in response to the news and also the grapevines as people start to hear about hospitalisations in their networks.  Whilst I’m convinced this effect is real from all the data, I haven’t the foggiest how much of it is due to formal interventions and news on cases influencing people ("good citizen"), and how much is down to news and the grapevine on hospitalisations and deaths ("scared citizen"); with the latter expected to be much lower, I don’t know if this auto-moderation effect is going to emerge this time around or not.  We shall see. 

Initially interventions were strongly targeted in the first outbreak regions, spurred on perhaps also by the relatively low vaccine uptake in some of the areas hit hard and early.  If hospitalisations continue to be low, it’s not clear to me that we should continue to intervene against cases indefinitely. 

• For sure, put me in charge and I’d be holding us away from growth until all adults have been offered their first dose and all adults over 40 have been offered their second.  It looks like we’re not going to wait...
• If cases are allowed to continue doubling at this rate, antibodies are coming to the whole population one way or another in the next 8-12 weeks or so.
  • Is this the “ripping the plaster off” stage?
  • It must be a heavy burden to be faced with making the decisions on the next few months but at some point we have to push on to letting the virus circulate without restrictions, so that the population's immunity updates in track with mutation of the virus, so that we don't end up back in a situation where there's so little immunity to a new variant that it's lockdown-level disruptive.  
• My educated but lay perspective is that almost all the lethality in this virus lies in a total lack of pre-existing immunity, and so moving to endemic status is the best way forwards and perhaps even a silver lining in terms of de-fanging a resurgence of MERS, original SARS or the next nCov.
  • I wish we were a month ahead with vaccination vs cases, I really do
  • This pandemic has given a massive push to therapeutics targeting immune dysregulation.  Hopefully these will show sufficient efficacy and safety to be on the market soon.
• Dear Prime Min mister, please don't open night clubs etc on June 21st and wait another month...

Link to previous thread: https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_29-...

England, Scotland and Wales now clearly all have growth in cases.  Wales' growth is still in the provisional zone of my plots.  It's notable how similar their doubling times are.  NI looks like it must just be turning to growth; as the higher R0 value and reduced cross-immunity (especially for one dose of vaccine) of the Indian variant is likely a key driver of the spread, it's not surprising somewhere across an ocean border is delayed in the process; a sign of how powerful hard geographic borders and travel controls could be in a future pandemic.

Scotland has had the worst exponential rate constant (more growth or less decay) for most of 2021, and is on course to beat their lockdown-era daily case numbers in just over another 2 weeks of data.  Hospitalisations don't seem to be rising with the same gusto, and I'll try and get some conversation rate measurements done on the last two waves soon.  

Quick analysis though - holding a straight edge up to the cases plots shows cases are rising with a similar doubling time to the last rising phase (10-15 days, comparing now with late December 2020) and hospital occupancy has a lower doubling time.  Occupancy as I said in my OP is a more relevant measure in some ways (looking at a "healthcare is ok" level).  Plot 9s shows this more scientifically, deaths are removed as the curve is low number statistics and so very noisy.  The doubling times curve for occupancy is at longer doubling times than for the end of 2020; better vaccine protection working directly and indirectly.   It looks like things were worse at the start of this wave than now; I think this is likely because the importation events of the new variant that kicked it all off were in to areas with lower than average vaccination - this also shows as a brief period of growth in deaths in the English cases; then as the outbreak areas come under control the infection segues to other areas where better vaccine uptake offer more complete health protection.

England is further behind than Scotland in this new wave; so it's a week too soon to look at comparative doubling times for cases and hospital occupancy.

•  I've got no reason to think it's going to be much different here to Scotland however, so my take on this is not all doom-and-gloom, more just a "wait and see".
• Critically though this means we're not going to have actual, solid evidence that it's really going to be okay to let cases keep rising for another week, so if there is to be a week's notice for the next round of reopening in the interests of sensible logistics, it just can't happen on June 21st.  Given the additional latencies in the political decision making machine, a postponement of the decision due on June 14th for two weeks seems sensible.
  • Let's not put people in hospital who don't need to go there when another few weeks of vaccination will make a material difference.  

Plot 16 - English UTLA Watch Plot

• Almost all UTLAs are now in growth

Plot 18 - Regional Rate Constants

• I adjusted the y-axis range as it wasn't all being used before, so colours are a bit more vivid now.
• I have re-assigned the arbitrary  red/blue colour coding and y-axis ordering on the heat map; this was previously set up for what turned out to be the Kent variant.  
• At a regional level, cases are now clearly in to growth everywhere in England - hospitalisations are more of a mixed picture; it probably needs another week of data for the later-hit regions.

The Plots D1.c

• Now both classifications are clearly in sustained growth
• In the outbreak areas, doubling times were initially standout short (fast) in < 15 years of age.  Now, numbers in these groups are in to decay
  • I really wish data was available by UTLA, and by age, and by PCR or LFD classification
  • Is this because more infections were caught sooner by LFDs in school children, or is this school closures, or is this something else?
• Hints of the same thing about to happen in the rest of English cases for < 15s.

Plot 22

• There've been claims this week on Twitter from one of the usual band that ITU occupancy isn't rising.  This is a plot of hospital and ITU occupancy in England over the last 5 weeks, raw data and a filtered trend line.  Both measures are at a very low level but it's beyond any shadow of a doubt that they are rising.
• This is a tiny, zoomed in corner of the plot and it's very small numbers compared to previous waves; but we're just at the start of this one.  The hardest hit areas up front in this wave are likely those with the lowest vaccination uptake, so hopefully this initial hospitalisation rate is not predictive for the next couple of months.

As I said, ran out of time today so I've not proof read anything I've written.  I'm basically incapable of proof reading things without putting them down for a couple of hours, and I was busy.  Sorry!

Thanks as usual.

Re: your conclusions about relative growth rates in red and orange areas in plots A and E. Bolton has been falling and still has a high absolute number of cases - what happens if you exclude Bolton from the doubling time calculation for red areas? Is the result still significantly below the doubling time for orange areas, or is Bolton now the outlier dragging that number down? Obviously Bolton rates coming down is a good thing, but rates got extremely high in the worst hit areas before turning over*, which we don't want to replicate everywhere else (only Blackburn being close so far). So I'd be interested to know if in practice at this stage all other red areas are continuing to rise at similar rate to the orange areas?

Good point; Bolton and also Blackburn with Darwen are masking some of the others in aggregate measurements.

All lumped together as in plot E, the "red" UTLAs have doubling time of 12.6 days.

Splitting it up, we get:

• 40.0 days for Bolton and Blackburn with Darwen together; close to zero growth or decay
• 11.0 days for the sum of the remained "red" UTLAs - so yes, they are doubling a bit faster.

I think it's probably time for me to dust off the somewhat broken code for doing rate constant maps.

This is now my go to for interpretation of data

You'll find this article interesting ref. human behaviours - when people saw the military going door to door with testing they bucked their ideas up!

https://www.bbc.co.uk/news/uk-england-57425730

Good good.  It's reassuring to know that even with the lobster-boiling effect going on where R0 just keeps getting larger, that control measures still work and that people respect the literal boots-on-the-ground approach.

Comparing where we are now in terms of response, readiness, testing, vaccination induced immunity, infection induced immunity and so on, it's not good to imagine what would have happened if this variant had landed in March 2020; I'm guessing doubling times of under 2 days.  

In reply to thread:

In the OP I asked for a month delay on the final reopening step, but if you'd asked met bet I'd have gone for two weeks.  I'd have lost!  Edit:  Jumping the gun of course, "government sources" aren't confirmed until the press conference.

https://www.bbc.co.uk/news/uk-57464097

Anecdotally I know of quite a few Covid cases in teenagers and young children whose parents then caught it. In one case, a two year old caught it, most likely at a bbq from another toddler. Both only showed cold like symptoms. The mum of the toddler went to get a test kit from the pharmacist, pharmacist said ‘my toddler had cold symptoms that turned out to be Covid’.

Also, my wife teaches in a neighbouring LA and just got a memo: ‘all staff please get jabbed because teachers are catching it from their pupils.’  
I do wonder whether home schooling until the summer holidays (apart from key year groups) would be a good idea?  

I wonder in the US if our plan is ‘rip the plaster off’ now to let it spread and hit herd immunity that way. With 25-35% of the population unwilling to get vaccinated it may be the only option. More of the elderly are at least vaccinated. 
 

we’ve basically removed all precautions over the last month. The good news is we didn’t have a big surge in cases after Memorial Day 2 weeks ago.
 

it’s easy to get vaccinated here now so anyone over 12 should be vaccinated.

https://www.theguardian.com/world/2021/jun/14/covid-vaccines-are-working-bu...

You suggested some plots looking at cases and hospitalisations in hotspot areas.

I've put a plot together, so far it's just for English Regions and English NHS Regions.

Here's a stab at it for the North West.

The left plot is a Lissajous figure of cases vs hospitalisations.  

• Two ~50 day periods of rising early stage rising cases are hi-lighted for late summer 2020 (purple) and for the last couple of months (blue).

The right sub plot shows cases and hospitalisations vs time for those periods

• Cases and hospitalisations have separate y-axes.  
• It's really hard to pick the "best" relative times for the two rising phases as the background behaviour was very different for the two time period.

The maths went click in my head when I looked at the Lissajous plot.

• We can't determine the "case hospitalisation rate" R from this data, it's just not possible.
• With an unknown lag L from detection as a case to hospitalisation, only the ratio (R/L) is measurable by fitting against the data.
  • Both manifest as a shift of the hospitalisation exponential along the timeline in one direction or the other.  
  • The only way to resolve this is to look at data beyond just a rising exponential phase where the inflection point (onset of rising) or the turning point (onset of decay) resolve this mathematical degeneracy.
  • Past data can't be used for this because it was driven by different variants and there's been a massive vaccine induced demographic shift between past data and the current wave.  
  • In theory the turn to a rising phase could break the degeneracy for this wave, but things are desynchronised at a national level meaning we need to look locally, and locally the number of hospitalisations are so low as to be too noisy for any fitting around the inflection point - and there's the conflating factor of the early stage hospitalisations perhaps happening in areas with less vaccination to boot. 

Given the latencies from detection as a case, I don't think we'll be able to back out any sort of "Case hospitalisation ratio" from this data until about 4-5 weeks after an area sets in to ongoing decay.  Which is after it ceases to matter.

I don't feel that it's valid to make assumptions about the infection to detection latency or the infection to hospitalisation latency between really quite different variants. This kind of sounds like quitting talk, but there's only so much blood the maths lets one get from a stone.   

In terms of "how much better is our situation than last autumn", that comes down to the horizontal space between the different periods on the lissajous figure, and the difference in horizontal space between the black and red curves on the actuals figures.   Clearly, right now, we're in a much better place.  Hopefully almost all of that is due to a lower "case hospitalisation ratio" - the demographic shift alone gives reason to believe that let alone direct effects of the vaccine on older people - but there's always the possibility there's a bit more bad news "locked in" by an increase in latency from detection to hospitalisation.  I think the cards are stacked strongly in favour of the former, but I just can't put a mathematical value on it.

TLDR: To understand how much better the hospitalisation situation is, we have to look at statements released by government and in SAGE documents that are derived from longitudinal data considering vaccine history as well.

I think the more useful comparative measure we can do from the dashboard data going forwards is hospital occupancy...

• The more people there are in hospital, the more people are going to be dying
• Fundamentally it's having too high a level of hospital occupancy where things start unravelling.

At some point, you have to rip the plaster off.  Once you're out of other options, the longer that process is delayed, the worse the probability of something really bad happening with a partially vaccine evading variant that happens to come along.

The UK isn't out of other options yet, and I'm grateful further dropping of restrictions has been delayed to give us a month to exhaust the vaccine option.  Handily, it also gives us a chance to see what happens in the US...

As I've said before, I'm not going to question any parent who chooses not to have their child(s) vaccinated - indeed I think I would intervene on their behalf if I saw otherwise.  Now even that level of vaccination is unlikely to deliver herd immunity against the India variant and as there's absolutely minimal risk by that age, I'm not comfortable with applying "should" to parents burdened making the decision for their children against a backdrop of complex medical literature and vested interests pushing all sorts of opposing views - some with less than rigourours honesty.  It's not about evidenced, data driven reasons but my personal views on the position of parents and lines in the sand.  I have no problem with the MHRA approving this but that doesn't extend as far as "should". (although my faith in the FDA approvals process just took a knock for reasons unrelated to Covid, I know that unlike some smaller countries, the UK doesn't simply proxy the FDA process.)  

Hard to think about that without thinking back to my trip to Arlington and DC.  The sense of both greatness and tragedy that perfuses the area is like no other place I've ever visited - the cemetery, the monuments, the museums.  Hopefully we'll see more of that greatness going forwards.

Current pastime: looking at the forecasts (Warwick, Imperial) for hospitalizations and trying to guess the implications for the Scotland trip that we're planning for the first half of July...

Thanks for doing this. I suppose you're right that we need to look to people with access to fuller data and analysis than is published on this front. It's still interesting to try to get an early look where we can though and I think with a lot of this stuff, it's difficult to see what insights you might get from analysing the data without first just trying it out and spending some time thinking about it (which you've obviously done.)

Agree with you that the decision today looks like the right one.

Yer, I have 10 days planned in Scotland in August... having similar thoughts. I suspect if cases continue to rise a lot and hospitalisation data isn't completely clear then Sturgeon might be less reluctant to move backwards than Johnson.

And unlikely to happen. We're going all the way up and over the top this time. Hold on tight.

Local containment measures sort of work but there won’t be sufficient resources to do that on a regional scale covering all the large urban areas - it might delay things but I think we’re in for a huge surge in cases. Being in the middle of summer which I think naturally makes people more relaxed and with many people thinking it’s all over, I reckon it will spread pretty quickly through the unvaccinated and single jabbed cohorts (and to some extent to the double vaccinated). Hopefully we’ll avoid significant hospitalisations and deaths but I expect that current restrictions will remain in place for the next year and won’t be surprised if some measures have to be reimposed before the end of the summer.

Once cases are high and hospitalisations are significant, I suspect a lot of Tory MPs and the public will stop bleating on about how they want to get their freedoms back. That’s the silver lining. In fact some people might moderate their behaviour voluntarily. Now if cases climb high but hospitalisations remain low, no doubt BoJo will go for a relatively wide but not total unlock on the 19th. That’s risky in terms of producing vaccine resistant variants. I guess we’ll just have to see what the data show in the next couple of weeks.

The current variant back in March last year or indeed in December would have been hellish, though perhaps measures would have been brought in quicker, at least in December. Thing is, it could keep getting worse - measles has an R0 of about 20… Although I’d question whether being able to spread faster gives the virus much of an evolutionary advantage in a highly vaccinated population. Being partially vaccine resistant, on the other hand… which Delta is, to an extent.

I was keen to burn off some holiday early doors and had a week and a half up in Scotland and the Lakes recently. Would love to get back up there but as you say restrictions may well be reimposed. Big advantage of having a small campervan at the moment, don’t need to book stuff so can be flexible. I’m thinking early July would be better than late July, at any rate.

I find your view on vaccinating children a bit odd. Now I get that there’s a debate to be had about vaccinating children here vs sending spare doses abroad to vaccinate adults there. I’m more on the side of donating doses. However, hypothetically if there was no shortage, I can’t see why children down to whatever age is sensible shouldn’t be vaccinated. I use ‘should’ here in the same way as for adults - they should be but no one would force them. If I had secondary age children, I’d want them vaccinated. Not so much due to the risk to them but more so they don’t unwittingly spread it to me and others. Then again, I’m not a parent so it’s easy for me to say.

Having said that, there are perhaps greater gains to be made by focusing on vaccine hesitant adults. 

There’s a whole bunch of posts I want to reply too; out of time so I’ll be back tomorrow, but…

Perhaps it’s all just in the language semantics, but to me, saying “should” implies a degree of pressure to do this.  There’s a difference between applying societal pressures to an adult to make a decision for themselves, and to making a decision about their ward(s).

I can approach the issue from different directions and in doing so reach very different conclusions.  Perhaps I’m just feeble minded on this but I expect many other parents find themselves in a similar position.  I prefer that we recognise and reaffirm the ability of the parent to make that call.

Is it just me or did anyone else take away from the briefing that we're responding to this 'race' by reducing the rate of vaccinations?? To come anywhere close to the dates and targets they set we'd have to slow down the rollout. By quite a lot. Would be done with first jab offers by very early July at current rates. Wtf?

Edit: Just noticed Mainwood has laid on a similar rant.

Ah, but it's accelerating the target...

In practice there is no meaningful change, the over 40s eight week gap was also a reannouncement. It's just convenient for Johnson that going for a 4 week delay happens to align with a date that he can claim is an acceleration of the vaccine schedule (giving a perception that he is trying everything he can to relax as early as sensible) but still be confident of meeting. Politics innit.

I think I disagree unless completion* of AZ means "slow down of rollout".

As ever, looking at the Scottish numbers. I assume the situation in England looks pretty similar.

Scotland 800,00 1st jabs still to do in ages 18-39 and 120,000 1st jabs per week in this age range so that takes about 7 weeks.  There won't be 100% uptake so completion two weeks earlier which is roughly 19-24 July. That assumes 18-39 uptake matches 86% uptake of age 40-49. 

I do not think the rate of vaccination of under 40's is due to slow down. I don't see any signs a change in supply or splurge of stock is required for all adults to be offered an appointment by 19th July. 

In the absence announcement that initial Pfizer 40M is fully delivered rather than the vague "on schedule" I don't think we have hard facts on deliveries relevant to ages 18-40. 

We do have facts on AZ/Pfizer/Moderna usage. Usage looks pretty steady suggesting the supply chain ending in people's arms is fairly consistent. My assumption is steady or slowly changing usage will continue until uptake is completed.

Scotland still has 560,000 2nd jabs to do for those who have had 1st jab in ages 40-64 and 170,00 weekly 2nd jabs per week in this age range so that takes about 3 weeks. 

The overall rate of vaccination WILL slow down before mid July because in chronological order

• AZ 1st vaccinations were completed about 6 June when youngest AZ age group (40-49) saturated at 86%. 
• 2nd jab vaccinations for ages 50-64 will be completed next week (21-27 June).
• At that point all AZ supply then available for 2nd jabs to the age group 40-49 allowing completion of their 2nd jabs by the week of 5-11 July. This is 4 weeks after their 1st jabs were completed on about 6th June so perhaps no need to delay for best immunological response.

None of that AZ is very relevant to ages 18-30 except that there will be free capacity in the whole vaccination system if Pfizer/Moderna supply improves.

*completed/completion means saturation of uptake tailing off over a week. It is a quick transition here when the NHS runs out of people to send appointment letters to.

I'm not convinced that reflects the whole UK picture. We should be able to hit those targets much sooner.

In other news: BBC declares Blackburn past its peak. Pinch of salt reached for by scientists.

In a couple of years, when it's part of the MMRC jab, I like to think we can expect this debate to murmur on at the level we're accumstomed to.

Genuine question here, but I often hear that allowing uncontained spread increases the chances of variants because the virus gets more chances to replicate. But at the same time, it would seem logical to me that by containing spread we are putting evolutionary pressure on the virus to mutate into a more transmissable form by keeping virus-free hosts ready for mutations that make it across. What is the optimum here?

Least virus.
Optimum way of getting there is vaccinate everybody in the world on the same day, so there's minimum chance for virus to be challenged against vaccine.

Yes I’ve been wondering that too.

Presumably we’ve put huge evolutionary pressure across the world on the virus to become as transmissible as possible, as variants that are so infectious they can can spread despite lockdown restrictions will clearly outcompete those that can’t.

That’s my very noddy view of it. I’m sure someone will be able to explain to me why I’m wrong.

Sat in vaccination centre after 2nd jab, it's good to see it's busy and a significantly younger throughput.

Catastrophic events are the optimal way to allow resistant strains to quickly become dominant as you eliminate all the competion. Vaccine resistant individuals would benefit hugely from a mass vaccination event! 

Vaccination will turn out to be a poor strategy for tackling Covid. The Delta-variant is already demonstrating the limitations, the Echo-variant will be resistant to double jabs. It's a never-ending story... 

90% or higher protection against hospitalisation for delta variant. That's the sort of poor strategy I can get behind!

https://www.bloomberg.com/news/articles/2021-06-14/delta-variant-doubles-ri...

Vaccination does appear to be a never ending story against flu.

Vaccination does not appear to be a never ending story against smallpox, measles, mumps, rubella and HPV.

the mutations that are causing concern are thought to have originated for the most part as a result of evolutionary pressure in single individuals with chronic infection. As such what matters the most is reducing the number of individuals infected.

Complete aside:
https://www.independent.co.uk/news/health/covid-vaccine-book-second-dose-b1...

I can vouch for this. It's a risk, because you have to cancel to see new appts, but I took it and just moved my 2nd jab forward by a month.

Edit to add: I'm <40

Get with the picture, Lambda is next up...

In all seriousness, all strategies in all countries without comprehensive vaccination are doomed to failure either sooner or later. The only questions are how much (and how) you try to keep a lid on infections in the meantime, somewhere on the spectrum from Bolsonaro to Ardern or Xi. Your argument about variants leads to a conclusion that it's better to keep a tighter lid on them and vaccinate faster so that you can cut down the number of opportunities for a vaccine-resistant variant to evolve before you have everyone vaccinated and hence can cut cases right down or prevent them reemerging easily. And, of course, that it's a good idea to spend money developing new vaccines that provoke a broader response. I'm not sure if that's what you intended.

I wish they would put some proper guidance out (edit: realistically I'm hoping they might do this for people in their 30s in a couple of weeks if the programme looks like it has sufficient Pfizer supplies at the right time, but we'll have to see). I'd like to rebook but currently my second dose is a few days before I'm due to go on holiday for a fortnight, so am loathe to cancel with any possibility I'd then get asked to go a week later.

Yeah. It's supremely annoying that you can't switch without cancelling. But I suppose if you could do that, everyone would be constantly doing that, which wouldn't help.

The guidance is still: wait to be contacted, but if you're over 40 and you want to, go ahead and do it through the website. Can't really complain too much about that.
I just agonised over should I shouldn't I for a few days then took a punt. There wasn't loads of choice of date but it was soon clear which weeks were moderna weeks at each centre; presumably the rarest of the lot.

Since my last post, 3 friends have done the same. One of them couldn't get the same place as they had but still got somewhere local. Still obviously wouldn't wholeheartedly recommend cancelling a good slot based on anecdotes on a climbing forum though. Even ones that claim n=4.

Current vaccines were designed in Jan(?) 2020 for the first published sequence.

I wonder if a vaccine designed for delta would be 100% effective against serious illness due to delta, like the current vaccines were so effective against the original covid during clinical trials.

We've a holiday booked in Northumberland mid July.   I'm not sure if my lot is easier or harder - guessing the trajectory of the virus followed by guessing the English government reaction vs the Scottish...

There's some discussion on another thread on GCSE maths examples with people taking different views on the importance of pure maths or of applying it; I find it much easier to garner "pure" maths insights once I'm actually doing something in an area and applying it.  I remain in awe of the theorists I know who look at something totally new and instantly map it back to the pure maths in their heads.  If I could go back and do it all again, I'd have tried a lot harder at picking up maths down a pure route.  

In reply to Richard Horn:

Worth keeping in mind: if we didn’t vaccinate and didn’t control cases, naturally induced immunity would rapidly appear following the massive wave of disease that would result, and so create the same sort of selective pressure for immune evading variants, but with a lot more chronic illness (often cited as a hotbed of variant generation) and a lot more healthcare overload and death.  So whilst there is a risk to progressive roll out, it’s tensioned against the risk of not having a vaccine; so if we don’t go for near elimination and very low daily cases through lockdown level control measures, vaccination is better than the accessible alternatives.

My take: Vaccinate as fast as possible; if progressive then by geographic region maintaining hard travel borders between vaccinated areas and areas with loss of control of cases.  Failing that, control measures to prevent cases from rising.  Failing that, vaccinate as fast as possible.

In reply to mcdif:

I flat out disagree.

The virus seems to get almost all its lethality from being totally unknown to the immune system of almost all people walking the planet before late 2019.  That’s why it has pandemic potential.  Variants don’t wipe out immunity, they weaken it; with spike protein based vaccines , variants seem to hit vaccine induced protection-agiinst-infection harder than protection-against-severe illness and protection-against-death.  A future varian will probably have less cross-immunity with existing vaccines but they will still make the virus much less dangerous.

The way I see it - vaccines aren't a strategy for tackling this disease.  The strategy is to move the disease  from pandemic to endemic status without breaking healthcare and killing a lot of people.  Vaccines are a tool that allow this process to happen much faster with a reduced level fo fall out.

Further tracking variants with vaccines is going to be a lot faster than initial vaccine production.

In reply to various:

I'm in to my 40s; I rebooked my second jab today and there were a plethora of locations and appointments available; I'll now be getting it 3 weeks earlier than previously booked, and 3x closer to boot.   

In reply to Longsufferingropeholder:

Did you see that Nick Triggle alluded to there likely being a stockpile of 5m AZ doses in the UK on a recent "Analysis" bit on the BBC News?

I did. I did see that. 

Also seen a lot of him popping up on Mainwood's twitterings, with clear evidence that they're talking directly. Shame Triggle isn't a climber, isn't it?

I updated the Lissajous figure for the North West and did one for Scotland as they seem to be leading the way.

The Scotland plot has 8 days of near-exponential growth in cases with no corresponding growth in hospitalisations.   The provisional window (not used in this analysis) is gong to change that, but this is highly encouraging.

I've wondered before if theres's been initial "bad" phases where the varian lands in communities that pose a higher than average risk of transmission and that have lower than average vaccine uptake; this sees a significant rise in hospitalisations following cases; then as the variant spreads out into less vulnerable areas the hospitalisations decrease with respect to cases.  As absolute numbers in the NW are currently still being driven by the early outbreak UTLAs, it the tighter coupling of cases and hospitalisation there seems to fit this hypothesis; assuming the outbreak areas now remain under control and other areas continue to rise, will the curves separate as for Scotland?

Still not breaking out the zombie day checklist at the Wintertree Bunker over the behaviour of cases.

That said, AZ production should be all for export from now on. We have enough on hand to finish the job. If we're still producing 2.x million doses a week in the UK we should start to see some going abroad imminently. If this presumption is correct we could expect it to be confirmed by a flag/willy waving press conference any day now.

Um.... What's a rough guess at lag from cases to hospitalisations?????

Incidentally just saw this: https://mobile.twitter.com/BristOliver/status/1404857813248118784

Conflicted. But in a completely moot way. I don't know which to believe and it makes no difference. It's entirely f*****d and I'm getting jab 2 asap.

About 8-12 days?  But it's very dependant on a whole bunch of factors and will change again with vaccination and with the variant I imagine... 

Perhaps I missed it, but what region is this for?  England I presume...

I've put the Lissajous for England in below.  If you project the current position forwards a couple of weeks, it ends up right on the curve for last time meaning the same cases/day and admissions/day.

I think this is because of how the variant is spreading in the initial outbreak areas, and that what follows is going to be quite different - as we're seeing with the blue Lissajous curve going almost horizontal.

If the England curve on this plot doesn't start to transition towards horizontal in the next week or so, that sets alarm bells ringing.  It has in Scotland which is ahead of the game, it hasn't in the North West. 

I'm pleased I've been able to re-book my jab earlier.  

The other factor to consider is the size of the susceptible pool - in all previous waves we've basically had exponential growth unconstrained by availability of people to infect.  Given the prevalence of antibodies across the population from two waves of infection and the vaccine program, and with both vaccination and infection (moderated by age or vaccination) ongoing that susceptible pool is small and shrining.  The stats released by government on vaccination status of hospital admission suggest quite strongly that this is a major factor.  I'm still positive about our trajectory, just so long as the blue and purple curves do some more separating soon for England...

Covid has been endemic since last year but most people are in denial and still hoping to 'wipe it out'. 

Bullshit.

Yes, you're right, his plot must be UK or England and that is dominated by the outbreaks in the places with prime conditions for outbreaks. Would be good to see more evidence of the divergence though.

I try not to think about the size of the susceptible pool. It's bigger than you want however you maths it.

The job of all the advisors and modellers and ultimately ministers is to reopen as soon as we can get away with, because that is the optimum strategy to balance all the shitty bad things against each other. So, essentially if we get to within a hair of completely banjaxed without crossing the line, then that was the right time to reopen and they've done their job well. So that's happening. Is it the right plan? I'm not doubting that. But it's not going to be pretty.

That's horseshit.

It's one of those dodgy accounts that pop up, spout shit and get banned.

What's unusual is that it's come along at the same time as another pop up account, both active on a couple of specific forums on here, and the other new entry has a certain «Je ne sais quois» to it.  

Bullshit, horseshit or trollshit?

I think it's a bit more cautious than that, I really do.  The susceptible pool is shrinking by a couple of million people a week through vaccination, and this is always pushing the virus mechanic further along its logistic curve and away from the phase resembling exponential growth.  In particular the most recent demographic shift is going to factor in to this quite a bit I think.  I don't think it's going to be pretty, but what choices are left now with the ever worsening R0 values?  Backed in to a bit of a corner.   

I think this is a case of it being better to get the >40s double-jabbed than a load of new <40s single jabbed and leave a load of >40s single-jabbed. The >40s are probably much more vulnerable, and the effects upon society of an >40 getting ill are worse than a <40 getting ill.

Not the point. It looks like to meet the targets they laid out, just, the total number of jabs per week would be way lower than it has been. If recent rates continue we would smash both. Easily.

I don’t see making the decision for yourself any different to making the decision for your child (they might have their own view as well of course, once old enough). If medical advice is to get vaccinated then people should do it. I mean should as in you should be a considerate driver vs you must drive on the left side of the road, if that helps to distinguish the semantics. 

Well there’s a surplus of AZ apparently so the over 40s can be accelerated. But there’s possibly a shortage of Pfizer for the younger age groups...

I’m no expert but by reducing social contact I think we primarily reduce opportunities for the virus to replicate and for variants to emerge. In theory a more infectious variant would have an advantage but that would always be the case. By keeping cases low, the chances of that variant emerging are lower and the chances of it spreading far and wide even if it’s more infectious are lower. 

Encouraging re hospitalisations but I have a sense of sitting on a  belay at the bottom of say Gogarth, watching a ferry going past nearby and thinking “wait for it...”.

If hospitalisations remain lowish (say low 100s per day), I suspect BoJo will go for an unlock on the 19th. At that point cases will explode (the unvaccinated plus the single jabbed plus the 20% of the double jabbed), or explode even further. The issue there is that with a full blown epidemic, it will percolate into the more vulnerable population and then hospitalisations will rise. The saving grace might be that cases are set to explode before the 19th anyway and BoJo might see sense even if hospitalisations remain lowish. We shall see. 

It’s been epidemic.

Given over 40 is AZ and under 40 is Pfizer / Moderna, I’m not sure it’s one or the other. 

Honoured to be thought of as special but actually was just hoping to find some fellow climbers on here 'plotting' some weekend action despite covid. Instead find myself in one of the internet's weirder rabbitholes having to explain basic evolutionary theory and getting slated for stating the bleeding obvious. I'll leave you to it! 

Yes, we can all see your numerous contributions to threads looking for climbing partners.

I wasn't looking for a climbing partner, just a bit of sanity! Ended up finding a bunch of people obsessing over graphs and playing with some borderline dangerous ideas about minorities. 

Not easy without the vaccine though.

https://www.telegraph.co.uk/news/2021/06/15/pfizer-shortage-could-derail-ju...

https://www.scotsman.com/news/politics/covid-scotland-health-secretary-warn...

https://www.standard.co.uk/news/uk/uk-coronavirus-latest-cases-pfizer-vacci...

https://www.birminghammail.co.uk/news/midlands-news/birmingham-city-council...

Is that you Rom?  Back to running two different accounts at the same time are we?  Playing both sides to get our kicks these days? 

For the record, I don't believe a single word you have said about why you are here.

Rather than making thinly veiled and rather unpleasant accusations you could come back and give a reasoned explanation as to why you think some of the analysis is either wrong or "dangerous".  That would hardly be your style though, would it?

This might not be the website for you

Doesn't hold up to any scrutiny though. Read some of this, save me typing it all out:

https://mobile.twitter.com/PaulMainwood/with_replies

I don't disagree with any of this. But my train of thought compared a guess at the size of the remaining susceptible population as it might be in a few weeks with the size it would need to be for us to have...... concerns. It's close. There are good reasons for that; like I say if we were comfortably far from any potential catastrophe then we'd pay a higher price in very many other ways. But.... Deep breaths (outdoors of course).

Good news story of the day:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/06/...

"Work is expected to be completed shortly so that patients that wish to rebook are able to check the level of appointment availability on the NBS before cancelling and rescheduling their existing second dose appointment."

Massive win if true.

Some new Lissajous plots with a few variables on them.

It's basic maths, but I had to resort to pen and paper to figure out the interpretation of these.

For a model where ....

• the x-axis (cases) are growing exponentially with time and rate constant k
• the y-axis (hospital measures or deaths) are growing with the same rate constant, a conversion ratio R (e.g. R=0.05 if 5% of cases become hospitalisations etc.) and a lag L from the cases

... the gradient of the line on the curve should be 1, and the vertical offset is log(R) - kL.  So, the difference in the vertical offset between two waves (purple and blue) tells us how much this factor changes.  The blue curve (recent wave) is below the purple curve (late summer 2020 wave) for all measures and all regions, telling us that the conversion rate is lower and/or the lag from becoming a case to hospitalisation/death is longer and/or the rate constant is lower.  We can separately measure the rate constant (from cases vs time) and broadly speaking it’s similar across the two time periods.

In the absence of longitudinal data on that lag, we're left a bit uncertain about the interpretation, but it seems reasonable to assume that the lag isn't much longer with the vaccine or the new variant.

I've fixed the aspect ratio of all the plots to be 1:1 (in log space).  

It makes little sense to consider the gradient when the plot transitions from a falling phase to a rising phase (e.g. hospital occupancy in England now), as the plot has to turn a corner from falling to rising, so the simple model used to guide interpretation isn't valid.

Looking beyond the corner turning, it's notable that some of the blue curves have a gradient < 1 (e.g. deaths in the NW) during their rising phase.  This tells us that the noddy model is not holding true, and that one or more of R, k and L are changing (only when the lag, L, is 0, would a change in k drop out of these plots, that thankfully does not apply).   Assuming that this is not down to the lag increasing this means things are getting better - demographic shifts, more vaccination, lower growth rates.  

My interpretation for the NW: 

• Admissions rates in the NW don't currently look much better than the last wave, unless the blue curve starts to bend over soon, it's going to be back to the same levels (per cases) as during parts of the last wave.  I'm still hoping it's going to tip over for reasons that've come up on here before.   If it doesn't tip over in a week or so, I think things start to look more serious
• Hospital occupancy however looks better, the blue curve has an offset further down than the purple.  This measure doesn't really fit the noddy model for interpretation as it's somewhat integrative, but there's about a 2.5x reduction in occupancy over the last wave in relative terms.   So, a bit of headroom but it only permits a bit over one more doubling time in cases before the limits are hit.
• Unless there's some unexpected reporting lag creeping in, the deaths rate is in decay - perhaps indicating a move from transmission rooted in less vaccinated areas to broader spread? - and is running with a ~20x reduction compared to the last wave.  Again, assuming this isn't a due to a change in lags it's really reassuring news.

Excellent! Like this analysis a lot.. re: hospital admissions, it’s worth pointing out that admission criteria are not static and will be in general a lower bar when services are less stretched. Therefore as cases fall, you’d expect the hospital admission rate to rise as less serious cases are more readily admitted as a precaution. 

Something causing me to worry more than I otherwise would about the hospital data is the data on people on mechanical ventilation. I can understand there is quite a big pool of 50 yos with a single dose or 30yos who have only just had their first still who are susceptible to infection and might get ill enough to visit hospital briefly if they are unlucky (edit, especially given Minimike's point above). But if the vaccine was doing it's job against severe disease and there wasn't some big change in severity, I struggle to see that many should need a ventilator. The population vulnerable to needing ventilators in large numbers should only be those in their 40s/50s or older who haven't got vaccinated at all. Yet according to this data (North West) the mechanical ventilator occupancy has doubled faster than total hospital occupancy over the last 3 weeks. I'm struggling to square that with a theory that it's all down to the populations in which greatest spread has occurred - especially because, as I showed a few weeks ago there was little correlation after the first fortnight in Bolton between case rates by MSOA and either deprivation, ethnicity or local vaccination rate. I don't think that can be the answer?

Edit to add image.

could be a coding issue - is being in a MV capable bed synonymous with being on a vent?

I'm reminded of German data early on that showed they had way better ICU admission outcomes than the UK - heavily influenced by the type of patient they could admit to an ICU....

I wouldn't rule it out for reasons I anecdotally asserted a few weeks ago, relating to the msoa boundaries being totally uncorrelated to the boundaries of ethnicity and deprivation around at least two of the places that start with B.

Since then we had that table of vaccination status of cases/hospitalisations in the voc report too. We'll know the answer to this particular question sooner than any of the others though.

Following on from your post; zooming out from the plots you did and looking at the ratio of occupancy at the least peak to occupancy now doesn't tell a reassuring story about ITU occupancy either for the North West.  

Thinking on minimike's post, there isn't the same pressure on ITUs now as during the last peak.  But...   Similar observation on looking at the early stage of rising cases late last summer where hospital occupancies were the same; ITU is higher this time.

The gap between the dashboard data and the answer is growing all the time frustratingly.  The key question is what fraction of the people going in to ITU have not been vaccinated, and their age distribution.  AFAIK neither of these are public domain except where there's a comment from a minister or released SAGE documents.  Comments from a few weeks ago were reassuring that the vaccination (or lack thereof) was involved, as does the technical report longsufferingropeholder mentions.  But, things can change...

Another facet of this - as with previous improvements to patient outcome, is that when people stop dying, occupancy can go up because they remain in hospital until they recover enough to leave ITU.   The numbers for the North West don't show deaths increasing with ITU occupancy or hospital occupancy.

It's all rather bamboozling.

In reply to Dr.S at work:

Part of it perhaps, but there seems to be a big change from last summer which doesn't fit with this.

Also it seems that, as a % of total admissions, there are now more younger people admitted and they are less likely to require prolonged treatment. Still, wintertree’s point about this ‘gain’ only ‘buying’ us one more cases doubling time gives pause for thought. 

The Covid guidance for Delta affected areas was updated on Tuesday. This seems to have had little publicity.  https://www.gov.uk/guidance/covid-19-coronavirus-restrictions-what-you-can-...  Scroll down to “If you’re in an area where the new COVID-19 variant (known as Delta) is spreading”. Couple of observations:

Most of the areas mentioned are in the NW but also Birmingham, Leicester, N Tyneside and Hounslow. For now.

Advice is to get vaccinated, do LFD tests, exercise caution meeting others and minimise travel. Sensible but I think the ship has sailed and reimposition of national restrictions will be next.

Personally I’m going to continue getting out climbing at weekends but for me this puts the nail in the coffin of a work lunch arranged for next week, which I already wasn’t sure about attending. A case of cutting out high risk stuff. The bit that’s tricky is that the climbing walls will probably stay open, whereas previously they got closed every time cases got totally out of control. I go when it’s quieter late in the evenings and having had two jabs the risk is somewhat reduced but still I imagine I might need to refrain at some point. 

Length of stays in hospital is shorter now. That's surely more true for non-ITU cases than the very sick ones. Though I'd be surprised if that wasn't already on your minds so that can't be all of it so I'll think it through more on the way to work and apologise for stating the obvious.

https://www.icnarc.org/DataServices/Attachments/Download/483d4e84-3fc5-eb11...

It's not everything but it's something

All fair points. The higher proportion of hospital occupants on mech vent now could also be partly explained simply because a high number of occupants previously were too old and frail to be put on mech vent, and most of those are now double vaccinated and less likely to be in hospital.

I agree we don't really have the data to understand the size of the problem. I wouldn't say this is something that makes me think the country has got the vaccine effect wrong, it just adds to my sense of concern until we have more real data the other way.

Meanwhile the population in which spread is occurring have mostly given up bothering about it. At the wall last night there must have been about 100 people under 30 crowded on the mats with no distancing efforts at all and no more than 1 in 20 of them wearing masks. Even with the ventilation going it felt like it was a super spreading nightmare waiting to happen. I tried to keep my distance and then left after an hour. This in an area with fast rising cases, already over 400 per 100k in that age group. I'll be cancelling my membership until I'm three weeks post my second jab.

Yes - a lot of people are really lowering their guards

It's a difficult thing to come to terms with but at some point we do need to start our new lives where this virus just is a thing. I'm not sure when I'll be ok with doing that, certainly not yet, but one day has to be the day. Is it 2 weeks after my second jab? Is it when cases drop below a certain number? (They won't, only going up from now on). Is it when Boris says so? (Nope). Is it when my workplace says so? Or is it when everyone I interact with is double jabbed? I don't know, but one day we have to pick a day to go back out into the world.

For me the answer is definitely not yet, but when is it?

Its pretty clear there will never be a light bulb moment when the risk from CV is over. I think people eventually need to get over worrying about dying of CV, and rather add it to the list of many reasons why they might die, none of which probably concerned them overly on a day to day basis too much before CV came along. For me we get to that point when CV deaths are not standing out above deaths from any of the other major causes of death, you might argue we have got past this point already, but you also might point out that this third wave may take us back again. After over a year I am happy to wait a couple more weeks to get more info on how far this third wave is going.

Many people I think aren’t worried about dying of it but about a very large number of people requiring healthcare in a short space of time, and of this breaking healthcare.  Healthcare is needed by a lot of people for a lot of reasons unrelated to coronavirus.

1.18 into this video is a useful graph for hospital admissions vs non jabbed/ single jabbed/ double jabbed. No age brackets mentioned so still not full info, but does give some indication

youtube.com/watch?v=l5v0ic-um7A&

Re: rebooking jabs and being able to see availability; that's a great and logical development and one that will I think address a concern that was holding a lot of people back from rebooking. I like to live dangerously so I cancelled mine a few days ago, worked out for the better in the end.

Great link, thanks.  

• Figure 14 is similar to Si dHs observations - the % of hospitalisaed patients in ITU has been rising since January; looking at this its now at about the same level as at the start of the outbreak suggesting this is partly down to people being more likely to be admitted in quiet times perhaps.  There's no sudden inflexion in this curve suggesting a change to the process, except perhaps in the last week....?
• Figure 23 - massive gender disparity that gets very little attention politically or from the media compared to other aspects of diversity
• Figure 24 - areas of deprivation are a massive factor in ITU admissions.  
• Figure 27 - I need to un-do some of the effects of lockdown sharpish  (BMI plot)
• Table 5 and 7 - breakdown of information on people ventilated (6) or requiring any respiratory support (8).  
  • A few people have asserted on here repeatedly and confidently that this is a disease only of the very old and those with other severe illnesses.  This always leant heavily on a misrepresentation of co-morbidity, with the accumulation of morbitidites being more or less a part of ageing.
  • Table 4 gives a mean age at admission of 58
  • These tables list "very severe comborbidities" and these are presenting in below 10% of patients.   

> For me the answer is definitely not yet, but when is it?

Make a plan to taper back to normality with some goals and a timeline?  For some people it's quite a difficult and agoraphobic experience going back to reality.

Great weather for outdoor socialising, and the risk of a transmission event between you and another in the group is lowered - greatly lowered if the other person has their second dose, and the risk to them if they do catch it is further lowered by the vaccine.   

Thoughts on probabilities etc.

• In terms of transmission between you and the people you socialise with, waiting for your second dose may not lower the risk, as we have rising prevalence to consider.  It's not to clear to me that the risk of transmission is ever going to get much lower, as we move to endemic circulation.  
• I feel that very soon I will have no role to play in slowing transmission - likely I don't already.
• Beyond that, if I'm going to catch the virus there's bugger all I can do about it now having children in school/nursery, so what will be will be - accepting more risk elsewhere in my life just brings that point forwards.
  •  In terms of personal health consequences for me, the risk was never that great and its lowered a lot by my first dose and by all the improvements learnt about and developed for covid care since the start.

Availability checker allegedly live now, but you still have to intrepidly click the 'cancel' button to see it. Sounds like that may change. (By the way this is from twitterers, which I don't take part in at all or even explore a lot; I never go more than 2 clicks away from Mainwood before I get disillusioned and retreat)

As for risk aversion (not just personal risk but the social responsibility feed in too) vs agoraphobia, and when to start living again, it's always going to be a spectrum. That said, going back to the wall in the next month would feel like taking part in a challenge trial. I've been ok without for 15 months now. I can wait til it's not a million degrees in there again.

I know my position, and I'm sure it'll change but I can't predict what will change it. Interested to hear the consensus on what events and parameters people will look to as markers.

We're only at the point of low deaths / case numbers because of the restrictions. Personally, as a 40-something I'm not particularly worried about death post-2nd vaccination, but I am concerned about long covid affecting my ability to earn money and support my family, and also run my scout troop.

Waiting a bit longer is the best thing we can all do.

The psychology of risk was always badly played by most, too many worry about trivia and miss elephants in the room. Even in climbing I've had lectures on being irresponsible from dealing with a reality of the solo game (yes it's a real extra risk I chose but all climbing choses risk) to the risk being so trivial it's plain dumb (idiots who think locking crabs are required on all belays). Yet serious risk in climbing from distraction when tying in or belaying to say not being prepared for likely weather change gets too often ignored. I can't remember the last time I went indoors to a roped venue and didn't see at least one example of terrible practice.

I saw negligible risk of meeting people socially outdoors even at the peak of the pandemic. I still obeyed the rules and nealy all the guideance but I won't be wearing hair shirts and not meeting people outdoors when allowed . Covid risks are almost all indoors with poor ventilation where households mix: I won't be going anywhere with any of that (unless I end up in hospital). Many people are not as lucky as I am: they have to use public transport and go to work in conditions that are less than ideal or are in bad health. Others have school age kids.  The biggest risks fall on multi-generational homes in deprived areas, with kids at school and adults in essential minimum wage work

One hidden scandal in this pandemic is almost no legal action has been taken against covid unsafe workplaces despite many thousands of complaints.

These percentages refer to Delta variant.

First dose of Pfizer-Biontech used for 18-40 offers 94% protection against hospitalisation so offering 1 jab to all adults before opening up further on 19th July looms like a very good strategy provided that first dose is Pfizer-Biontech. Second Pfizer-Biontech jab takes protection to 96%.

Oxford/AstraZeneca first jab has 71% protection against hospitalisation so that really needs the second jab (92% protection against hospitalisation).

https://www.theguardian.com/world/2021/jun/15/the-covid-delta-variant-how-e....

Enforcement action would be more useful than prosecutions.

Enforcement action like removing every closable ventilator window from every bus.

I'm not clear on how what these oft-quoted percentages actually mean? Does this assumption take into account the exponentially falling likelihood of severe disease with age?

It may well that AZ protection is perfectly adequate to keep hospitalisations down enough after unlocking - I guess those modelling this have a pretty good idea.

I think yes because it's based on comparing hospitalisations now with vaccination status rather than hospitalisations now with hospitalisations last year when elderly were unvaccinated.

I certainly hope that is correct.

I think it needs both. Problem is those who inspect and enforce were stretched  pre pandemic thanks to austerity and with covid absences incapable of doing what they would like. Money was there....it was OK to bung billions on test and trace.

I am not too clear on your meaning. What I am asking is does "70%" effectiveness mean, across a large cohort you see a 70% reduction in hospitalisations over an equivalent vaccinated cohort?

Another general question I have is whether there is data whether the effectiveness of the vaccine changes with age (after all the disease it treats has a distinct age based profile). It may be vaccines are more effective in younger people (or vice versa).

Thanks. For anyone else who wants to see the actual paper (and supplementary data) rather than the Guardian's summary, it's here:

https://khub.net/web/phe-national/public-library/-/document_library/v2WsRK3...

It's a preprint using fairly small numbers and there are big uncertainty bands still, but very encouraging. The central estimates of efficacy against severe disease are actually very slightly better for Delta than for Alpha, after both 1 and 2 doses.

It also explains what the figures mean and what was taken into account (for Hardonicus' benefit.)

yes

Another 2m mRNA doses coming this week according to EU export requests. 

Supply problems my arse.

Based on Scottish usage, that's about how much is needed this week.

Yep. Same as normal. Supply problems my arse.

Yes, Same as normal.

No sign we're responding to this 'race' by reducing the rate of vaccinations.

No sign that anything other than running out of people to vaccinate will reduce rate of vaccinations. 

This is all true, at least if you live in England and booked your first dose online. There are a few pitfalls though. For example, it only shows you the next few available appointments at the site you have booked already and with the right vaccine. But if those are too early (ie before 8 weeks post your second dose - this was the case for me), then apparently if you cancel and try to rebook you won't be able to access those appointments, and you might end up with nothing. It's worth people looking at this Twitter thread before going ahead:

https://mobile.twitter.com/fordie/status/1405281727761711109

For me, I had decided to start getting back to normal (had a meal out, going to the wall) after 1 dose while rates are fairly low. Now rates round here are rocketing up again I'll be more cautious until after I've had my second dose + 2-3 weeks. After that, I think I'll just go back to complete normality (within restrictions that exist) unless I'm planning to see a relative who is still nervous or another variant comes along. And I'll probably take some LFTs. But like you, this will probably change.

Yes, worth knowing it is incredibly picky about the 8 weeks thing. So picky in fact that although it was clear that the venue was configured for the style of appointment I needed for the whole week, it would only let me book Tuesday AM onwards, and only from 8:50 onwards. (My 1st appt was 8:30 on a Tuesday). I'll be sure to ask my white cells to make the most of the extra 20 mins.

Yes, another of the Zoe study videos talks about this. Tim Spector is another of my main sources of information alongside Wintertree!

I don't think they have put a percentage on it (maybe not enough data yet for that?) but he says that those more susceptible to severe covid also see a lower immune response to the vaccine. 

Edit: here's the link

youtube.com/watch?v=08XKlIDwjXI&

Little known fact about me; surname is Smersh.

Death to spies?! 

Item on BBC News this evening, looking at the timeline of the Indian variant, and the government failings that allowed it to get an early hold.

I didn't spot a single point that hadn't been made on these threads, at the time. Pretty depressing that we could see it coming, but those in power failed to act in a timely manner, again...

Well then it won't take until mid July to meet these new 'challenging' targets.

As ever, the answer is 'it depends'. For a start, it depends on what's important for you in your life. It also depends on your personal risk profile (age, health, vaccination status and so on), as well as your level of risk aversion. Thus the answer will be different for everyone.

As a climber, I like to think that I understand physical risk. I've been in plenty of situations where falling off would have resulted in broken legs or even death, particularly in winter and in the Alps. Sadly, I know several people who have died in climbing accidents. Unfortunately injury and death are never too far away in climbing and we have to think about it. As we all know, it's about assessing, mitigating, managing and avoiding risks. Sometimes you mitigate risks to an acceptable level, which will be a function of difficulty + objective danger vs skill + experience. Sometimes you can avoid a risk altogether. Sometimes you just have to say no.

With Covid, you can't rely on some kind of skill and experience. All you can do is mitigate (vaccine, masks, SD, going somewhere at quiet times) or avoid altogether. The way I see it, I will mitigate as far as possible but if I can avoid a risk altogether without a significant impact on my life, I might as well do it. Going to the pub / restaurant falls in that category for me - I hardly ever do it anyway... Going to the wall is going to be harder to give up but I might need to for a few weeks, depending on how bad cases get locally (even though I'm on day 10 post 2nd jab). I'm not going to give up on climbing trips though as the risk of infection / spread is pretty low (outdoors, only one other person, all climbing partners at least single jabbed). Not planning to go back to the office any time soon either. I've been saying all year that it won't be before September but, the way things are going and given the risk of new variants, I reckon I might be WFH till next summer.

As a healthy, double jabbed 40 year old, my chances of dying from Covid are close to zero in the scheme of things and my chances of ending up in hospital are pretty low. What concerns me more is long Covid and the fact that we don't know what the long term consequences of even a mild infection might be (could it be like glandular fever, lying dormant in your system for years, ready to strike you down one day?). I just don't want to get Covid at all because I can't risk it impacting my health and fitness, which could prevent me from going climbing!

You'll be pleased to know I heard on the news this morning that vaccination reduces risk of long covid by either a)1/3rd, or b)down to 1/3rd (wasn't listening properly).

It must be a bit early to assess this with the delta variant?

Anyone know what's going on in Cornwall....numbers up 800% in a week? Is this a big school outbreak? Seems to centre on St Ives and the region around Falmouth

Cornwall cases all seem to be concentrated in 15-35 age bands, there's not much going on in school ages.

There are lots of places outside the north west (albeit mostly cities) seeing rises over 100% in the last week. Combination of pubs opening and delta spread I would guess.

Cornwall was quite late to start rising under “Kent” and then rocketed when it did eventually land; same sort of thing happening now with numbers makes me wonder if their relative isolation is a factor, perhaps creating some slack for more personal control measures, until the isolation fails…

In reply to Kirsten:

The protest groups? I don’t know how many are local vs travelled in from elsewhere.  I can imagine the hospitality, security & media components have a lot of people moving in from out of area for a while.  

 I can imagine the hospitality, security & media components have a lot of people moving in from out of area for a while.  

yup… we sent at least 20 people in the latter category

I think that is a dangerous way to look at it.   There's an implicit and false assumption you will only catch it once.

If immunity following infection only lasts for 6 months to a year and if there's enough of this stuff in circulation that the prevalent strain changes every 3 to 6 months the end result of 'back to normal'  could be people who need to get out and about catching it every year or twice a year.   

It's one thing to 'take it on the chin' once but if it keeps coming back every few months and punching you again until it eventually gets you that is quite different and you've got to be more careful about not getting punched.