UKH

Post 1 - Four Nation (Cases)

We can see all the home nations turning to rapidly rising cases, as omicron takes over driving the top level everywhere.  Plot 9x makes it clear that Scotland and England turned to top level growth first, then Wales and finally Northern Ireland.

This is all very preliminary but In terms of omicron, my view of the early science coming out is that…

• Accounting for immunity levels, omicron is looking about as lethal as delta, maybe a little bit less. 
  • This is pretty good news, as controlling for immunity and therapeutic advances, each successive variant had been getting a fair bit more lethal until now...
• Omicron is infecting a lot of people on exposure who wouldn’t have caught delta on exposure.
  • This is generating a lot of mild infections and so dividing (severity of infection) over (number of cases) is giving a much lower number; be it judging severity by hospitalisation or death.  
  • This is bad news in the sense that a bunch more people are now spreading omicron to those who were going to have a bad time under delta, and who will have a similarly bad time under omicron.    
  • It’s good news when looking at skyrocketing case numbers - these hopefully won’t produce comparable hospitalisations to what we’d see under comparable levels of delta, because now so many people are so immune it’s almost water of a duck’s back for them, and they’re increasing the denominator in CHR and CFR calculations.  But critically, we wouldn't have seen such levels of delta.
• So, the severity for healthcare of the acceleration of events by omicron is determined by the size of (a) the ever-shrinking pool of people with no immunity to any variant and (b) the pool of people who have some immunity but would have had a poor outcome in terms of delta.  I’m pretty optimistic about this especially with the amazing up-tick in 3rd dose rate which should make a major difference to group (b), and increasingly over the last two weeks of data I think it hints we were really close to the end of the exit wave from delta meaning group (a) was close to empty.  Perhaps we are in about as good a position as we can be immunologically; but we pay for those months of achieving this in terms of exhaustion levels across healthcare.  

On the healthcare front, I’m wondering how much I have to rescale my ambitions in life enough to be able to buy everyone in the NHS a pint…. If it’s brewed by a charity for the purpose and given away, can I avoid the excise?  Seems like a good reason to get in to micro-brewing now the fad is passing and kit must be going cheap…. I always fancied a job in quality control....

Merry Christmas to all!  I hope it's a better one than last year, and I hope it's going to usher in a belter of a spring.

Links to previous thread:

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_57-...

https://www.ukhillwalking.com/forums/off_belay/covid_plotting_57_continued-742...

Post 2 - Four Nation (Hospital Occupancy)

On the healthcare front, I’ve trimmed back the England plots today as I’ve other things to be doing; but here are the hospital occupancy plots for the home nations; England and Scotland have turned to rising; in England this is mostly driven by London - for now.  A quick glance at breakdowns for Scotland suggests cases are largely growing in urban areas; omicron definitely looks to have an affinity for cities.

One thing becoming increasingly clear is that Scotland has had hospital occupancy falling for much longer than other nations - despite similar case levels.  A complex issue I think related to demographics.  I've put some recent CFR estimates on below; these were quite noisy when cases were lower, but from August to October or so, about 2x as many detected cases were dying in Scotland as in England; their centre of infection was older than in England, and so outcomes were worse. That has been coming to an end, which involves the demographics becoming younger - with rising cases in the young masking the fall in the old from cases, but not from hospital occupancy and deaths.   This is why I don't consider the last few months of reasonably constant case levels to be anywhere near "steady state" because a lot was going on under the surface.

Post 3 - London

London is leading the way with Omicron, so it’s worth diving in to the data there first.

A look at the time-series data for a few ages in London shows how bonkers it was in young adults, doubling close to every 3 days at peak; now the young adult rate constant is collapsing towards decay.  I suspect this is a bunch of different factors including the WFH move, the end of Christmas party season, the wave of precautionary cancellations, ongoing 3rd doses now landing in these ages (already embodied in older adults), and a massive round of immunogenicity given the sheer scale of infections.

The most recent time-slice of the rate constants (red curve) shows that cases are now doubling faster in adults around retirement age, around every 4-5 days.  As the centre of infections starts to shift to these older ages, we’d expect to see hospital admissions rising despite top level cases for London falling given the collapse of the truely bonkers young-people spike.  A look at the rate constants for London on plot 18 seems to support this.

As some of those older cases were no doubt downstream from young adults (I could just about convince myself I could see casualty children > parents > grandparents following some school peaks and troughs in plots D1.c) hopefully the collapsing cases in the younger removes some pressure from the older.

Big wildcard over Christmas, obviously.  Compounded by a 2 to 4 day reporting blackout and an expectation of reduced testing over the 4-day weekend as well as reporting lags.  I don’t really expect cases data to be “sane” again for another couple of weeks.

Post 4 - England excluding London

To get an idea how the regions are following London, I've done the same plots but for "rEngland" - which is the English cases data after subtracting the London cases data.

The curves on plot 18 make it clear the regions aren't homogenous, with the North West being the closest to London.

• Fastest and most sustained doubling time on cases after London
• The fastest and most sustained doubling time on hospitalisations after London

Still, lumping them all together gives a way to look at what's happening outside of London.  

• The time-series plots show that the slackening of of growth (longer doubling times) set in a day later than London in younger adults; to me this suggests that we had an immunological barrier from infection building up in London before nationwide measures and precaution kicked in; other interpretations are available such as much more buzz and impact locally from the developments moderating behaviour sooner.
• As with London, we're not (yet?) seeing the doubling time for older ages back off.
• We seem to be heading for around a 7-day doubling time across the board.

Living up north, I'm quite grateful to be feeling the benefit of the increased precaution driven in large part by the explosion in London whilst benefiting from lower absolute prevalence and lower growth rates.  This all feels towards the optimistic side of the range of what was being considered very early on.

Post 5 - ONS Infection Survey Data

I know a few people have said they’re looking to the ONS data now for various reasons.  It's given me the incentive to get back on top of looking at that data.

I’ve made a plot of the ONS data of people with live Covid infections and of new cases data from the dashboard.  The distinction here is that new cases are detected some time after infection occurs with a narrow distribution of times (perhaps between 1 and 3 days), where-as the live Covid infections are detectible over a broader range of time post infection (perhaps between 1 and 10 days or so.  I haven’t looked for sources for those numbers, and I expect they may well change with the new variant.)

The second plot shows the rate constants for both data sets.  One plot is raw values measured by the week-on-week method, and the other puts both rate constants through a 19-day, 2nd order polynomial filter.  This filter smooths the curves to reduce noise and erode the sharp edges in the ONS data which can be considered a kind of quantisation noise; I find this makes the curves easier to compare; others may vigorously disagree.  The filter also rings and introduces false wobbles on the ONS data.  I picked this filter as it’s the high pass (noise rejection) filter that gives the best correlation in the weather analysis when tuning it with 2nd order filers; and higher frequency data (seen on the LMH plots) looks pretty much like noise not signal.   (I should probably find the comparable 1st order filter and use that instead).

I have time-shifted the ONS data left by 3 days on both plots.  This was done to maximise the strength of correlation between the two rate constant data sets (the R value).  If minimike is wondering, I get 5 days without SG filtering the rate constants.  The sweep of time-offset vs R value is really interesting, very asymmetric and perhaps someone smarter than me can figure out how the different distributions of new case detection and live infection detection kernels encode in to it without resorting to a simulation…  There’s epidemiology in that there data…. (Probably much easier to look for it in a correlation of raw cases than the rate constants).

The next couple of weeks of ONS data are going to be interesting; I’m not sure how messed up it will get over the Christmas period.

There's pretty good concordance between the datasets; the ratio between them changes between alpha and delta; can't say from this data how much is down to reduced infection:case detection ratios and how much is down to an increased period with live virus present under delta.  Someone may have literature to hand on the later.  We reasonably expect fewer infections to be symptomatically detected in the era of the delta wave because the increase in immunity from alpha wave (garnered through both infection and vaccination) will render a larger fraction of infections symptom free.

I was going to finish with a couple of Europe plots, but I think it's nice to close out this Christmas Eve thread on a tentatively positive note; we watch hospitalisation and occupancy as cases move in to older adults - perhaps there is an up-tick in London intensive care occupancy corresponding to the rising number of hospitalisations as the older demographic lands (plot 22L, below) - and I haven't the foggiest what the case will be by the time ministers meet to discuss restrictions next week.  I'm hoping one of the antivirals coming online gets re-branded as "Deus Ex" based on its effects; that would be good for the UK and about 8x more important for much of Europe I think.  

A happy christmas to you аnd yours. I’ll be reading this when I’m meant to be working tomorrow! 

Thank you - a merry Christmas to you and yours as well.  I’m going to try and do most of the kitchen work tonight, start tomorrow with a spotless kitchen and everything ready to go….   

The temptation to slack off and have a festive screening of Die Hard is however calling me.

We’ve seen the odds of a white Christmas here tanking since plotting #57 but it smelt back on the cards when I went to get some firewood half and hour ago.  Weather warning for Boxing Day…

A merry Christmas, wintertree, to you and youra and to all who contribute to these threads in good faith; I say little but read avidly, and these threads have been a major source of sanity for me in this last year. Wishing everyone a cosy Christmas with appropriate refreshment.

Thanks for keeping the flag flying. London hospitalisations are indeed starting to take off - let’s hope the growth drops off in the same way as for cases. 

Merry Christmas!

Merry Xmas. Hope you have a great one. Thanks as ever

Yup, was just reading: 

NHS leaders alarmed by rise in hospital admissions as Covid cases hit record:

https://www.theguardian.com/world/2021/dec/24/uk-hits-new-covid-record-agai...

Merry Xmas WT and all. Thanks. 

Latest modelling

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

Interesting that they’ve only modelled step 2 measures.

The numbers seem hard to believe but it’s a classic case of ‘if you wait long enough to find out, it’s already going to be too late’. Having said that, people are definitely moderating behaviour and January is relatively quiet for hospitality anyway. I don’t know to what extent his has been factored into the modelling. I do feel sorry for the bars and restaurants here in central Brum and generally - it’s been very quiet over the last week and they’re getting hardly any support. A kind of Zombie lockdown. Rishi should just get his cheque book out again.

Thoughts on this?

https://nitter.pussthecat.org/i/status/1474453515883974659

It's a long one, but interesting plot twist at the end

Pretty much where we've arrived at I think.  Couple of comments:

 For example in London, cases in younger people have been falling sharply recently, but cases in older people have been rising and may only now have reached their peak (that's if we're lucky)

• Before the data blackout, I saw no sign that growth rates, let alone cases, in older adults had peaked in London.  Perhaps rates had but we hadn't got to the point of seeing the rate constant fall; Ceases clearly have not peaked and likely have at minimum 5 more days of growth locked in.  

I agree that we're likely to see London hospital admissions rise as the changing demographic in London cases lands.

Generation time and speed of collapse of omicron in the SGTF data?

I don't think they heed the caveats that should be applied to the SGTF data enough.  They're not the first to moot a shorter generation time as a characteristic of this, and it fits with both the bonkers doubling times and the rapid efficacy of control measures they think they see.

If I wanted to poke holes in this, the phenomenology that very high doubling times (~3 days or a rate constant of 0.25 / day back in pre-vaccination, pre-delta era) were common at the start of local outbreaks when absolute cases were low, always moderating as cases rose.  I did a plot ages ago on this and have found it in the archives [1].

Assuming that phenomenology still holds, there's no need to invoke the generation time argument to the backing off of the rate constant.  Most of this "auto-moderation" in the linked plot occurred with no changes in policy tightening control measures, and with no concerted media campaign on a new variant, and no wave of workplace closures for Christmas, and no total closure of schools for Christmas, and no crazy-fast vaccine roll out .  All of which are going to send rate constants even more negative in a short space of time.  If all that kicked in just as the phenomenological "auto-moderation" kicked in...

As they say on the link you posted, it's likely we're going in to the holidays with a lot of potential for spread still there in the population.  I like their terminology of "unwinding" it, and that is likely to pose a challenge.  I think in effect we're getting a fuzzy-edged firebreak without having to actually lock people down, and it's going to give some much needed time for hospitalisation and fatality rates to be better evaluated.

The different changes to rate constant for omicron and delta they hi light could be support for the generation time there, or they could be related to the different demographics as driven far apart by the recent growth patterns.

Be very interesting if they are on to something... Interesting iIn a good/bad way depending on what kind of phase we're in...

[1] https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_5-7...

It's not the first mention of shorter generation time I've seen. And it's something I'm quite keen to believe because it would explain a lot of the difficult to explains all at once. It not the only explanation for any of them (except possibly the hitting of a wall in Gauteng. That turned off way too fast for me to be convinced by most other postulates), but it's a really convenient "ohhhhh ok" if it turns out to be for real.

I agree with the reversal of cases in SA being unusual. Their hospitalisation signal is now slackening of growth as well.

I don't think the data can rule it out, but it can't prove it either.  Hopefully there's going to be a lot of stuff coming out in the submissions to SAGE and elsewhere in the next couple of weeks.

If you're looking for another mystery, it seems strange to me that Omicron isn't showing in the (very low) top level data for India yet.  It is rising to prominence in their sequences.  Late starter, or something else going on?

India doesn't make sense right now. Tests, positivity, cases all going an inexplicable way. All numbers small enough to be dominated by noise or selection/corruption biases though tbh. 

Yup.  In other news I was reading the Imperial paper.  One interesting part:

Most intriguing is an apparent difference between those who received AstraZenca (AZ) vaccine versus Pfizer or Moderna (PF/MD) for their primary series (doses 1 and 2). Hazard ratios for hospital attendance with Omicron for those who received PF/MD as their primary vaccination schedule are similar to those seen for Delta in those vaccination categories, while Omicron hazard ratios are generally lower than for Delta for those who received AZ as their primary vaccination. Given the limited samples sizes to date, we caution about over-interpreting these trends, but they are compatible with previous findings that while protection afforded against mild infection from AZ was substantially reduced with the emergence of Delta, protection against more severe outcomes was sustained (2,3). 

So, the "old technology" (as some would call it) of infecting someone with live viruses might just be more immunogenic against T-cells (the source of enduring protection abasing severe illness against a background of genetic changes in the virus) than the "new technology" approach of a non-adjuvanted introduction of mRNA in a synthetic capsule that doesn't look much like a virus and that omits some of the translational steps of a real virus?

Well, that would be embarrassing if I'd spent the last 9 months consistently insisting AZ is a "worse" vaccine than the mRNA ones because it's "old tech" and the mRNA ones are "new tech" and are better, relying only on antibody data and wilfully misrepresented YCS data to make my case.

Of course, this is just another piece of weakly supporting evidence and the authors caution against over-interpreting them.

Still, one would almost think there's something to be said about using billion year old technology to introduce the antigen - perhaps the human body has honed the way its immune system works against it....  It does also raise the question of what would happen if an mRNA virus was adjuvanted for whatever the missing factors are.

With you on that.

I can see two interpretations though. Mine was that PF edged out a lead in the delta round, by taking less of a dip, but AZ is back in the game against omicron.

Fits with the simplistic but ideal explanation that omicron is from the opposite side of the family tree from alpha/delta. 

Yes, I can take that other interpretation as a possibility.

'tis a shame it comes with the certain side effect of congenital penoscrotal fusion though. Inconvenient, that.

It comes with what now...?

Well, it's that or micropenis...

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

Unless of course we consider that the YCS data is a raw, uncontrolled aggregation of reports submitted by un-authenticated members of the public, hence the rider the scheme puts front and centre on the cover page.

A report of a suspected ADR to the Yellow Card scheme does not necessarily mean that it was caused by the vaccine, only that the reporter has a suspicion it may have. Underlying or previously undiagnosed illness unrelated to vaccination can also be factors in such reports. The relative number and nature of reports should therefore not be used to compare the safety of the different vaccines.

Still clutching at straws on AZ when every government in developed countries have ditched it?

The YCS data was for some symptoms different by factors of 5 or 10 between AZ and Pfizer.  Even the UK government thought the symptom with a factor of 10 was enough to put a warning on.  If you want to argue against that stop talking sh*t about generic disclaimers and find some difference between the populations which got Pfizer and AZ which could explain it.   There's no reason why two completely different vaccine technologies should have identical side effects and it turns out they don't.

Sometimes you should just give it a rest.  You lost one.  Move on.

A useful mask article:

https://www.theguardian.com/commentisfree/2021/dec/27/best-masks-covid-test...

My "citation needed" stamp has run out of ink.

There's been a few good papers (and some really bad ones) come out recently, so it's absolutely inexf***ingcusable.

I suspect that's downstream of a paper Bruxist posted elsewhere a week or so ago - https://www.ukhillwalking.com/forums/off_belay/mask_for_public_transport-74232...

In reply to thread:

The data blackout is over. I've only got time today to run off an updated plot 18; this runs up to Dec 24th; expect the data to be pretty messed up (especially cases) for the 4 days after this.  Some observations:

• London cases are now in decay; I suspect this is decay from very large numbers in young adults masking continued rise in older adults, but I haven't looked.
• Hospitalisations have landed in all regions now.  They're rising in all regions with doubling times of between about 10 and 48 days - so much more moderate than the rise in cases, presumably reflecting the stronger growth of infection in younger adults.  
  • The doubling times look to be getting worse (sorter) in all regions outside of London.
• So far, deaths aren't rising anywhere; it'll be interesting to see how the mix of vaccinated / unvaccinated going in to hospital changes, I think we must have been very close to running out of the later when this landed given the way delta seemed to be wrapping up.
• No sign of the much mooted 2-day doubling times some were using to suggest we'd have 1000x the number of cases by New Year's...  

Edit: in reply to longsufferingropeholder; I suspect it's the paper Bruxist shared that I've re-linked above.  In other news, the BBC today have managed to quality reporting on Omicron's lower severity to note that increased immunity is a big factor in this.  

Curfew announced in Delhi. Points to a disconnect between reality and the data we're seeing.

I did wonder about what primer and probe sequences they're using, but haven't found a canonical reference...

I'm not sure what you're getting at. Offwidth linked to a newspaper article by a guy who has been researching masks and posting YouTube videos on the topic. The article contained a link to the YouTube channel. He also linked a few other studies within the article. What's the problem? I actually thought it was quite a good article. It's well intentioned and if it encourages a few people to get a better mask then it can't do any harm.

Fully agree with your last sentence. And I'm not disputing the message. My problem is that a national had the option of peer reviewed journal articles but went with that most virtuous of institutions, a YouTube channel.

Also "high-performance masks provide significant protection to the wearer at levels that are between five and 10 times that of a cloth mask" not unreasonable, but where's that stat come from? And "A typical cloth mask, while better than nothing, only provides around 30-60% protection to the wearer. Surgical masks, while better at 40-80%...." Again, citation? It's just lazy/shit journalism.

Thanks for the update.

looking increasingly like we might get away with this one 🤞🤞🤞

We went all in based on Omicron being a cold with no plan B. 

I’m so pleased and relieved to see we might not be covid fodder yet again that I can even put up with the inevitable public broadcast from our intrepid leader claiming the gift of foresight.🙈 
 

Quite a while ago I wondered about some of the attention failings of AZ were getting. The AZ economic model is at odds with the bulk of the industry, and I can't see it being that welcome. It did go through my mind that the AZ vaccine might be getting a lot of extra attention. This would be quite easy to be seen as  objective studies. Obviously there are differences, failings and some different (rare) toxicities but these could be pulled out quicker, more critically appraised etc (and that even seemed to extend to the FDA).

Not sure if this is sliding into a world of conspiracy, or just a thought we need to keep in mind.

You certainly wouldn't be the first to suggest the unusual economic model of the Oxford/AZ vaccine has had an impact behind the scenes.  It's a discussion I've had offline with a couple of people well placed to comment.

Currently a lot of Europe is facing significant lockdown because of far too much vaccine skepticism and refusal.  It's almost a year since Macron jumped on the non-scientific, anti-AZ bandwagon and called the vaccine was vaccine "quasi-ineffective" for over-65s.  It seems to me like this nonsense statement furthered the general anti-vaccination sentiment in his population as much as it did steer people away from the AZ vaccine.  It was astonishing to see a top level politician coming out with self-defeating nonsense against the vaccine so rapidly.  Of course, our resident ever-returning troll, then known as "Alyson30", was all over the subject like a rash as well.  Someone else was too, can't quite remember who.

Not exactly related, but not 100% unrelated either in terms of what it speaks to:

https://en.wikipedia.org/wiki/List_of_largest_pharmaceutical_settlements

Take a reckless gamble enough times and eventually it pays off, and this is by far the least reckless of the gambles too date...  Just prepare yourself for the triumphant, pound shop Churchill speech if it all pans out.

Still, far from clear we're going to avoid a lockdown...  Only time and more data will tell I think.

Updated D1.c plot for London below.  

• There's enough blue to darn a sailor's trousers on the lower right of the rate constant heatmap - meaning cases in ages 20 to 35 are in decay.  
• It might even be the case that ages up to 65 are queuing up to successively turning to decay as the diagonal of changing colour moves up and right through the ages from the blue patch - that'll be obscured by the festive 4-day weekend sampling madness.  
  • If they go in to decay, that's great news as that's where most remaining zero-immunity vaccine refusers likely to go to hospital are.
• The provisionally bad news is growth is looking more set in in ages 70+; most of this will be post 3-doses infection and it's going to take another week or so (I'd guess) for the hospitalisation rate of infections in old-but-well-vaccinated individuals to be determined.  

Good guess! It is indeed - plus a few others. LSRH: let me jump to Aaron's defence (if not the Guardian's), if you will...

He's been doing the testing himself, importing KN95 and KF94 masks from South Korea, Hong Kong, and China, and testing them against NIOSH-approved USA-made masks and FFP-rated EU-made ones. He's not a journalist, and I agree he's been not well served by whoever at the Guardian should have edited it, but then I think it's clear that they don't have the expertise to do so. The stats he's cited in the article are those from his own tests - the public spreadsheet is here: https://docs.google.com/spreadsheets/d/1M0mdNLpTWEGcluK6hh5LjjcFixwmOG853Ff... - but now that there are studies like those from the Max Planck coming out to reinforce the validity of the stats (and now that WHO have acknowledged the primary mode of transmission as airborne and openly advised use of respirators), it seems the press is finally paying attention.

The place we (I contribute to this too) hash out issues over validation of certification, testing, and offer public advice on how to obtain, fit testing etc is another forum, r/masksforall, on Reddit, though that's slackened off a bit since most of the academics headed for Twitter instead. Making noise on Twitter seems to get journos' attention a bit more. They might mangle the message but, given UK Gov's resolute faithfulness to its long-outdated guidance on 'face coverings' and a compliant press, I'm surprised to see anything in the UK press at all.

Coming back to our discussion from the last thread about the rapid change in the situation with the spread of omicron; one more factor to add to the list of things that all seem to have come together at once...

Apart from a brief cold and snowy spell on Boxing Day, the cold spell forecast for the Christmas weekend didn't materialise.  The latest weather passband plot shows recent temperatures as more positive than the local average, and a correspondingly more negative rate constant compared to the local average.

Several of these factors coming together to reduce the rate of growth aren't going to last..  But they keep a lid on things whilst the hospitalisation rates for older, double and tippled vaccinated adults are measured and whilst 3rd doses continue flowing at pace.

The other notable thing is an approximate doubling in first dose rates in the run-up to Christmas; I don't know how much was down to a perception of increased risk over Omicron and how much was down to the rising number of vaccination sites lowering the barrier for accessing them for people with scant free time or travel opportunities.  Regardless, I thought it was really good to see. 

Agreed. Bloody freezing on the tops today though. That said, n=1 reports of seeing lot of people out for a walk. All bets off for Christmas.

I think it’s still a bit early to really tell. The growth in cases among older age groups hasn’t yet had a chance to land in hospitalisations and occupancy. Let’s see what it’s looking like in 2 weeks’ time.

Indeed, although I don’t think a full lockdown is likely. We could however see stage 2 or stage 3 type measures. 

Re masks, waiting around outside the local big supermarket in London, almost everyone going in /out was wearing one, but I was surprised by how few cloth masks there were, mostly surgical or FFP2. Think Omicron has spooked people (thought the same when I saw the first jab uptake tick up too) 

Hilarious Pearson vs Ward twitter thread.... (warning note:  this is the view of a Guardian reader, so inadvertent mouth frothing may ensue.... wear that mask! )

https://twitter.com/JamesWard73/status/1473964874535419909?s=20

Unless I’m missing something it’s a set of posts from someone called Roby who is a doctor both medical and scientific and who goes through the lethality of omicron and thinks it looks likely it’s more intrinsically lethal than it’s ancestors, it’s mostly appearing less lethal due to its ability to re/breakthrough infect highly immune people and that it’s almost certainly more lethal alpha.

Is the 21st century version of “Time Twins” (from the Biggles movie) “Twitter Twins”?

Edit: you fixed the link.  First one was here - https://mobile.twitter.com/roby_bhatt/status/1475052548331610112

I was looking across the western European data today (mostly improving) but one stand out difference is our comparative very low ICU numbers: does anyone know what is going on here?  

Sorry that's me messing up my linking from twitter (I think I'm allergic to the site)... fixed now.

Top tip: use nitter. Makes it sooooo much less frustrating to read

https://nitter.pussthecat.org/JamesWard73/status/1473964874535419909?s=20

Sorry, your right there... I just picked up the thread elsewhere and still haven't stopped chuckling.... happy holidays

Blast.....the comment about Mozart being lectured on composition by Atomic Kitten seems to have gone.

I had also noticed that. There was some comment yesterday that I read that Germany’s ICU numbers were up by 800 or so. Think it was the Guardian. 

Our dashboard 'ICU' figures are actually only those on mechanical ventilation whereas many other nations include people on other interventions such as CPAP in their equivalent data. This may be the whole story or may only be a part of it, but needs recognising when comparing these figures.

Is it mostly improving?  Plenty of countries with the rate of rise in their cases accelerating with omicron, and where everything is falling, it’s doing so because of lockdowns that will have to be released at some point.  

My best guesses:

• In part we know most of Europe (except Denmark I think) is under-detecting cases compared to us (rolling CFR measurements, test positivity).  Some nations also have much better intensive care provision than us and some are more happy to use it when it’s available preemptively.
• In part because we have far fewer vaccine refusers, which means our hospitalisations are less biassed towards adults under 70, and it’s normally only people under 70 or so who benefit from and so go on mechanical ventilation.  There’s been a lot of data and reporting on the number of unvaccinated individuals in our intensive cares over recent months; when winter sent delta in to rapid growth across Europe it would have run in to a higher fraction of unvaccinated adults at vulnerable ages.  Those demographic details of vaccine uptake generally ignored by people focusing on top level % uptake.

Edit: as Si dH says, the definition of intensive care is pretty variable internationally as well…

I was thinking as much at a more subtle level...encouraging people to look 'carefully' at data sets, making sure the results of that attention are efficiently communicated etc. Nothing really 'wrong' with any of that, and not easy to pin down.

The economist wrote an interesting piece on AZ( behind a paywall )

https://www.economist.com/britain/2021/12/16/the-triumph-of-the-oxford-astr...

Almost, it’s the “number of MV beds (capable of supporting mechanical ventilation) occupied by Covid patients”.  The dashboard documentation page is a bit ambiguous by a page on NHS weekly reporting adds the words “capable of supporting”.  I don’t know what fraction of CPAP runs in these beds, I imagine other monitoring functions of the MVBeds and the O2 supply are both useful for CPAP.

https://coronavirus.data.gov.uk/metrics/doc/covidOccupiedMVBeds

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospi...

Short story: comparing intensive care occupancy is of little use!  

It's actually a very low pay-fence. Have a leg-up:

https://12ft.io/proxy?q=https://www.economist.com/britain/2021/12/16/the-tr...

(And before anyone gets ethical/sanctimonious, all I've done is link the version that search engine crawlers get to see for free)

Apart from being instantly riled by the by them calling it a covid variant: 

https://www.nbcnewyork.com/news/coronavirus/nyc-er-doc-breaks-down-how-omic...

Limited update today as the cases data is clearly heavily impacted by Christmas (some mix of under-sampling and increased latency, BBC News report today of some results taking 5 days to come back).  Deaths data  also looks impacted.

The healthcare part of plot 18 has no surprises, but the plot 22 update (general vs intensive care occupancy in hospitals) is not a happy update.  he previous tend of declining intensive care occupancy has gone in to full reverse.  Almost certainly the lag playing out of the rise in older adults of omicron after the initial young surge.  No great explanation for the previous drop; I had mooted that it might delta cases drying up as measures and vaccination for Omicron accelerated the reduction in delta cases.  I'm cautious of reading much in to any of the data though.

The ITU increase isn't as dramatic as the plot looks because the axes don't start at zero; the intent here is to focus on recent changes; still, it';s around a 10% increase in the space of a week; and older cases are still rising.

Bit concerned by total number in hospital in England going up by 1k a day for the last two days. Perhaps an exception but something to watch. 

Unavoidable when admissions go up but discharges haven't caught up yet. Definitely to be watched, but give it [average stay] days before bricking it.

I'd be surprised if that 1k/day doesn't keep rising for at least a week; admissions are rising in all regions and whilst the doubling times might be breaking from a rising phase in some, it's a ways to decay yet.

The difficulty with this kind of absolute number and the lags from policy changes though to downstream hospital admissions is that there's only about 2-3 weeks left to take the required action to stave off serious overload.

• On the plus side, the flow of data through to policy seems to have been improving a lot;
• On the minus side, there's a big hole in the quality of cases data from Dec 25th that lasts for 4 days but will temporarily be stretched out for longer by the increased analysis and reporting lag in the systems.  This hole means if there is really bad news downstream of Christmas, it's going to come at the 11th hour in terms of being able to prevent serious overload.  
  • That 11th hour is about when workplaces and schools are set to return, likely ratcheting the rate of spread of infection up a bunch.

Seems like a great set of reasons for more immediate precautionary measures to take the heat out for a couple of weeks, to get to the point a lot more questions over hospitalisation rates and length of stay with the new variant vs vaccine status are better answered, and until the data is back in a groove.

The other 3 home nations are all being more precautionary than England right now, and that seems wise...

Merry Christmas!

News from here - 80-90% of the ~10% of cases we're sequencing are Omicron, a very rapid rise in relative prevalence from 2 weeks ago.  We're now stopping confirming positive LFTs with PCRs as they want to reserve PCR capacity for healthcare staff. The new rules for a +ve LFT are to report it and s.i. for 10 days, with early release possible after -ve tests on days 6&7 with no symptoms. You're supposed to tell your close contacts to do 10 days of LFTs and minimising social contact yourself.  If you're symptomatic with negative LFTs you still need to call up about a PCR. No problem getting hold of LFTs, just go to the leisure centre and tell them how many in your family and they give you them - 2 boxes for a family of 5. Current 7 day rate as of Christmas eve was 1318 cases per 100k. 14 day rate was 2175.

When you are a Telegraph journalist in a hole remember to never stop digging

https://twitter.com/JamesWard73/status/1475887309555998728?s=20

From the clutching at straws department, perhaps it’s harder to discharge some patients over the festive weekend?

Ah, should have read the news first - Triggle - I’ll paste the text before it gets buried in the live page…  Both slow discharges and the number of patients with “incidental” covid rising.

https://www.bbc.co.uk/news/live/uk-59816431

With the Omicron variant leading to milder disease, we need to think differently about Covid now. 

Hospital data requires much closer analysis than it once did. 

On paper there is the highest number in hospital in England since early March.

But that has been artificially inflated by two things this week. 

Firstly, the number of people being discharged from hospital will have dropped significantly over the festive period. Last year the rate of discharged halved, meaning there are likely to be hundreds of patients in hospital who have recovered from Covid.

Secondly a growing proportion of hospitalisations are for what is known as an incidental admission. They are people being treated for something else, but just happen to have Covid.

Last week this stood at about three in 10, but the expectation is this will have increased by now. The latest figures will be released on Thursday.

Therefore, it is possible of the 9,500 in hospital maybe around 6,000 are acutely unwell with Covid.

These numbers are undoubtedly going to go up in the coming weeks as Omicron spreads.

But the raw data will only tell us so much.

Another view on 'with covid' numbers:

https://mobile.twitter.com/jamesward73/status/1475887309555998728

Plus some more random news...

https://assets.publishing.service.gov.uk/media/61c2df2e8fa8f54c18a64100/X_v...

Yes; apparently 30% and rising - although that 30% only represents a few days to a week of growth in “because of covid” cases perhaps, and it must still pose a real operational problem over containment measures; I wonder if/when we’re going to see those redefined over susceptibility rather than PCR status?  I should fire up my estimates of “died with/off” covid in a few weeks - presumably there’s going to be a similar issue there and we’re going to see the ratio shift from its long term value of about 10x more “of” to “with”.  Perhaps a kick to compare the 28-days and death certificate numbers.

It seems like a lot of the common measures are becoming less useful; might not be much point in continuing these threads in a month or so.

That lawsuit is quite something; it shouldn’t be a religious belief that an employer takes appropriate measures over H&S; I hope they challenged the H&S interpretation before going full-bonkers….

Friday night common cold plotting has a certain ring to it.

or Saturday night fever ? 
 

meanwhile recorded French cases are topping 200k - not sure what they’re gaining by keeping us out. 

Nationalist votes presumably.

You beat me to it.  Cuts of a convenient scapegoat though…

In reply to VSisjustascramble:

I’ll be pleasantly surprised if this ends up at the level of a common cold from a healthcare perspective during this winter, and I expect next winter is going to be rougher than normal as well - but better than this one.

But the data is certainly getting more muddled as we lurch towards wherever we’ll end up.  Which still isn’t that clear on the spectrum [bad flu ….. common cold]

Yes, that's also definitely a thing. And reporting is garbage just to ice the cake.

Just having my regular read of the overseas newses. I can summarise what I've read in one four letter word.

In reply to Šljiva:

Seems a good time to revisit the excellent Flo: https://nitter.pussthecat.org/flodebarre/status/1475891948938530816

.....or for the unvaccinated who haven't caught it yet and many of the extremely vulnerable potentially more lethal than a standard flu variant for years to come.

I'm pretty certain we're world beating here now, today's stats have just been published (last update was Christmas eve).

1007 new cases (roughly equivalent to 1million in the UK), average of 192 a day (~192k in the UK)

7 day rate (for UK comparison) - 2049/100k     14 day rate (for Europe/WHO comparison) 3121/100k

5 in hospital (was 3), 1 death.

Majority of cases in 20-24yr olds, followed by 25-29yr olds - definitely a 'partying spike' if ever there was one.

Why would they want sick people escaping a collapsing health system coming to them?

Very interesting to see the massive change in tack of the approach in the bailiwick once the time was right, somewhat similar to Australia?  New Zealand are sticking closer to the old course, which is interesting.  Same sort of spike as London!  Good beta for any terrorists planning to release a bioweapon in the future. 

In reply to Longsufferingropeholder:

I like Flo's histograms - there's something of a "Hollow Mask Illusion" where I start looking at it and thinking "that's bad" about one side, then once I spot the "holy crap that's bad" view of the other side of it, I can't flip my perception back...

(In reply to thread as well as you)

Updated OWiD sourced plots below.  I've taken the liberty of redistributing the post-chrismass reporting spikes for the UK, France, Denmark and Italy to remove the most glaring spikes from the case rates; it slackens off the measured doubling times for all of them.  The "sanity" plot shows data after this redistribution.  Most nations don't seem that impacted by festive reporting holes.

• Keep in mind that - going of rolling CFRs and test positivity - most nations are detecting a significantly smaller fraction of infections as cases than the UK; Denmark looks similar to us in detection efficiency; so their leadership of the pack isn't as bad news for them as it looks.
• If you measured the curl of this plot it would be close to zero - very little sign of lockdowns sending things in to decay and longer.  It looks more like The Wolverine has raked his claws across it.
• Germany continues to benefit from their restrictions in terms of case rates; interesting to see them in almost the same place as Hungary.  Both had very similar timing in their recent wave of delta, but there was a lot more death and a lot less control measures in Hungary, it looks to me like they've exited it the hard way where-as Germany has suspended it by stringent control measures.    
• The small by incredibly significant gaps in Flo Debarre's histograms give a hint about how this is going to play out between the UK and France. Similar data makes hints about some of the other nations.  

In reply to Offwidth:

Doubt that will be much of an issue after this winter.  After that, it should stop posing a societal problem in terms of healthcare.  

We don't know the relative lethality for the more vulnerable going forwards but unlike the flu there are various MAB therapeutics for Covid to help counteract lack of immune function, and there is more monitoring capacity for Covid than for other virus to help protect them; I rather think the door should go the other way with staff supporting the most extremely vulnerable using repurposed testing capacity to screen against all the main viral threats.

Nice. 

Had a thought though; next time you're bored, or really aren't bored and should be doing something else but aren't, how about colouring the tails by owid's stringency index? 

As it happens, I just reached my limits for ditch digging today, but having thought about it, cooking a damned good chilli takes priority over laptop time.  Good idea though, I’ll add it to my grab bag of ideas to try and improve this plot (it needs it).

Yep, it pretty much got to the point in late summer where everyone who wanted to be double jabbed was, and so opening up border controls was necessary to allow the virus in to start infecting the kids and unvaxxed. Worked well until Omicron kicked off, so there was a massive drive to get people boosted in the past 3-4 weeks and we're now up to 82% of >50s have been boosted with 69% of the total population boosted.  Anyone double-jabbed at least 3 months beforehand can get boosted at walk-in clinics now. I estimate everyone wanting boosters will be done in a couple of weeks and restrictions will be relaxed at the end of January depending on how schools are coping.

A plot 18 update - it looks like Dec 25th is going to show a "false" decay due to under-sampling, but Dec 26th - amazingly - is shaping up to show growth....  So other than for London, I'd take the turn to decay on the cases rate constants with a pinch of salt, a sampling low artefact.  

The more important part is hospitalisations - the doubling times look to have maxed out everywhere (for now).  That's kind of good, but it means they're still in exponential growth.  Up by 500/day with today's data [1] starting to look pretty unnerving.   The doubling times are backing off for the leading regions (London and the North West), and London's raw hospitalisation data also looks to be heading for decay.  

Deaths data is almost certainly suffering from a reporting hole over Christmas right now.

A plot 22 update shows that at the national level,hospital occupancy is rising rapidly but this hasn't started translating in to ITU occupancy yet.

Edit: Added a plot 22 version showing the whole pandemic;

• The dark blue loop is the wild-type wave of infection
• The pale blue / white loop is the alpha wave
• The pink / red shape is the delta wave
• The last few points heading off to the right are the start of the omicron wave.
  • Notice how much further apart the red markers are in the omicron start than for other waves at a comparable hospital occupancy level.  This shows that occupancy is rising much faster than at comparable levels in previous waves.  In part this is hopefully due to the lack of discharges over Christmas so we're looking for that to back right off shortly.  Otherwise.... 

My general take is that we're getting pretty close to locking in some red lines, but that if more control measures are brought on line, the heat is going to come out of this very quickly.  

• The critical question for is how much of the end of growth / turn to decay seen in London and starting to manifest in the North West is because the worst is behind those areas, and how much is down to the temporary closures of workplaces and schools over Christmas and the current warm spell?  
  • The demographics (D1.c yesterday) suggest the worst daily infections in older adults are yet to come in London. 
  • By hook and by crook there's going to be a lot more immunity in the populations as those factors turn against us again.  Will it be enough?
• So, once again the roller-coaster is on the lift hill and like it or not, we're along for the ride.  Hopefully the people in charge have got their heads around the data and aren't going to crash anything, and hopefully this is the last time round the loop.

[1] https://coronavirus.data.gov.uk/details/healthcare?areaType=nation&area...

I thought Germany had a vaccine  procurement crises a couple of days ago ………….

The main takeaway from Flo’s chart is of course that France has an issue with the number of unvaccinated and non-boosted older people. The other point though is they’ve done better with younger people, presumably due to their Covid Pass. If only our politicians took note… Clearly cases among younger people are less serious but they still contribute to general spread and seepage into more vulnerable groups.

Not sure how much weight to give this, but https://www.medrxiv.org/content/10.1101/2021.12.25.21268301v1

Err not really. The success of the booster campaign meant 70m doses would be needed for the first quarter 2022 but only 50m had already been ordered as a booster campaign hadn't existed at the time of ordering. Moderna have delivered an extra 30m doses this week as far as I know.

You're missing my point. ONS still estimate 5% (over 3million) with no antibodies, a number which is not changing fast and most of those people will be being careful (so no big change into spring). The most vulnerable are also mostly being very careful. New medicine will help all groups but as long as covid is in common circulation many millions will feel they need to remain careful. As I said from the start, that "vaccinated, recovered or dead by spring" idea initiated by that idiotic german health minister was always going to be proved wrong.

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

On Western Europe their key pandemic control issue is the same as ours: hospital pressure staying below overload levels. I've not seen consistent reports yet in any Western European country with the same levels of ongoing stress as are occurring over the last months in the NHS. The omicron wave will sweep through a good proportion of the Western European unvaccinated and vulnerable...so lets hope the lethality is actually lower than delta and just doesn't seem like that (as it's facing higher population immunity levels).

That's as at 29 Nov so before we started the Omicron surge.

I'd also note the piece of the link below:

Question mark in my mind as to whether antibody decay over time is what's driving any flatlining - effectively it reaches equilibrium state. We know that there's been lots of infection from July onwards so the only reason it can be flatlining is decay out the back end. Increasing the rate of new infection as we know Omicron is doing plus increasing the rate of boosting in response will push that equilibrium level upwards.

Either way, I'm not sure the data can be used to suggest there's a reservoir of 3m people with no prior exposure that we should worry about (and in any case, the gaps are widest at younger ages which is suggestive of a lower risk cohort). They might be there, but I'm not sure this proves it.

Possibly because your point wasn’t clear.

Antibodies are not the same as immunity mind, and “no antibodies” includes people whose antibodies have broken down (as they do) but whose protection from serious illness remains.  It also includes people who have no immunity.

Edit: as AJM notes, that 5% is a lot smaller if weighted by demographic risk, even before the point than no antibodies is not the same as no immunity for some.

The stated purpose of serious control measures has always been to maintain universal healthcare and we’ve never even considered closures or lockdowns when healthcare has been overwhelmed by the most vulnerable in prior bad flu seasons.  So I’m not clear what you’re advocating for - is it

1. For a change in policy to control covid levels not to preserve universal healthcare but to protect the most vulnerable in a way we never did pre covid? 
    
2. To remember that winter sucks for a lot of vulnerable people?

Re: 2 - yes, it sucks.  covid has taught us lots to do to make it suck less.
Re: 1 - that’s a big mission creep from what was voted on with control measures.

Perhaps I’m missing something here?

I rather think that idea has been behind the policy in most nations long before he out and out said it.  Some people have been pretending to misunderstand the plans and then getting outraged.  Compare Toerag’s description of their approach in the Bailiwick up thread.

It's true that not all the 3 million plus with have no immunity but it's very likely a good proportion of that number will (and we really could do with data on that).

I guess what I'm saying is what I've always said (for the vulnerable and long covid): pay attention to these people and do what can be done...better data collection, better coordinated support.

I'm also saying, it's also looking very much (despite omicron) that a million plus people in both Germany and the UK won't be vaccinated, recovered or dead by spring, irrespective of policy or idiotic pronouncements from health ministers.

A fraction of the population might not get it this winter, but by the end of next winter that group will be even smaller. The winter after that even smaller.

You seem to want permanent restrictions to prevent these people from catching Covid? 

That seems very undesirable to me.

Yes.  I think with Long Covid it's got past elephant-in-the-room state that the reporting conflates (a) slow recovery and (b) chronic debilitation in the style of post viral fatigue, with the consequences of the two being very different and with (b) buried in the data for (a), and the confusion over the data stripping the focus from where it's needed.

I'm not sure why you find it idiotic?

• He was spelling out the options to a population where vaccine refusal is a more serious problem in those more vulnerable. I would argue strongly that such plain talking and clear explanation is a sign of respect (in terms of due consideration) for the population - he's making it clear that it's now or never for vaccination for a lot of the refusers.
• I'm not sure why you think a million+ are going to come through spring in the UK never having had exposure to immunity; there are some who are declining vaccination on religious/ethical grounds and who are isolating hard but I doubt that's near 1 million; and they've chosen to set themselves aside; they don't in number represent an existential risk to healthcare and I'm happy to set them aside from the minister's comments.
  • Antibodies are not the same as immunity

The German health minister may have been over-optimistic in his timescales.    For reasons that are entirely opaque to me, they held off allowing the virus to spread when the seasonality was in their favour for controlling it, then rapidly had to enter stringent control measures in winter.  If they're going for a policy of permitting live infection to keep moving forwards to an endemic state, this is not the way to do it...  Now omicron makes it even harder to move forwards sustainably in mid-winter; they're likely to have to keep stringent control measures all winter and then try again in the spring/summer.  Unless omicron turns out to be significantly less lethal in those with zero prior immunity or the antivirals turn out to be a deus ex.  Both seem like heaping hope on to slim odds.

That’s not what my German friends are saying. Only time will tell .either way it’s a long  winter before you can laud it that Germany has “escaped”.

It's idiotic because you don't convince the vaccine hesitant to get vaccinated by telling obvious lies (I could support the honest spelling out of options, but that's not what he did)...you achieve the opposite...a boost to the anti vax movement. We can probably agree the german response over the last few months was well below expectations but at least they don't have a health system crisis at the same time (ditto for Belgium, Netherlands, France...) It's just deflecting to say "he may have been over-optimistic with his timetables" in that context.

I think a million because that's less than 2% and I know quite a few people in that category and I proportionally know more middle class people who are way more likely to be vaccinated (these people are frustrating to me but they are spooked by vaccine misinformation and know full well covid spreads with indoor mixing in poorly ventilated areas, so, although not all are isolating, most are actively seeking to avoid catching it and have succeeded so far). It would be great to have actual data (pretty easy....just log people on the ONS study with no antibodies who have been vaccinated or infected).

What evidence do you see to draw that conclusion? "Very much" implies some confidence in your view that must be backed up by something concrete - whereas I don't see any. It seems extraordinarily overconfident to be making predictions about how this will look in the spring when we are 3-4 weeks into a regime shift and 3-4 months yet to go until you could start talking about it being spring.

The number in the "recovered" bucket is probably unknowable from the data we currently have, so I suppose you could rely on it being impossible to prove you wrong!

The alternative strategy was of course to keep Covid low through the summer to allow the health system to catch up with postponed treatments and push the nexr wave/s out as far as possible to allow time for more effective treatments to save a larger number of people in the future. The final body count (of both Covid and general health care)  sometime in the future will tell us which strategy was better.

Well we can argue either way on what persuades those declining vaccination.  An impasse is largely reached in both nations.  At that point I’m happy to see consequences spelled out to remove any possibility of doubt.  I don’t see that as idiotic but blunt.  

What am I deflecting from what?

It seems clear to me that short of a miracle their plans, such as they were, have been reset by omicron.  They were intending for an exit wave this winter, now I don’t think they can manage one safely.

> It would be great to have actual data (pretty easy....just log people on the ONS study with no antibodies who have been vaccinated or infected).

That’s a lot of assumptions.  I think it needs detailed serology, perhaps only for those not showing antibodies.

I think maybe a key word or two is missing from your “I think it’s a million” - whatever that number is, it’s smaller by the day.  The intent of restrictions on people has always been to preserve universal healthcare.  To argue for a shift in the purpose of restrictions towards preserving the health of an ever shrinking group choosing not to be vaccinated is a big over-reach from what was agreed and what was sold to the people.

Remaining in limbo for this group has wider ramifications by holding off endemic circulation; you can’t hold that off without recharging pandemic potential.   So, as long as they’re not crashing healthcare I wouldn’t expect the government to swerve at this point.  They’ve been an incessant pressure on healthcare for months now, and that’s part of the cost of our different approach to much of Europe.  But it’s a cost that comes with significant tangible benefits; it’s not a one sided failure as some paint.

Yes I'm sticking my neck out a bit but much less so than the german minister responsible for the health of his nation. I've given my reasons in my post above. I guess its partly because I'm incredibly frustrated that vaccination persuasion efforts  based on good public health information with active attempts at specific communities with low take-up are going so badly in the UK (let alone Germany). It can be done well, as some people involved have told me of good practice.. it's just not a common focus or properly coordinated nationally. Its partly because the Lansley 'reforms' left English Public Health teams in such a parlous state. We even are way behind target on home vaccination of the vulnerable from those that want it.

Yes, I’ve never denied the alternative strategy.  I’ve just banged my head in to a wall trying to show some that the UK had a strategy that was also valid, and that the “best” is not clear post vaccination.

As I’ve long said, there are intangibles on both sides to waiting - the intangible benefits of future therapeutics vs the intangible risks of new variants recharging pandemic potential whose you hold off endemic circulation and the intangible risks of future variants accessing more of the lethality we know is available.

An interim count clearly shows the UK pre vaccination to have done stand out bad IMO.  Policy and outcomes need to be considered separately for pre and post vaccination however, it’s two very different eras.   The loss pre vaccination was so great that no post vaccination strategy can likely compensate, but that does not mean the post vaccination strategy is a failure.

There are so many future intangibles at the time decisions are made I don’t think it’s fair or appropriate to judge based on eventual outcomes, rather on if the best decisions were made at the time with what was known at the time.  I recognise merits and risks in the approaches taken by both the UK and Germany.  I’m not as invested in the UK’s approach as Offwidth seems to think, but I have rather exhausted patience with a minority hell bent on pretending there is not valid science embodied in our approach.  

Unseparable from our responses as it shapes the possible are the pre existing states of our healthcare.  Some pretty stark observations there.

From my view, across western Europe it’s more a case of finding out which strategy was less bad.   

I really struggle to see (let alone celbrate) much 'tangible benefits' as the western EU has better health systems  so will come through all this more easily (albeit with some lockdowns). It may have been the best of bad choices for us, given the mess the NHS has been allowed to get into and relying on NHS staff continuing to break themselves with the effort, with goodness knows what consequences for their long-term health. Then we have the monster waiting lists. The government could have U turned on NHS and care staff immigration (with funding for that) a year ago but it did nothing. This has to snap at some point as planned departures still exceed new recruits, let alone long term sick and burn-out departure (that will accelerate the crux). Today we are told we are opening mini nightingales, tomorrow we will realise there is not enough slack elsewhere to staff them.

How do we know we have hit a vaccination impasse when in most low uptake areas there has been no serious community effort (and certainly no national plan)?

I was cautiously optimistic with the plan in the summer (you've seen my posts) but even my cynicism has been exceeded by the way our government have foot-shot their way to a risk of snatching defeat from the jaws of a sad victory (thousands still died and more suffered).

Mask use and ventilation would have kept the NHS in a better state in the autumn leaving more ability to cope with stress now.

Not forcing unvaccinated care workers out of a job would have reduced bed blocking and reduced general hospitalisations from care. Forcing unvaccinated NHS front-line staff to have a first jab by Feb 3rd in the face if current uptake is just nuts.

Javid picking fights with everyone in the NHS from Trust CEOs down to nurses was a very bad plan in a pandemic. Blocking NHS bad news was also a very bad plan.

We all know the booster program could have been faster from the start as the evidence is before us now the government have pulled their finger out.

Testing is breaking (Alan McNally reports it probably hit limits the week before xmas).

The 'maintain access to healthcare' argument has always been Tory bullsh*t.  It is a phony argument, about framing debate by pretending that something which wasn't agreed was agreed.

The actual goal of mitigation measures, like any other health measure is to prevent or reduce death and illness.   The only reason for maintaining access to healthcare is as a means of reducing death and illness.  If people who caught it dropped dead instantly without ever going near a hospital you'd still want mitigation measures.  If people who caught it didn't die or need ICU at all but developed long term symptoms that affected their life for decades you'd still want mitigation measures. 

Nobody is celebrating any of this Offwidth.   Since the first plot I posted showing the data for many European nations was heading in a bad direction you sometimes seem to be to be  hell bent on taking this as rabble rousing for the British approach.  It's not.  It's the data.  It's what it says.

Increasing immunity across the population.  

Immunity ɪs ᴛʜᴇ ᴏɴʟʏ ᴡᴀʏ ᴛʜɪs ᴘᴀɴᴅᴇᴍɪᴄ ᴇɴᴅs

Most Western European nations have been forced in to or near to lockdown level control measures this winter because they had insufficient population level immunity to keep their ...

... "better health systems" from being completely overwhelmed by Covid patents.

If they're not having spread of infection and they're not making progress on vaccinating those without immunity, how are they "[coming] through all this"?  The only way "through all this" is to raise immunity across the population.

They're not doing that.

They're storing up pandemic potential behind control measures - indeed, they're recharging it as antibodies and immunity-from-infection fade, meaning that their exponential rate of spread once restrictions are dropped gets faster every day they wait, making the rate those without sufficient immunity go to hospital worse.

Well, actually, so far what it looks like they're doing is slamming healthcare as much as possible then slamming the brakes on to control it from being higher; they're doing now exactly what we did in the summer, only with much harder to control spread due to the seasonality.

The question becomes what are they holding out for?

• A breakthrough improvement to engagement with vaccination (not happening?)
• A breakthrough better vaccine (not much space for that given efficacy against serious illness of current vaccines...)
• A breakthrough therapeutic that allows them to let it rip with an order of magnitude lower consequence (maybe, maybe, maybe...)

Holding out may or may not be the better strategy.  Nobody knows.  

Every nation has to find the best of a bunch of bad choices, and that judgement is different for every nation out there. 

Yes, this is awful for healthcare staff.  I can't have been much clearer than I have.  As you say, there are no good choices. 

Yes

Yes

Yes

There is also the vaccine mandate on healthcare staff which seems very at odds to wider policy on spread of the virus and likely to cause a staffing crisis.

There are many worrying - increasingly worrying - things going on with healthcare in the UK.  

Edit: looks like you’ve more or less tripled the size of your post after I replied.  If we’re getting to that level of silly bugges, I’m out.

Incidentally the statement attributed to the then German Health minister is in fact a quote (as he said) from Dr Jana Schroeder who is a reasonably eminent virologist and epidemilogist.

Do you not find it odd that France had 200 k positive tests yesterday and German has barely moved. Irrespective of Covid regs etc there is something not right. 

I'd agree on the first and third. On the second point Valverna can't be far off and Pfizer say March for the start of an Omicron specific vaccine (and if the  EU suffers then the US will suffer more and that might soon see acceleration funding). 

The big 'wait and see' for me is omicrom is a big narrow peak in SA and we still don't know hospitalisation data on the unvaccinated (we may still be lucky cf delta). It may 'blow through' in a shorter time, even with restrictions (OWiD stringency for the western EU is not as high as the historical peaks... except for Germany).

I'd add the western EU countries are not quite doing the same as we are did in healthcare... there are clear stresses but nothing like the massive problems we have in the NHS...we have pushed our health system limits much harder. As I said, maybe the best of a bad set of political choices, but it is political.... they could have injected NHS funds and staff when the first covid waves showed just how vulnerable we were. They could have avoided the foot-shooting.

More regs mean the rise of omicron is slower. Reasonable to assume it may eventually set R>1 in Germany at current restrictions.  If so, “wait for it…”

I'm hardly the hardcore anti lockdown sort, but breezily dismissing lockdowns as a mere blip in a comparison of the UK and European approaches since freedom day (to pick a point at which approaches to the end of the main first vaccination cycle obviously diverged) feels a bit dismissive.

Obviously there are tradeoffs with any approach, but do you really struggle to see why anyone would see a tangible benefit in not having to opt for socially divisive lockdowns of the unvaccinated followed by lockdowns for all, to set against the increased healthcare strain over the summer?

Austria was the canary in the coalmine in that respect but you could see cases growing at a steady pace across much of western Europe through October and November. Omicron drove a regime change before some of the others had to take more concrete action just to stave off Delta but it was something of a ticking clock.

To be clear, because you have a habit of misinterpreting these things - I'm baffled you can't see any balance in this situation, not baffled you don't think the UK approach was unquestionably superior.

True but German cases are well below ours, and admissions are half UK levels and both are dropping for now and their health system is in a much better state to cope.

We will have to see how this pans out.

I'd add Germany has big differences from state to state.

https://www.nytimes.com/interactive/2021/world/germany-covid-cases.html

Offwidth: Retired ex-academic 

Stable income not linked to the performance of the wider economy, plus likely to have vulnerable friends and family and has no real world experience of the economy.

Lockdowns have no negative impact for him and a host of upsides.

I’d be a pro-lockdown loon if that was my set of circumstances.

Good points on Europe but you skip that we effectively had a soft lockdown: it was just people acting despite of, rather than because of, government.

I'm baffled why you misrepresent that I don't have some balance, even if I could agree we might not agree where that sits. I've directly criticised most EU countries over their delta response. Still the UK health system has taken harder recent hits than in any of those countries... so much so that I worry for it's future.

Denmark record numbers and a tightly run Covid regime. Germany is just about surrounded by countries all reporting high number all with similar Covid regs. 
 

Not in October and November we didn't. I was carefully talking about Delta for a reason - you'll note the comment below with references to the months in question and the variant I was and wasn't referring to:

If you want people to think you have some sense of balance, you should word phrases like the one below in a way which implies that you can see some tangible benefits to both approaches, rather than that you're really struggling to do so:

As a hint, one way of adding some balance to that would have been to completely reword it as "I can see some tangible benefits to the UK approach, but..."

As I said in my post to wintertree it's on public record here that I  was cautiously optimistic about the UK covid approach in several posts in the late summer before the government started foot shooting. All the subsequent government mistakes I listed pre-dated omicrom. I never expected to miss Matt Hancock but I do now.  My key balance is recognising it was a political choice to leave the NHS so vulnerable in an ongoing pandemic, despite it being brutally exposed three times by January 2021. There was certainly public support for increased resources. If you want to lecture someone on balance you might want to think on that.

The current NHS crisis situation is arguably more due to government inaction and mistakes than covid (if we had average western EU investment levels we may even have coped with omicron with current restrictions). I think the key debate now should be about NHS investment.

This 'real world' experience is actually something engineered by Tories to make people desperate and force them into a 'dog eat dog' right wing attitude.  It is manipulation of the poor for the benefit of the rich.

I run a one person company and every month I only get paid if I sell stuff.  Yet I am in favour of lockdowns and Covid mitigation because in the 'real world' if I get ill I won't get paid.   The whole economy vs lockdown thing is incredibly stupid and short sighted because the number of working days lost to illness if you f*ck up will be orders of magnitude higher than the number of days lost to coherent mitigation measures.   The UK had more lockdown days *because* it held off on mitigation until the situation was out of control.

The same thing is happening now.  The risk of mitigation is a few industries losing a few weeks work.  The risk of non-mitigation is potentially millions of infections, hundreds of thousands of Long Covid cases and thousands of deaths.   Maybe Omicron in the presence of high vaccination levels will prove mild enough it is OK to let it rip and people don't need to worry too much.  But only an idiot lets it rip before establishing that is the case.

For what it's worth, and in case it helps clarify any of my other posts, I would probably divide up the pandemic to date into maybe 3 broad phases:

The first wave and the rise of Alpha (Feb 20-Jan 21)

UK definitely did poorly here. Reluctance to implement control measures at a point where there was no real other alternatives (no vaccines, far from herd immunity, limited understanding in wave 1, limited therapeutics/improvements in wave 2 - dexamethasone and CPAP good but not enough to turn back the tide by themselves).

The vaccine rollout and exit wave (Jan 21 - Nov 21)

I tend to think we did a decent job of the vaccine rollout, and certainly seem to have got a lot better engagement at older ages than some of our neighbours. 

In terms of the exit wave, I think you can definitely say Austria failed, since having to revert to full lockdown seems unlikely to be a deliberate planning choice which means they lost control of the situation. I'd be tempted to say that much of Western Europe looked like it might end up having to put in far stronger control measures to make it through the winter, but we never really saw it pan out before the third phase arrived.

Similarly I don't think we will ever know whether the UK succeeded or failed in the exit wave. Somewhere in the range between a success at a cost (we might have got through with no restrictions and without breaking the NHS), through pyrrhic victory (more NHS breakage), slight defeat (plan B required to support NHS) through to a moderate/medium defeat (more than plan B required, or plan B plus some degree of NHS breakage). I doubt we would have failed to the extent of needing full lockdown to control cases though.

Omicron (Nov 21 onwards)

Another significant step up in transmission and greater immune evasion is why I'm putting this in as a separate phrase in a way I haven't for delta. It breaks some of the planned pathway to endemic that we were on with alpha and delta.

Outcome obviously too early to say.

This needs expanding and editing.

I'd say in March we were hampered by poor pandemic preparation in the UK but otherwise did about average (squandering some natural advantages). The government could have acted a week faster but thee was not a clear position on that from SAGE (because it was set up less well than it could have been due to poor planning). Initial financial responses were good but with sub-standard auditing. The government messed up PPE and testing but did OK on vaccine investment.

In the meantime in Jan though March two groups of Oxford scientists kicked off some of the most important international research in modern history, at their own risk (on vaccines and on setting up medical assessment of useful drugs treatments).

In September and December the government responses were a disaster costing tens of thousands of unnecessary lives, severe damage to the NHS and massive extra economic damage. The impact lasted until spring 2021

I think you're entitled to your view; it's a bit presumptuous to tell me that mine needs editing to match it!

I don't necessarily disagree with some of the comments about preparedness, but it seems optimistic to suggest that our outcome [edit - as per the time horizons in the link below, I mean the outcome of wave 1] was anything close to average.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriage...

Welcome to the party, pal.

It's a forum... we can respond how we want within the rules and if you post misleading or incomplete information you can expect to be picked up.

On the detail  I thought you were talking about quality of government responses, not just the part of that relating to total excess deaths (which links to all sorts of health system and deprivation differences). Deaths have never been a key control factor in the UK pandemic. In terms of what was our main control factor, protecting our NHS, we were average, but as I said we squandered advantages that should have meant we did better. The PPE debacles and a poor TTI system also contributed to additional unnecessary deaths and a longer lockdown.

On the March 2020 lockdown, the timing the information given to government by SAGE is on the public record. As reluctant as the UK government may have been they did not delay significantly. Earlier the UK flirted with herd immunity ideas with Sweden and Netherlands and the PM put out some terrible personal public health messaging but the decision was timely wrt SAGE, unlike disasterous delays in Sept 2020, Dec 2020.

It's funny that you should say that...

So..  From my view this is maddening.  We had a lot of "but cases!" talk a while ago; I explained in words why I thought cases are a craptastically poor basis for international comparison.  Words didn't work and I came up with some rolling CFR analyses that showed how the fraction of infections being detected as cases vs deaths was far lower in Germany than the UK.  Not an earth shattering revelation if you look at the positivity data, but none the less from my view you went through the five stages of grief over this and had got to acceptance...

I digress.  

Strike 1 - German cases per million have been below or web below UK cases per million data for all but a handful of the last 90+ days but their recent deaths per million have been far higher.  Yes, theirs are now falling and may even end up lower than the UKs in a few weeks, but it's astoundingly clear that showing "but our cases are higher" is not in any way informative and starts to sound like incessant negativity to push a different or wider political case.  

Strike 2 - and in part this also applies to cases as Strike 1.5 - the UK is about 90% omicron by sequencing now, Germany about 10%.  Cases and admissions in the two nations are not comparable.  Much of the admission in Germany is likely immunonaive + delta, an increasing fraction in the UK is "with Covid" not "from Covid" (30% and rising by the last link you gave), and a some subset of admissions are highly immune Omicron infections in the vulnerable, not Delta infections in the immunonaive.  Right now we don't know how this is going to pan out; we have some reasonable ideas but need to see it and it's getting to the point it would be madness not to take some heat out of infection whilst that data comes together, incase it goes against expectations.  

Strike 1.5 - we have a lot of omicron cases being detected in a society with high prevalence and low control measures => lots of sub-clinical infection much closer to the endgame is being detected here.  Total nonsense to compare this with immunonaive delta infections in a nation under much more stringent conditions. 

The other error I'd not in your comments is that UK hospital admissions are not falling, they're rising.  Big time - including in the weekly OWiD updates.  Which, as you say, is worrying as we have healthcare that's been through the wringer.  And the mangle.

I wholeheartedly agree, and from my perspective it would be great if you could either significantly tighten your engagement with the Covid data rather than trying to massage  it to fit your concerns over healthcare, or if you could use a separate thread to focus on the healthcare side.  There's one going on now [1] and it's strongly agreed with your position to my reading.  A decade of policy choices from post-Labour governments over health, Brexit and the pandemic are combining for some truly awful consequences for staff and for patient care.  It's a massive under-publicised crisis and scandal.

We can't make the pandemic go away; it doesn't end until almost everyone has sufficient immunity.  One way or another healthcare is going to suffer for this; and as I say a lot of choices seem to be compounding this when they should be alleviating it.  

We could continue in indefinite lockdown in the hope that progress in vaccines and therapeutics outweighs genetic divergence, increased nasty properties of variants and antibody fade.  But that’a a case to make explicitly recognising where it falls in the stable of actual, technically viable / scientifically feasible ways forwards.

Still, that's no excuse to try and twist every aspect of the Covid data into drum banging to the point you're making basically dishonest comparisons between some measures.

[1] https://www.ukhillwalking.com/forums/the_pub/dual_reality-742539

You seem to be contradicting yourself. On the one hand, you say that the 5% without antibodies will be careful and so ‘vaccinated, recovered or dead’ doesn’t apply. On the other hand, you say that Omicron will sweep through the unvaccinated. I agree with that - which is why ‘vaccinated, recovered or dead’ is broadly correct. I just can’t believe that 5% of the population (none of them vaccinated) would want to self isolate / be very careful. There will be some people in that camp but probably well under 1%.

You also seem to be interpreting the quote very literally. Do you think he really meant every single person would be vaccinated, recovered or dead? Of course not, it was a bit of poetic licence to reinforce the point.

Anyway, if the unvaccinated want to self isolate, that’s their own problem. In fact I hope as many of them as possible will do. The real issue is unvaccinated people running around picking up Covid and then ending up in hospital. It’s one thing to have restrictions to protect the general population, it’s another thing to have restrictions to largely protect the unvaccinated. Which is why I think vaccine passports are a good idea. 

You've got a streak of arrogance in some of these responses that's most unflattering. You're still confusing "picking me up" on something with saying your opinion differs from mine. You aren't right and I'm not wrong, so please don't act as though you're somehow correcting me. I don't particularly mind being disagreed with, but as in previous discussions on other topics you seem to struggle to do so politely (I am prepared to accept you may think you are simply providing robust challenge with no intention of being rude; I can confirm for you once again that this is not how it comes across). I'm remembering why for some time you lived on my fairly short list of posters that just weren't worth the effort of engaging with.

Allowing an opportunity to clarify before I just give up - I've reposted the part which you seem to feel is either misleading or incomplete below. It would be nice if you could pick out a single part which you think is inaccurate, or what you think is misleading, or what in particular you think is missing (by which I mean "what key point have I missed from a two sentence summary", not "how could I have expanded it to provide two pages worth of detail", since that was never my intent).

- You agree with me on control measures being late - you think only a week late first time round (two doubling times, give or take), but you've agreed it was late, and agreed with the second wave too. I'm not making a distinction as to who drove the timing, because it doesn't matter to the outcome.

- I'm not aware of anything inaccurate in my list of alternatives to control measures available at that point. 

- I can evidence a far poorer outcome than the rest of Europe. Yes, the drivers of this are complex, but it's quite a wide pool of comparison in terms of individual situations.

Incidentally, can you tell me how to square these two excerpts from your recent posts?

My "initial and rise of Alpha" timeframe to which you were replying was from early 20 through to Jan 21. The first quote above, from a direct reply to that, suggests we did about average at protecting it over that period, whilst the second from an hour or two earlier suggests that we had left it brutally exposed three times by the end of that phase.

My post, and my view, tends to align better with the second of your excerpts. But since you seem to be vehemently disagreeing with my post, I am left somewhat puzzled.

That all depends on what you do. You are self employed in a high tech and value sector where a few weeks here and there makes in all honesty no real financial difference . There are plenty of organisations / self employed who do not have that financial resilience. So it’s not really a fair comparison. 

It's just Offwidth being lazy and reading stuff from the Beano or similar and using it to further his opinion.

As I wrote it wasn't an original statement from Jens Spahn anyway and he actually said "it is highly probable that by the end of the winter pretty much everyone will be......"

Which seems a reasonably accurate observation as it stands.

Journos love sound bites, context is irrelevant!

Government response wasn't a week late in March 2020, after the SAGE advice...  days late at most. I was as surprised as anyone when the minutes came out showing that SAGE was mainly to blame, as Boris did seem very reluctant. The fact is the government acted within a reasonably expected time scale required to make a properly briefed cabinet decision.

https://www.theguardian.com/world/2020/may/29/sage-minutes-reveal-how-uk-ad...

Sorry about squaring the excepts... I was trying to make the point that after Jan 2021 the desperate need for urgent  NHS funding had become very very obvious and pre summer was the best time to do that, so resources would be in place for the pressures of the next winter (be they covid or those of a normal winter). Instead Boris ignored SAGE (and Cummings) and fell for Heneghan's lies about herd immunity.

Instant funding does not mean that you can still get the resource in place straight away . As there is a shortage of nurses anyway funding really makes little difference in the immediate short term.  

Cheap shot. We will see where Germany are at in spring and someone can claim bragging rights. I've stuck my neck out and expect a million not yet dead, recovered or vaccinated which can't be described as reasonably accurate to that quote in my opinion. 

I don't think it matters if the health minister is quoting someone else, as once he repeats it he then owns that message (the odd UK virologist has got carried away and worse still Profs Gupta and Heneghan have been driving actual anti-factual propaganda throughout the pandemic from their cosy Oxford Uni positions).

I think anything that looks like state exaggeration to excessively pressure people to vaccinate falls directly into the anti-vax conspiracy narrative.  It helps them, not the vaccination efforts.

Its just as well I’m not really thick, or else I’d have just been googling “Jurnos Germany covid” to see which minister or adviser you were taking about…

Interesting that the quote actually came from an expert advisor; presumably the ministerial repetition was an endorsement and not a disagreement…. 

Agreed, so I would have liked to see them starting as soon as they could after Jan 2021 and recruit trained staff that need little extra training (for nurses... by expanding a programme that already exists) so things are as improved as much as they could be for the following winter pressures.

https://www.england.nhs.uk/nursingmidwifery/international-recruitment/

What's the best estimate for the number of people who have had Covid in the UK?

People who have tested positive at least once is 12.6M but that excludes a similar number or more who didn't get tested, perhaps because they didn't even realise they had Covid or testing not available in early days.

ONS infection survey quotes numbers (& confidence intervals) for those testing positive in a week (very useful information) but not a cumulative total.

Is this simply because a cumulative total is a useless* measure for gauging anything significant.

*Immunity fades so it makes no sense to count an infection 18 month ago as equal to an infection this week? New variants come along? In general there are a plethora of such complications so cumulative total is fairly meaningless? 

 

I think it will sweep through the unvaccinated with no infection immunity who are not being careful and there will likely be many more of them in the EU nations with high anti-vax levels compared to the UK, as delta will have infected most of those here.  My guess was 1.5%: those being careful or very careful but remaining unvaccinated and uninfected in the UK by spring.

I think too many posters here have underestimated the population compliance with imposed regulations...and now those self restricting when nothing is imposed, as the risk is obvious. It's why hospitality in England is suffering so much despite a lack of restrictions.

Yes I explained why I misread what you were doing on CFRs (they are widely misused...but I should have realised earlier you hadn't done that) so I pretty quickly apologised and praised the new plots (and recognised that the discussion you found so painful bore useful new outcomes ). Hardly 5 stages of grief.

German deaths have only been double ours per capita recently.

I've been clear all along the number in hospitals being below a level where hospitals become overwhelmed is the key pandemic control factor for any country that didn't follow an elimination route. I agree the German infections are under-counted (the case count would be higher with better testing)  and that they are not the most relevant factor. Higher deaths per infection is a normal expected position where so many more of the most vulnerable are unvaccinated.

Yep and will see where German admissions go. Since you seem to think I'm clearly more optimistic than you, you must be predicting to an extent.

If I said that, it's a typo I missed: I know full well what UK admissions are ...at least those we are told about (as some trusts still haven't reported for xmas in England).

I've been very clear I won't do that as I see the UK NHS pressures as fundamentally mired in politics so it's pointless to me to look at covid data alone. Accusations of massaging are below my expectations of you.

We have done this before... pandemics can just become less serious with time (Spanish flu did from the evidence on those neighboring Pacific islands); medicine and vaccines can improve with time, there is no rush unless the health system is under threat.

Done this as well. Indefinite lockdown is a false alternative, we have never had this. I'm generally pro restriction (where necessary) to try our hardest to avoid lockdowns where we can. I was optimistic with the UK position late summer before the latest round of government foot shooting.

More ad hom stuff where I expect better from you.

Yes, whilst cases have almost constantly been lower.

Major Point: You have also responded selectively, ignoring my point that there's a clear difference between mostly breakthrough Omicron cases and mostly Delta cases.

Comparing cases - as you were - is pointless in any meaningful sense.  The whole "but our cases are higher" has no merit.

Down at the moment.  Omicron has been delayed in its rise to prominence there by both their stringent measures and good adherence.  If anywhere can keep cases down over the next few months in Europe, my money is on Germany.  It remains to be seen.

It's possible I mis-understood your "and both" comment in terms of what the "both" applied to.  Apologies if I did; I'm happy to read that sentence however.

And a focus on cases bereft of any context was below my expectations for you.  Since you stepped in to try and re-write a post of mine  "what wintertree isn't telling you" as part of your denial stage I've been redefining my expectations.  Interesting to note another poster raising much the same comment today.

For someone insistent on urging more precaution you seem to have a clutching-at-straws attitude here.  Pandemics always become less serious over time or the race would be extinct. Expecting a magic variant to solve it is wishful thinking at best.   Generally they become less serious because people get immunity.  

So, if you accept that elimination is off the cards, shouldn't it be a sign of good progress when somewhere has more cases and less death?

Flu doesn't exactly change in the same way as Covid with a much more promiscuous gene swapping habit.

You don't know that.  You are taking a one sided view building on your wishful thinking above. Yes, medicine and vaccines can improve - I have said that clearly.  To date, variants are getting worse by and large - more transmissive, more intrinsically lethal, more immune evasions.  You're living in a fantasy land if you think it's one sided.  The point I keep making is that both sides are intangible.

Yet here we are with continental Western Europe having held out, waiting, and with a correspondingly much larger holes in immunity and a new variant that is evading immunity in most of the rest of their population.  Unless Omicron turns out to be a lot less lethal in the immunonaive or medicine delivers a deus ex, holding out will have worked out badly.

I don't know which is the right solution, you don't know which is the right solution, frankly I don't think anyone knows which is the right solution, but you're sticking to a one-sided view and sticking to statistics that point a one sided picture, and clicking at straws over your pacific island and Spanish Flu, despite the mega differences between a coronavirus and an influenza virus when it comes to how they charge on a regular basis, and despite the evidence that every major Covid strain to date has been worse than the one it derives from (not necessarily worse than the one it displaces, but there's a hint in the direction of travel about what might come next).

No, I genuinely feel that you are banging a one-sided drum.  Call it an ad-hom if it makes you happy.

I've come to expect some posters to bang on about "but cases" bereft of all context; it's no skin off my nose if you want to join them.  I'd hope you expect better of yourself.

Hint Hint:  I think you should start a thread led by the issues facing the NHS.  I think it would be a good thread.  I think you'll get a better and wider audience than here, and you can do it without trying to pivot data discussions around to the NHS situation.  I think you have a lot of good things to say, and I think a lot of other people have insight to contribute. 

Edit: I pretty much agree on the drum you’re banging, but I’m not convinced your drive to bang it as loud as possible isn’t sending you down a very one-sided view of the wider situation.

As you say, there’s been a lot of compliance and self restriction. I’ve self restricted myself to some extent and I saw that the local bars here were very quiet for the time of year. However I suspect most of the unvaccinated crowd don’t really believe in restrictions anyway. As you’ve pointed out, some religious groups don’t accept the vaccine and they might be careful because they realise that they’re vulnerable. However that’s a lot less than 1m people. Even if it’s 1m, that’s a small minority out of 70m. So Jens Spahn was right (see jim titt’s clarification on what he actually said).

I sometimes get the feeling on these threads that there's a tendency to retrospectively rationalize Gov actions by measuring them against what might not be the relevant yardstick. A case in point: herd immunity as a public health strategy. Earlier this year, we all looked at what Gov seemed to be doing in terms of permitting natural infection whilst failing to implement NPIs, reminded ourselves of Vallance & Whitty's focus on herd immunity from late Jan 2020 onwards, recalled the audience a "take it on the chin"-minded Johnson granted to Heneghan, Gupta et al in Sep 2020 - and came up with a theory that explained Gov's post-vaccination course of action in 2021. We had a rational explanation for the implicit strategy, even if Gov was not explicitly stating what strategy it was following. Our inference seemed to be justified when Whitty, a few months ago, explained that running things hot over the autumn would relieve pressure in winter.

We're naturally (owing to most of our backgrounds) inclined to want to believe that the public health decisions taken by Gov have been rational and scientifically-informed ones, even if we in different ways and to different degrees disagree with those decisions. But I think we might in fact be trying to force ideological decisions into the Procrustean bed of scientific rationality.

I'm not persuaded that our current course of action is rationalizable as a public health strategy at all. I'm reminded of Brexit, and the post hoc attempt to scry the essential foreign policy meaning of the term - when it turned out to have little to do with foreign policy and everything to do with internal Tory party power struggles. It is really quite striking that the last SAGE minutes (99, from 16 Dec) seemed to anticipate and advise for a situation in which testing capacity fails, contact tracing becomes no longer viable, and hospital admissions become overwhelming. You don't have to read between the lines to find the minutes a rather bleak document of a committee that isn't being listened to; indeed, they don't even seem to believe they know what the aims of Gov policy are anymore.

Ouch:

"Policymakers will need to make difficult decisions to make about the implementation of measures and allocation of resources which incorporate factors beyond scientific advice. In some circumstances it may be useful to have frameworks developed in advance to support decision-making. Design of such frameworks could include input from ethicists"

I take your point, but...

The past madness in early 2020 with H+G and Johnson's comments filled me with horror; they were so far before the appropriate time, and so out of touch with bloody obvious data it was atrocious.  I still can't get my head around it.   I ranted a lot on UKC from very early on.

But I also believed that that time would come when things would move on, how can it not?

As we got to the summer of 2021, it seemed clear from the data that we could at least afford to dip a toe in the water, and another toe, and so on.   Toe followed toe, and the situation has moved on.  

We saw the results in the ONS antibody surveys (especially when broken down to include non-vaccine antibodies) and we saw the results working their way through the demographic data, and through the vaccine surveillance reports.

I don't so much see this as a post-hoc rationalisation of the government's strategy, so much as them trying the same thing repeatedly and eventually not triggering a catastrophe.  It didn't make sense the first two times they tried it (far from it), so I'm not going to credit them with getting it right the third time; nevertheless it was moving things on and that's to be acknowledged.  It's not a mater to celebrate given what came before.

To me, that depends critically on what fraction of the people going in to hospitals and particularly intensive care from Omicron are vaccinated.  

• This was pretty clear before Omicron.  
• With Omicron, it's not clear.  Early hospitalisations data was encouraging if viewed only against case numbers - but as has also been clear it was from mostly young adults who don't represent the barycentre of risk.
  • If lots of vaccinated people are going to hospital and especially to intensive care from Omicron, this is not a self limiting problem, it's not fixed by a controlled spread of cases, and it's back to square 1.

It's not looking good for carrying on without substantially more restrictions, not because the answers to the above are bad news, but because we don't know the answers, and if we leave it much longer to find out, it could be too late.

Christmas is washing through the data and the doubling times for cases are continuing to shorten in the regions beyond London, despite the Christmas low, and despite the reduced test availbity and increasing positivity.  Both in London and beyond, the rapid doubling times are working their way up the ages to the oldest and most vulnerable.  We're only just starting to see major exponential growth - to be followed by large numeric growth - in the oldest ages, hospitalisations come later.

As the consequences of infections locked in unfold over the next two weeks, there should be sufficient data to figure out where we are and how fast we can move forwards.  The next vaccine surveillance report is going to be very interesting, it's probably the one after that that's the critical data we'll get to see. 

If that's bad news, by the time we've figured it out, it'll be too late.   I've not had a problem with things moving forwards to this point - but carrying on much longer without a pause is going to be a bad idea.  Especially as the new year will bring a big boost to R with the return of workplaces and schools...  

We're +2 days from my lockdown date in LSRH's sweepstakes from plotting #57...

Edit: I’m still pretty optimistic that omicron isn’t looking like fundamentally bad news, but it is (as expected) accelerating events that we can’t afford to have happen much faster, and I think it’s a couple more weeks before the data is there to see if I am wrong with my optimism.  I think each of those reasons alone is enough to tighten up restrictions at least to the point daily case numbers in over 50s aren’t growing.  

If your assertion is correct start of the new term could be even more challenging than the last in lots of schools. 

So will the GOBSHITE hit the proverbial fan with huge numbers of kids and teachers off school? 

Or, will the government’s carefully considered plan of doing pretty much bugger all and just letting it rip produce the best outcome with minimal disruption to education?

In reply to bruxist:

I've just gone back and read those minutes. They are kind of prophetic really. I remember all the articles in the right wing press rubbishing the "alarmist" modelling that informed them but hospital admissions are already at the top end of the 1000-2000 range given back then for the end of the year, so well on track to the 3000-6000 "optimistic" scenario for the peak.

We're also well past the point of no return from all of the pre-Christmas modelling for restrictions having any effect, so we'll see what the "hope for the best" approach does.

It's easy for me to keep being hopeful; I think that you're on the sharp end of this so don't feel you have to beat about the bush if you disagree.

Still, here's a plot I hope heralds some positive news.  It's occupancy in the London NHS Region using dashboard figures.  

• I chose London as it's more or less leading the other regions with omicron, it seems.
• Pure raw data from the dashboard,
• Two regions sliced out showing the rising phase of the alpha wave and the start of the omicron wave.
  • The time periods were manually picked to give a good plot; I've intentionally put omicron a bit to one side of alpha so they don't over-draw each other.
• Hospital occupancy is in black and on the left x-axis,
• The measure I take as more-or-less ITU occupancy is in red and on the right axis.
• The ITU axis maxes out at 15% of the general axis; this gives both curves for the alpha wave the same peak height on the plot.
• We can see a pretty consistent lag between the two measures for the alpha wave (Dec 2020) with ITU occupancy hitting a comparable level (15% of general occupancy) about 5.5 days later than general occupancy.
• With the delta wave, ITU occupancy os looking a lot slower to up-tick following occupancy.  
  • Part of this is probably due to a deceptive up-tick in the last week of occupancy figures due to lower discharges over the long festive weekend, but even before then it looks like this is much less heavily weighted towards intensive care than the wave this time last year.
  • Part of this may be due to a faster rise in general occupancy, but again I think some of that faster rise is deceptive from festive discharges?
• There's also the conflating factor that a larger fraction of general occupancy is now "incidental" covid which is probably not expected to go to ITU?

This seems like a positive sign that whilst we've got some bad daily admissions numbers coming up, the wider situation is not like-for-like as bad as it was for those last year.

Really though I'd want to see another week of data (at least) on this plot before accepting this.  Tentative for now.  

Edit:  I did a different plot with the omicron wave shifted up and right so the black curves align.  Instead of axis values this has scale bars, as the y=0 origin is different for each curve.  My interpretation of this is that it's not resolvable *from this data* how much of the difference is due to a larger lag for admissions to intensive care, vs due to a lower conversion rate. That's always the uncertainty in conversion rates in the early stages of a wave, and it’s a bit more involved for occupancy than admissions - but daily ITU admissions isn’t published I think

Edit 2: Could also be a balance deceiving me as the impact of third doses hammering delta down is leading to a big drop of the delta component of ITU occupancy masking the rising omicron component.  There’s a signal in demographic cases that could tie up with this.  So, a false hope?  

I’ve just arrived in a land where Covid doesn’t appear to exist  - amazing what next to no testing will do to your numbers! I’ll be keeping my mask on and staying mostly outside though, just in case. (Ain’t half strange though) 

I wonder if German cases are being kept down by their stricter rules for kids - All secondary kids need to wear masks at school. Our autumn delta increase was heavily driven by schoolkids, Jersey's earlier in the year was too. Without that and with WFH orders in place their spread will be significantly slowed.

PS. our 7 day rate is now 2605/100k and 14 day 3537/100k.  I suspect there'll be some people who delayed admitting to being infected until after Christmas in those counts.  Government briefing today said schools are going back next week as planned, but with 'enhanced surveillance' - probably daily LFTs. Still only 5 people in hospital from ~100 new cases a day last week.

Interesting plot, thanks. I can't help being concerned that the general occupancy is rising so fast - I hadn't clocked it was now going up faster than last year and the difference seems to be more than the 30% incidental admissions would cause - so hopefully this is down to slow discharges over Christmas. Have I understood that correctly?

I've noticed a few times that anecdotal media reports from hospitals generally imply the opposite, ie that hospital stays are in general shorter now.

In a couple of weeks it would be useful to do the same as the above for hospital occupancy Vs daily deaths. So far they don't seem to be going up. With reference to the other thread on isolation (which I've read but am not entering the bunfight), I think it's when we have a good idea of lower ICU and death probabilities that we should start changing policy. Obviously it would be nice if that started to emerge over the next month but it still seems too early to get an idea.

Positive LFT count is very high at the moment by the way. Growth by PCR has slowed down in comparison to overall growth. We'll have to see if that continues in the coming days but it might mess up some of your plots that use PCR only results? It appears to be increasing LFT (reported) positivity rather than being down to an increasing number of tests, as the total number of LFTs reported hasn't increased proportionally in the last few days.

Last post for now... just came across this in yesterday's daily Omicron report. Hadn't checked it for a week or so and hadn't seen the data previously, not sure if it's new. Certainly seems to suggest vaccination still provides significant protection against hospitalisation as we had hoped.

Yes, the horizontal dot spacing on plot 22 is one way of seeing this, it’s growing well faster than it did last time occupancy was at this level.

I don’t think incidental infections can possibly drive this for long.

Hopefully; Triggle seems to think so.  I don’t know how much the increased problem discharging some patients in general this year is going to apply to covid patients…?

Length of stay is well evidenced as being less for vaccinated people.  I think I’m going to bite the bullet and start typing in the data from the tables in the weekly vaccine surveillance reports.  Copy/paste doesn’t preserve the table layout.  Would be good to make a plot of how the balance is shifting.

Indeed.  

In a practical sense, the demographics from London are being repeated elsewhere with the case surge coming to young adults then working it’s way up the ages.  That’s perhaps the least bad timing when it comes to isolation orders vs patient demand.  

Interesting to see the CDC slashing isolation periods for the symptom free to five days; release without a test but masking required.  Does seem a bit early on for a policy change like that; clearly they have to come at some point…

Re: PCR vs LFT - the data is all messed up.  Will be interesting to see the next ONS update….

Have a look here https://www1.nyc.gov/site/doh/covid/covid-19-data.page

It's a bit of a faff to find but there is a plot of hospitalisations by vaccination status. It won't surprise. Feel free to get angry about choice of scale.

Actually, it's reproduced here but possibly out of date: https://nitter.pussthecat.org/cooperlund/status/1476612381153411077#m

Thanks, I think the scale allows the latest changes to be seen clearly enough in that case  

Seems more extreme a change than is maybe suggested by the limited UK data I attached, maybe down to differing vaccination rates (not sure what rates are like in NYC.)

Thanks again for putting things into words better than me.  When 'looking at tea leaves' in troubled times and where key information is being actively withheld or is becoming meaningless due to hitting limits, as well as keeping a close eye on the data we do have, it's best to look as well to what's being said by those who are most trustworthy in the system.

SAGE gets a bad press because of the uncertainty of modelling but the message has been pretty clear recently from short term trends (that are clear also here). I agree this seems ro say there is no coherent public health plan (at best government actions indicate a desire/hope).

I trust health commentators and people in the NHS system. Roy Lilley in particular when top down government press control becomes dangerous (as it has) as trust CEOs will just leak to him and he will post things up.  The message he gives is there is no coherent plan... the government are playing top down bullying games yet again, because they are desperate to blame anyone but themselves for the mess they have created (and are still creating.... let's see if reality forces a U turn on  removing unvaccinated staff from front line roles if they don't get their first jab by Feb 3rd).

I trust Prof McNally on all things testing. Again the testing plans are in tatters and the govenment are like rabbits in headlights on the matter. It's urgent now that PCRs are prioritised ... it's mad when NHS workers cant get priority tested. The pressure from absent staff is being said to be as serious or worse than the additional hospitalisations by the NHS Confed (who also heroically seem to be ignoring the bad news ban).

I trust the people I know in the vaccination service and public health. The low hanging fruit are nearly through the system now and recriminations are starting, as the lack of action on the critical paths has been ignored.  Expect press scandals soon on that, as big centres empty and the home jabbing runs into Feb and the deprived area poor vaccination uptakes remain (as there is no local coherent public health plan because its not been resourced and local advice has been ignored). I predict desperate mail drops soon as the evidence has always been people trust government information in twenty languages more than their community leaders and local role models (sarcasm).

All the pinch points in the response to omicron are subject to government foot shooting reminiscent of top down communist plans.

Cheers for that. It would be nice if we had a UK page like that to get the vaccination message out more clearly.

Sage gets bad press because 99% of journalists have no understanding of statistics, or science, and that sage are a mixed discipline committee offerings only their advice, not policy. So instead the hacks just search for figures which will make biggest news, usually the largest or smallest, don't reference any context and the equally ignorant public soak up the daily express style headlines. 

Some journalists are a lot better than others and I think the Fail and Excess have been exposed as gutter press, despite their middle class pretentions. Pick the scariest outcome from the modelling (which shows worst case what could happen if no actions are taken) to sow fear, then later on accuse SAGE of lying because those scary numbers didn't happen (completely ignoring the fact that restrictions were applied). No one is that stupid... it's definitely editorial policy. These papers are bad for everyone's health. The Telegraph and Spectator are not far behind in spewing covid misinformation that is highly dangerous for UK public health.

I add that it's no wonder the parties chasing the old UKIP vote do so badly when more than a hundred tory backbenchers are representative of the dangerous public health views of that party.

Yeah. Chasing revenue whilst increasing their readerships health risks. 

Edit. Idiots like Vine need sorting too, they try so hard to give both sides, even when one is nonsense, he starts sounding anti vax and anti lockdown. Plus they keep giving deniers air time.  

False equivalence. Look how long it took before the dangerous climate change deniers lost their other side of the argument debate seat on the beeb. Worse still, on covid, never forget Prof's Heneghan and Gupta haven't had any ethical based action from their employer, Oxford University. Not many academics can say they have influenced government decisions against a massive majority academic concensus, such that ten thousand plus citizens died unnecessarily and with all the additional damage to health and the economy that a longer then otherwise required restrictions led to.