UKC

As with last week, the case numbers are a bit muddled by the inclusion of far more asymptomatic mass testing related to the return of schools.  I talked this through in more detail last week [1].

The plot below is for England and shows symptomatic cases (PCR) and the sum of those and the unconfirmed and confirmed LFD tests which includes asymptomatic workplace and school testing (uLFD and cLFD).   The symptomatic cases continue to fall, all-be-it very slowly - which suggests to me that R is still < 1 and that infections are still falling.   A complication is that PCR is also being used for some asymptomatic testing I think.

A simplistic way to think about it is that cases were halving roughly every 14 days before the latest slackening of decay.   Historically, detected cases have run at about half the level of infections (going off ONS data).  So, if testing improved to the point all infections were being detected, this would counteract one halving period.  After that, if infections are still halving every 14 days, cases would return to doing so as well.   In other words, improved testing can’t keep increasing case numbers indefinitely.  So for now, I think there’s uncertainty about what the near stagnation in PCR case numbers really means.  If it persists by this time next week, then it will mean that infections are not falling much.

The time was, the behaviour of hospitalisations data would in due course help understand trends in cases, given how it would track them.  Now, we have the effects of the vaccines significantly reducing the hospitalisation rate; this is fantastic although it does make it harder to understand the trends in cases and how they related to infections - but it also reduces the importance of understanding them somewhat.

The breakdown of PCR and LFD data is only available for England, not for the other home nations or for regions, and not for demographic data.  So, in all the following posts I use the usual “cases” data which includes LFD data.  I assume a similar mass testing regime is affecting curves for the other home nations.

Link to last week’s thread - https://www.ukclimbing.com/forums/off_belay/friday_night_covid_plotting_16-...

Cases for all 4 home nations have had a recent period of stagnation and now look to be turning to decay again - this is visible in the halving times getting shorter at the right of plot 9x (in the highly provisional region) as well as the downturn in their curves. 

Scotland, often seeing a slower exponential rate of decay than the other nations, bobbed over in to growth of cases for a little bit.  Was that asymptomatic testing switching on, or genuine growth?  

This feels consistent with the switch-on of mass asymptomatic testing in schools temporarily masking decay but I only have a data driven insight in to that for England.

Everything looks to be in decay in England - and we know cases are decaying a bit faster than is shown here, because this plot includes the swithch-on of way more asymptomatic LFD testing and the masking effect that has. 

Deaths continue to fall with a shorter halving time than the other measures. Deaths are falling on a faster exponential rate than hospitalisations, themselves in turn halving faster than cases.  To me, this suggests that the vaccine is keeping some fraction of infected people out of hospital, and of those that do go in, it’s keeping more of them alive. 

Good news all around. It seems conceivable that soon enough deaths won't be a daily occurrence.   As a few people have said over the last few months, it's just as well this virus came out now and not back in 2003 instead of the original SARS - the last two decades of R&D in the life sciences and the specific research undertaken because of SARS allowed these vaccines to be developed so rapidly; without them things could have been very, very different.

Plot 17 has been retired as it’s all scrunched up and doesn’t really convey anything useful, and as the separation of regions based on the emergence of the new variant is no longer relevant

Plot 18.1 and 18.2 - every measure is in decay in every region.  The curves for deaths are becoming very noisy (jumping all over the place), because the numbers are so low in any given region the statistical noise dominates measures of halving time.  Yorkshire and the Humber looks to have had a period of growth in cases; it’s hard to say how much of that was the switch-on of asymptomatic testing as broken down data is not avialbile at the regional level.

Plots 22 and 22r show that Covid related hospital occupancy is really winding down in all the English regions.  That’s got to be the worst part for some of the staff, when the pressure finally comes off and the exhaustion and thinking hits home.  I’ve not read anything on it but I hope there’s strong support networks being put in place for all the staff who worked well beyond their usual experiences through this.

The spike in cases from the switch-on of asymptomatic testing is really visible in D1.c as the orange blob in the bottom tight of the rate constant plot.  It’s interesting that the growth in cases was not sustained in the 15-20 age bracket, but is so far being sustained in 5-10 and 10-15.   This might suggest that school related transmission is happening more in the 5-15 range than 15-20, or it might be because 15-20 is a hybrid bin containing some school aged people and some non-school aged people.

The slackening of symptomatic cases is visible in the working aged adults as the purple turning to white on the far right of the plot - with there being more purple indicting decay in the oldest ages.

Plot D3 shows the average current rate constants over the last week as circle markers- also given as halving and doubling times by the second y-axis.  The red lines show the change from two weeks ago, and indicate a slackening of decay in all bins; with ages 5-10 and 10-15 going in to growth (+ve rate constants, doubling times).  The growth I think is a false signal caused by the inclusion of asymptomatic testing catching more cases, and is actually a good thing for reducing cases, as it means more infected and infectious people are getting quarantined.  Hopefully we'll see that start to reverse next week.

The question remains - why is decay slackening at other ages else?  I’ve not seen this addressed formally anywhere.  I think it’s likely that the return of schools sees more parents and carers mixing in the workplace and it’s just shifted people’s mindsets that much further away from lockdown.  Cases aren’t growing yet, and I hope the slackening isn’t going to continue.  Notably, the halving times changed the leat for 80 and over, hard to say how much is because that’s the ages least affected by the return to schools, and how much is because of the vaccine.

Plot D1.x is shown with gradiated and discreet colour schemes.  If I ran this plot over the course of the pandemic it would be a series of closed loops as we switch between growth, healthcare overload and lockdown driven decay. If I could anthropomorphise a plot, I would say this is now a very happy plot, because that is not happening.  Instead it's breaking out for the bottom left corner where everything decays ever faster.  This plot will probably only run for another week or two, as after that deaths will be so low that a meaningful halving time can't be measured.

I think the halving / doubling time captions are mixed up in the first post. Fantastic work though, as ever!

Good spot, thanks!  I missed the edit window to fix it by 30 seconds.   Fixed plot below.  

Plot 16 - the UTLA watch plot.  This is to be treated with caution this week, as it includes the switch-on of much more asymptomatic testing, which means the case number are much harder to interpret.  I'm comparing them to a baseline 3 weeks before the most recent date for which good data is available (March 15th).  It's in to "pinch of salt" territory but it's a jumping off point to looking at individual UTLAs that are showing the least decay.

In that period, 4 UTLAs have risen above their level on the baseline date, one has fallen by less than 10% and 10 have rebounded to more than 1.5x the minimumn level seen since baselining.

North Lincolnshire looks pretty alarming [1] and is near North East Lincolnshire which has stubbornly refused to decay for over a month now [2].

[1] https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=No...

[2] https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=No...

Thanks. A case of ‘watch this space’... Hard to make predictions but my feeling is we’ll ride out the return to schools without cases increasing overall but with significant regional variations (so your last plot will be very interesting - it already is). Then an increase in cases from the second half of April as things are unlocked while the vast majority of the under 50s haven’t been vaccinated yet. 

Thanks again and reassuring to know, there has definitely been some WTF is going on moments over the past week or two.

I am hopeful that the schools/people back in the office won't cause much change, don't the the kids break up for Easter end of this week anyway? This then gives us a mini circuit breaker of two weeks which will hopefully keep any growth in check and we can get more people vaccinated.

711,156 Vaccines delivered on Friday is incredible, shame it isn't going to last for long if the reports are to be believed.

Thanks again, I'm pleased to see there are fewer areas standing out as rising or not falling than I had expected and it looks like your overall case graphs are turning down more than I had realised too. Fingers crossed it continues for a few more weeks to build a bit of margin before April 12th.

Thank you again, I turn to this post regularly for the comfort of rationality in a world full of nonsense.

Re people in the office - some have returned already (in some cases unnecessarily so) but I doubt there will be many more until after 21 June as the WFH guidance is intended to remain until then. I actually suspect it might get extended as the case numbers may well be growing again by then.  

Hopefully not, it just seems like there is more traffic on the roads since the schools have gone back.

>711,156 Vaccines delivered on Friday is incredible

Scrap that, they issued just under 874,000 yesterday!

Incredible isn’t it. Sounds even more impressive when you say “ three quarters of a million first doses” !!!!!

I did set the "rebound from minimum" threshold quite high for this week - 1.5x vs typically 1.2x, but the other thresholds remain the same.  

In reply to Punter_Pro:

Phenomenal isn't it.  More than 1% of the population per day.  I expect great things for the cases data as the last few weeks of vaccinations start converting in to immunity in largely working age adults.  The last week has backed us to deliver 3.5m second doses in one week 12 weeks from now.

In reply to BusyLizzie:

Putting it together is a very cathartic hour, it helps me feel like I have half an idea of what's actually going on in the world...

We certainly need the ‘assistance’ given the overall decay rate has dropped off and some areas are growing. Reported number up today week on week - could be noise but any uptick isn’t exactly encouraging. The issue is that most under 50s haven’t been vaccinated yet and they’re the ones most likely to be out and about mixing once things open up.

As you say, they’ve baked in a lot of doses 12 weeks from now (unless the 12 weeks advice changes) but I think it’s best to get them done now rather than spreading it out. Worst case is some people will have to wait over 12 weeks, which is hardly the end of the world given it’s more of a top up for longer lasting protection. I certainly prefer getting it last week and potentially having to wait for the second... in fact I’d rather they prioritised people in their 20s and 30s over my second dose. For older, more vulnerable people second doses would be more important. 

Your last point is particularly important given the PHE report published on 17 March which gives real world data on the effectiveness of the vaccines.

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

The first sentence states;

“Analysis of routine testing data continues to show a vaccine effect against symptomatic COVID- 19 from either vaccine in those aged 70 year and over, for whom the vaccine effectiveness (VE) of a single dose reaches ~ 60%.”

Not sure if many people who have had a single dose of vaccine realise that there is still a significant risk that they may develop symptoms if they become infected.

My area (UTLA) has risen 28% in the last week (to 15/03): up 14 to 66 cases. The biggest rise seems to be in 60+ (from almost zero), although <60 also rising. Still only 41/100k, but that has obviously gone up. 60+ doesn't sound like schoolchildren parents; are they all rushing off to see their grandparents...?

Nearly one quarter of the population are vaccinated at least once.

Fingers crossed we see something similar to Israel, I know some posters on here mentioned a plateau/uptick in cases but that appears to have all changed, their daily cases have dropped off a cliff from the 6th of March onwards.

https://ourworldindata.org/coronavirus/country/israel

Will be very interesting to see what happens as they open up more and more and lift travel restrictions this week etc.

They also have a potential oral vaccine candidate in the works which could be a real game changer if proven effective.

Some interesting ONS comparisons of excess deaths across Europe

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

I think they are spreading out (earlier) many second appointments. Mine is 11 weeks from the first, some even sooner. I was over a week after the call for my age group as the area booking system date of birth block wasn't applied and once that news got out the booking system crashed with healthy people under 50 trying to get earlier jabs.

These latest results seem to be more encouraging than those in the PHE study.

https://www.ox.ac.uk/news/2021-03-22-results-usa-trial-oxford-vaccine

“In the trial, which recruited over 32,000 volunteers across all age groups, the participants received either two standard doses of the Oxford-AstraZeneca vaccine or a placebo vaccine, at a four-week interval. These data show that the vaccine is 79% effective against symptomatic COVID-19, and 100% effective against severe, or critical symptomatic COVID-19.”

But note the participants received 2 doses of the vaccine at a 4-week interval.

Given the vaccine nationalism that seems to have taken hold I can’t help feeing that it would have been better if countries had worked together to sort out the development, testing and production of vaccines. I don’t think it’s the scientists at fault as much of their work seems to involve international collaboration. Perhaps I’m being naive.

There has been a lot of International collaboration, but I also think it's important that we had lots of separate approaches all well funded to the R&D of vaccines.  The success of these  R&D programs has largely (there are some failures) been spectacular - better I think than expert opinion was cautiously predicting in advance.  The resultant diversity of technology platforms, supply chains and manufacturing locations all factor in to a robust, de-risked and scalable basis for global vaccination, and at the time the decisions were made IMO represented an agile way of giving us the best chance at success given the then-uncertainties. 

Moving beyond the R&D to the roll out, I think the emergence of nationalism was unavoidable. Governments are elected at and responsible on a national level, and people in Europe tend to have a moral/emotional hierarchy of protection and safety that starts with the family unit and works its way up.  Add in a critical emergency and a near-magic way out that is severely limited in short term quantity and nationalism arrises as an emergent phenomena.

That doesn't make it attractive, or helpful.  Far from it.

The key to me is that some places invested more in production capacity long before trial results were out, and others did not.  India for example started working around last June on their capacity to produce the AZ/Oxford vaccine and are now turning out 100 million doses a month.   

I'm pretty torn on the best way forwards - the pandemic isn't over until it's over everywhere which suggests equitable vaccination roll out everywhere.  Conversely, minimising the chance of partial vaccination providing the ideal selective pressure to amplify more nasty variants suggests vaccination progressing unit-by-unit through segmented by hard geographic borders which opens up deep moral, political and practical questions about the priority for areas.  However it's done, we will get there better if we don't descend into pointless trade and PR wars.  

Totally agree with what you say. I just wish that some of our politicians and media took a similarly enlightened view.

I reckon it's the vaccinated believing they've got a personal invulnerability shield now they've had a jab and socialising more.  Everyone and their dog seems to think that vaccination makes you invulnerable when it's patently not the case.

Yesterday's vaccination number is another record - it's the highest yet (by far) for its day of the week.

PCR cases look to still be falling and perhaps the halving time is improving a bit.  

The unconfirmed LFD data for March 21st is a sudden doubling over the total LFD numbers for previous days.  Some of it is likely to switch to confirmed LFD data over the coming days or be presumably be discarded as a result of a negative PCR test.  I haven't been paying enough attention to know if there's normally a giant spike on the most recent day of data, that's waiting for PCR confirmation to remove a bunch of false positives, or if this is a genuine and substantial increase.  Numbers of tests undertaken hasn't doubled.  We'll see what tomorrow brings - but perhaps it's the effect of transmission in school starting show through - which got me thinking - will school related LFD tests continue in to the first weak of the Easter holidays?  Could be useful given the lags involved.

I stressed quite firmly to my Aged Ps that it didn't make them supermen and women...

"There's No Going Back"...

The 1,914 +ve LFDs is the highest in the last couple of days (and hence ever?), though we've had a couple of 1,400 days in the last week.

I don't know if +ve LFDs which are subsequently negated by PCRs are removed from the historic numbers as haven't been following the numbers that closely. Let's see what happens with this 1,914 (which might increase a bit as more get reported), i.e. does it simply drop out into the middle column or does it actually reduce over time.

It's odd to have 1,900 on Sunday by specimen date - people testing before sending kids back to school today?

Taking into account this 1,900, today's numbers aren't as bad as they look (week on week by reported date is slightly up). I wonder though whether it's now time to start focusing on the overall numbers rather than just PCRs, given last week's numbers are 'fully loaded' with LFDs. They do seem to jump around a bit day on day.

Looking at my local numbers, I'm pretty sure they must be; the rises I reported earlier seem to have lessened today, such that they are much less noticeable. The % and absolute rises seem to have fallen. I wish I'd been recording the numbers each day  rather than just relying on my fading memory...

Yeah same. Let's see if the 1,914 drops after a few days as that's a relatively large number so good to use as an example.

More LFTs were reported on Sunday the previous week too. Whereas Saturday both weeks had a very big drop. The numbers of tests support this to an extent - the number of tests is higher on Sundays, although proportionally not as high as the positive cases this week. It must have messed up Wintertree's deweekending filter a bit last week and will do again for this week because Sunday is usually very low - but, because from this week onwards I think the tests are due to be done at home rather than school, I suspect the behaviour may well change from next week onwards anyway.

I don't know what causes the Sunday peak but if you are doing a test twice per week at home then it would seem an obvious choice to do one of them the night before your first day at school that week. (Personally I wouldn't be keen to get a kid to do a covid test early on a Monday morning while trying to get them to put their clothes on and drink my coffee, but maybe parenting older kids is easier than I imagine...) Maybe some schools are currently bringing in all the kids for tests on a Sunday?

Captain paranoia - I meant to reply to your post yesterday but forgot. I think you're somewhere in the East? The only place looking in that general area like it's on a consistent trend is North Lincolnshire, which has been rising since the beginning of March. Everywhere else (edit - I should have said "lots of places" as some are still falling) is just broadly flat with bumps and troughs. For areas with the numbers of cases you quote, the variance is a huge percentage of the absolute values; it's not uncommon to see double the number of cases one day than the day before for no apparent reason. The weekly average week-on-week change is heavily affected by this noise and gives completely different ideas one day to the next so for places with these low case rates, it's pointless to look at them (changes in weekly average). You really need to look at the cases graph for your area on the dashboard if you want to get a sensible idea.

Was talking about this yesterday with some of my colleagues who have children, they are doing at home tests in this area (Cambridgeshire) on Sunday Evenings and Thursday Evenings.

Last week I posted about the scary growth in Brazil. This week it's got worse. Also check out various Eastern European countries (including strong growth in Poland, Hungary, Bulgaria, Bosnia, N. Macedonia and very high ongoing deaths per capita in Czechia, Slovakia and Montenegro).

Deaths are doubling a lot faster in Brazil than cases - even before accounting for the lag from detection to death.  Detection not keeping up?  Exhausting medical support for patients?  Variants?  

The political side is not positive either - https://www.bbc.co.uk/news/world-latin-america-56479614

I wouldn't trust death stats let alone case stats in Brazil (both are likely very large underestimates) but it shows a massive problem for the world if the local variant can partly bypass previous infection and/or vaccine immunity.... I'm amazed it's not bigger news. They have already had mass graves twice in Manaus...what needs to happen to wake up modern journalism? I thought the Eastern European problems would be bigger news as well...scary growth in those I detailed and several countries shooting up towards the top of the world deaths per capita charts.

Montenegro have screwed up. They did really well in the first wave and on the 23rd March last year had had 82 cases, fewer than the 87 we'd had in the Channel Islands at that point even though their population is 3.5 times the size. Until July they had virtually no live cases, then they opened their borders and that was that. They've now got 87k+ cases and 400+ deaths yesterday .

I think they've overwhelmed their healthcare system:-

https://www.theguardian.com/world/2021/mar/19/brazil-coronavirus-intensive-...

“Today, 49 patients are in the A&E waiting for a bed in ICU,” he said on Thursday morning. There was only space for four.

Yes, really bad in lots of Europe.  From Worldometer, death rates per million population,  areas apart from UK and USA seeing big increases in cases so this picture will get worse.

1 Gibraltar  2,791

2 San Marino  2,354

3 Czechia  2,336

4 Belgium  1,955

5 Hungary  1,940

6 Montenegro  1,923

7 Slovenia  1,917

8 UK  1,852

9 Bosnia and Herzegovina  1,839

10 Bulgaria  1,764

11 Italy  1,744

12 Slovakia  1,683

13 North Macedonia  1,681

14 USA  1,673

15 Portugal  1,650

16 Spain  1,573

How many in the jungle have access to intensive care? What about the slum dwellers? In Manaus at the peaks huge numbers died at home of unspecified causes.

Agreed but noting if you use ONS deaths the UK is still close to 3rd.

Grim reading.  It's hard to believe people were seriously advocating for this approach in the UK - including where it's going.

Updated plot of the sequencing results below from [1].

The SA variant seems to be tailing off which is good news...

A new variant, VUI-21FEB-03, is rising fast with a doubling time of ~ 15 days.  It's hard to know what this means, because the testing is targeted not random, often surge in nature and probably geographically uneven.  

• Perhaps it's rising because of surge testing driven by the interest in the variant, and actual infections are falling
• Perhaps infections are rising

 It has the E484K substitution on top of the Kent variant - one that keeps cropping up and is perhaps associated with escaping a neutralising immune response.  If infections are rising, there isn't long before the window of opportunity passes to try and shut this down through contact tracing. 

[1] https://www.gov.uk/government/publications/covid-19-variants-genomically-co...

Looks worrying, thanks for the update.

I think from your ref [1], the Kent variant plus E484K is VUI-21FEB-02. VUI-21FEB-03, aka B.1.525, the one that is growing, is different but also has E484K.

You are right on -02 vs -03; all this alphanumeric soup is kryptonite to my dyslexia...

Access is surprisingly straightforward, as Brazil has a system pretty close to the NHS - if you have a CPF you get emergency healthcare whether you live in the favelas or a deluxe condo. That's why the example of Manaus is, for me, such a telling one for the UK: similar health system, but levels of inequality, density of housing, and close-quarter manual work comparable to the UK's worst-affected areas. Their hospitals were genuinely overwhelmed, and I don't think the UK appreciates how close it was to being in the same predicament for the same reasons.

The 21st is up today to 2201 unconfirmed, 48 confirmed.  The 22nd is currently posting 1428 unconfirmed LFDs.  Looking at the number of tests done they've not risen correspondingly, so LFD positivity is up.  I suppose that means there's going to be a few thousand additional asymptomatic cases picked up this week, and a few thousand more going under the LFD radar.  It's just as well the easter break is coming hopefully PCR cases will be lower still when schools return but I'm not sure given the consequences if this is a sign of school based transmission.  

Well if the papers are to be believed, there's noise in government about restricting overseas travel for a while. The way I see it, better to put the international travel sector on furlough until next spring than to increase the risk of another lockdown for everyone this autumn...

Re Brazil, it's been in the news on and off for a long time. There's also an element of 'well, the president is a moron and it's all a mess as a result of that and limited resources, so of course cases and deaths are high'. So 'it's really bad' doesn't necessarily get distinguished from 'it's pretty bad'.

Yes, more LFD test results dumped into the system for Sunday. I imagine that should be the vast majority now so let's see if the total drops from 2,249. I'm sure there will be some more inflows so we won't have an accurate picture but directionally it will be interesting to see to what extent this reduces (i.e. what the level of false negatives might be, noting that no all false negatives will be weeded out).

The schools have been back for 2 weeks now so if infection was spreading from kids to parents in a big way, I'd expect that to show through in the PCR numbers by now (assuming that the adults are going for PCR as opposed to LFD or not getting tested at all). 

Not surprising really, Brazil has been in and out of the news for a while now, a poor government response combined with social housing, close working requirements, a new variant and limited vaccine supplies and you end up with Manaus. If anyone wanted to see what a let it rip approach would have looked like, there it is... 

Also Re: Eastern European Countries. We have a number of Polish, Bulgarian, Romanian workers etc on the farm and they started arriving back in Jan/Feb. They have a very lax attitude over there and a lot of them are of the opinion that it ''it is just the flu'' The culture is very much a just get on with it attitude which is why the are such hard working.

They are also very against getting the vaccine which could pose a problem as my company is being very encouraging that all staff get one when it is their time.

That chimes with what I'm hearing from back in Russia. I don't really get this reluctance to get vaccinated, particularly as there was high vaccine discipline in Soviet times (I don't know if they were compulsory as such but a lot of things were 'voluntary compulsory'). Even Putin has been reluctant to get vaccinated as far as I can tell - apparently he got the jab this week but he refused to get filmed (the man who loves being filmed doing all sorts of random shit) and they refuse to say which one of three approved vaccines he had. May be he did get it but it doesn't exactly come across as someone wanting to promote vaccination. They seem to be very interested in selling their vaccines abroad through, as a way to extend soft power.

Having said that, it does sound like Sputnik is actually around as effective as AZ and Pfizer etc. It's just that it got some initial publicity because the initial results were based on vaccinating three blokes who happened to be playing dominoes outside the research center and a goat.

Week on week spike in the number of cases by date reported this Sunday and there will be a bit more to come. Not surprising given the c. 2,250 LFD +ves. Saturday was down though, so it's broadly flat when you take the two days together. Number of tests on Sunday was exceptionally high, though not proportionate to the number of additional LFD +ves.

It will be interesting to see the head map once it reaches Sunday in 3 days' time. At the moment cases are growing only among the 5-20 year olds. If that's still the case with Sunday's figures, that would be a good start but still won't tell us if it's due to picking up more asymptomatic cases, growing infection levels among children or a bit of both.   

I know Brazil has been in the news but not enough in my view given the scale of the crisis there and the potential implications and possible impact for elsewhere.

Wish I'd spotted this link a few weeks back. Includes lots of interesting insights, notably a chart showing (unsurprisingly) that vaccinating people in poorer areas saves more lives than vaccinating those in wealthier areas.

https://www.health.org.uk/news-and-comment/charts-and-infographics/what-nex...

Updated variants plot - new data release after 2 days.  The jumps in both SA and VUI-21FEB-03 is more than the recent trend would predict. This reflects in the best fit trendlines having shorter doubling times, and the most recent data point of both still falling above the trendline.

Hopefully this is an artefact of improves/more intensive contact tracing and sequencing and not indicative that these are rising as part of the spread showing up in the schools-associated asymptomatic testing LFD results over the last few days...

SA = south african, VUI-21FEB-03 = ??

VOC-20DEC-02

I’m update it to that with SA in brackets the next time the data is updated.

A new U.K. variant with E484K I believe.

Any suggestions how to respond to this (I was trying to encourage someone to have the vaccine by saying it was for the benefit of all of use, and the only realistic way out of lockdown):

<quote>

i don't buy that arguement tbh. You see the vaccine protects you, not anybody else. So if you are vaccinated and I am not it won't affect you. 
On the flip side, people who are vaccinated can still catch Covid and indeed spread it, however, because they are vaccinated they may display no symptoms, so in effect become super spreaders as they think the vaccine is in them, so job done. People who aren't vaccinated will tend to be more cautious still so as not to contract Covid. The unvaccinated will also, more than likely, know when they have Covid symptoms so are more likely to keep themselves isolated. Therefore less chance of  them spreading it .
Now I know there is talk that the vaccine reduces the transmission rate of Covid but we could end up with a scenario whereby the vaccinated people are helping this virus transmit and mutate due to my reasons above .
Personally I would rather know I have Covid and take precautions accordingly than not know and go around spreading it 
So your arguement is slightly simplistic and skewed for me. Hence why I don't buy into it and why I have my dilemma

</quote>

Evidence seems to be growing that vaccination does reduce transmission.

I would think that if vaccinated people are catching covid, but not feeling unwell, it's because their immune system is attacking the virus before it is able to multiply to significant levels, thus reducing the viral load in respiratory particles.

I'm also sure the epidemiology has considered this argument, but I don't want to use an 'argument by authority'.

And, of course, if you're not vaccinated, and you catch it, you're likely to suffer rather more significantly.

This is where the red lights and klaxons fire up.

If you're not vaccinated and pre- or asymptomatic, you are like a road gritter full of covid.
And I call bollocks that this person will behave as they are now and be fastidious when restrictions ease and all their mates are doing fun things.

I think it was also found in Denmark and Nigeria around the same time as here so where it started is anyone's guess. It's this one:

https://cov-lineages.org/global_report_B.1.525.html

In better news there is still no sign of school transmission increasing general cases measured through PCRs. Data in the attached image for England is now effectively complete up until this last Monday (22nd) and still showing a smooth gradual downward curve.

You tell them to keep behaving properly and have the vaccine. That's what sensible people will do.

Just noticed their worldometer stats - 90k new cases yesterday, 88k the day before. Percentage-wise only 0.7% (less than Germany or Sweden), but the pure volume has got to be overwhelming. At the start of March they were doing about 50k a day. I'd say they were a it beyond where the UK got to before the Xmas lockdown in terms of crashing healthcare.

Drinking a couple of pan galactic gargle blasters and accepting that some people are going to make up tenuously thin arguments regardless?

Otherwise:

Quote: On the flip side, people who are vaccinated can still catch Covid and indeed spread it, however, because they are vaccinated they may display no symptoms, so in effect become super spreaders as they think the vaccine is in them, so job done. People who aren't vaccinated will tend to be more cautious still so as not to contract Covid. The unvaccinated will also, more than likely, know when they have Covid symptoms so are more likely to keep themselves isolated. Therefore less chance of  them spreading it .

(1) Taking a statistical approach to their core idea that the vaccine weakens symptoms, plenty more people who would have be asymptomatic spreaders will now not be infectious, and plenty of people who would have been severely ill and sometimes eventually dead will no longer be presenting an infectious risk in hospital, but will be symptomatic but not gravely ill and quarantining at home - so for plenty of people it reduces transmission risk.  I should think it would take a very unique set of circumstances to create the situation they describe where transmission risk is raised on average and therefore net total, and as one can't know where one would land, the responsible thing to do is take the vaccine.  

Regardless of point (1):

Quote: Personally I would rather know I have Covid and take precautions accordingly than not know and go around spreading it.  So your arguement is slightly simplistic and skewed for me. Hence why I don't buy into it and why I have my dilemma

(2) Unvaccinated they are at risk of being highly infectious before or without developing symptoms.  As this person is clearly a deep thinker who prides themselves on their smarts, and as they have demonstrated clear awareness that they might still be infectious without symptoms with the vaccine as without, they personally will clearly take sufficient precautions to avoid driving a/pre symptomatic spread of the virus, and so their general argument does not apply to them as an individual.

The LFD results are staying pretty high; I wonder if that's going to translate in to PCR results from household members in the next couple of weeks?  Hopefully lots of extra open windows and precautions in households where there's been an LFD positive.

PCR halving times seem to be stuck at around 40 days; it wouldn't take much at all to push this over in to growth.

Number numbers of people - mostly working age adults - vaccinated in the last couple of weeks; hopefully that'll start limiting cases more soon.  First doses are still going at ~300k/day this week as second doses really pick up.

Would an analogy work? Edited version of their argument below:

i don't buy that arguement tbh. You see the seatbelt protects you, not anybody else. So if you're wearing a seatbelt and I am not it won't affect you.

On the flip side, people who are wearing a seatbelt can still crash their car and hurt other people, however, because they are wearing a seatbelt they don't hurt themselves, so in effect become super car-crashers as they think they're wearing a seatbelt, so job done. People who aren't wearing a seatbelt will tend to be more cautious still so as not to crash their cars. The drivers who don't wear seatbelts will also, more than likely, know when they are likely to crash so are more likely to stop. Therefore less chance of them crashing and hurting other people.

I fear that will just make them stop wearing a seatbelt...

Heh! Best not to double the trouble, then...

If their real dilemma is because they think they’re more likely to spread Covid after being vaccinated, I would make two points. Firstly, vaccination makes it significantly less likely that they would develop any infectious Covid in the first place (they can still catch it of course but the initial viral load will be snuffed out before it can spread and become infectious). Secondly, they can just carry on acting responsibly as if they haven’t been vaccinated. Best of both worlds. I suspect the real reasons behind their vaccine hesitancy are to do with something else though. 

Yes; and I think that's borne out by the increasing evidence that vaccination does reduce transmission (for the reason we're all identifying; the primed immune system gets to work before the virus can 'take over')

I suspect there is, too.

So looks like 32m first doses by the end of next week if they keep going at the current rate of about 300k a day. About 10 days earlier than expected and that deadline was itself brought forward from the original end of April date. Of course that 32m won’t match up the 32m in priority groups 1-9 but it will be close enough. I imagine by mid April they will actually get everyone in groups 1-9 who wants to have it. Good work!

Hopefully they can ramp up the first doses from May after the dip in April but I’m not very optimistic on that. With about 28m second doses left to do after Easter, they might not get to the under 40s till mid June. Cases will be growing by late April due to the 12 April unlock. I’m not very optimistic about the 17 May unlock and reckon 21 June is for the birds (or rather for the CRG).

I know Moderna is coming on stream in April but only a few hundred thousand doses from what I’ve read. J&J and particularly  Novavax (as it’s made locally) would make a big difference but who knows when they will be approved.

Still, the vaccination situation is a lot better than I expected back in the autumn. The third wave will be far less deadly and should be a lot less demanding on the NHS as well. I doubt I’ll be back in the office before September (or at least wouldn’t want to be even if it’s allowed, as our office population is mostly 20s and 30s) but there’s a part of me which thinks it won’t be till next summer.

Well, I tried...

He came back with a claim that the survival rate is 99.96%. I have pointed out this would require 315M cases in the UK...

Should I expect the 'fell under a bus' argument for 98.5% of the claimed covid deaths...?

Someone who's that much of a bellend won't respond to logic or reason. I'd call him a bellend and block/unfollow.

I find the argument about death rate is a bit irrelevant for most people, as most are not in the risk group for dying. Dead people cease to be a burden at societal level. Point out the huge burden of ICU beds being blocked for months, the 10% of people developing long Covid and the cost of all of this to society.

Obviously people should keep acting responsibly with all the low cost things like hand hygiene, social distancing, hand washing etc.   

Acting like you are in lockdown and not taking part in activities which would be relatively safe for a vaccinated person such as going to a climbing wall or going hillwalking is not the 'best of both worlds' if the vaccinations only provide a six to nine month period of relative safety before a new variant makes them ineffective.   There is an element of 'use it before you lose it'.

What really needs to happen is more development of the vaccination infrastructure on the assumption that we will need to do this process several times.  We need to be able to vaccinate everyone over a much shorter time period by having more vaccine production capacity and using less cumbersome techniques for getting it into people e.g. devices which squirt vaccine straight through skin  and don't require a medically trained operator.

It might, of course. I'm far from convinced the increase in LFT positives this week (since 21/03) means increased transmission coming through, though. If the testing programme has proceeded per the original plan, then the weekend of 21/22 would mark the start of bulk testing of kids and their families at home, rather than all kids being done in school. Although overall numbers have stayed fairly similar, that's likely to mean the demographics of those being tested have changed, with lots of adults doing tests (and some secondary kids presumably now not, which is not unexpected.) It would not be at all surprising if young to middle age adults had a higher average prevalence of asymptomatic disease than kids - after all they have had higher prevalence throughout the pandemic. That would explain an uptick this week. I'm not sure if we have the data required to verify this theory though.

Right on cue, stories on the front pages today about drive through centres and an October booster.

I'm not a medical expert but I'm pretty good with fluid dynamics.  I'm fairly sure the ability to do that accurately and without pain is complete science fiction. A needle is far better because you can manufacture it to a very sharp point. A liquid jet in air doesn't behave like that.

Have a read of this if you’re curious:

https://www.nature.com/articles/nrd2076

Water jet delivery is a thing. It was used until it was discovered that cross-contamination was unacceptably high.

The article is about jet injectors held a couple of mm from the skin, which still produce more injection site after-effects than a needle. Holding a jet injector steady that close to the skin and telling people high velocity liquid is about to penetrate their skin will be neither less cumbersome nor less scary than a needle. I have seen something in the past suggesting you could use liquid injection from a greater distance on multiple people soon after each other, to speed up the process of vaccination, and thought that was what Tom was referring to. I maintain that sounds like science fiction to me - I doubt it would be possible to keep the frontal area of the jet small enough.

J and J have said ‘available in UK later part of 2021’, iirc.

https://www.google.co.uk/amp/s/www.chemistanddruggist.co.uk/cpd-article/eve...

I think there are a few more modern ones e.g.

https://pharmajet.com/news/

I wasn't trying to push a particular technology, just the general theory that if you wanted to vaccinate the population of the UK in a month it would be a lot easier with something more scalable.

Interesting take on it.  We'll see what the demographic data holds tomorrow.  I was thinking a bit about this - one question we can ask: "are the total LFD positive results enough to explain all the growth in the 5-20 age bins?".  If this answer is "yes", it's not conclusive but if the answer is "no", it implies some definite facts. 

I think as recent events show, sticking people with hypodermics is really very scalable.  Vaccine supply, less so.  

in reply to Si dH and jonny taylor:

Ain't nobody sticking me with what's basically a high pressure diesel injector.  Nop, no way

Oravax Medical are taking a pill based vaccine to clinical trials.

Of interest to those following this thread - we're introducing lateral flow surveillance testing here and the sensitivity is being rated at 76%.  Also, they are not being given to people that have been vaccinated due to vaccines reducing the viral load of a victim and hence the lateral flow tests won't pick them up.  So, as our population becomes more vaccinated the lateral flow tests will be phased out correspondingly.

Actually it's 99.3% now:- https://www.bbc.co.uk/news/55949640 , 70 deaths per 10k instead of 3.

Yep, but that's easily blown out of the water.

When you consider what fraction of those deaths have happened after Dex, CPAP and proning were adopted - with great beneficial affect on survival chances - it's really very sobering.  

I was going off the confirmed deaths and confirmed cases: 126k and 4.3M, which gives just under 3%. To achieve the 0.7% case fatality rate, there would have to be 18M cases, a factor of 4x the confirmed cases. I guess that's not entirely unreasonable.

I was responding to the argument made by captain paranoia’s acquaintance. However you raise an interesting point. Should there be a difference in how vaccinated vs unvaccinated people behave? I think inevitably there will be some difference but at the end of the day what’s important is doing what is sensible (which might not be the same as what is allowed).

I had the AZ last week. Would I go the wall on the 12th? Yes, towards the end of the day when it’s quiet and I will try to maintain as much SD as possible, plus stringent hand hygiene. Would I go if I hadn’t had the AZ? Yes, with the same basic precautions. It’s important for me. Would I go to the pub? If it’s with one or two others (say after climbing) and in a beer garden well away from other people, yes. If it’s indoors and/or busy, no. Even though I’ve had the AZ. It’s not that important for me and it’s unnecessary risk. Would I go to the office before about September, considering most of the office population is in their 20s and 30s? No, it’s high risk and I can work effectively from home. 

The English heatmap on the dashboard now runs to the 21st when there were c.2,250 LFD positives. The uptick in cases is among secondary school age pupils - the other ages are flat or falling. This is also borne out by the ONS data out today. So we haven’t seen a wider uptick yet and it might not happen if we’re lucky. The PCR tests are still falling as well. Then again, Scotland has growing rates and they opened schools earlier so could just be a matter of time? We should have a better idea in a week’s time but so far we seem to be winging it...

The 12 April unlock is bound to tip things into growth though.

Cases reported today up on last Friday but that was an unusually low level so I’m not too concerned.

Re injection method, at the end of the day the constraint is on vaccine availability rather than jabbing capacity. We managed 750k in a day about a week ago so I imagine 1m a day is feasible with more resources. Especially if you do it by household which would be a lot more efficient. That means vaccinating everyone in the country in just over 2 months. Could easily be 2-3 boosters a year, if necessary. The real issue is production capacity including availability of raw materials and consumables. If I were the government, I’d be funding a couple of massive vaccine plants right now. 

I think vaccinating by household would make a big difference. The time taken to jab someone is minimal - couple of minutes including a couple do of verbal questions and a short spiel on side effects. What takes time is everyone being done one by one,  it least due to SD. 

The vaccine supply is getting sorted with more factories coming on stream. 

They already used jet injectors when they were eradicating smallpox.  The new ones are presumably much better.  How do you inject billions of people faster than the vaccine can mutate in countries with limited trained workers.

Even in the UK the best the current system has done is 500k people/day.  Thats still 120 days minimum to inject 60 million people once.  And the number of people involved is vast.  That's a problem if you end up doing it more than twice a year between 2 doses and new strains.

It needs better equipment without tens of millions of disposable syringes and vials.  Larger containers of vaccine loaded in a robotic vaccinator that can jag someone and be ready for the next customer in seconds.  Put the vaccination robot in a booth accessed by a smart card and stick a bunch of them in places like stations.   Faster, a lot less clinical waste, no needle stick accidents, and no army of trained staff pulled from other health service tasks.

On one hand you object to the AZ despite copious  evidence it works. On the other you want untested, unsupervised automated injections!

Well some of that already exists for farm animal vaccination - certainly the big bottles and vaccine guns - just wielded by a friendly farmer rather than a robot - perhaps a post-brexit diversification option for family farms?

I think it's inevitable that the vaccination will change people's behaviour. On a similar theme, I decided last summer and autumn that trips to my local wall were too high risk, but I will be going again in April. Why? Because my mum has been vaccinated. Climbing is important enough to me that I would take the risk myself, but I couldn't take the risk before on her behalf as we see her every week. Now, however, the balance of risk has changed a bit. If rates shoot right back up high I might reconsider, but to begin with the fact she has been vaccinated will definitely change my behaviour a bit. People all over the country will be making similar calculations.

ONS confirmed a rise in prevalence amongst secondary school kids through their random sampling yesterday, by the way, so obviously there has been some school measurable transmission effect on rates above the effect of increased testing. Hopefully transmission beyond kids' families is being constrained by all the testing and isolation.

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

Yep, we have been eating dinner outside with my mum every week since May. Tonight we might meet indoors as I am now fully vaccinated and she has had one dose. My husband isn't done yet but has been on holiday from work this week (and works outdoors anyway), so now we feel that we can have her indoors for dinner. Yes, it definitely changes things!

I didn't say anything about untested.  I'd expect the equipment used to be thoroughly qualified and actually to do a better job than humans.   Some of the systems have sensors which can actually see through the skin to find blood vessels so they can be sure of what is under the site they stick the needle / spray in.  A robot can also be extremely accurate about the depth and rate at which the fluid is released.

Latest 'outing' of a prominent antivaxer, for info (thanks to OMM on the other channel for spotting this).

https://www.snopes.com/news/2021/03/26/geert-vanden-bossche/

Multi-dose jet injectors were withdrawn from widespread use due to the risk of cross-contamination and blood borne viruses.

Any kind of mass vaccination is going to require large numbers of disposable items. The easiest way at present is with single dose pre-loaded syringes as per flu vaccination. Our GP surgery gives them at 3 minute intervals - so easy to see how much quicker that would be if scaled up.

This seems to suggest they can do quite a few more than you claim https://www.bbc.co.uk/news/uk-56477291

Yes.  But the fact that there were some problems with the technology which caused it to fall ou tof use some time ago doesn't mean that it can't be further developed to resolve those problems.   It comes into its own in a situation where you need to vaccinate very large numbers of people fast.

I'm not arguing with that being the best option today.  I'm saying that if you give industry a multi billion dollar market for mass vaccination equipment they can come up with something better.  It is what engineers do.

I don't object to AZ, in fact I just got a dose of it today.  

What I said was Pfizer was a better product.  Which it is.  Saying Mercedes is better than Ford doesn't imply you wouldn't get a Ford if that's what's on offer.

It takes a few seconds to give a vaccine using a prefilled syringe and needle.

The majority of the time taken is actually due to human factors - the patient walking into the room, then explaining the vaccine and checking consent, then the patient walking out afterwards.

850k a day including second doses highest so far.

I don’t disagree that the tech you’re talking about would be great but we don’t have this tech yet. The limitation is currently on the supply side anyway. 

Indeed. Which is why (1) doing it by household could save time and (2) using walk through jet things might not work for a legal and ethical perspective. 

True. My approach has been not to see my parents from September until now but they had the vaccine over 3 weeks ago (plus my dad has had Covid anyway - almost certainly picked up from going to work once or twice a week) and I’m now on 10 days post jab, so going to see them for a few days today (household bubble, so allowed and I think reasonable in the circumstances, whereas back at Xmas I didn’t go to see them even though it was allowed).

As I’ve been WFH and the walls are closed, this is probably about as low risk as it will get for a while. If I had to see my parents every week and they were in a more vulnerable category, I won’t have gone to the wall back in autumn either. It’s an evolving situation. 

I’m still not clear why you think Pfizer is the better product? 

newer technology is not inherently better

the data from Scottish patients suggests they are broadly equivalent in clinical outcomes

The point I was trying to make wasn't about today.   It was about the potential situation over the next few years where there is an ongoing race between vaccination and emerging virus variants and it becomes necessary to inject entire populations potentially two or even three times a year (e.g. this year some people will be getting two doses of the first vaccine plus a booster).    

The faster you can get the latest vaccine into everyone the less opportunity the virus has to evolve.   And in the end we need to vaccinate everyone on the planet not just the rich countries to really stop this thing.   Automating the vaccination process could be an important part of the solution.

To be fair, Pfizer is meant to be 95% effective vs 76% for AZ in the latest US study but both seem to be 100% effective against death and sever disease. I think people are forgetting that over about 50% is generally considered good enough for authorisation. The real numbers will come out in due course from real world data as. It all studies are directly comparable. 

Indeed.  

It’s easy to get carried away with new technology (more or less the purpose of my career) but “newness” doesn’t correlate with how well it works - that comes down to way more stuff and both “old” and “new” vaccine tech can work astoundingly well against this virus it seems.

In this case, “old” brings established manufacturing technology, strong and diverse supply chains and multiple experts experienced in debugging a new production plant. 

A lot is made of headline efficacy numbers without considering the CIs.  Which isn’t really good science or very insightful IMO.  Edit:  I missed Misha's post - as they say "The real numbers will come out in due course from real world data".  Further, the critical efficacy right now is protection from hospitalisation/death, rather than catching the virus. 

From what I've read Pfizer is significantly more effective (defining effectiveness as reduction in chance of catching the virus after both doses).   I think it was mid 90s % vs mid 70s for AZ. 

From what I've seen anecdotally the side effects with AZ are a little worse.   Maybe have an anecdote of my own in a day or two.  So far nothing.

From what I've seen Pfizer seems to be working better against the new strains.

From what I've seen the Pfizer guys seem to have a better handle on volume manufacturing where AZ seems to have some issues with process control.

No, but it seems like this mRNA technology is pretty good.

Yes, under their criterion which if I remember correctly was about how good they were at keeping people out of hospital after just one dose they both came out well.   You'd get exactly the same kind of effect if you compared Mercedes and Ford cars - there will be plenty of reasonable criteria on which they'd both come out roughly the same.   But most people would still reckon the Mercedes was the more desirable  product.

That's what you'd think: AZ is old tech it should be able to get to market faster and get to volume faster. 

But in fact Pfizer got to market faster, Pfizer got to volume faster and Pfizer is having less production issues.   That's not a good place to be for the old-tech competitor.   20 million of the 29 million doses used in the UK so far have been Pfizer.

When you see that happen in my industry (electronics) you start to think the new tech is going to wipe the floor with the old one.

I think you should go on a sabbatical in a biology lab.  If you survive without giving up hope (a very real possibility when confronted with it all...) it might be instructive.

Yet at least one other new tech competitor is going to be later through approval (hopefully!) and to market.  It's small numbers with lots of stochastic effects.  I don't think that much inference can be drawn from the relative times.  Yet I think it is this other "new tech" vaccine - Novovax - which may prove easier to manufacture at scale in the long run.  

The supply chain for Pfizer/BioNTech in particular looks to have a single point of failure that is directly tied to new tech.  So far it's only caused minor troubles, but there is always a risk to being on the bleeding edge. 

On the other hand, it's the old tech that's going in to significantly larger mass production at the Serum Institute of India - 100 m doses/month of the Oxford/AZ vaccine is the plan.

Even the "Oxford" vaccine is relatively new tech in some ways.

To me the important thing is that we had such a diversity of tech platforms in the development pipeline, and that so many of them have come successfully through authorisation.  This would have been unthinkable back in 2003 if this virus had come out of a cave instead of the original SARS.   I hope one day a decent interdisciplinary group will run some "what if" simulations/modelling on that.  My gut feeling is that luck doesn't just protect fools, small children and ships named Enterprise...

I'd sooner back something like this: https://www.pharmaceutical-technology.com/news/vaxart-oral-vaccine-candidat...
Sounds like one to watch.

Not sure if this accounts for enough, could be a drop in the bucket but it might take the edge off some of the worrisome localised trends noted this week.

"On 27 March 2021, 850 historic cases were removed from the dashboard. Due to a laboratory processing error these tests were reported as positive when they should have been recorded as void. This affected specimen dates between 23 and 25 March in local authorities primarily in the North East and Yorkshire."

https://coronavirus.data.gov.uk/details/whats-new#removal_of_cases_incorrec...

Thanks; I was just adding that to my write up notes for tonight.  I have to put them away now for an hour or two, as I only spot the howling errors in text I write if I put it down and do something different for a bit.

Re: the correction - every little helps.  I could almost reduce today's update to "Groundhog Day"...

Well yes, if they can make a vaccine pill or nasal spray work that's far better than any form of injection in terms of uptake and scalability.