UKC

Cases continue to go up everywhere, and the massaging is towards more restrictions being dropped on July 19th, so the immediate questions for me are about hospital admissions and occupancy. The Lissajous figures seem a good place to look for that.

• Scotland - leading the charge.... Cases have exceeded their peak from early 2021.  All measures downstream of cases remain well below their comparable levels in that last wave (or projected beyond the end of it) for a comparable case number; some estimates read off the graphs with a bit of “by eye” interpretation to plaster over the loops in the last wave (caused by the “ lockdown broken by Kent variant” blip).  Quick numbers, assume big margins for error:
  • Hospital admissions 4x lower
  • Hospital occupancy 10x lower
  • ITU occupancy 6x lower
  • Deaths 32x lower
• England - same synopsis as Scotland; eyeballing ratios between waves:
  • Hospital admissions 5x lower
  • Hospital occupancy 10x lower
  • ITU occupancy 3x lower
  • Deaths 25x lower

It's not entirely fair to compare cases:occupancy ratios between waves, but it's looking like occupancy rather than admissions is going to be the potentially limiting factor if the growth in cases doesn't peter out first.

Two notable things in the ratios:

• ITU occupancy is not improving as much from the last wave as general hospital occupancy, something Si dH first noted in the North West I think a few threads back.  I can see some very different interpretations to this, it's really not possible to tell from the top level data; what's needed is demographic longitudinal data including vaccination status - I'd hope this is in or will soon be in submissions to SAGE, because this looks like the potential breaking point during an uncontrolled rise in cases.  
• Hospital occupancy is improved more than you'd expected from hospital admissions; there are so many other changes between waves it's hard to interpret this, but perhaps it means the mean duration of a hospital stay is reduced - not unexpected with the vaccine improving healthcare outcomes even when it fails to prevent infection, and with the demographic shift presumably meaning more people going in to hospital are younger.  There might be longitudinal data out there that sheds more light on the specifics.  

The gains in ITU occupancy vs cases don’t seem so great in England compared to Scotland.   This relates I think to the North West; that region contributes less than 25% of recent English cases but is contributing nearly 40% of ITU occupancy for the whole of England (noting differences between the English Regions for cases and the NHS regions for hospital figures).  The plot for the North West shows that hospitals have less general occupancy than in the last wave at matching daily case rates, but that ITUs are about as full.   I don’t think demographic differences in vaccine uptake explain that well; for example in ages 45-60, second doses are close to the national average; first doses are a few % behind the national average, but the fractional changes this make to the susceptible pool are not that great - much smaller than the effects seen at ITU level.  With the new strain so prevalent, it seems unlikely to tie back to geographic differences in prevailing strains either.  The BBC ran a story related to Covid and the north west earlier this week [1].

It would be really nice to be able to read off from these plots what the conversion ratio is from cases to admissions, but with a new variant, ongoing vaccination (first and second doses plus the time for them to become effective), outbreaks, and the gradual demographics shift, I think it would be a fool’s errand.  The only meaningful data at this point I think can come form longitudinal analysis of case histories.  If you asked me to play the fool, I’d say “somewhere around 2%” but I’m not going to stake anything to it.

The other point to keep in mind is that we might expect more people to disengage from testing for various reasons so perhaps the cases numbers are soon to become a less reliable a barometer of infections than they have been.

The big question:  How long can this sustained exponential growth in cases continue before rising immunity levels start to moderate it?  Perhaps the English demographic data shows hints that it's already running out of steam.  Continued growth can be tolerated for some weeks yet before healthcare starts to look at risk, although if the situation in the North West doesn't improve soon over ITU occupancy, it may be that patients have to start being bussed about to other regions.

[1] https://www.bbc.co.uk/news/health-57658479

Link to previous thread - https://www.ukclimbing.com/forums/off_belay/friday_night_covid_plotting_32-...

A look at the demographics for England.

• Fastest exponential growth was in the younger adults (“A” on the annotated version of plot D1.c) but now we’re seeing exponential rates slack of there and faster growth in both the younger and older (“B”).  I can think of two very different interpretaions -
  • “Bleed through” of cases from where absolute numbers are concentrated to other age groups. The uniformity of the recent rise in demographic rates across a wide age range, its presence on both sides of this age group, and the amount of time between “A” and “B” means I’m not sold on this - even with the possible effect of universities sending students down from residence.
  • As we’ve seen at the UTLA level before, the most rapid exponential growth rates are never sustained for long, falling lower as absolute cases rise; perhaps the same mechanisms are happening here, with growth in the younger adults having auto-moderated after its fast spurt - combined with vaccination reaching this age range, then further relaxation of attitudes is driving faster spread across the board, but whatever auto-moderating effects the young adults have continue to hold against the across-the-board rise.  Lots to think about here, and lots of airy fairy inference over the mechanisms limiting growth combined with some wishful thinking but it could almost convince me that we're seeing early signs of very high levels of immunity.  Wishful thinking on my behalf, and as ever it’s a case of watching the data carefully as things keep unfolding.

The demographic shift of cases towards younger adults seems to be running out of steam, the probability distribution plot P1.e looks pretty fixed over the last couple of weeks, and the recent change in it as shown in Plot C is small.   We've seen in the annotated D1.c that exponential growth rates are moderating here, so I don't think we'll see any more improvements in this distribution, it may even go backwards a bit looking at the elating edge of D1.c.

The four nations plots - sustained exponential growth in cases in all 4 nations;.

The Scottish plots.

All measures are rising. Cases are now higher than they peaked in winter 20/21.   Cases remain pretty exponential looking (near constant gradient on the log- y-axis plot).

About 3 doubling times left in hospital occupancy before it tops that of the last wave, and there's a worrying up-tick in the rate of admissions and occupancy over the last week.  Occupancy has been consistently doubling more slowly than cases (plot 9, remember the far right is highly provisional) so it's a ways to go yet before it's a limiting factor, but still...

All measures re rising.  - although deaths remain in low absolute numbers and subject to a lot of noise.  Cases are about 1.5 doubling times away from exceeding their winter 20/21 peak, or about 15 days from the end of the data; 12 days from now if the exponential rate holds.

There’s some interesting structure in the rise of cases than can probably be tied back to outbreak areas coming out of growth whilst other areas continue rising.  The complexity in the plot 9 curve for deaths on the right might related to some of the outbreaks, or it might reflect how noisy the data is.

Admissions and occupancy continue to double more slowly than cases, which indicates I think that the severity of cases continues to reduce in an ongoing way.  Which is great.

Rate Constants: 

• The growth of English PCR cases remains sustained with a ~10-day doubling time.  
• The doubling time bounces up and down in a way that makes me think "weather"; now June is behind us I'll try the same analysis I ran against the Central England Temperature for the spring.  
• The good news is that despite some bonkers doubling times around 4 days in early outbreak areas and some university MSOAs, the nation level time has remained sensibly bounded and longer than a week...

Plot A - UTLA Case Rates 

• A change this week showing all UTLAs directly.
• There are no longer any falling UTLAs.  
• I've put two early outbreak areas on in black - it's really interesting I think that these remain in their stagnant / very weak decay even as other areas rise to higher cases/100k.  Promising, I think.  But, these areas had a lot of strongly targeted "boots on the ground" intervention which I can't imagine being rolled out to basically everywhere in England at this rate.  

Vaccine plots

• The number of second doses coming due has dropped - but the number being given hasn’t fallen so much, so we’re seeing my notional estimate of the delay from first to second doses dropping quite a bit over the last week; it’s now down to ~10 weeks and perhaps still dropping.  So, a sign that some people are re-booking and taking their second doses sooner.  
•  I’ve put in a different vaccine plot that shows first doses above the x-axis and second doses below them.  Perhaps it’s clearer in this one that the rapid pace of first doses around mid-march gave way to the ramping up of second doses; now the number of second doses coming due ramp downs, one might expect the first dose rate to ramp up again, but it isn’t.  Is the lack of a speed-up down to supply or demand limits:?
• Demand: With only ~14% of the adult population left to receive a first dose, it’s tempting to put this all down to the most difficult to reach people being left to engage.   
• Supply:  With the most outstanding vaccinations being in young people, the need is now more for the Pfizer  vaccine; I haven’t been following the news on supply in any detail, but that’s perhaps part of the slowdown.

As ever, thanks!

There's still that drought in supply from Pfizer that we need to ride out; the first order will see us through only so much and the next lot is only slated to start arriving in August. It's fine, as long as we don't all flock to the walk in places that are naughtily offering second doses at 4 weeks. An 8 week gap it'll be manageable. If too many people demand/expect/get it sooner, maybe things like this would be necessary:

https://www.timesofisrael.com/liveblog_entry/israel-negotiating-covid-vacci...

Interestingly, my husband got his letter through today for his second Pfizer jag, about 4 weeks earlier than we expected. Maybe some areas have spare kicking around?

Thanks as always. On the annotated D.1.c, the higher growth among 20-somethings was back in May. At the time, cases were still relatively low and the growth was mostly driven by Delta in the NW. I seem to recall reading that a lot of that was driven by younger people. It could just be that ‘A’ was a blip due to high growth (in the context of total absolute numbers being relatively low) which happened to be among a particular age group in the main outbreak area. However I might be talking rubbish. 

My rudimentary understanding is that R0 is about 6 and that vaccination reduces transmission (and I assume R) by 40-60%.

Hence even if every single person were vaccinated, R still exceeds 1.

Vaccine induced immunity may not moderate ultimate number of cases much, it still ends up as most of the population.

Reinfection is relatively rare so infection induced immunity looks to reduce transmission by close to 100%.

Infection induced herd immunity might occur when 60-70% of a wholly vaccinated population have been infected.

Herd immunity at 60-70% is 1-1/R where R is R0 of 6 reduced 40-60% by 100% vaccine uptake.

Given that not everyone will be vaccinated you might as well say 80% (1-1/6) of population infected for herd immunity.

Infection induced immunity appears to persist but we don't know if it will last for a lifetime.

I hope the above is pessimistic or wrong because infecting several times as many people to reach 80% infection induced  herd immunity means several times as many of deaths massively reduced  (>90%) but not eliminated by vaccination.

TLDNR - vaccination induced immunity does not limit cases but has a massive impact on deaths. 

I had a second dose booked about twelve weeks after my first. It was automatically cancelled and rebooked for me. The new appointment wasn't a good time for me so I had to go through the process again but it's probably a good way to make sure people do it. I'm keen enough on getting vaccinated that a text telling me it was an option would have sufficed, but for the ambivalent, it might be a usefully stronger prompt. Though with some risk that people might miss the unexpected email and miss the new appointment. Not sure whether my experience is now common or some kind of trial.

This. It may be a rudimentary analysis and miss a lot of subtleties but I think it gets to the core of the issue. Whether the thresholds are 70,80 or 90% for herd immunity.. the point stands. We won’t achieve it, and new variants will continually partially reset it anyway.

vaccination primarily benefits by reduced morbidity and mortality, with the associated reduction in healthcare overload (apart from the backlog... 😨)

Say there will be a combination of vaccine induced immunity and infection induced immunity (either through unvaccinated people catching it or through vaccinated people catching it (mildly, hopefully)).

My question (to anyone who understands this) is if a vaccinated person fights off Covid knowingly or unknowingly do they then have infection induced immunity to the level an unvaccinated person would have? Even if, say, they don't notice being infected at all?

I think you are over interpreting the difference between vaccine and natural infection immunity. We can only have some idea of natural infection immunity from symptomatic disease (we know reinfections happen but are a small% of the total.) We have absolutely no data on how much prior infection prevents you from picking it up again and transmitting asymptomatically, which is the comparator necessary for the vaccine 40% efficacy I think?

Immune responses from natural infection in different individuals have had very variable strength I think. I haven't seen any evidence it is actually better than vaccine induced immunity, of I've understood the data correctly.

On the other hand, I don't think you need to protect everyone against carrying and transmitting the virus. If you protect a sufficient% of the population from any symptoms either by vaccination or natural infection, then you will get to a point where there is very little symptomatic disease left. Ultimately that is what matters - many people might get it asymptomatically and be transmitting virus for a few days but they won't even ever know about it. I think that is probably the end game. We have known for a long time it won't reach zero, in particular because of international travel etc.

This may be down to the fact that in previous waves ITUs were largely overwhelmed and a lot of patients with multiple co-morbidities and a poor prognosis were instead kept on general wards to preserve a few beds for (for example) fit and healthy 20 year olds that have just piled their Fireblade into a dry stone wall. Re Scotland, I think they have more ITU capacity per capita hence the variance from England now.

The reduction in length of stay and severity in hospitalised-but-not-ITU patients must be playing some part in this. Remember occupancy = people in - people out, so if the out happens closer to the in, the daily admissions stat isn't the harbinger it previously was.

Edit: also remember it takes a different time to get to each of the two ways of leaving hospital. If more people are leaving via the front door, this might also manifest similarly in the occupancy numbers. Lots going on. Hard to interpret.

I was purely speculating on the lag in reducing ITU occupancy, nothing else.

As usual thanks for doing all this.

It (pretty obviously) appears to me that although the number of cases is increasing worryingly, the numbers in hospital and dying are not (currently) increasing worryingly.

So an overall question - does it look like we're on track for Covid to get to an endgame where it's of the same order of "danger" as seasonal flu?

Not asking for a prediction and of course it's with all the usual "assuming a worse variant doesn't arise" caveats - really just a "does anything in the data show that we're not going to get there".

I'm using "seasonal flu" as a comparator because I think most of society would accept that if Covid was at that level, then societal restrictions wouldn't be necessary even if personal choice restrictions were (e.g. vulnerable being careful where they go, who they mix with).

I ponder this a lot. My fag packet maths: about 10,000 normal flu deaths a year, assume occur over 200 days = 50 deaths a day. Currently at about 20 deaths a day, and total infections is now double than 2 weeks ago. So by Freedom Day we could be very close to a 50/death rate. Jabbing is really slowing down, but infection immunity going up. I think society could handle the death rate of a bad flu year (ie way more than 50), so it’s going to be a close one.

(thread hijack - saw a hobby chasing a house Martin bottom of my street this morning!) 

On the same very approximate fag packet that's case rate doubled to 50,000 per day which takes 1340 days to work through the UK population. 

It's a continuous flu season for a three or four of years killing 60,000 at 50 per day.

Yet again, I hope I am wrong.

Let’s hope my fag packet is too pessimistic... 

Couple years back, 22k deaths associated with normal flu in England, so perhaps not too pessimistic

Thanks for the comments on vaccine supply.  It's good that people are looking at creative ways of using batches near expiry.  

In reply to Misha:

It could be; I can split that plot for the North West and for England excluding the North West; I'll try and get that done.

In reply to elsewhere:

I broadly agree but there's lots of unknowns in there; it does seem that with the latest variant, that holding R<1 by immunisation and tolerable control measures alone seems even more difficult, and with a raised R0, as you say more people without sufficient immunity are going to end up getting infected before we're out of the pandemic phase; this "ripping off the plaster" phase should be quite brief in duration, so hopefully people with vaccines who have reason to believe they're still at elevated risk can take precautions for the next ~6 weeks.  It's not clear to me how much infection and then hospitalisation once fully vaccinated is random vs based in a person's genetic and medical histories.  I'm guessing it's biassed towards the later, with a strong dose of social inequality.

What matters critically I think is that protection against the worst health effects lasts longer than protection against catching the disease, so that the "normalised like flu" phase of this disease doesn't suck.

In reply to Luke90:

Interesting, thanks.  As you say that's probably going to shift a lot of people - especially those who had been concerned about loosing a convenient appointment.  Hopefully they can re-book a convenient one still; I suppose there's suddenly a lot of space in the schedule from all the cancelled appointments...  Hopefully this is about the right level of carrot/stick and keeps people on board.  

In reply to Si dH:

"Better" has so many different dimensions to it.  Naturally acquired immunity can be induced by viral proteins not covered by current vaccines, and that aren't undergoing the rapid host adaption at the locations of key epitopes of the current vaccines.  This feels to me like a key step towards normalising the virus in to "healthy" or at least "not awful" circulation.  

But yes, as natural infection is across a broad range of exposures and scales compared to a carefully studied and controlled dose for vaccination, the outcomes are a much broader range which is going to limit the ability to forwards model the situation - and it seems reasonable to imagine that asymptomatic cases could leave a weaker immune signature behind them as you suggest.

In reply to Stichplate:

Thanks; "use it if you've got it".  Another poster also mentioned admissions thresholds changing depending on the level of overload.  One thing to look out for to address this is comparator numbers on people being ventilated or put on CPAP as well as being in an ITU bed.  I think I recall seeing this in a spreadsheet somewhere but can't find it...

In reply to Michael Hood:

I hope so, I really do. ;I'd like to see the next couple of ONS random sampling reports to get an idea how the ratio between infections and cases might be changing.  Listening to  Javid, I think we'll find out soon enough.

I'm not sure it's the "endgame" so much as the start of the next phase - a bit like being mindful of aftershocks after a big earthquake... It's clear this is a very different beast to seasonal flu and I'm sure the challenges and realities of living with it in endemic circulation are going to differ from flu, as are the steps needed to deal with it.   I'm still hoping for great things to come out of the clinical trials pipeline over modulating early immune under-response and later immune over-response, which will hopefully take the pain out of any aftershocks. 

I think it's going to be an edgy situation for another 18 months or so, with much of our immunity being based on "first generation" vaccines; unlike the flu we can't predict and prepare ahead for the next variant, and if one arrises in a far off land that significantly evades first generation vaccines, we might temporarily regress.  I think that a booster vaccine targeting the M- and N- proteins might be a good insurance policy here...  I certainly hope some lab coat wearing boffin types somewhere are working on it. 

I discovered after a year of worrying like fu+ck, that it's much better to not think about it. Carry on normish, wear masks etc but otherwise carry on. Much better for mental health. 

Yeah it was me. The other thing worth considering is that typically elderly and frail people of those with significant comorbidities won’t go on mech vents.. because it would kill them. They therefore would have been admitted to ICU briefly and died or recovered and moved to a general ward quite quickly.

now, because of vaccines, the hospitalised cohort are much younger and fitter, so those that go to ICU are likely to have much more invasive treatment leading to longer stays and higher occupancy.. because they have a better chance of surviving it.

To continue this thought from a different thread, I wonder if the ‘vaccines prevent serious outcomes but not infections’ scenario is potentially a blessing in disguise. Allows our natural immunity to be updated (and include other epitopes than S based) by infection with variants, rather than blocking everything until the mega variant appears which we have no response to.. I hope.. 

Yes, it’s the direction I’m wondering about.  It’s all a bit intangible and complicated but I’m leaning towards “best of a bad bunch of possible futures” which is a rather begrudging take on “blessing in disguise”.

Sorry, I missed this question - a good one.  I'm hoping the (surprisingly large) resident gang of immunologists chimes in.

I'll just note that there's more than one dimension to the induced immunity - e.g. how strong it is, how long lasting it is and what parts of the virus its targeted against.  How long it lasts is also a function of the rate at which the virus changes as well as the rate the body's immunity fades; how fast viral change reduces immunity depends on how many different parts of the virus one has immunity against, and which of those parts of the virus change rapidly or slowly etc.  It seems change is particularly localised to some parts of the virus at the moment, presumably as it tries to adjust to its new human host.  

I can't see how "ripping of the plaster" can last six weeks unless we get 1M+ infections per day to get through most of the 67M population. Although if that corresponds to 100k detected cases per day that might not be catastrophic.

Is 10:1 the right ball park for ratio of ONS survey of infections to positive cases in tests? 

That would be ten times better than my fag packet estimate so it's great to be wrong.

Surely the infectable population is now 《67 million?

It looks like a bunch of people posting on this thread have bought into the latest government propaganda of “We can live with covid”.

It’s what they want you to believe because the fact is that the government have blown it again and learned nothing from what happened in 2020, or in Chile, and opened up too soon before enough people were vaccinated to keep case rates falling.

The thought of 10,000/year dying from covid might be palatable to many when those dying are old but when a new variant evolves, as it may well do, that’s more harmful/deadly to children people won’t be so forgiving. Flu in young children can be more than just unpleasant and we vaccinate kids in the UK against it for a good reason. 

I hope it would be obvious from my posting history that I've no time for "government propaganda" and have been quite plain in my views on this from the start.  I think the same can be said for many other contributors to this thread.

Vaccine uptake appears to be stalling from lack of demand, do you propose a more forceful vaccination program for those who have chosen not to engage?  That could undermine public trust in vaccination with all sorts of nasty consequences beyond Covid.   If we're running out of people willing and able to be vaccinated, the longer we delay the inevitable, the closer to winter we get with all the troubles that brings - both Covid and Influenza - and the further the variants are going to get from the vaccine induced immunity.  There're real but hard to estimate risks to moving both too slowly and too fast.  Given how intangible many of the key parts of modelling this are, I find it quite hard to criticise a median path.

A new variant may well evolve with increased lethality in younger people - as I've said before, both SARS-nCov-1 and MERS-nCov leave no doubt that it's possible for much more lethality in much younger people.

Given what's going on elsewhere in the world, we need to be prepared for that variant to arise - it seems likely it would come from abroad at this point. 

A variant that's lethal in children seems close to a worst case to me; given where vaccines are (not) with approval for children, and given the questions raised over vaccinating children on emergency licensing against something posing absolutely minimal threat to them, it's not clear to me we're going to be vaccinating children based on the status quo any time soo, and it's also not clear to me that immunity granted by our current vaccines would necessarily make much difference against the "bogeyman" variant you posit.  So, delaying the inevitable with regards adults not engaging with vaccination and not fully protected against catching the virus by vaccination might perhaps just increase the probability of a bogeyman variant arising before more children gain broader spectrum immunity from infection.

I really don't know.  It's a hellishly complicated problem made up of a large number of moving parts, half of which we can't see.  Having thought about it a lot, read a lot, discussed a lot and pondered a lot, I just don't know what the "best" option is for us now, but I'm not aghast at the current route.  But I sure as shit haven't arrived at my current view as a result of government propaganda.

Yes, people are going to keep dying. Yes, that's crap.  The coming flu season looks like it could be crap as well.  A lot of things about the last year have been crap, but there's no way this virus can be eliminated any longer, and unlike flu we can't predict future variants to pre-produce and pre-approve vaccines. in advance  We have to be responsive, and we have to take advantage of every break there is.  

FWIW, "ripping the plaster" seems like a really terrible metaphor for what's being talked about here, and I can't help suspecting that it's been pushed by people who are in favour of it to make it sound good. The whole point of ripping the plaster off is that it'll hurt just as much whenever you do it so you might as well do it now. Waiting until you've got more people vaccinated before giving up on trying to control cases with NPIs is about taking a bit of ongoing pain now so that the eventual phase where almost everyone who hasn't been vaccinated just catches covid will hurt less.

What do propose? We cant get rid of it so it is either living with it as best we can or permanent restrictions on normal life (which may not work anyway with more transmissible variants)

Again,  what do you propose?

Vaccinated people can be infected. They're more difficult to infect, more likely to survive and less likely to spread but every single one may be infectable.

It may not be 100% are infectable but it is definitely not close enough to 0% to reduce transmission by more than 40-60%.

It looks like a third booster jab is planned for 50+ and vulnerable people so it looks like vaccinated people are infectable enough to get a third jab.

I think we’re starting to see that restrictions aren’t enough against this variant in the cases data from Australia.  I really hope they can box up their outbreak.  

In reply to Elsewhere:

It really depends on how the ~80% protection against symptomatic infection given by the vaccines against the new variant works.  If I follow you right you’re assuming 100% of people are each protected for 80% of their exposures; the other end of the spectrum is that 80% of people are protected 100% of the time.  This makes a big difference, and I’d expect reality to fall closer to the later scenario…?

But 95% or so aren't, at least in a sense that matters. Nothing like 65m people need to get it. This is why we are using vaccines!

Not currently.  They may become so as immunity fades or variants arrive.

I don't think anyone on here has 'bought in to government propaganda'.

But we will have to live with covid; we cannot eliminate it now.

I would have preferred the current policy to have been discussed more openly some time ago; it has been clear that the government have adopted a 'let it rip amongst the rest of the population' policy for some time, without admitting that is what they are doing, or discussing the rationale or possible consequences. We haven't really heard much from the scientists in the last few weeks. Or from politicians, come to that. I heard a discussion on the BBC news today, about the relaxation policy, and the consequences, for the first time. Maybe I've not be paying attention, but I haven't heard that sort of discussion on national news before. They discussed the growing disconnect between rapidly rising case numbers, and hospitalisations; the sort of thing that has been discussed on these threads for weeks. The shadow health secretary said she wanted to hear from the scientists; I'd like that, too.

I don't think this is a case of the government losing control again; this is a deliberate policy of allowing cases to rise, since the associated severe illness is now much reduced. It's a considered gamble, but one that I wish had been discussed before it was taken. They have allowed some large events to take place 'as an experiment'; theatres, open-air festivals, etc. I suspect the Euros, too, is part of that experiment. I dont think they have explained the experimental method, or how they intend to measure and analyse the results.

Sorry, I didn’t mean to imply you had bought into government propaganda as your posts clearly show you haven’t but I think others have, particularly in the wider population. Perhaps that’s one reason why vaccine uptake has stalled. With just over 50% of the population fully vaccinated we’re still some way off reaching herd immunity and the government’s latest messaging clearly isn’t going to help. 

I accept that a more deadly variant in children may be a worse case scenario but the precautionary principle would be to guard against it. Would parent’s be happy if the government’s policy was to let the infection rip through schools in the hope of achieving herd immunity? I doubt it. In the 1918 Spanish flu pandemic unusually most deaths occurred in young adults so as you say things are unpredictable. 

80% of people are protected 100% of the time would mean viral load does not matter for them. I don't know if that is the case.

I can see how transmission is only reduced 40-60% with many or majority of the vaccinated population being infectable.

30% less infectable and 30% less infectious mean 50% reduction in transmission (70% X 70%) so 70% of vaccinated population infectable is consistent with 40-60% reduction in transmission.

R is reduced but remains above 1 after mass vaccination. The disease spreads and grows exponentially but a bit more slowly. The amount of serious disease reduced 95%.

See bbc24 news this evening reporting on third jab.

China and New Zealand seem to me to have done a much better job with covid resulting in fewer restrictions and less damage to their economies than most countries. With our “world beating” Test &Trace and vaccination programmes we should have done just as well.

Thanks so much for keeping this going, and for your even-handedness. You are a proper UKC legend.

Javid's messaging is somewhat disturbing, and I'm really uncomfortable with the de facto policy of abandoning the young to their fate now, after they've sacrificed what they had to for the old ones. But it is hard to see an alternative.

Time to start looking outwards again, and seeing what we can do for the rest of the world. Some grim times coming elsewhere.

Yup, a lot of thorny issues.  But, can we reach herd immunity through vaccination any longer?  It’s not clear that’s actually possible now…?  Which re casts the argument significantly.

Would they be happy using vaccines on emergency use authorisation on their children, when their children are known to be at very low risk from the virus, and when it’s not clear the vaccine would work against a “bogeyman” variant?  Not that there are vaccines approved for children below 15 years of age I think, even just on an emergency label.

I think we could find quite a few parents of each persuasion - I’ve seen both sides presented thoughtfully by different parents on UKC.  I don’t think the level of restrictions required to keep R<1 would be tolerated until parents could be offered the choice, and I don’t think it would be in the interests of child welfare as it would probably need school closures and isolation from friends.

One of the arguments for not delaying much longer is that if the biggest growth in cases falls over the school holidays, children are perhaps more isolated from it than if they’re in the classrooms, and if the brakes have to be thrown on cases for whatever reason, they’re spared more disruption.

I agree, but it’s not clear to me that holding the inevitable off for much longer is the best way to guard against it.  I do know I’m very glad I’m not making that decision or advising those who do, trying to pick the least bad choice with a lot of unknowns.

> In the 1918 Spanish flu pandemic unusually most deaths occurred in young adults so as you say things are unpredictable. 

One of the arguments I’ve put forwards before to stall for more time with restrictions is the progress of immune modulating therapeutics through the trials pipeline.  The same sort of immune dysregulation seems to underline the lethality of the 1918 pandemic, SARS, MERS and Covid.  Getting these therapeutics in to use is a big insurance policy.  I’ve not even seen this argument made elsewhere, not much appetite for it.  As these viruses apparently kill by confusing the immune system and not through intrinsic lethalities, perhaps they can’t evolve resistance against such therapeutics.

May be I’m missing something but why do we need infection induced 80% herd immunity if we get 85-90% of adults vaccinated? Are you assuming that vaccination does not protect from infection? My understanding is that it does, though not 100% of course (by infection I mean whatever level of infection is considered significant / capable of onward transmission - I guess technically people could get infected multiple times at a very low level but the immune system would snuff it out quickly).

I think you’ve answered your own question there - if a vaccinated person fights off infection, they have just demonstrated that they have immunity. I’m no expert but I’m not sure infection induced immunity is any better than vaccine induced immunity or if you can go from silver leaves vaccine induced immunity to gold level as a result of getting infected. I’d have thought you just have whatever level of immunity your body is capable of...

I suspect deaths will remain low enough to be ‘acceptable’. I haven’t really looked at the death figures in any detail for a few months now. The bigger issues are around hospital / ITU capacity and case numbers (which are significant as large numbers of people off sick / isolating are a problem for the economy even if those people don’t end up in hospital, plus the issues around long covid and potential new variants).

Vaccination only reduces transmission by 40-60%. If 90% of your population is 40% transmissive you have 10% unvaccinated unchanged transmission plus 90% reduced by 60% to 36% as a best case. Overall transmission reduced to 46%. This is not enough to take R below 1 for herd immunity for Covid.

Infection induced immunity might be enough if is stronger than vaccination. It might not be.

95% protective against serious illness and death. Less so against mild or asymptomatic infection as it has much less of an impact on transmission.

Good point.

I’d like to see some updated modelling of this, taking into account what is now known about Delta (level of deaths / hospitalisations / ICU admissions). Instinctively, given the case numbers and the status of second jabs, keeping current restrictions in place or even reimposing some of the restrictions relaxed on 17 May until mid to late September would be sensible. It would delay the current wave but also hopefully reduce its severity.

What I think is completely wrong is doing away with rules for masks. It’s not exactly a big deal (at least for those who don’t wear glasses) and it makes a difference. Jenrick was asked if he’d be wearing a mask after the 19th and he said no because he doesn’t like it. That’s after calling for personal responsibility! Moron...

Agree on transmission but that’s only one side of the equation. The other side is susceptibility to infection. If someone is capable of transmitting but people don’t get infected, R will drop, I’d have thought. What I’m getting it is we don’t need say 80% of the population to get infected (about 20% probably have been already but that’s by the by). But we might need 80% of susceptible populations to get infected... The impact of this wave will be very unequal I suspect, even more so than the previous waves. 

Waiting a couple of months would enable another 20% to get second jabs - so it would hurt less. 

It seems we are on track for 90% of adults being vaccinated (perhaps a bit less for second jabs). Among adults, that’a pretty much herd immunity, especially given that a reasonable % of those who don’t get vaccinated will have had it already. Of course we won’t get herd immunity through vaccination due to children. At least they don’t tend to get seriously ill (as such, I’m not too bothered about it burning through children - you can tell I’m not a parent!). 

Worth noting that children won’t get to herd immunity through infection until the autumn due to the holidays. Another reason to delay ripping the plaster off for a couple of months, as if we do it just as school term ends, it won’t actually be simultaneous across the ages.

From the Grauniad:

The north-east of England recorded a particular surge in infections, with South Tyneside reporting a 195% increase in the seven days to 29 June, Gateshead a 142% increase and Sunderland a 131% increase. Only Oxford and Tamworth have recorded greater increases during this period, with all five areas having a prevalence of between 480 and 585 coronavirus cases per 100,000 people.

“Something weird is happening in the north-east, and it is a bit worrying,” said Christina Pagel, a professor of operational research at UCL. Not only were cases there rising rapidly, so were hospitalisations and the proportion of tests recording a positive result, she said.

Hello Delta +? One to watch...

Looks to me like the UK vaccination rate has been dropping off since the start of June while other countries are keeping going at pace.  

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelect...

The total % of population of vaccinated in UK is considerably higher than in those countries and our rate is dropping probably due to hitting younger ‘can’t be arsed’ age groups. But you most likely know this. In some European countries vaccine hesitancy is much higher than in the UK and they may never reach our numbers. 

More likely because they need mRNA vaccine for younger people and they don't have enough.

If it was vaccine hesitancy instead of vaccine supply young people wouldn't need to wait so long to get jagged and there would be minimum manufacturer specified gap between mRNA jags instead of about twice that.

The UK media is overselling the UK vaccination program.  It started out fast but ever since there's been competition for supply and a need for mRNA jags it has fallen back relative to the EU and US.

Re school: I reckon some schools near me must be reaching their own herd immunity. I guess if the rate of bubble closure is steady (and hopefully falling) whilst local population cases rising, thus would indicate this?

Herd immunity forces R below 1 so the disease is in exponential decline rather than exponential growth.

It's reported vaccination reduces transmission by 40-60%.

It's reported R0 is 6.

I think that means R is 2.4 to 3.6 after 100% vaccination uptake. 

I think you would have to reduce transmission by 85% to get R<1 or herd immunity.

I do not think a transmission reduction due to reduced susceptibility (infectability) and/or reduced viral shedding (infectiousness) of 40-60% takes R below 1 to produce exponential decay.

Without exponential decay you don't have herd immunity.

And how much does catching it and getting antibodies that way reduce transmission.  From what I have heard the theory is that catching it is less effective than vaccination at producing long term immune response.

So if catching it is less effective than vaccination and vaccination on its own isn't enough for herd immunity we either need to maintain social distancing and so on to reduce infections to the point there is decay or we all catch it two or three times a year and each time we catch it we roll the dice on long covid or worse?

Possibly, although I dont think either are out of the woods

Ok. But what do you propose from the position we are in?

Infections after vaccination more common than reinfection after infection? That's the limit of what I have picked up.

Largely yes. Endemic. Vaccination reduces  but does not eliminate deaths. Long term everything is an unknown.

Long time no see, I hope you’re keeping well.

It’s like he’s getting his sound bites from the same people who’ve been writing copy for the anti-control measures agitators in the press and social media.  I guess we know which schism of the party he’s with then.  No cautionary note either which makes it all the harder to re introduce some mild restrictions, as may well be wise come winter.

It would have been respectful to at least have an honest debate in Parliament and to communicate the intent by way of having an actual policy.  Not exactly an “alternative” but at least everyone would have known where they stood.  I do wonder if the AG has given advice on the liability implications of an actual policy.

Indeed.  I’m trying not to borrow trouble but it really doesn’t look good.  We’ve got the plant for Novovax due to come online soon, and the Valneva one down the line, so hopefully we can be a significant net exporter of vaccine, but it’s a drop in the ocean.

Counterintuitively no, it wouldn't; that puts the exit wave in winter, right on top of the badass flu season we're about to have. All the modelling says that now really is the least worst time to do it.

We have comfortably enough to do it at an 8 week gap. Any shorter universally and we'd run out of the first pfizer order before the second batch start to come through. We couldn't do everyone's pfz second dose at 4 weeks. We can at 8.

I think we're all agreed now that the minimum specified isn't the best idea. Or even close to the best idea. Longer gap just is more effective. I'm happy to repeat that statement as fact now.

No, it hasn't. We've basically finished. That's why it's slowing down.

Have I got it fundamentally wrong? Do we expect R less than one through vaccination for current vaccines and variants?

The SPI-M-O stuff is freely available.

This guy also makes his amateur efforts very accessible very well https://mobile.twitter.com/JamesWard73/status/1406978310022774788

As you'll see, this isn't how it would work.

Faith in facepants is a tricky subject. They probably don't do as much as many people think they do. My attitude throughout has been if I need one to go in there, it's not safe to go in there.

The SPI-M-O stuff is freely available.

This guy also makes his amateur efforts very accessible very well https://mobile.twitter.com/JamesWard73/status/1406978310022774788

As you'll see, this isn't how it would work.

Faith in facepants is a tricky subject. They probably don't do as much as many people think they do. My attitude throughout has been if I need one to go in there, it's not safe to go in there.

Yes and no. 

R won't <1 as a result of vaccinations. But we don't have to wait for the entire population to be infected/reinfected in order to get to R=1. 

That's the main thing. 

Not really. The other stuff you mathsed is equally important, but you made some odd assumptions there. It won't take nearly as long as you implied.

I'd say masks do more than 'most people' think they do, as 'most people' still don''t properly understand how they work in reducing how covid spreads. Masks have been shown to have significant benefit for reducing droplet and aerosol distribution. In indoor areas with poor ventilation that's a big benefit.

Lucky you, that you can avoid 'going in there'. Many have to use public transport and go into work. The government defining indoor mask use as a personal responsibility is plain dumb... it's a very sensible population precaution measure.

Um... Thanks for the presumptuous lecture, but where did I say I get to avoid it? 

OK, giving you the benefit of the doubt, do you support this unscientific government decision or not? Calling masks facepants and being dismissive about their very real utility on a thread dealing with covid science doesn't make sense to me. Was it black humour or what?

Continued indoor mask use and other simple covid precautions would also cut flu risks.

I am happy to keep using a mask in shops etc.  However, the decision to enforce it or not is neither scientific nor unscientific, it is political.  It balances the importance placed on public health and individual freedom not to be dictated to by a government.  The scientific evidence is that they have some effect on reducing transmission but the decision over whether this reduction is  worthwhile when balanced against other matters isn't a scientific one.

How about stating your credentials before pontificating?  

Your post is a series of statements with no references to back them up and no statement of credentials.

The fact is young people are having to wait to get their jags.  My daughter is 18 and her and her friends only got jagged yesterday.  They put their names down for it the second they could and got the jag the first day it was offered.

I have another daughter in Germany and friends with daughters in the same age range in California.  The US jagged their kids sooner, they jagged them with Pfizer and they jagged them with manufacturer recommended gap.  My daughter in Germany got her Pfizer more than a month before the one in the UK and with a shorter gap to the second.

AFAIK there is a study that says AZ is more effective with a long gap.  I have not seen data that says the same is true for Pfizer and Moderna.

The obvious explanation is that the US and Germany are swimming in Pfizer and the UK is not because the Tories f*cked up.

To use a mountaineering analogy, there can be many routes down from the the top of a mountain that can look good because they seem to get you down quickly but which in fact lead to dangerous territory. I’m sure there are many people who have been in the situation where the wise thing to do is stop descending, turn around and go back to the top if necessary to find a safe route down. MRT logbooks are full of cases where people didn’t make the right decision, often with fatal consequences.

Unfortunately, due to poor leadership the government have got themselves into a position where they won’t even stop. As others have said we should now stop lifting the restrictions until the the vaccination programme has caught up. 

To quote from the Guardian this morning, “To most scientists, living with the virus means doing everything you can to reduce the risks, before taking the brakes off. It doesn’t mean taking the brakes off and just seeing what happens”.

https://www.theguardian.com/politics/2021/jul/04/pm-confirm-19-july-end-cov...

I'm sticking to my comment. You seem to be getting upset by the presumptions you've made yourself.

They help some but they're not the magic forcefield that some are treating them like.

Quite probably true. It's good to be wrong sometimes.

https://www.ukclimbing.com/forums/off_belay/friday_night_covid_plotting_33-...

The only way the immunity by catching it thing would make any kind of sense would be if that kind of immunity lasted for many years.

You can't take 5% level risks of long covid or hospitalisation and have 60 million people roll that dice twice a year.

Your right. I don't have a daughter who couldn't get a jab straight away. All I've done is Google it and read the dashboards and add up some numbers, so I can't possibly know as much about this.

The US has excess supply because of the crippling levels of hesitancy there. Look at where the curves flattened off compared to the UK.

Well yes, and the decision about which to take isn't a scientific one.  This isn't just a pedantic point.  The idea that science can be a substitute for political (or personal in the case of mountaineering) decision making is wrong.

It looks like in some respects it will

https://www.bmj.com/content/373/bmj.n1605

Again, what is the alternative?  If you are correct, at some point the decision is severe restrictions for ever more vs accepting the effects of covid.

Unfortunately, you can’t cheat gravity with a political decision!

You seem to be assuming that the only considerations are minimising the number of covid cases, or the risk of an accident while descending a mountain.  Neither is the case.  You might take a steeper descent route because its more fun, or quicker, despite it being more risky.  Equally, we might decide allowing growth in covid cases in fine because people have had enough of restrictions, or for economic reasons, or because of ideological reasons.  None of this is a scientific.

It would also make sense if that immunity offered better protection against future variants than the first generation of vaccinations do.  I can't comment on how that benefit weighs against other risks, there're intangibles on both sides, but it isn't one sided IMO.

We take the risk of post viral fatigue from a whole bunch of other endemically circulating viruses; as elimination of this virus now seems extremely unlikely it's not clear what else we can do beyond minimising the pain of getting to that status?  This is putting post viral fatigue in to a sharp focus for research and clinical support, and hopefully things are going to progress rapidly there.  

That's such an incredibly selective way of looking at it I find it hard to believe you're not deliberately misrepresenting the situation at this point.  Here's the counter-side to your link:

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelect...

The vaccination rate in every country is going to drop to zero as they approach the point that all people who can and want to be vaccinated have been vaccinated.  The UK is significantly closer to that point - much closer than it looks when considering the limiting % of the population against which vaccines have approval.   

This whole "which nation is doing better/worse" over vaccination argument politicised in to a rant against the Tories is pretty distasteful and so myopic of the complexities of the situation.  It reminds me of the endless circular trolling of a now departed poster and their suite of 20+ accounts.  There're clear examples where cabinet decisions deserve heavy scrutiny , adding meaningless noise just detracts from those. 

There does seem to be a rising "go fever" on the dropping of further restrictions.

The exponential growth rates are hovering around a level right now where there's still enough time for detailed analysis of the data to inform policy in time to avert healthcare overload if things go worse than expected.  

I worry that a big triumphant "Freedom Day" further boosted by very one sided messaging could lead to much higher exponential growth rates, so that there isn't time for policy to respond to a worsening situation (in terms of changes to hospitalisation rates etc) before disaster is once again locked in.

Which is why I'd favour a more progressive relaxation of the restrictions, and cautious messaging rather than go fever.  

The one I really object to is the dropping of quarantine requirements on double vaccinated travellers to amber list countries.  The image in my head is of a lightning rod for vaccine evading variants.  A fractal lightning rod with millions of tendrils.  With a giant powder keg next to the receiving end.

We are about to find out.

See graph of cases over 3 months at https://www.travellingtabby.com/scotland-coronavirus-tracker/ for example. 

I interpret that graph as reflecting an unstated policy of unconstrained growth since early May. 

I interpret the cases graph for May 2020, November 2020 and January 2021 as reflecting the stated policy of Covid suppression.

May relate to why I’ve had an increase in deliveries to households self isolating over the past week. Speaking to those householders all of which had one or more family member with a +ve test result, it appears to have been either a child from school brought it back into the house or a younger adult male who had been watching the football either in a bar setting or more commonly in a mates house. 

In terms of this being a political, not scientific point...

I agree, with one big caveat which has been my motivating force in this event.

The political decisions about what to do rely explicitly or implicitly on science, as the political decision is between different potential futures, and the scientific side contributes exceptionally (compared to most political decisions) towards the most reasonable assessment of each of those possible futures.  A lot of the political debate from the very start has presented sham futures that existed in imaginations but couldn't be seen as reachable through a scientific lens.  The science is critical to ensuring an honest political debate.   There are tragic examples now internationally that show what happens when the political debate becomes entirely uncoupled from reality.

"personal responsibility but I personally won't wear a mask" is up there with "don't shake hands (SAGE) but I (PM) shook hands with everybody on the Covid ward" for a lack of personal responsibility.

We are back to the days of political ideology trumping science & medicine.

I think the  key difference is reality/non-reality, not science/non-science.  Science is one (large in this case) input into decision making but other factors are also important.  Just because these aren't science-based doesn't make them un-real.

Regarding the evolutionary pressure on to produce a vaccine resistant strain if there is partial vaccination, isn't this the case with most vaccines (e.g. measles, polio).  Are they just less prone to mutations or is there something else going on?

I'd agree with most of that, and was fairly optimistic on these threads myself just a few weeks back, but unfortunately cases are getting out of control and cases mean large numbers with long covid and risks of new variants and some extra stress on the NHS. Speak to anyone working in hospitals and the system stress is most commonly serious already. Keeping the current minimal restrictions that barely affect most lives or business is the mainstream scientific position let alone a wise precautionary principle. Where business is still affected (night clubs etc) it should be supported. 

The Indie Sage weekly broadcast is well worth a listen this time.

youtube.com/watch?v=vuQnvRVkwSo&

The other factors are important, but if they rely on un-real science then they become un-real themselves.

All the factors I've seen raised - e.g. economic damage, mental health, children's educations - are entirely valid and the later two haven't seen as much attention as I'd like - but cases built upon them that neglect the science are tosh, and some of them provide clear emotive angles to push people based on emotion not evidence.  

Equally, a case that uses the science to determine what's needed for an endpoint (say keeping R<1 and so eliminating the virus locally) are not magically elevated by the science, the science should simply be used to evaluate the possibility and cost of reaching the endpoint, so that decisions can be made about which endpoint to go for based on all the angles.

Early on the science was near-king of decision making because it came down to one thing "How do we not break healthcare in the next two weeks", but now we're in a place where there are intangibles in every direction, and where there is the luxury of more time to evaluate decisions.  

This is why I've been distinctly unhappy with the "following the science" angle from the start.  You can't follow the science because it has no means to choose a direction.  It contributes to estimates of the cost and benefit to each direction, but that's it.  A more suspicious person would think that there was some sort of blame transference mechanism being built here.

The levels of burnout in non-healthcare staff I know are horrific; I don't know many people working in healthcare but I can see the effects.  This doesn't seem to be getting much parliamentary or media attention.  It's really worrying.

Listening to Javid that's all out the window with gusto.  As Elsewhere notes above, the phrase "personal responsibility" is back.  [...]

Other than the amber list changes (I'm almost livid over that, look at how the importation of the current variant has forced everything) I'm trying to remain sanguine about the effect of the other restrictions being dropped; as much as I'd like more caution I can see a hopeful side as well.  As ever, the data will tell soon enough.  

It's simply dangerous rhetoric to say they 'help some' when they are shown to be crucial in reducing infection risk indoors in poorly ventilated areas.

The whole public discussion of masks has been a complete mess from the start when the message should have been simple and clear: they significantly reduce droplet and aerosol spread that causes infections indoors with less than ideal ventilation.

An accusation repeatedly levelled at these forums by various disgruntled posters and trolls is that it's an Echo Chamber.

I should bookmark this thread to show them next time someone makes that claim...

The clear and obvious answer there is to sort out ventilation.

I still see busses with all their ventilator windows closed.

I see LSRH's point that an area that needs masks is an area that's not safe.  

FTFV.  It's really disappointing that a lot more hasn't happened here over the last 12 months.  I've heard word from some of large institutional failures to grock the basic point.  I just don't understand.  I spent weeks pushing this hard in the very early days with my institution.  The responses I got went on my pros list for leaving them to it and finding greener pastures.  I never got round to the cons.

Re young people and jabs: in Wigan there are a number of walk in jabbing centres, scattered throughout the Borough, varied opening times. I guess many areas doing similar. Encouraging young people to turn up for a Pfizer. Cant do better really:

https://healthierwigan.nhs.uk/covid-19-vaccination/walk-in-vaccine-clinics/

"All the factors I've seen raised - e.g. economic damage, mental health, children's educations - are entirely valid and the later two haven't seen as much attention as I'd like - but cases built upon them that neglect the science are tosh, and some of them provide clear emotive angles to push people based on emotion not evidence. "

It's become double speak. All these problems were identified over a year ago and the government even promised significant investment in some and were in complete denial about others. The reality of investment was pathetic. You cover the ventilation point but should have said this needed a strong government lead. NHS mental health services are on their knees and have no significant extra investment. Laptops for all deprived kids never happened. Payment for self isolation of casual workers never happened. Careful border controls never happened. On lockdown damage, the government has never once admitted poor pandemic control means more economic damage and more non covid health impacts.

Above all clear messaging is vital in a public health emergency but this government cares more about itself than the population.

Yet imagine if some new variant makes all of this fabulous vaccine success irrelevant. Extrapolation to July 19th even on a relatively conservative basis currently indicates we are heading to all time record daily case levels, with current restrictions and all the inbuilt herd immunity from jabs and infections. Even best case this means hundreds of thousands more with long covid.

The alternative is a level of restrictions which combined with vaccination get to the point where infections start to decline.  Once you get infections near zero within closed borders you can operate almost as normal and gradually and cautiously move the boundary of the closed borders outwards as more countries attain the Covid free status.   

All the while you keep going with developing all the technologies used to deal with Covid and scaling up vaccine manufacturing.  We have come a long way in a year and a half and we will keep making progress.

The data from Israel is that even Pfizer is only 93% effective at keeping you out of hospital and 64% effective at preventing symptomatic infection since Delta.    

https://twitter.com/CrushCovid/status/1411900917625020416

Clearly complete failure of vaccines would be very bad.  Although (see link above) this seems unlikely, and completely evading naturally acquired immunity seems even more unlikely, which is a (perhaps weak) argument for allowing infections now in relative safety.

There is not much we can do about this unless we are willing to tolerate indefinite severe restrictions.   Long covid seems overblown to me.  The reports seem to combine of "a bit of a cough for a few weeks" (large numbers), with long-term debilitation (small numbers, and a factor with many viruses).

I'm starting to conclude the level of vaccination is irrelevant to the number of cases compared to human behaviour and policy.

UK - 360 daily confirmed cases per 1M
UK - 116 vaccine doses per 100 population

Germany - 7 daily confirmed cases per 1M
Germany - 90 vaccine doses per 100 population

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelect...

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelect...

It doesn't need to be complete failure just some vaccine escape that makes serious illness more likely in the vaccinated. Running hot at potential record levels with a significant proportion of the population partially protected is just nuts in risk terms. It's perfect conditions for generating a variant with some escape.

There is plenty that can be done... tweek restrictions to keep infection levels well away from peak levels and population antibody levels will do the rest for you. The government seem to have have decided to 'let it rip' based on no clear scientific advice.

On long covid you clearly have overlooked the ONS data and the proportion reporting many months of serious debilitation. 

The Indian variant also features strongly perhaps - we had a lot of early importation events.  With a higher R₀ and marginally more evasion against complete vaccination in terms of infection/spread, if that's the case it's really bad news for other nations with further to go with their vaccination programs.  

What happens within the UK is irrelevant in the context of the global pot of virus mutation. I am however quite surprised at the general lack of long covid consideration in mainstream media i.e. proper reporting on the actual distribution and nature of long covid symptoms. There's serious debilitating illness and there's having a bit of a cough for 3 months - they are not the same thing and this needs ratifying.

As Hardonicus points out,it would seem to be global rates that the issue here

Yes, I was referring to long covid.  If people get the disease, this will remain a risk.

No, they bear out what I said

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

I'll do a quick edit to "level of vaccination is irrelevant compared to human behaviour, policy and variant." to make you look dumb!

In reality it's not, as external variants can be controlled to a degree with border measures and emergency track and trace and it's only the west that has the perfect petri dish of large proportions partially protected that increases the probability of mutation with vaccine escape, and of those only the UK that is proposing to do this at near or over record infection levels.

On ONS at least get the right link!

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

Nearly 200,000 with an ability to undertake daily activity limited a lot.

Too slow, too slow will be the cry when the edit window has passed you by…

Yes, thank you. A busy spring of work and the weather being too good to waste indoors have kept me quiet…. that and not having anything useful to contribute. But now the weather has broken here and, as every year, the long damp Scottish summer of discontent begins.

I agree about the lack of decency/courage in making the de facto policy public. Which is strange given how much the "just flu" bulls must be thrilling to it. Your suggestion about the AG and liability rings true to me.

The other issue you raise about the government’s stated policy on removing quarantine for double-vacced travellers to amber list countries is very damning. The government’s reckless laxity about foreign travel is of course the reason we are where we are so soon with the Delta variant, and left with so few choices. It would beggar belief, had not this government already made disbelief so devastating wealthy, that even now they are more willing to bend to the travel lobby than to learn from their previous mistakes. 

I don't think we'll have much of a problem getting second jabs in people, it's just a matter of time but we're not going to get to herd immunity in the traditional sense where outbreaks in unvaccinated sub-populations are firewalled by the vaccinated wider population. It's just going to circulate doing less harm than it did. This is terrible news for the immunocompromised who are once again prisoners in their own lives and it permanently ratchets up pressure on healthcare right at the point where we might expect to see people burned out by the past years leaving the sector further increasing pressure. The historic approach of importing people to cover multi-year skills shortages won't work either given brexit and the global nature of our problem and I don't see much evidence of a massive domestic recruiting drive into healthcare.

Maybe but how and for how long at what cost? The precautions are dangerous to kids too, their education and social development is being severely impacted.

In all likelihood a nasty new variant will arise somewhere pretty soon and we'll be back to social controls while we deal with it. We might as well get on with life largely safeguarded against this one by vaccination until it arrives. The alternative is living in semi-permanent lockdown, socialisation all but banned, strict border controls with minimal passage through quarantine. It's not workable long term, we're going to have to address the problems we will likely face as and when they actually arise, in the meantime we plan for them as best we can.

It would be good if the government could explain the rationale behind allowing kids to acquire immunity through infection vs vaccination, show the balance of risks to them really does push us that way though I suspect that maybe isn't the case, at least not simply, that there are other considerations at play so they're unwilling to shine a light on this compromised choice.

That's pretty much exactly what's happening but with the added disruption of still isolating classes/year groups and connected families because we're not yet fully committed to it. Deal with the inconvenience and I suspect most people having lived with covid as a nuisance rather than a killer for a while will just shrug and accept it.

jk

They have, and I would far rather we had been more like New Zealand during the last 16 months; I don't think we could have held hospitalisations and deaths down to their level but we could have tried, and our partial success would I strongly feel have been much better than what actually happened.

But, NZ can't remain isolated forever, and the world isn't going to eliminate Covid.  

In some ways their situation is far more precarious now than it has been to date, with almost no naturally gained immunity in the sub-populations most likely to transmit and receive the virus - which is where it will naturally concentrate in places like the UK, with much more of their vaccination roll out ahead of them and with the Indian variant rising to prominence in many places.  I really hope NZ can continue to shine a beacon proving it was and is possible to control this virus and to preserve healthcare until vaccines are rolled out, but once they are rolled out there, I can't see NZ remaining isolated for much longer.  I don't envy the choices they face, but I envy and respect how they're getting to those choices with their national dignity intact.

Society can't function without hospitals so we simply cant let them get overwhelmed. The only workable long term measure with repeated vaccine escape is letting people be treated outside hospital with much suffering and significant higher chance of death....good luck with the politics of that. Infection control in hospitals will still be incredibly difficult and the knock on to other health impacts huge.

This virus is already a perfect storm for the NHS, and worst case maybe for life as we know it. On the former point the service capacity is way below levels of our northern european neighbours... being run by a populist government who always seem to lie first...with covid impacts so far leaving staffing, staff health and staff morale at rock bottom modern levels yet facing the biggest backlogs ever. A new order of periodic lockdowns seem the only possibility in your scenario until the point the world economy will likely break.

Luckily this currently looks to be a lower probability outcome but it's best to be careful as we can with the odds when playing dice. As a minimum the science presented to the public indicates most current restrictions should stay on July 19th, especially mask use indoors (and is vital where ventilation is poor). After all that has happened who seriously believes the science backs the government current proposals and if it did why on earth wouldn't they publish it?

If and when a degree of vaccine escape becomes a problem and assuming improved treatment hasn't yet controlled the problem we'll be back to dealing with Covid2n like we did Covid19 and its significantly more infectious successors: periods of reduced social contact and rapid vaccine development. As you note, there's no practical alternative, nothing has changed here, I well know we can't overload our healthcare system to the point of rationing life-saving care and hold together for long as a society. Personally I think the idea of opening nightclubs and travel* with cases at an historic high is pretty risky but primarily because of all the 'one way', 'no going back' rhetoric from government which will dangerously delay any re-imposition of social controls if and when they become necessary for whatever reason, be it miscalculation of the timing re the 19th and vaccination, variants, winter, flu...

*I suspect whatever the UK gov says, travel may be effectively limited by external pressures for quite a while given how hot we will be running this summer with the current worst variant.

Or our economies strain then adapt. But yes, I think a medium term future of periodic 'lockdowns' is quite likely and probably the minimum harm realistic option given our meagre ability to work together as a species outside our petty national differences. See also run-away climate change for shit futures we could theoretically avoid but will flirt with for a long time yet.

Which version of the future do you think is more likely, covid somehow coming under control globally and trending toward eradication?

jk

So despite the claimed reductions of 90% / 60%+ improvements in things like infections, hospitalisations and deaths by vaccination, the 'real world' figures are much less? Obviously many of those will be partially or non-vaccinated people, but governments should be basing their calculations on the 'real world' values.

Interestingly my noddy stats say the rate of increase in UK live case rate has not peaked. It has a mini-peak at 4.7%/day in mid-june, before dropping back to 4% in week 4 before ramping up to 5.5% yesterday (not peaked yet). I'm putting it down to sustained infection nationally as opposed ot the early outbreak areas.

Is that doubling rate reducing? If so, how fast?  Can NHS overload be avoided (I'm thinking of your '3x doubling times left for Scotland' point)?

Of interest to the thread, at the weekend Jersey announced it's abolishing self-isolation requirements for contacts irrespective of vaccination status as long as they agree to testing:-

https://jerseyeveningpost.com/news/2021/07/04/breaking-isolation-rule-scrap...

They've basically done this because as of Friday they had 370 live cases with 3012 contacts, of whom only the double-jabbed didn't have to isolate. The S-I rules were starting to kill their economy and society. Their vaccination & restriction levels are similar to the UK.

Majority of school busses roll up at my son’s secondary with no windows open. 

Lots to pontificate on and argue about in this thread. In no particular order:

1. Herd immunity thresholds. Various numbers being taken out of context I think. It's important to look back at studies of vaccine efficacy and look at how they were actually measured. I think I agree with LSRH's view of elsewhere's analysis. We will eventually get to the point where the level of ongoing symptomatic disease drops to a relatively low level because of population immunity developed through a combination of vaccination and natural infection. I don't think it will take very long for case rates to peak given the number of people who already have antibodies* (and definitely not require anything like the whole population to be infected), but I do think it will take longer for rates to gradually decay because as r turns negative at national level it will only do so very slowly and at that stage there will still be lots of individual areas on the way up. There will probably be ups and downs at a local level due to spillover from other places.  *I put a lot of weight by the ONS's studies of population antibody levels, which show they are pretty high (86% of adults with antibodies last time I looked, which can only have increased.) 

2. Efficacy of masks and any other remaining restrictions. I think the importance of masks was misunderstood early in the pandemic and this was a big problem. We shouldn't just chuck them away (although, they are already effectively ignored in some of the highest risk settings anyway). I think most people misunderstand the importance of masks and other measures in the future. There is this idea that we either achieve herd immunity in some way *or* we need some restrictions. People recognise that some level of population immunity means we need fewer restrictions to keep things manageable, but they don't seem to recognise that it works the other way too. Keeping some measures like masks in place will reduce the level of population immunity required to keep cases (and therefore consequences) down long-term - and the size of the exit wave. Lots of people talk about living with the virus - this doesn't mean exactly how we lived before. We need to decide exactly what it does mean. Some stuff will be easy or happen by default - eg more working from home (at population level) perhaps more reluctance to attend work or school with a cold will immediately reduce r and therefore have some positive beneficial effect on the level of population immunity needed long-term to keep cases down.  Some stuff will be harder, like mandatory mask wearing or occasional limits on high risk activities eg in winter. Improved ventilation in buses and indoor settings might also be a difficult sell but I would agree is practicable outside of winter in most areas. But we need to consider things like this properly, not argue over-simplistically that they should all be set aside because we are going for herd immunity.

3. Timing of the exit wave. I'm not completely sold on the logic that we need to do it quickly to avoid overlap with winter flu season. This is (1) because there were lots of predictions of a problematic flu season last winter which didn't transpire (fortunately) and (2) because, as has been reported recently in the news, children's hospitals are currently seeing rates of non-covid respiratory disease admissions as high as a usual winter, supposedly because having 'missed' the usual bad winter season in lockdown, kids don't have the immunity they would have, and are going through these diseases now instead - this suggests the whole respiratory disease cycle is less constrained to seasons than people might think. I think basically that uncertain science is being used to justify the policy that people want.  Having said all of the above, I do think it makes sense to aim to go through the exit wave, if inevitable, while kids are off school, and from a selfish perspective I'm hoping the worst can be over before my son starts reception in September. This means the focus needs to be on maximising vaccination before 19/07, which brings me on to...

4. Several people are suggesting the government have done what they can with vaccines and the rate is now demand-constrained. I don't believe that's really true yet. From a personal perspective I have been trying to get an earlier appointment for my second dose (currently scheduled early August) but despite checking the website every day for the last three weeks, have been unable to do so. If someone offered me an appointment three weeks earlier I would take it at the drop of a hat, but they haven't done. Once I actually hit 8 weeks (in a week and a half) I might be able to just turn up at a walk-in centre, but as far as I can tell Sefton council are doing a poor job of advertising these and they are only open on odd days at short notice. (Edit to add, this is even less helpful...https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/...)

5. WT mentioned that he thought a new variant was most likely to come from abroad. I'm not sure why? They are still keeping some travel restrictions at the moment and it feels like high levels of cases here for a while are as likely as anywhere to breed new variants. But a new variant could still arise either here or abroad. Which brings me on to...

6. Lots of people suggesting that the number of people getting tested will wane as high infection rates become less of an immediate concern. I agree this is likely, but it's really important that government keep pushing the importance of testing so that new variants can be identified and tracked.

7. I agree with some others that Government messaging has gone off the rails. I suspect that Boris's address tonight will sound some caution so that he can't be held quite so strongly to account if we hit problems, but then his team will carry on encouraging people to go straight back to normal at every opportunity.

Just as an observation on this - I've had several messages from my surgery pestering me to get vaccinated. I've not done anything about it yet (I'm 6 weeks today from my first one, and I assumed it was a mistake because I thought it was supposed to be 8-12 weeks?), but when I looked at the link I was being offered a pretty wide range of slots. May be a local thing?

If 8 weeks is being relaxed further, and especially if the double vaccinated are afforded extra privileges from the 19th, I should maybe get number 2 done asap!

Surely just because our populations is such a small proportion of the world's. I don't think he was suggesting we're less likely per capita to produce a variant.

It's specific to individual vaccine centres too. My first dose was at a small centre that seemingly isn't running again until August. Ruth's was at a big centre and after a couple of weeks trying she managed to rearrange it to come forward to mid July. They won't show availability for an alternative appointment at a different centre from your first dose unless you cancel your existing appointment.  Neither of us had any contact from GPs etc.

Lots of thoughtful points.

I'm not sold on the logic, but I see it.  I think there's sufficient intangibles on both sides so modelling is of limited utility, and and some point someone has to make a decision and then make it work.

The absence of one flu season raises the stakes for the next flu season, and it seems clear why we missed the last one (heavy lockdown), and with restrictions dropping that doesn't carry forwards unless there's a big policy u-turn on restrictions coming for the winter.  Which certainly isn't heralded in the messaging...

The respiratory infections rising unseasonably in the young now are not influenza viruses as covered in the ongoing surveillance reports [1].  So I'm not sure this supports your suggestion about he cycle being less constrained - perhaps it is for some viruses and not others.  As metaphors go, I've been thinking about "anchored" rather than "constrained".  Without an anchor it can float around, but with the right (wrong!) seasonal/behavioural links it ends up anchored to winter.  There must be so much to be learnt and understood from all this.  Is flu not rising now because it's so close to being eliminated, or because its not its time?  

What we do know is that right now there's no flu about, and it's remaining absent despite other respiratory illnesses presenting in children.  We don't know what the winter will bring - perhaps against expectations there will again be a record low season.  If we think we're about at the limits of vaccination, and some people are going to have to go to hospital, there's a lot to be said for making use of hospital capacity when its available; we don't know what things will be like in the winter, we do know what they are like now.  All options seem crap at this point, but at least some are bounded by certainties.

I've a lot of time for the argument that another 3-4 weeks would make a big difference with 2nd vaccines coming due, especially where they can be accelerated forwards from 12 weeks to 8 weeks.  I certainly wouldn't be dropping any more restrictions until 2nd doses are complete.

Another argument for "sooner vs later" is the - once again intangible - chance of a more evasive variant emerging abroad..

I'm glad I don't have to make decisions on this stuff.  Eventually as the intangibles stack up, analysis paralysis looms and we have to make a decision and we have to make it work.

Sheer numbers. There's a lot more infection happening abroad than here, there's partial vaccination in most places where lots of infection is happening, and global travel is active enough to spread anything that arrises.   As we saw with the Indian variant.  It seems likely that there's gong to be quite a lot more happening abroad as a result of that variant.  

Travel restrictions didn't keep over 1,000 importations of the India variant out.

7% of global cases yesterday were in the UK, but it's likely we're detecting a larger fraction of infections than some other places.  So, the odds are stacked in favour of it arising abroad.  Nothings certain, and the more infections we have, the more the risk for us for sure.

One of my concerns a few months ago about not hammering cases down was that the (formidable) sequencing capability wouldn't be able to keep up and that would delay latching on to a worrying new variant.  I think the best mitigation now is to prioritise sequencing of hospitalisations, ranked by medical history - age, vaccination status etc.   There just can't conceivably be the capacity to sequence all mild and moderate symptomatic infections.

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

Re: point 7.  Indeed.  I expect Jonathan Pie's take in it will express my thoughts quite well.  I might just wait for that.

Ah, I’ve only had contact through my GP pretty much, so I don’t have a second appointment booked at all, I seemingly went via a system that let me do one at a time.

I'd agree with most of that but would ask just how long is your 'not long' for cases to peak. Current simplistic exponential extrapolations show we will easily hit new case records by July 19th (see the back end of the Indie Sage presentation for a look at that and more conservative estimates). Watching the weird way the virus spreads in growth phase it reminds me of watching things like fungal flares with areas of rapid local growth that slow before new flares start. I also think peaks in countries with weak lockdown measures were as much due to population behaviour response (fear), as any immunity. Plus Manaus shows apparently being close to herd immunity is clearly not reliable with covid. As such, and with current antibody levels, I expect the Indie SAGE more cautious prediction might still be a slight overestimate but it won't be by much, as the exponential slope would already be shifting. We are heading for near record case levels even with current restrictions and we already exceed the November peak. Confused government messaging in the last two months has got us to, yet again, risking snatching defeat from the jaws of victory. They are now clearly following dates and not data and my optimism of a month back has gone.

Was the Hancock resignation a strange co-incidence with the almost ideal timing for Boris to help facilitate a policy change or was this just the time to knobble him (as useless as he was Matt did sort of seem to follow broad data)?

I haven't looked at the indie sage stuff recently but if you are suggesting that the current strategy will lead to exceeding previous national infection rate records, I definitely agree with that.

When I say not long, I obviously can't put a good estimate on it, but I wouldn't be that surprised if cases started to moderate within a few weeks (rather than months) of restrictions changing. At the current level of restrictions, WT's data seems to suggest that infection rate exponential constants in the lead age groups and areas have already moderated slightly.  What do we think the national average doubling time will be if we just unlock everything - under a week presumably? At that rate of increase, from a very high base in the most-exposed groups, I don't think it will take long before we reach a point that things start to turn over in the lead age groups and areas.

I've been trying to read into recent events in Bolton and Bedford, to a lesser extent Blackburn and half of Glasgow, where case rates very definitely peaked and then fell while others around them were rising, but have now started rising again. I thought the fall was an indication that local population immunity was having a significant effect on case rates, but I'm now less confident.

It's not just about flu; any exit wave would be worse in winter, absent all other factors.

There's a strong argument for getting on with it. And a really strong one for letting everyone get their 2 doses before throwing the gates open. And another strong one that says step 3 was a big one anyway and 4 might not be all that much change. And yet another that says we can't ignore the downsides of restrictions. They're obviously incompatible. Way above my pay grade to take the flak for picking which shitty end of the stick we grab hold of.

Just for folks interests: Bolton info from the dashboard.
Cases shot up but then started to come down, rising slightly recently. They’ve also vaccinated fewer than neighbouring areas. My guess is infection immunity now kicking in, but perhaps indoor football watching has caused the uptick?  Timing seems about right and tominedinburgh said health data showed this happened in Scotland. 

Re: vaccinations, indeed you can't see full availability everywhere before you cancel, but you can now see availability around what you're cancelling, so at least in theory you can see whether in the worst case you can rebook more or less the same as you had. That seems to be put in place to reassure people that they won't lose out by giving it a go. Still feels brave to do it though.

Given the reduction in vaccination rates,  this could take a very long time, and might never hit the required number.  

A lot of the reduction is in second doses, because they're not coming due right now, so it's not quite as disappointing as it looks.

We'll have offered first doses to all over 18s any day now. Seconds is nowish +8 weeks. Teenagers would in theory come next.

In contrast, any adult who chooses to gain their immunity the natural way will probably be doing so between August and October.

How? Whenever I go on the checker it just tells me there are no appointments available. It doesn't give me any options in any date range - it never has except that when it first loaded up, it gave me options in late June, which were way too early. Maybe I should regress from the internet age and try 119!

In the last two weeks or so, second jabs have been about level, first jabs dropping. Given vaccine hesitancy in young adults and the ‘one jab is good enough for me’ attitude, I reckon second jabbing young adults could drag on. Unless this is a supply problem?

The last week's first dose rate seems to have stalled at the weekend low instead of rising up during the week as is typical.

If it is, it's being kept very quiet.  Edit: Which would be very hard to do, as it would be resulting in a lot of last minute cancellations to first dose appointments, which would make a lot of noise I should think.

Can I ask a stupid question? Why are these local area charts not available as a 'positivity' ratio i.e. number of cases/tests given. You could then better decouple surge testing impact on number. This would make sense and would surely be easy to implement at a local level.

Is the first dose what's relevant, though? I'd expect someone who's still a couple of months off from their second dose to still be fairly unhappy about having to commute on public transport or work in a crowded space for a while. "Choosing to get their immunity the natural way" feels a pretty glib way of putting it when a lot of people are going to have very little choice in the matter.

You've missed the context there. Came after a post taking about waiting until everyone had an opportunity to get their second.

Oh. Then maybe there genuinely isn't availability at the centre you booked. Or as you hinted it's a fleeting, temporary pop-up sort of place.

It only ever shows the one location, and only a few days either side of your existing appointment, and only after you've gone a fair way through the process of trying to cancel. That is until you go all-in and hit cancel. Then you get to see everything.

Why are this guy's dashboards (there's another one for the UK as a whole), which he freely admits are cobbled together by someone who only just knows what they're doing, so much better than the official government dashboards - makes them look like complete amateurs.

So much information presented in ways that's easy to absorb all on one page (actually I think there are a few pages) - I am impressed. Edit: actually I'm gobsmacked, he has got so much info on there - it's insane.

Ah right, yes, sorry.

I think a lot of what's doing my head in at the moment is that the "argument for just getting on with it" isn't really being presented as such, insofar as there's no acknowledgement of how it's going to play out, what the downside is and why the government think it's worth it. As it is, they just seem to be acting like they either don't understand or don't care that things are still going to be pretty crap for a lot of people over the next few months.

It is. But the obvious counter argument is if not now then when?

Kind of laid out my position a few posts back; I don't know what the "right" answer is. It's easy to say we should wait a bit longer, and it always will be. Much harder to say "now's the time".

Sadly it was always going to be this way, a lot of the brunt of this* has been and will continue to be borne by younger generations:

- Open up before everyone has had both jabs / remove all covid protections in public places / shops etc = more younger people (who work in shops, travel to work) are going to get seriously ill and some will die as they haven't had both.....they don't have the option not to work (i.e. a pension which is tripple locked, mortgage paid off on an appreciating asset)

- Fail to put in place a proper support strategy ref. schools / self isolation / work = anyone with kids gets hit ref home schooling, with organisations starting to get a lot less sympathetic, with women being disproportionately hit by this circumstance

That's before you get to the longer term economic damage/repayment elements.

* acknowledging that older people have died in greater numbers 

One thought on the lesser fall in ICU admissions compared to overall cases is an age old problem of active immunization when related to individual risk rather then herd risk. This will take some number crunching, but might be one problem with modelling on a population basis.

With most vaccines many of those individuals who are most at risk of severe disease are also those least likely to have a good response to the vaccine (pneumococcal vaccine is a good example).

Thus you take out the mild and moderate disease (which is a good thing), but unless you suppress new cases the group most at risk of severe disease has the the smallest benefit (NOT no benefit).

Someone picked the moment to push him under the bus. There's no way that video hasn't been sat in a lock box waiting for the riggt constelation of events and nods. As with so much of our rotten political process we don't get to know who pushed him or why.

Not Johnson perhaps since he made a fool of himself over it all but then he had no choice really but to back Hancock given his own proclivities... 

Jk 

I agree, it could have been anyone from the top of government, from the Tory backbenches or from a disgruntled member of DHSC, all have possible motivations so it's difficult to draw any conclusions.

I wouldn't trust Boris not to play a double bluff: it must be done but I must be seen to defend him; negative news in the press never seems to bother him. His wife's connections with the new minister are certainly well known.

It's quite possible, it'd be appropriately spineless. Nothing sticks to Johnson after all and he apparently has no personal shame.

Equally it could be a two for the price of one hit on Hancock and Johnson's credibility* by Cummings.

* not a word one usually associates with Johnson but I guess ordinary voters who've long though him a complete t**t aren't the target audience for such theatrics.

Or something else entirely.

jk

I still don't understand why the system doesn't simply let you book a new date, and then automatically cancel your existing one. It knows who you are. It knows where and when your existing booking is.

You'd get a lot higher uptake if people could be sure they wouldn't lose out. I opted to wait a couple of weeks rather than gamble on cancelling and rebooking (in the days when you had no clue of availability at all).

I had the same problem and called 119. Turns out the checker can only see appointment at the original location, and the smaller it is the less likely it is to have appointments, or even be open (some opened for 2 weeks and then again for 2 weeks , 12 weeks later). 119 could not see appointments at other locations, so all I could do was cancel and take a punt.

That could either be done on the phone to 119, or online myself - both apparently shows the same info but of course if you DIY then you can take your time and pick and choose. So I hung up, held my breath, cancelled online and.......

Got an appointment the next day just down the road

This is the stage I am at. That seems like what is happening at my centre. It was very busy for a while but I haven't seen it open when I've driven past recently. Thanks.

I'm reluctant to cancel because if I then have to delay my current booking by more than a couple of days, then I'll have to either cancel a holiday or delay it by 3 weeks, which would take me to 14 post first dose. I'll keep looking around for any evidence that there are sites currently with appointments for Pfizer if you aren't already booked...

I've often thought this, but in reality I suppose it's probably because it's already hard enough planning the logistics behind the scenes without everyone constantly pissing about with their appointments, so they can't make it too easy to change. Instead they've shown you enough to know if you'll be left high and dry but no more.

Or one other theory: There has been concern locally after vaccination rates dropped off as Covid infections soared. But Dr Jane Carman, the GP clinical lead for Newcastle’s vaccination programme, said she believed that the recent low take-up was due to the large numbers of people having to self-isolate, unable to leave the house.

I was invited to change my appointment. That's how it was working. If they wanted people to change their appointments to bring them forward, then it would be easy enough to only allow invitees to change their appointment, once.

Presumably you're booked through your GP then? That's a totally different game. The national booking site is leaving people to it.

It's not ideal from a user point of view, but I can sort of see why it is the way it is. You can rebook if you want to but you have to want to.

Edit: slight aside, if you/WT haven't looked at nerdle for a while you might notice some big things have happened in recent weeks.

No. Booked through English NHS online booking system.

[edit: this is historical; invited to rebook mid May. Had my second jab as per original booking. No idea what the system does now]

Thanks.  If you think about the process of infection to death as a pipeline with conversion ratios at each step, perhaps the greatest improvement is in ICU admissions.to death - prognosis for those admitted used to be very bad, and now it seems almost all are living.  That suggests the vaccines haven't got that much leeway in them when it comes to the most vulnerable - perhaps there's a hint of luck that the critical fall-off of vaccine performance with vulnerability wasn't a bit further down the pipeline.

In reply to Ramblin dave:

I'm guessing this evening press conference hasn't improved your take on this.  It doesn't quite feel real that all this is going ahead without much clearer and more upfront messaging and preferably another 3-4 week delay to the next round of unlocking to let those second doses keep flowing.  Well, it might be all right - it's the best odds we've faced by far going in to an uncontrolled rise of cases, and relying on a bit of luck is a great way to manage a public health crisis, right?  As LSRH said, one can reasonably argue that things are going to happen in any direction over the next few weeks; let's hope its a better one.  I should have jacked in the data habit 6 months ago and started making and selling peril sensitive sunglasses.

In reply to Toerag:

If you look at the doubling time for plot 9s, it's been lower than that for cases for much of this rising phase.   It's hard to really link the two without a lot more data, but I'd expect the doubling time for occupancy to get shorter - over the last couple of months the ongoing demographic shift has been decoupling the exponential rates for admissions from those for cases; now the shift seems to have run out of steam (in England data, assuming similar for Scotland), the rate constants for cases and admissions should tend to similar values - and occupancy will somewhat track that.

So, if the exponential growth in cases doesn't abate, that's perhaps  40 to 60 days to hospital occupancy overload in Scotland; could be sooner for intensive care.  I think the exponential rate for cases is going to slacken pretty soon; if it still hasn't within another 10 days or so....  

In reply to Michael Hood:

It's worth nothing that the government dashboard was a major step forwards from the earlier, ever changing presentations of numbers, and is a stand out level of openness with government data; none of these threads would be here without it and nor would those dashboards.  It's a commendable commitment to openness and I hope it's paid off.  

I particularly like travellingtabby's world map of vaccination.  I don't like what it means, at all, but I like the presentation.  Mongolia are doing surprisingly well, I assume some of the effects of severe covid are a lot worse for high altitude nations?

Also stand out is that he includes children under 16 on his vaccine plots, precluding the possibility of, say, a prime minister accidentally muddling fraction of people vaccinated and fraction of adults vaccinated. 

Me too. I booked my original jab dates via NHS website. I had a text and an email from NHS last Monday inviting me to move my appointment forward. I checked, they had availability all week at the centre I had my 2nd jab already booked at, so cancelled & rebooked for last Friday instead.

I was speaking to some friends from NZ this weekend, and it's bonkers.  They know that one dude from Aus came to NZ for the weekend, then flew home to Sydney and tested positive, and pretty much where he went.  We on the other hand are living in our Brave New World of x1000 new cases a day, but restrictions are lifting.  

My friends are 40ish and expecting to be jabbed *by the end of the year*, of their parents one set have been done because their District Health Board has their sh*t together and the other has not.  

They've got many months more of self-isolation whilst they get their jabbed rate up, living in fear of their defenses being breached by a rogue Delta case which then runs amok through their country.  We on the other hand are returning to some sort of normality.  Would it have been better to trade our experience over the last couple of years for theirs?  Yes, but oranges and apples.  You can't get away from the fact that they are a small island hundreds of miles from anywhere in the middle of the South Pacific and we are not.  

It's an easy stone to throw but why aren't their jab rates better than they are?  You can say they've done a bloody marvellous job but in getting their population vaccinated not so much.

I await ben_b's input with interest (and that of other NZ and Aus based posters, Andy P rest his soul, you missed this one mate)!

Thinking of it in terms of pipelined conversion ratios, I suspect the hospitalisation to ICU CR has increased, as discussed above (lower threshold for ICU admission, assuming therapeutics are unchanged). This will have a knock on effect of reducing ICU to death (as, hopefully, will the reducing age demographic). All other CRs are probably down significantly.

We can stop an exit wave and a bad flu season with the same kind of measures we used to halt previous waves of Covid.   They are only inevitable if you act like a total dick and remove all the public health measures.

This article in the Independent pretty much sums it up.

https://www.independent.co.uk/voices/covid-lockdown-easing-restrictions-del...

I think of vaccination as like wearing body armour (I play a lot of Grand Theft Auto).

If you put on body armour but you act like it made you immortal it does you almost no good.  Run into ten hostile NPCs shooting at you then you get killed pretty much as fast as if you weren't wearing body armour.  It isn't 100% effective and one of them is going to get you with a lucky shot.

On the other hand, put on body armour and play cautiously and with good tactics and it significantly increases your chance of getting through the mission without dying.

If we let Covid rip and basically there is a ton of virus everywhere then being vaccinated and having 60% better chance of not catching it isn't going to do it.   We will be coming in contact with virus so often even if each encounter is safer than it would have been it will still get us.   And with 7% chance of hospitalisation and 10% chance of long Covid and no guarantee of not catching it again six months later the medium term odds aren't that great.

But if you combine vaccination with upgraded masks and other measures you could get to a situation where the combination of measures is enough to make life fairly safe.    Like wearing body armour but also staying in your Armoured Karuma and shooting out the windows until most of the NPC enemies are dead.

Natural immunity can target more areas on the virus than just the spike protein. I suppose we don’t know for sure that its beneficial over just the spike protein, but I’d put my money on our immune systems being correct on this as we have co evolved with viruses.

Most of us are going to catch Covid at some point IMO. It’s endemic now. Perhaps if you catch delta after two vax doses and build natural immunity, that is not only potentially broader, but will target new mutations in the delta variant, you’d be better off than catching it this winter when the next new nastier variant comes along. I do think we’ll see further advances in treatments though as time passes.

There are also inactivated whole virus vaccines e.g. Valneva in the pipeline.  If our immune systems need to see the whole virus then we are only a few months away from being able to achieve that with vaccination.  We don't need to go crazy and have tens of millions of people take a 7% chance of hospitalisation and a 10% chance of long Covid. 

Pesumably R is calculated assuming no immunity in the population.  So your R of around 3 would actually be lower with say 85% of adults vaccinated, unless the subject mostly interacts with groups where vaccine uptake is low. I might be completely wrong. 

I can see the various arguments but it’s not now or never. The expectation is to finish second jabs in mid September so a relaxation from October could perhaps work. Might be a bit late to get past the peak by December I suppose. Fundamentally I think it’s unfair to throw under the bus anyone who hasn’t yet had a second jab but wants one. Especially all those younger people working in shops and pubs etc who will now need to deal with massless, non SDing customers.

October. Or may be next summer. It depends how things turn out. Or would have turned out. Wait and see. The last 16 months have shown that rushing things is unwise. There are downsides to delaying of course but on the whole I don’t think they are significant.

Good thing I’m not in charge. We’d have rolled back the 17 May relaxation a while back, if it was ever allowed in the first place. Easy for me to say though, I’m not a politician concerned by my popularity...

You start from R0  estimate of 6 when no immunity in population. R might be reduced to about 3 after 100% vaccine uptake. That is my interpretation of 40-60% reduction in transmission starting from R0 of 6.

To me, R of 3 means spread* until most people have been exposed and survived with 95% fewer deaths due to vaccination. It is still a lot of deaths so I'm happy to be wrong.

*unless social distancing maintained to reduce R below 1 as it did in May 2020, Nov 2020 and Jan 2021 or as it does now in Germany and lots of other places. We know it can be done as we have done it ourselves 3 times.

I also look at the graphs of the growing case numbers as incontrovertible evidence of a policy of "let it rip".

You and Tom make good points but the graphs say your points are not being listened to.

I take your point especially regarding long Covid and it’s some think I tend to agree with. I do agree we are not being cautious enough and that many people think what the government allows them to do is safe.

However inactivated vaccines don’t work quite the way you were hoping. “.But because they cannot infect cells inactivated vaccines only stimulate antibody-mediated responses, and this response may be weaker and less long-lived.”

https://www.gavi.org/vaccineswork/what-are-whole-virus-vaccines-and-how-cou...

Well me too. I'm with you on this; I'm not that arsed about doing anything I can't do right now. I don't care about going to the pub, I don't run a nightclub, and I give absolutely zero shits about anything that happens in a stadium. In fact having an excuse not to do any of those things has been the silver lining. But not everyone thinks the same way, and there's a balance somewhere, and we can't tell everyone to stay 2m apart forever, even though I'd be very happy for it to stay that way. 

Thing is though, having the exit wave run into winter, with the increase in transmission that brings, would be a proper full on disaster. Doing it in summer, maybe less so. So it's now or 6 more months, and what's been quietly overlooked is that 'freedom day' actually mostly happened a few weeks ago.

I said up thread you need to look back at what the studies whose results you quote were actually measuring.

The only transmission study available via the PHE website is this one, which suggests a 40-50% reduction in household transmission. I'm assuming that's the one you are using. There was a similar study done by PHS too I think which gave slightly lower numbers.

https://www.nejm.org/doi/full/10.1056/NEJMc2107717

What you need to do to understand the impact of vaccines on r is estimate the reduction on transmission *and* reduction of susceptible people. Most estimates I've seen actually discount the transmission bit. So if (assuming you are correct) r0= 6 and ignoring any effects of behaviours etc, then the effect on r0 is usually I think estimated as follows:

Vaccine efficacy of 67% against infection (this % made up to give round numbers in my example) means that each infected person will spread just as much virus as they did before, but only a third as many people will actually pick up the infection from the viral load they initially breathe in. So r would be reduced by a factor of three, in this case from 6 to 2.

If you also account for a separate effect on transmission of say 50%, then this means the initial person's viral spread is also 50% less, providing an additional average 50% reduction in the number of people they infect. So r drops from 6 to 1 when both effects are considered together.

The study whose results you cite looks at only the second aspect. It calculates the reduced chances of **unvaccinated** people being infected by a vaccinated person in their household **given that the vaccinated person has already been infected** So in using that number to calculate an impact on r, you are missing out what is probably the most important part.

There were further limitations to the study which make its results a lower bound.

Firstly, of the vaccinated, positive cases whose households were studied, 93% of them had only had a first dose. There were very few people at the time of the study who were double-dosed and went on to test positive.

Secondly, this looks at household transmission, so it's looking at infection of unvaccinated people who are in close contact with an infected individual for a period of at least several days. That's not representative of all transmission cases.

Thirdly, it's possible that some of the secondary cases in the study picked up their infection from someone else outside the home rather than from the infected, vaccinated person in their house. Any cases like this would bias the study results downwards.

(Edit, on the other hand this was all with Alpha, not Delta.)

I hope this helps. It's actually incredibly impressive in my view that a single dose of vaccine makes a positive case 40-50% less likely to infect their unvaccinated household members. This is only one part of the overall spread reduction benefit that vaccines give.

(Edit to add: for estimates of reduction of susceptibility to symptomatic infection: https://www.medrxiv.org/content/10.1101/2021.05.22.21257658v1 suggests that having 2 doses reduces your chance of getting symptomatic infection by Delta by 60% (AZ) or 88% (Pfizer) (middle estimates).

There is less data covering asymptomatic infection as well because most asymptomatic cases aren't picked up. However, the Siren study suggested Pfizer had an overall efficiency against susceptibility to both symptomatic and asymptomatic disease (alpha) of 85% after 2 doses:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00790-X/...

)

Si

Many thanks for taking the time to write such an excellent and informative post. 

Judging by case rates (single jab almost complete/saturated for adults) not yet getting R<1. Do you think vaccination will get R below 1?

Hmmm, 85% after 2 jabs plus reduced viral shedding might do the trick.

Imminent improvement would be a strong argument to delay unlocking.

Thanks again.

It's simply not an 'either-or'. If, as you say, we effectively had freedom day already (as we pretty much have ), why are we removing rules for mask use indoors and other useful restrictions that don't affect business a jot. I've still seen no clear science for why we are doing this and the idea being peddled by the PM that holding current restrictions will push things to xmas is pure bs. The scientists who are already speaking up are not looking for a lockdown, just reasonable smaller control measures.

If people (especially those who are more vulnerable) want to avoid the big risks of catching covid they could always have avoided your 'can't be arsed' venues but it's a lot more risky now when they need to shop or go to the doctor. People working with the public will have to deal with a different group of 'cant be arsed', the covid deniers, with no response for their safety at work being compromised, and that's before we start looking at bad employers. I see a big rise in anxiety related mental health problems when ministers claim they are doing this to reduce mental health pressures.

The government said in the Q&A yesterday that they expect a peak of 50 thousand daily infections. That's very much on the optimistic side so I'd love to see their modelling. Even if they are right that's around 5 thousand with long covid and around a couple of hundred hospitalised daily..... and then we remove all restrictions.

Did they say *infections*?   27,700 *cases* yesterday; odds are we’ve already passed 50,000 infections…

Any idea that we need to drop restrictions to get the exit wave done in a reasonable time is demonstrable nonsense given the current absolute numbers and exponential rates.  It’s not stopped someone stating exactly that on another thread today, and the likes on their post are getting big ger.

No, sorry, it was cases... I need to count to a bigger number as this is making me pretty angry.

Javid just said on BBC news it's estimated from models with a range but something like 50,000 daily cass by July 19th and increasing a bit after that.On masks he said  we can now trust common sense. He is claiming individual businesses (shops or transport providers) can decide their own rules. It's seriously nuts!

I can't blame the likes of VSScramble and TomD on that other thread if the scientific establishment won't stand up for scientific truth anymore. It's not good enough to leave this to the political opposition and make science look like a difference in political opinion. Boris is saying the alternative to a total release is a winter wave and that needs calling out.

​​​​​

50k cases still feels very optimistic - although when we’ve ended past exponentially rising phases it does happen surprisingly quickly so it’s not impossible.  

I’m hoping this unlock has less effect than the last one; in some ways I’m more concerned by the messaging than the message.  I think dropping a requirement for masks on public transport is asinine however; where some people have less choice about sharing confined spaces it’s almost an aggressive attack on them to remove basic control measures.  

But these massless people will just lift off into the upper atmosphere, unable to use any oxygen, lost in space forever

How hard have you looked? A lot is published, as are plenty other groups'. It is correct to say based on all the models I can find that unlocking slightly later would be worse. You'd have to leave it until winter isn't a threat.

Comes back to the question of what does the future look like and then how do we get there? There has to be either an exit wave, or no 'exit'. Neither option is great.

Sajid Javid this morning claiming cases are leading to only 1/30 of the hospitalisation rate before the vaccine programme kicked in.

This is absolute bollox as recently we have seen around 300 admissions a day.

300*30 = 9000

Daily admissions never even got to half this level during the peak last January.

That's easy then, if the government modelling is widely available link it for us. All those Indie SAGE people asking for it must be so incompetent.

We are not unlocking, we mostly did that already, we are removing light restrictions that already are allowing strong growth. Keeping things like mask use will just slow the edge of the curve. Given you say you are looking at modelling you must know that. The idea keeping the current light restrictions will increase model deaths seems highly unlikely to me. The idea it will push the pandemic peak to the winter as Boris said, is a plain lie.

The last lot of modelling done by LSTHM, Warwick and ICL is available on the SAGE site.

Vallance said yesterday more recent modelling will be available on there next week.

So you'd love to see it, but not enough to bother to do a quick search? You can Google it, same as me. 

Indie SAGE is the guardian. Have a look for something with less of a political agenda. Read something by Warwick or Imperial. Or even James Ward.

Mask use really won't make the difference you seem to think it will. It's some. It's not loads. It's the thing that the guardian has picked to tell people to get angry about, because it's a really easy and obvious thing to take an opposing position on. It's probably worth carrying on with because it's an easy small win but it's not a silver bullet. Opening windows and staying the f*ck outside are what really reduces transmission [1]. That's why if we're going to do it, doing it in summer gets my vote.

[1] https://www.irishtimes.com/news/ireland/irish-news/outdoor-transmission-acc...

Out of interest what's your thoughts on something I've been wondering.  Do covid vaccines actually completely prevent disease in most people or do they just raise the viral load necessary to get ill. When controlling for other factors,  do many of the double vaccinated people that catch covid 19 just get a higher viral load?

Are the Imperial modelling team lying as well? 

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

”…delaying step 4 until 5 July or 26 July is predicted to delay and substantially reduce the magnitude of the third wave. Delaying step 4 until all adults have received two vaccine doses is projected to delay the third wave. In some of our modelled scenarios, this long delay paradoxically leads to more total deaths since the third wave would be pushed into the winter, when transmission may be higher because of seasonality and increased indoors interactions, and when an increased proportion of individuals may have lost protection from prior infection. “

You’re spouting politically motivated nonsense.

Depends what sort of masks you mean. Cotton is probably not very effective at all, it may even be counter productive in some cases IMO. FFP3 masks with no outlet valve are a different beast. https://www.bbc.co.uk/news/health-57636360 . Personally I do try to avoid public indoor places and when there wear a good mask. There are also reports that delta is transmitting more easily outside BTW.

It’s disingenuous to frame modelling as “lying”.

Modelling for the present is always out of data.

The data on cases shows close to 30,000 cases per day and a ~10 day doubling time.  That’s the actual, measurable reality, not some historic project of historic measurements to the present.  Measurable take precedence over historic models.

Offwidth I am confident understands this and is not accusing them of lying.

Intensive cares are filling fast enough that we need to have space in the system to measure and respond to changes in case:admission ratios. Right now cases are rising very rapidly *and* there is time to measure and respond to changes.  I’m hoping dropping more restrictions makes little difference to growth rates, as otherwise that margin for error is gone and we’re back to relying on luck.

Sorry don't know - there are probably others reading these threads who are better placed to answer that.

Do I think vaccination alone will get r below 1 - no. But it's entirely theoretical.

Do I think vaccination combined with natural infection and some residual tramsission-reducing behaviours will get r below 1 - yes.

How much further natural infection is required beyond this point - I don't know, but taking together the ONS antibody survey data and available vaccine efficacy data, I think we can have confidence it will not be a large proportion of the adult population. Kids a different question.

We have seen the R fluctuate above and below 1 already ofc. In some countries with little measures in place during the below 1 phases. I think we will see this pattern continue for the foreseeable future. I think there is a distinct possibility we'll see some kind of increased restrictions at some point due to Covid.

What Boris said was that the modelling predicted cases could reach 50k per day by the 19th July. He didn't say it was a peak. He was readying people to get used to high numbers of infections and his intent to remove restrictions anyway. The obvious implication was that case rates would subsequently rise significantly beyond that.

The advisors didn't present any predictions of the peak and when the question was explicitly asked by the press they studiously avoided giving any numbers, just highlighting the uncertainty associated with the predictions. The only number they gave other than historical data was that they estimate the current doubling time to be 9 days.

Personally I feel case rates this time are likely to plateau and then fall more slowly to start with, with dips and troughs at local or regional level. I can't really see what would cause things to turn over as quickly like they have in the past without any restrictions, unless a lot of people are scared and change their behaviours. I might be wrong though. I suspect we will see a lot of difference between locations in how long it takes for rates to fall as well.

They did say they expected this wave to peak sooner than the previous ones.

I suspect it will be a case of vaccination reluctance - certainly some people here (Guernsey, covid free from May 2020 until this spring) were avoiding vaccination because of the scare stories about AZ and clotting and felt our border restrictions were good enough to keep them safe until more data was available on vaccination risk, or a better vax option appeared, or the virus 'went away'. This was in the Pre-Kent and Delta variant days, our second wave (pure Kent strain) re-focussed people's minds a bit.

For the three, here's a big ger reply I gave to VSisjustascramble on another thread on this subject:

Last week's forecast for today said hot and sunny.

I've just been outside, I got cold and wet.

Is it raining today?

You're comparing the present actuals with the results of a model published a month ago and so build on data more than a month old.

That data is all from early on in the new variant's spread.  Here's my copy and paste from the report - my bold.  It's flagging up that the uncertainties in this modelling are great, and hi-lighting the need to delay the unlock previously due June 21st to get more data to better forwards model different scenarios for policy making.

In short, it's telling you quite clearly that this model is not safe to use to predict very far at all, and that the next round of models - due to be published soon - are required.

Our results highlight that the uncertainties regarding the levels of transmissibility and immune escape of B.1.617.2 translate into large uncertainty on the possible future epidemic trajectory. If step 4 of the roadmap happens on 21st June 2021, a third wave of hospitalisations and deaths is predicted to happen, very likely as big as the second wave but potentially orders of magnitude larger. Delaying step 4 by a few weeks would reduce the size of the third wave, while simultaneously buying time to more accurately estimate the characteristics of B.1.617.2 and consider other control strategies (e.g. vaccination of <18 years old and distribution of booster doses) which could further help to mitigate a significant third wave.

The government are publishing policy change ahead of the models they used.  Offwidth and Indie SAGE are IMO entirely correct to note the disconnect here - the previous round of models including the one you cite are mired in the uncertainty that comes in the rising emergent phase of a new variant.  LSRH has said the models are available - but they're old models, using old data, and they themselves note the high degree of uncertainty.

The more recent models against which the policy changes have been decided are not yet published to the best of my knowledge.

There is no support in "the models" to which we have public access for a pressing need to drop the final restrictions.  There can be no support because the modellers themselves are at pains to point out a period of more data is needed to remove large uncertainties from the models.

Again (why am I defending them?) this isn't quite true. Boris's stated objective yesterday was to tell people what life would be like after 19th July if the changes went ahead, but he was careful to reiterate that he will make the decision on 12th July with the latest data. Vallance said the modelling and data supporting the decision would be published as normal. There is precedent for publishing some of the data after a significant delay, though.

"we can have confidence it will not be a large proportion of the adult population" - that's excellent, I was thinking it was most of the population which was scary prospect even with vaccination providing massive protection against serious illness & death. 

It's important to keep the facts at the forefront and most of us guff up at times.  If it helps salve things, I see it as keeping comments focused and accurate rather than defending anyone...

It's all too easy to take the announcement as policy but you're right to bring me up on this; and I should see it as promising that they're waiting for more data and presumably more recent modelling to make a final decision.  It seems to me like there's no going back from yesterday's announcements, and the news today further's that sense.    

I should have added the word "proposed" to my post as below, otherwise I stand by it entirely.

The government are publishing proposed policy change ahead of the models they used.
The more recent models against which the proposed policy changes have been decided are not yet published to the best of my knowledge.

So, another week of wait and see.

People can watch it on I Player. There was no such obvious implication in my view. In any case Javid on the BBC news this am directly contradicted any such implication. He said a  small rise above that.

I thought it was obvious but I recognise I pay more attention to covid data than most people. Certainly Johnson said that was what was predicted by 19th July and given that's the date on which he intends to remove restrictions, only a someone who has lost the plot could genuinely believe cases won't then go up further?

The fact that cases are going to go up a lot was repeated a number of times later in the conference but without explicit reference to quantified predictions or dates.

I think I predicted yesterday that Johnson would sound a note of caution so that he isn't quite so accountable if it all goes wrong, and then his team would start telling everyone to get back to normal. O haven't seen any of this morning's interviews.

BBC news' headline is, having said that, now "cases could rise to 100,000 a day - Javid". That seems like it's in the realm of possible realities to me.

.....and the news from Israel that the effectiveness of Pfizer against infection is down from 94% to 64% will make a significant difference to the modelling as it will increase the 'peakiness' of the exit wave.

How about some scientific links to support your view on masks. All the science I've seen shows mask use indoors in poorly ventilated areas has very significant benefits. That's the old government covid advice, CDC and WHO advice. On the point of "some" I hope you are muddling specific mask effectiveness in a particular indoor area with the smaller likely population differences from the change overall, due to various factors, including some poor compliance where masks have the most benefit. .On ventilation, where I worked until retirement last year the windows usually didn't open and the main new labs had no outdoor windows even if they could open. Labs still had to go ahead.

Equating Indie SAGE with the Guardian is plain childish. Firstly some members of Indie SAGE are also in SAGE. They are scientists so open to scientific scrutiny and I don't see much mainstream scientific concern with their opinions (unlike the Guardian, where although being much better than most of the press and generally good, they do occasionally drop clangers). The government In contrast have ben proved seriously wrong on multiple occasions.

The Irish Times link is a squirrel and a pretty poor quality example of it's basic message (which I agree with). I have been pushing the science that showed outdoor covid risks were very low since last summer in the face of some serious sceptics here. 

Yes that number was said to come from Javid's inteview on Today at about 8.10.  As ever it seems ministers get away with  being more vague on the morning BBC1 news, that ordinary people are more likely to watch.

https://www.bbc.co.uk/sounds/play/m000xlt2

Listening to this right now.....seperately the modelling scientists are said in the briefing papers, from yesterday's announcement, to describe the risks of the government action as high risk. Ferguson is also on just after 7.00.

The thing about mask use is that regardless of how much impact it has overall, it's such an easy win that the government dropping it seems to change their position from "we don't want you to catch COVID but we have to balance that against the impact of lockdown measures" to "we actually DGAF about you catching COVID provided you don't overload the NHS."

Given that quite a lot of young people would probably still rather not catch COVID, at least until they've been double jabbed (like sure, "probably no worse than a bad flu" but I'd actually rather not have a bad flu either if I can avoid it), this does make it feel more like a "screw you" message.

I'm genuinely not sure how workplace safety rules are going to work for people like bar staff, factory workers, call centre staff etc if they're expected to work without PPE and with social distancing rules removed when we get to a point where there are 100,000 infections a day.

Just listened to what Ferguson said this morning on the Today link about the models.  Firstly there is a risk of well over 100,000  cases a day where impacts on hospitalisation might require some action (restrictions). Secondly he was asked about the timing 'sweet spot' being peddled by the politicians.  He said the benefits of the four week delay to July 19th were significant; the benefits of further delays much less significant (hence, won't be making things worse).

Just glancing at the news before lunch ... so yesterday the figure of 50,000 infections a day was floated past us. No doubt softening our perceptions ready for today's idea that 100,000 a day is supposed to be ok. Move along, nothing to see here ...

I'm now so used to astonished that my astonishment nerves have been de-sensitized, my panic antennae have shrivelled, just keep swimming.

No requirement to self isolate if double jabbed after the middle of August, based on the statement just now.

But until that point logically we must be requiring of the order of a million people per week (50-100k cases per day plus close contacts - huge guestimates but it's easy to hit big numbers) to self isolate, many of those working in the sort of places you mention since they are all obvious places for infections to spread. 

That's going to be a huge challenge logistically, even besides the safety point you mention.

Something of an abdication of responsibility enabled by confusion around ventilation and a thorough lack of enthusiasm for enforcement action?  

It's a notifiable disease, and there are IMO clear and proportionate steps employers can and should take to protect both their employees and their customers.  I banged my head in to an institutional wall on this in early 2020 - armed with evidence from a preliminary study in Japan - and it doesn't sound like things have to much better since in some places.  Where it has, there's often a big gap between policy and execution.  E.g. why are ventilator windows still often closed on busses?  They should have been welded open a year ago; having watched people choke on leaking diesel fumes rather than open the ventilators on a chilly day, it's clear many people would rather risk Covid than a chill on the bus...

Like boiling a lobster.

I look back at life before children and life now - it's phenomenal how well humans can re-normalise what was unthinkable to be the standard order of life.  Probably an ancient and strong evolutionary thing, that.  

But there's a difference between boiling a lobster and sitting it atop a nuke and pulling the trigger.

It's 150,000 - 200,000 now. Keep up.

Prof Neil Ferguson, from Imperial College - whose modelling helped lead to the first nationwide restrictions - said as restrictions eased there was the potential for the UK to have a very large numbers of cases - 150,000 to 200,000 a day - which could "still cause some pressure to the health system".

https://www.bbc.co.uk/news/uk-57733276

Brilliant stuff.

Others have commented on this subject in an equally humorous way.... being the Guardian most of this will be regarded by the covid deniers as untrue and Boris a national hero.

https://www.theguardian.com/commentisfree/2021/jul/06/boris-johnson-covid-r...

And now the point about making masks a choice as infections exceed historic highs is to accentuate the dividing lines in society, to stoke the culture war and bring voters back into tribal conflict. It's campaigning not public health. This is just a foretaste of the next horrific election campaign we have coming.

jk

Here's another thing. Have they changed the rules about self-isolating or what happens when someone at work comes down with COVID? Currently Pubs are required to close if anyone pops up positive my local landlord lives in fear of someone on the staff or customer getting a positive test as he can not afford to close any more (this has happened with another local pub). I kind of assume that if everything is open to the fates then so is test and trace but who knows?

Hi, quick request if possible.

When you start these threads, can you please make the first post short. So that on phone, don't need to scroll down loads to get to the latest postings.

Thanks

This is going to be the problem. They've already said 2+2 vaccinated won't have to s-i. Jersey are ahead in their opening up and were at this stage for about a week before abandoning s-i completely. Now contacts have to agree to take tests every so often or s-i for 14 days.

Good suggestion.  I can do that.  I could just give a “WINTERCON” value?  I’ll not share the current one, but it’s quite aligned to the corresponding value on the Bristol scale.

I've alluded to some of the recent wobbles in the exponential rate for cases as looking like weather effects to me.

Another poster had this to say:

I can't speak for them, but when I decide what I'm going to do, I look at my local weather, and its deviation from the seasonal normal around which my plans are based, not the weather report for Russia or India.

Below is an updated plot of the exponential rate constant for English PCR cases (measured by a week-on-week fractional change) and the Met Office HADcet data from [1].  Both curves have an 11-point 1st order polynomial filter applied.

It still looks to me strongly like there's a short term anti-correlation between temperature and rate constant over the last couple of months - when things get hotter than the norm, transmission drops, and vice-versa.  

There's a longer term coincidental correlation going on I think, as we moved in to summer the mean temperatures rose with the seasons and powerful control measures were dropped leading to an increase in the rate constants with a return to growth.

But shorter term, they anti-correlate. 

Is there a role out there for phenomenological epidemiology?  Where does one publish such stuff I wonder?

[1] https://www.metoffice.gov.uk/hadobs/hadcet/cet_mean_2021

For another month and a bit (16 August) self isolation continues as normal as far as I understand. Announcement today so should be easy to find further details. If I were your landlord friend, I would be worried - potential for skyrocketing cases with all the disruption caused by a positive test still intact?

https://www.bbc.co.uk/news/uk-57733276

Edit: I wonder if some places will consider delaying their response to full relaxation until 16 August if the risk of closure is very adverse to them (sunk costs etc)? Potentially penal business disruption caused by case driven self isolation, combined with customers and staff able to exercise their own personal responsibility as to how they carry on their lives and therefore much risk they expose the business to and rocketing case numbers feels like a stressful combination.

"and in today's weather there is a chance of mild COVID pushing in from the East, but that could change to a longer period of COVID by Friday. Expect some flu showers in the North and if you are going out take a mask and an umbrella"

We opened our borders to 2+2 jabbers from the UK on the 1st - they now no longer need to s-i or take tests at all. Correspondingly, a number of local businesses with staff who aren't at 2+2 status have told people not to visit their premises until they've been on island a week or two because they can't afford for their staff to have to s-i as a contact.

Self-isolation rules still apply until the 16th of August, and even then it's only people who are fully vaccinated who can skip self-isolating based on close contacts. So yes, as far as I can see a lot of businesses are just going to be absolutely screwed. I know quite a lot of landlords are also worried that many people won't actually want to go to the pub if covid rates start getting high enough anyway. But that's their problem and not the government's because look, we've re-opened the economy and removed all the restrictions so everything's just hunky dory.

Yes but you’re assuming everyone will get infected even if they’ve been vaccinated. For a start, not everyone will get exposed to infection in the first place. Secondly, vaccination presumably prevents a lot of ‘real’ infection (as in the viral load is effectively countered so it doesn’t spread to any significant extent). Same as ‘natural’ immunity. Clearly there will still be a significant wave, mostly but far from exclusively made up of the unvaccinated and the single jabbed. But I don’t think it’s a case of everyone ‘getting’ Covid. 

Dulux paint colours, or Red Dwarf coloured bulbs...?

It's really difficult to make a brown coloured light bulb.

I get your point but it relies on modelling which is continually evolving. What we know is that there will be a major wave now. The government’s argument seems to be based on a several assumptions:

- That there will not be a major wave in winter anyway (so we get two major waves rather than one - thanks, BoJo!).

- Conversely, that if we don’t let rip now, there will be an exit wave in winter which will be as bad or worse. That is one for the modellers but more fundamentally there doesn’t need to be an exit in autumn / winter. It can be delayed until next spring / summer if need be. Some sort of exit wave is likely either way but it’s about minimising that wave. That might mean next year.

Here’s an analogy. You know you have to pay tax now and you’ll probably need to pay tax in 6 months’ time. Your choices are: (1) pay £10k now and then possibly only £1k in 6 months but it might be £10k again, although either way you might be able to do some planning to avoid it; or (2) pay £1k now and then possibly £10k in 6 months but it might only be £1k and either way you might be able to do some planning to avoid it. Anyone for option 1? 

I get that there are other ‘costs’ involved around delaying, primarily around education. Well, how about spending the last year and the rest of the summer organising a mass testing system for children and students which actually works so that self isolating whole bubbles isn’t actually required, coupled with a proper online teaching system as a fall back, perhaps on a regional basis to make the numbers work? Where there’s a will, there’s a way…
 

This is all academic as the time for action was weeks ago. The 19th is just going to put fuel on the fire.

I’d love to be proved wrong but my inherently cautious nature is saying ‘stop’.

Depends how nervous you get...

That’s a bit like saying you’d never use more than one piece in a belay if the first piece is good enough. Sometimes it’s totally bomber like a large tree but usually you’d back it up. It’s about avoiding unnecessary risk. It’s also about not infecting others - and if everyone wears them, the overall risk is reduced. It’s not about faith, it’s about mitigating risk to a lower level. As climbers, we understand this - recognising that zero risk does not exist. 

Just read your response. You’ve explained what I was trying to say much better / more scientifically. 

Yeah there will be some social conflict for sure. It’s going to be fascinating for amateur sociology though - classifying maskless vs masked people across different social profiles and how this will change compared to the present situation. I await this with interest…

Not these days...brown just needs seperately controllable RGB LED outputs. Its possible to get any colour you like based on those three primaries in a single unit (in a similar way to how a large advertising and concert RGB displays work). With extra primaries (eg RYGB) you could even get a better colour range than a standard display.

On the impact of self isolation, talking to people working in the NHS it's already causing big problems. This is at 25,000 a day cases in a double jabbed workforce. At above 50,000 a day things sound very difficult. Unlike Boris and the general population I can't see hospitals just giving double jabbed staff a free pass with tests, as that could lead to major infection control issues. All frontline staff have to LFT a few times a week already.

Or use parcel tape..

Is Brown a luminent colour though, or are you just having your bulb make a dark yellow?  "Dark yellow alert" doesn't work so well.

It's going to be brutal for staffing everywhere.  The papers are running with the consequences of isolation and a deliberate big wave this morning.  School isolation orders are also causing a lot more disruption (I can contribute a n=1 observation on that as of today...).  It's almost as if, and I struggle to believe it let alone mention it, the plan hasn't been thought all the way through.  

My guess of c1 million people per week being forced to self isolate seems to have been way too low versus the Adam Smith numbers quoted this morning.

Maybe I have greater cynicism about how many copies of the NHS app will be quietly disposed of from people's phones on about the 19th July! 

As a customer, with a holiday booked in mid August but leaving before the 16th, I'm certainly going to be reluctant to "make a big contribution to the recovery" until the 16th is passed...

I'm a big fan of your charts, but please don't post a weekly photo to illustrate that one.

Yes additive colour systems such as those from mixed emissive  RGB sources are 'luminant'. You can see brown on your TV can't you? If you have never done it it's worth having a play with a computer screen colour picker: brown is generally a mid saturation green red dominant mix (with the blue level giving the white contributions to the desaturation).

to quote the Hitchhikers Guide to the Galexy "so this is it we're all going to die"

Some would say that you’re making dark yellowy orange and perceiving it is brown.  

I have seen it compellingly argued from a vision science perspective they brown is not a colour but a perception effect.  

I can fit a dark orangey yellow bulb and perceive it as brown, but it is not a brown bulb.  
 

Visual perception is fascinating.  Many different spectral combinations can give rise to the same percieved colour. An actual defined colour in physics (say CIE hue, saturation and brightness) can be perceived as different in different circumstances (colour illusions). Some people seem to have evolved different perception from the same cone responses in the eye. A tribe in Namibia are the most spectacular example if I remember right...Ill try and find the link.

https://gondwana-collection.com/blog/how-do-namibian-himbas-see-colour

Bottom line an RGB LED bulb set to brown is no different from a brown area on an RGB TV. Brown is a better simple description than alternatives.

.

Last Sunday I basically asked if things were still on track. If I'd waited until today then I don't think I'd be asking.

Looks to me like the chances of avoiding another shitshow are rapidly decreasing and that if we do avoid it then it will be in spite of rather than because of the government (still using lower case g for little people).

Real world example for you - Jersey currently has 4847 contacts from 632 active cases - 7 per case. It has been up to ~20 per case in recent weeks. The classic phenomenon of people not being careful to start with when they think the virus isn't around, then becoming more careful.  By my reckoning the UK currently has ~290,000 live cases (worldometers reckons 480k!), so between 2 and 5 million contacts on my figures if things are comparable to Jersey (which has similar levels of restrictions I believe).

The level of debate on here is something else!!

Join me on the AI bandwagon and call it "Turdly"....

https://arstechnica.com/information-technology/2017/05/an-ai-invented-a-bun...

Are a higher proportion of Jersey's cases from travellers though?

As I understand it, the average number of secondary contacts is generally much higher for travellers (roughly an order of magnitude) because they include, for example, others on a positive case's flight. This is identified as an issue that biases secondary attack rate figures in the PHE variant reports.

If my understanding is correct and if a far greater portion of Jersey's cases are in travellers then the numbers won't read across at all.

I never got round to the regional rate constants plot for this thread.  Latest version below.  All regions look to have their growth rates slackening off, and clear hospitalisation signals are now showing in all regions.

Looking at the updated English PCR rate constant plot, the national rate constant is also slackening off.   Similar may be happening with the Scottish data.  Why?  Possibilities...

1. Immunity is reaching herd immunity thresholds.  Seems unlikely that it would be so correlated across all regions and Scotland, as nice as it would be.
2. People responding to the growing case numbers - doesn't seem unreasonable
3. Weather effects - if you believe in the anti-correlation of temperature and rate constant over short timescales (< ~2 weeks), then at the end of June temperatures had just bottomed out and were rising, and the rate constant had just maxed out and was falling [a], that's probably played out and given the almost cyclical nature of our weather that'll probably have a little low valley in rate constant for a few days, and then go in to reverse soon enough.

[a] https://www.ukclimbing.com/forums/off_belay/friday_night_covid_plotting_33-...

It almost looks as if you should use temperature as a postdicting moderator in your provisional zone.

ONS data is showing about 80% antibodies in all fully vaccinated age groups. What's happening with the remaining 20%? This is a much a larger group than the unvaccinated (some of whom will have antibodies anyway).

The numbers look much higher than that to me?

I think this is the first time they have broken it down by age and region to this extent.

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

Weird methodological voodoo beyond my ken.  I have thought about using a Kalman filter and a “kinetic” (momentum/inertia) model to run things forwards a bit or at least refine the provisional zone; multi channel data fusion with weather would fit well into such a filter.   If I knew back last may what I know now, that’s probably how I would have approached this, with filters down at the UTLA level and some model of absolute cases vs rate constant auto-moderation for near term prediction; deviation from that might then give an early warning sign.

Next on the list is to look at rain to try and get a handle on how much might be behavioural (meeting inside/outside) and how much might be down to ventilation and window opening.

Don't be fooled - the terminology was naively descriptive rather than technical. 

Problem with rainfall and its effect on behaviour is that the timing of rainfall events will be critical. Simple precipitation will be a very blunt tool. I know you know this.

You fooled me!  I have a blind spot to Bayesian stuff and it sounded right on…

Indeed.  But there’re some stand out shitty days over the last few months in terms of rainfall/hail, as my poor fruit trees can attest - blossom shredded.  Grasping at straws, I know.   I don’t yet know how good a historic rainfall dataset I can access, but I think I’d need to go regional level to have any chance of finding anything.

Ah good. I cant what I was looking at now but it was Twitter, so I will  believe your link!

If you go down to regional level for rainfall (and obviously you should) then you might think about incorporating regional windspeed measures to refine your temp data (windchill and all that).

Thinking on it, the problem with going regional is that the only cases data publicly available below the national level is PCR+LFD cases, and the LFDs introduce a lot more variability.  Worth a try, but with the combination of worse statistical noise (smaller samples) and the LFD data salting things, it's not the greatest.

The graph in Figure 3 for 16-24 year olds doesn’t look right to me. Seems to suggest around 30% had SARS-COV-2 antibodies through infection last December (seems too high) and that % hasn’t changed much since. Perhaps I’m reading it incorrectly?

I think so. It's doubled from around 30% to around 60%. If you were looking at the 31.6% number on the right, that's the line for people with a single dose.

It should have risen substantially in the last three weeks too - all those graphs are up to 14/06.

 ONS figure below for England.

% with antibodies in December decreased with age - not unexpected as older people were trying very hard not to get covid for obvious reasons, and there had been some massive university/student outbreaks towards the end of 2020.  If it was 30% across all ages it would seem high, as estimates at IFR and cumulative deaths might suggest about 10% of people had had covid, but the concentration in the younger means there’s no clear conflict here.

Since then, the % with antibodies has roughly doubled.

What stands out to me is that there’s little sign of the current wave producing antibodies in addition to those explained by vaccination.  Perhaps it needs a bit more time to bake through in to data.

The ONS survey could really benefit from categorising S-protein antibodies and other antibodies separately to help understand the intersection of naturally and vaccine induced immunity.  It may even be possible to fully seperate them with a high fidelity assay given the vaccines use a long displaced version of the viral spike.

I think it's already more or less the default, just not widely or routinely reported. This is going back a bit but when NHS staff were eligible to be tested for antibodies, the report would come back with 2 types (igg and....ig...something else. IgN?). Only one of them would become positive after vaccination.

Edit: current wave wouldn't have come through in those numbers yet, surely? We've only just got up to significant case numbers and there's probably 4 weeks from case to showing up in those charts.

I think it's quite interesting how the antibody %s track the first and second dose vaccination %s and the variation in that between age groups. I think you can have a good stab at the significance of the vaccinations as opposed to otherwise from the shape of the different curves, because you can see the different relationships between vaccination and antibodies in the older age groups. Although obviously yes, it would be nicer to know for sure.

The other message this data really emphasises to me is how the ratio of antibodies/vaccinations, either first dose or both, and therefore presumably vaccine efficacy (? Correct inference or not?) is fairly strongly age correlated.

Some estimates of attack rate (and notably their CIs) go far higher. 30% in some age groups isn't crazy.

https://www.mrc-bsu.cam.ac.uk/now-casting/

Yes, I’ve seen some reports covering different letter soups; I don’t know if the ONS test but don’t report this, or don’t test it.  It may be that the CIs become too large to be useful when broken down by classification.

Growth was earliest and strongest in young adults so I thought that might start to show here by mid June; if the seroconversion time is more than a week or two I suppose it won’t.  

In reply to Si dH:

Yup, immune systems suck when you get old.  A hot topic for longevity research - and it’s probably not a simple relationship; too much immune activity can be as problematic as too little as one ages.   Perhaps immunity has to reconfigure and weaken to prevent it trashing an ageing body?  Fringe stuff suggests the immune system could actually be a driver of ageing, but I’m to clueless to follow the details.

Correct inference?  In terms of the neutralisation response with RBD epitopes, presumably as that’s driven simply by the higher binding affinities of antibodies blocking the RBD/ACE2 interaction.  I suspect if you looked at antibody concentration in serum it would drop off more rapidly with age than their binary test result.    Broader immune response requires antibodies and then the follow on systems that mop up antibody bound intruders; if those systems degrade with age too I guess you’re going to see a quadratic falloff in immunity with age where antibodies fall of linearly, for example.

Perhaps the pandemic wouldn’t have been as bad if we’d simply locked down all the youngsters?