Coronavirus in the UK - news, lockdown and discussion

[elbows]

I'm beginning to get might confused about the effectiveness of vaccines now..

If some of the vaccines are only 50% effective that isn't great progress is it?

Its more complicated than that.

Firstly the effectiveness against infection is one thing, but there are also the other key numbers such as effectiveness against hospitalisation and death. Those have been higher than effectiveness against infection in studies all the way along.

Secondly it an be a bit tricky to unpick multiple factors, for example how much of a decline is due to the Delta variant and how much is due to effects of vaccination waning over time. And there may be notable differences in that picture between nations where some nations used a different dosing schedule between first and second doses.

Another phenomenon that may also be part of the picture is that a lot of the real world studies of vaccines over time have limitations imposed on them by the epidemic circumstances that are in play during the study period. I believe it was expected that there might be a decrease in some of the estimates once vaccinated populations impacts could be measured under very difficult circumstances, and this Delta wave is the first to fully offer that opportunity. If the proof of the pudding is in the eating then this present phase is puddingfest 2021 as far as vaccines go.

I have been complaining for most of this year that the approach the UK has gone for in 2021 is bloody stupid and asks vaccines to carry more pandemic weight than it is sensible to ask of them. But for a while the estimated effectiveness against infection was so high that I was at least ready to entertain the possibility that the government might get away with their chosen approach. I still have to entertain that possibility even though those the estimates you mention have now fallen very far below the level where some of the most simplistic notions about 'herd immunity' seemed like a plausible goal to aim for. But the picture is complicated and messy and I havent seen modelling of what could happen next once the latest vaccine effectiveness estimates are taken into account.

And there are other complications too for the months ahead. There is the issue of waning immunity and booster shots. Israel have drawn a gloomy conclusion about that and are pressing on with boosters now, but their data is from their circumstances where they only had the short gap between the first two doses. The UK is likely to provide a missing piece of that picture by studying waning immunity in a country where many people had a much longer gap between first and second jabs, and indeed there seems to be a new antibody testing programme going live here which may be designed to help with those questions and some other.

And this brings me to the final complication I shall mention now. Time and time again we have seen studies where the immunity afforded to many people who have been infected and vaccinated seems notably better than for those who have been vaccinated but not infected. It is possible that vaccination regimes over time might be able to get closer to the protection offered by infection plus vaccination, especially if the nature of vaccines themselves is altered. But without such triumphs on the near horizon, in some ways the infected plus vaccinated route is music to the ears of the UK establishment, since it provides a new justification for their original instincts, for plans and priorities that see no problem in letting millions of people get infected, just so long as the hospital burden doesnt become too great.

 

[elbows]

If my potentially faulty memory serves, history suggests that lockdowns are triggered at the point that hospitalisations threaten to rise above something like 1000 per day in the imminent future. I believe that the hospitalisation rate is something like 0.5-1% at the current rate of vaccination? So that would imply that the government won't take serious action unless we get up to something like 100-200,000 cases per day. Unless one of the many things I am trying to remember in that equation is wrong, of course.

Not only has the UK government gone out of its way to avoid having publicly stated trigger points/red lines for that sort of thing, if they've even had any private ones internally they've kept them very close to their chests.

Because SAGE minutes from meetings conducted in July this year still felt the need to go on about the need to set such trigger points. And they didnt even know at what levels they should be set, and meeting minutes included actionable points about getting NHS England and the Joint Biosecurity Centre to report on the impact of certain rates of hospitalisation/bed occupancy/ICU occupancy.

It was the usual absurd bullshit that I was reading such requests in a meeting from summer 2021 rather than spring 2020. But it was hardly surprising to me given my long history of peering with contempt at the UKs pandemic response. SAGE minutes are rather dry, they arent even minutes at all, but its still possible to decode signs of exasperation in those documents from time to time.

Here are some relevant quotes from meetings 93 and 94 of July 2021.

If the aim is to avoid the NHS becoming overwhelmed, SAGE advises that it is important to understand the impact of different levels of admissions on NHS function and have appropriate contingency plans in place.

Pre-defining hospital (and ICU) admission or occupancy levels which would trigger further contingency planning and interventions would be important.

In the event that increasing hospitalisations were likely to put unsustainable pressure on the NHS, this would need to be identified rapidly and contingency plans enacted within days, given the delays between infection and hospitalisation (i.e., because hospitalisations will continue rising for a time even once infections start to fall). Having clear trigger mechanisms for this in place is strongly advised.

ACTION: NHSE and JBC to provide analysis of local and national NHS impacts at different levels of hospital or ICU admissions or occupancy.

From SAGE 93 minutes: Coronavirus (COVID-19) response, 7 July 2021 and SAGE 94 minutes: Coronavirus (COVID-19) response, 22 July 2021

Its no surprise that such things havent been put in place in the past because thats what youd do if you wanted a scientific, data driven approach to call the shots. A sensible regime might want such a system so that some of the ugly politics of restrictions could be bypassed via effectively automating the big trigger. The current government dont favour that, they want to retain all the power to make such decisions arbitrarily at a time of their choosing, and if there are trigger points they'd at least pay some attention to, they would probably hide them inside a black box.

I could go back and look at historic data to try to estimate where the red lines might be, but I dont know how reliable a guide that would actually turn out to be. And its certainly not just about current levels, its also about the doubling times in effect at that moment. If the doubling time is fairly short, and only one more doubling from the current level is required to land in deep shit, then the time to act is now or some time ago. One of the reasons Johnson was able to drag his heels for so long in the autumn was that the relatively long doubling time made things seem like a slow motion version of the first wave, right up until the point where suddenly the situation didnt seem to be evolving so slowly anymore, and then the shit hit the fan. The usual predictable pattern where idiots think they can ignore exponential growth because the first bunch of doublings seem so modest. This time around if things get worse we are already starting from rather high levels, and to hold their nerves for ages they will probably need the doubling time to be extremely long, eg more like the gradual, modest rises seen in England positive case numbers in recent weeks than the rather rapid rise Scotland is seeing in case numbers recently.

 

[elbows]

If my potentially faulty memory serves, history suggests that lockdowns are triggered at the point that hospitalisations threaten to rise above something like 1000 per day in the imminent future. I believe that the hospitalisation rate is something like 0.5-1% at the current rate of vaccination? So that would imply that the government won't take serious action unless we get up to something like 100-200,000 cases per day. Unless one of the many things I am trying to remember in that equation is wrong, of course.

I had a quick go at eyeballing the historic data and seeing whether I could make sure a simple trigger rule work. If I do things formally by using the dates that Johnson announced lockdowns, I cant really make it work, because there is a huge difference between hospital admission rates when he finally ordered a lockdown at the end of October 2020 compared to when he announce one in early January 2021. The same can be said for number of patients in hospital beds and in mechanical ventilation beds.

But then there is all the stupid detail behind the pictures at those two stages:

There is the difference between when the lockdowns were formally announced, and when they first started to look inevitable. We can use the mood music and leaks to the media to give us a broader range of dates than the formal announcement date.

There is the bullshit politics, some of which is influenced by the calendar - eg December was full of woe and talk of the new variant, but there looks to have been an agenda to delay the inevitable in order to let certain aspects of the Christmas economy have their moment, an attempt to fudge the rules over Christmas itself and lean heavily on alarming messaging and words of caution, with the inevitable formal lockdown postponed till early January. And the November lockdown wasnt as much of a lockdown as we'd seen before or since, in that it had a short fixed length and the schools didnt close for any pupils.

And there is the fact that it wont just be trigger points that lead them to these decisions, it will be stuff like various modelling. In the pre-vaccine era the modelling picture was pretty straightforward, with waves becoming unbearably immense, and a pretty solid sense of inevitability in regards the doom in store past a certain point. This time around is more complicated, with opportunities offered by some modelling output that would allow the authorities to believe that things would pass with a horrible period of pressure that was nevertheless still modest enough to get through without having to slam on those heavy brakes. Now we've had the additional complication of an 'unexpected' early peak in July and then things deteriorating quite slowly for a time after, and now alarming indications from Scotland about what could be next. And the authorities had the wiggle room afforded by school holidays, which is soon to disappear.

I dont know what will happen next and I dont know to what extent the latest modelling may have changed to take account of how people have behaved post-restrictions, what impact the latest vaccine-Delta estimates have on how bad the modelling thinks things can get, etc.

But with all that said, personally I would actually use 1000 as a rough guide. At least in the sense that I am fond of going on about the shit hitting the fan, and over 1000 hospital admissions a day and/or over 1000 people in mechanical ventilation beds would probably be the sort of level where I'd be saying the shit has indeed hit the fan. But it does depend on the rate of increase too, and how long modelling suggests such a rise might continue. We really arent far away from 1000 for either admissions or ICU bed figures right now, and I expect that my posts here will be somewhat different if it next crawls past the 1000 level compared to if it shoots past that level rapidly.

Anyway I often take the piss out of aspects of media pandemic reporting but I can use their output as an unsubtle guide as to when the authorities realise the shit has hit the fan and that a u-turn looms. Because of this I cannott say that previous lockdowns or delays to the roadmap were a surprise to people by the time they were announced. But again its a bit more complicated this time because the current approach involved an inevitable period where the government fully expected the shit to hit the fan, but where they thought it wouldnt go on for too long so they could get away with letting it happen rather than having to u-turn as they did in the past. And to stand a better chance of not exceeding the limits, they made use of gloomy mood music and toned down the freedom day rhetoric and timing. So I need to be able to distinguish between that sort of messaging in the media as seen in early July, and the previous versions of this which we could take as an indicator that a u-turn & lockdown was coming.

 

[kabbes]

To be clear, I wasn’t suggesting that 1000 hospitalisations a a day was any kind of official or documented trigger for action. I was just looking for when the government has seemed to take action and noting that this has been at the point that the NHS seemed to be within sight of being overwhelmed (which seems to be at about 1000 hpd). They’ve been quite consistent about not doing anything so long as hospitals are ‘coping’ but then reacting in a panic when it’s looking like this will stop being the case. I fully expect this to continue.

 

[cupid_stunt]

I'm beginning to get might confused about the effectiveness of vaccines now..



If some of the vaccines are only 50% effective that isn't great progress is it?

The first reply is more reassuring...

 

[_Russ_]

That document does show again that AZ is less effective than the MRNA vaccines, why does everyone avoid discussing this and just lump all vaccines together in most discussions of how good they are?, because its uncomfortable?

P.S. I believe the majority in UK have had AZ?

 

[cupid_stunt]

That document does show again that AZ is less effective than the MRNA vaccines, why does everyone avoid discussing this and just lump all vaccines together in most discussions of how good they are?, because its uncomfortable?

P.S. I believe the majority in UK have had AZ?

With 2 doses, when it come to symptomatic infection AZ is less effective (70% -v- 85%), at least in the short term, I did read a report recently, that in the longer term AZ overtakes Pfizer, as efficacy drops faster with Pfizer over time.

When it comes to hospitalisation and deaths, both are very effective at 95%

These are the Public Health England figures, based on a longer gap between doses in the UK compared to most countries.

 

[_Russ_]

But if the document in that tweet is correct and AZ is only 60% effective against infection against mrna at 83% then AZ will have measurably less ability to kerb transmission which I suppose aids keeping that reservoir of the infected present, its complicated innit

P.S. what do the colours in the different boxes represent?, is it confidence in the data?

 

[teuchter]

But if the document in that tweet is correct and AZ is only 60% effective against infection against mrna at 83% then AZ will have measurably less ability to kerb transmission which I suppose aids keeping that reservoir of the infected present, its complicated innit

That relies on extrapolation from symptomatic infection to judge effects on transmission though, and it seems no-one is very clear about to what extent you can do that.

And those numbers are for symptomatic infection, not infection, which are two different things.

 

[gentlegreen]

And those numbers are for symptomatic infection, not infection, which are two different things.

I don't understand why they never made clear that vaccinated or unvaccinated, the initial infection / replication / shedding phase is the same whether vaccinated or not and that this will not magically solve the problem.

I was reminded the other day of the estimate that double-vaccination assuming it worked, basically gives you a 20 year advantage in terms of disease progression - so as a healthy 61 year old and with some children actually dying, I plan to continue treating everyone else like they were Typhoid Mary.

 

[teuchter]

the initial infection / replication / shedding phase is the same whether vaccinated or not

I'm not sure that's actually known is it?

 

[SpookyFrank]

That document does show again that AZ is less effective than the MRNA vaccines, why does everyone avoid discussing this and just lump all vaccines together in most discussions of how good they are?, because its uncomfortable?

P.S. I believe the majority in UK have had AZ?

Current thinking is that immunity from the AZ jab declines less quickly, so that about nine months after a second jab the AZ is more effective than the Pfizer. Early results though.

 

[gentlegreen]

I'm not sure that's actually known is it?

I believe it has been tested recently - possibly looking for live virus rather than just fragments ...
So far as I understand, the immunity given by prior infection / vaccination can't get to work until there is some replication - and then it's a game of catchup ...

 

[Spandex]

Are we heading for another lockdown?

I can't see there being another lockdown until we're well into a complete and absolute shitstorm. Johnson put off lockdown last spring, last autumn and last winter, and after all his irreversible no more lockdown you've had your vaccine new normal talk he'll be even more resistant to introducing another one.

We're currently bumping along with 30,000+ positive tests per day, 900 and something people going into hospital every day and around 100 people a day dying, with all the figures drifting up for a few weeks. Apart from the odd story about local NHS struggling all the messaging is still Get Back to Normal, and plenty of people (especially in government) are fine with this.

If numbers really take off again - a possibility as summer comes to an end - I expect the government to try everything they can to avoid locking down again - denial followed by talk of annual flu rates and the success of vaccines followed by pingdemic 2 and bringing back local 'restrictions', anything to avoid another lockdown until it's past inevitable.

I really, really hope we don't end up there. I'm sick of the whole fucking thing now. My 7 year old was 5 when this all started, he barely remembers a time without Covid. But if there's a government who can manage to fuck things up in the most disastrous way, then it's Johnson's shambolic excuse for a government.

 

[Petcha]

Wrong thread!

 

[weepiper]

 

[elbows]

Talk of the 'sharp rise' and the current situation being 'fragile' and a 'pivotal moment'. And the typical mix of calls for people to do their bit by wearing masks, keeping distance, ventilation etc. Joined by vague comments about how limited, proportionate restrictions could be reimposed in future if necessary.

Also revealed that about a third of current positive cases are vaccinated.

Avoided giving any concrete info in response to journalists questions about what trigger points would be. Did point out that due to NHS resuming other forms of care, it will take less Covid pressure to cause a problem this time than it would have done earlier in the pandemic.

Also bits of detail about their public inquiry.

 

[elbows]

Todays press conference from Scotland also included a good example of the phenomenon where the focus on which age group have the highest cases ends up distracting from very important things happening in other age groups.

For eample the trends in other age groups are really important, not just the absolute numbers. And cases in some older age groups have always been lower than some other age groups, but the different ratio of hospitalisation in older group still makes their numbers a big deal.

Here are the latest 7 day averages by age group for Scotland from this website Scotland Coronavirus Tracker

Its not hard to see why younger age groups grab the attention, but the trajectory of other groups actually bothers me equally if not more.

 

[scalyboy]

Apart from the odd story about local NHS struggling all the messaging is still Get Back to Normal, and plenty of people (especially in government) are fine with this.

Agree.

The 'get back to normal' message seems (at least round my way) to have encouraged more and more people not to wear masks, sometimes it's the majority on a bus or in a shop - just now I noticed several shop workers who've stopped bothering to wear them too.

Ceasing to wear a mask in a confined space seems very much at odds with the sharp increase in infections over the past week(?) and I suspect the two are directly related!

And as you said Spandex , Johnson will be very reluctant to introduce another lockdown - he looks at his popularity and not the nation's health, or at common sense - and if he does bring in another lockdown, there will be a looooong delay before he does so, as was the case before.

So let's hope it's not necessary, cos the f*cker will delay and prevaricate all the way into autumn/winter.

 

[Riklet]

Bloody nora the south west is being hammered by Covid again. Bloomin tour-er-ism!!

I had a look at the age breakdown for Somerset and Bristol and it's still very high rates with under 40s and much lower with older ages. So socialising must be a big factor.

Loads of selfish cunts dont wear a mask inside at the local places here now. It's only the chemist's that's actually strict.

 

[two sheds]

Yep my area has one of highest case rates in (looks like) the country. Apart from holidays and second homes and boardmasters in Newquay I'm presuming that it comes partially because we got off so well in the first rounds. Even though most are now double vaccinated.

 

[Elpenor]

Very high in my part of Devon which will probably include holiday parks etc in Dawlish. Thankfully I can more or less lock myself away from the world. I agree with two sheds that the SW having had low rates initially is suffering more later on

 

[two sheds]

Same here - I've always liked the idea of a desert island and I got similar now but with deliveries

 

[IC3D]

With an increasing number of people in London who have already had it, I'm not surprised mask wearing reducing and local in inner city boroughs it is very low with shop workers and has been for ages. Totally different world if you go to an affluent area.

 

[SpookyFrank]

Very high in my part of Devon which will probably include holiday parks etc in Dawlish. Thankfully I can more or less lock myself away from the world. I agree with two sheds that the SW having had low rates initially is suffering more later on

Bank holiday weekend coming up. We're pretty much gonna stock up on everything and then stay indoors for the duration

E2a: Dartmoor's still miraculously quiet though. I guess because most of it is more than forty feet from a car park or a place where you can buy some fried grease or an inflatable giraffe.

 

[elbows]

Yep my area has one of highest case rates in (looks like) the country. Apart from holidays and second homes and boardmasters in Newquay I'm presuming that it comes partially because we got off so well in the first rounds. Even though most are now double vaccinated.

Yes thats a theme in the modelling too, areas that do better in previous waves wave have more potential to do worse in the next. And this logic still works in the vaccine era because numerous studies imply that infection + vaccination offers better immunity than vaccination alone.

This came up in the Scottish press conference at one point too, when a comparison to the situation and timing in England was being made.

 

[Elpenor]

Bank holiday weekend coming up. We're pretty much gonna stock up on everything and then stay indoors for the duration

E2a: Dartmoor's still miraculously quiet though. I guess because most of it is more than forty feet from a car park or a place where you can buy some fried grease or an inflatable giraffe.

The few times I’ve driven into Dartmoor during a weekend it’s been quiet.

 

[StoneRoad]

Much the same here. Also in a "tour-ista" area [Roman / history plus some scenery / walking routes]
But with plenty of local cases and much reduced masking - although we do have a very high vaccination count especially with the more vulnerable sectors of the population - a few refusniks despite evidence.

Regular grocery delivery on Saturday night, then we'll batten down for the next few days.
Maybe watch film(s) and drink some wine once or twice.
Might even have a "picnic" if the weather behaves !

 

[Flavour]

Covid infection protection waning in double jabbed

Experts say it is to be expected and boosters may be needed, at least for some people, ahead of winter.

www.bbc.com

 

[Supine]

Covid infection protection waning in double jabbed

Experts say it is to be expected and boosters may be needed, at least for some people, ahead of winter.

www.bbc.com

I’d say that headline over dramatises the actual findings and expert opinions tbh.

Vaccines would protect a lot more people if they were given to developing countries rather than used as third doses.