Coronavirus outbreak

[mjr]

Bravo to the Belgian Francophone TV for this headline...

Rather than a third wave, they are apparently seeing localised "wavelets" possibly as new variants try to break out and are stomped. Alongside that and their GPs wanting to vaccinate, there were also some reports about flights being stopped (Morocco being the latest) and the rules for picking daffodils.

 

[Wobblers]

Of the 4 tests in the 'Indicative timetable for relaxing Covid-19 NPI restrictions' it seems likely that the first two are pretty assured. And the last: increased risk if there's a new Variant of Concern in domestic circulation - is unpredictable - more likely in countries which have a continued high case rate and not done well with vaccinations (no names, but plenty of pack drill).
Which leaves: "Infection rates [cases reported per day] do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS."
I reckon infection rates will rise in April but by Easter numbers in hospital will be less than 8000 and still falling. The cohort who get infected, despite continued restrictions, will be the unvaccinated and they are far less likely (than over 70s) to get so ill they need hospital. So the likely increase in cases will not "risk a surge in hospitalisations" still less "put unsustainable pressure on the NHS".
Edit: I think, therefore, it is unlikely that these 4 tests will not be satisfied at the various 'not before' dates shared by the Prime Minister. But I also think that if the data say otherwise, hard decisions will need to be made.
One of the key papers which influenced Government's plans was (I surmise) this (26 Jan) one from Warwick University:
Vaccination and Non-Pharmaceutical Interventions: When can the UK relax about COVID-19?
But the timescale of the UK (and devolved) Government(s) plan(s) for gradual removal of restrictions has been informed by values for key parameters which are much better than the study's assumptions, specifically: speed of vaccination roll-out, the %age uptake of vaccines, and the effectiveness of the vaccines both to prevent hospitalisation and in extremis, death, and the extent to which they reduce transmission (and there're good data now on that) - so the green line is relevant.
NB The study takes no account of those unvaccinated who are resistant/immune following infection (~11 million under 50s in UK), which will combine with number immune through vaccination significantly and increasingly to reduce Rt. The study also takes no account of seasonal effects which will bear down on transmission from May onwards and hopefully see us through to the autumn (by which time 80+% will have been vaccinated).
View attachment 576019
The grey shows gradual removal of restrictions (starting in mid Feb, first graph quicker, second graph drawn out) and the green line shows infection transmission blocking effect of vaccine at 85% (orange is @60%). Apart from schools, the plans for relaxing don't start till 29 March, so the second graph is more relevant. We can still expect more deaths next winter from C19, but small as a proportion of the average number of deaths per week (2015-19 normally ~9000 increasing to @13000 in January).
View attachment 576022

There are two underlying assumptions in government strategy that I find worrisome.

The first is the use of hospitalisations and deaths as the sole metric to judge the success of the vaccination program and inform the rapidity of exiting restrictions. It is becoming increasingly clear that Covid has significant long term consequences for many who catch it. This isn't just "long Covid" which, by affecting as many as 10%, is in of itself is a major economic consequence of this pandemic. Perhaps (probably, even) more significantly is that many are left with long term health problems. There's a MedCram video which goes into this - the data examined suggested over twice as many were likely to suffer cardiac damage as die. The economic effects of that alone on the NHS will likely dwarf the immediate effects of the pandemic. These long term aftereffects seem to have been neglected by current strategy.

The other assumption is that the virus won't mutate significantly. That is clearly untrue. I've been looking at the latest data to come out of Manaus in Brazil. It had a large CV outbreak in spring, and about 50% became infected. Yet despite this, it had a second major outbreak at the end of last year, due to the P1 variant. The data just out (note it hasn't been peer reviewed yet) paints a disturbing picture. P1 is 1.4 to 2.2 times more transmittable than earlier variants. Worse, it's capable of reinfecting 25-60% of those who had an earlier variant. As I've said before, this is a virus that is mutating towards antigen escape.

Let's put this into the UK perspective. The most optimistic case means that to achieve herd immunity from P1, 80% will need to have been infected or vaccinated [1]. Assuming 100% vaccine coverage, and assuming 75% vaccine effectiveness, that leaves 25% of the population vulnerable to P1. A further wave due to P1 would thus be inevitable. This is best case - more likely, the vulnerable population will be over 50% as not everyone will be vaccinating (we're not vaccinating children! We need to), I've used the low number for reinfection - 25%, and assumed that the vaccines are as effective in conferring protection as infection (unlikely). More likely, the vulnerable population will exceed 50%.

With one person with P1 at large in the UK... well, it's quite possibly more than that by now... it's certainly on the cards that it will become the dominant variant. The mass vaccination campaign will select for variants that are capable of antigen escape, like P1. From our past record, I've little faith that test and trace will be able to contain any new strains. Even if we contain P1, there is a reasonable chance that a new mutation will arise with similar properties. After all, with restrictions being lifted while only some the population have been vaccinated this creates the perfect environment for such mutations to evolve. Regretfully, I'm coming to the conclusion that a third wave of a partially resistant variant in the late summer is becoming increasingly likely.


[1] More realistically, the number's over 85%

 

[mjr]

Regretfully, I'm coming to the conclusion that a third wave of a partially resistant variant in the late summer is becoming increasingly likely.

Only if it can time travel, as we've had three wave peaks already.

I agree that leaving the virus breeding room as planned would be a big gamble in some ways, but more variants will almost surely escape from somewhere, so it will need some reforms and restrictions, such as an increase in outdoor social activity, which I hope the government will do something to encourage tomorrow, such as exempting street seating from rates and easing evening road closures.

 

[stowie]

I know it is easy to scoff at social media, but I like to think there is plenty of good, informative stuff out there, and I hope the below falls into this category.

The cardiologist who hosts the "medlife crisis" channel presents a very balanced view on the schools reopening. As someone with secondary school child, it helped reassured me. The studies and articles he discusses are referenced in the comments. He is not a virologist and doesn't claim to be an expert. Just someone with a medical career who examines the available information.



Oh, and a lot of his other videos are rather entertaining and cover a very wide number of subjects

 

[Wobblers]

Only if it can time travel, as we've had three wave peaks already.

I agree that leaving the virus breeding room as planned would be a big gamble in some ways, but more variants will almost surely escape from somewhere, so it will need some reforms and restrictions, such as an increase in outdoor social activity, which I hope the government will do something to encourage tomorrow, such as exempting street seating from rates and easing evening road closures.

I'm sure we had this discussion before, about whether or not the autumn peak was separate from the bigger New year one! I now agree with you: they're really part of the same thing. But whether or not it's a third or fourth peak is academic when in reality it will be simply bad.

Most people seem to think that once everyone's vaccinated, it'll all be over. Unfortunately that simply isn't the case: this is the end of Act I, hopefully. But there's a long way to go yet. I've seen next to no discussion in the media about this. As you say, escape variants are likely - we can predict that simply from the observation that we're already seen two in the last 4 months. The best scenario is that CV19 has a small number of viable mutations, so in a few years we'll have experienced all possible variants, and dealt with them. The worst case is that it'll turn out to be behave more similarly to flu, and will continually generate new variants which will require much effort to contain.

Governments the world over (it's not just the UK) really need to be more honest about this, that defeating Covid is a long term project, and promising that we'll be back to normal soon is far from the mark. There is a very real danger that we'll see a resurgence down the line - even if we dodge the P1 bullet over the summer, a further peak from another mutation is likely. In particular, I find Johnson's use of the word "irreversible" in describing the easing of restrictions dangerous. Should it be necessary to re-implement them, I suspect the use of such language will reduce compliance.

 

[deptfordmarmoset]

It looks like we now have covid-19 terrorism. https://www.theguardian.com/world/2021/mar/03/dutch-covid-test-centre-hit-by-suspected-bomb-attack

 

[mjr]

It looks like we now have covid-19 terrorism. https://www.theguardian.com/world/2021/mar/03/dutch-covid-test-centre-hit-by-suspected-bomb-attack

Is that new? Some test centres in England have an army presence but maybe that is purely for looks and logistical support and absolutely nothing to do with arson attacks, fights and attempted thefts of equipment following a social media myth spreading that the testing sites contain "active covid" to check each batch of tests works.

 

[mjr]

Israel deploys electronic tagging to ensure people stick to quarantine. https://www.reuters.com/article/us-...rantine-hotel-tracking-bracelet-idUSKCN2AT3FT

 

[matticus]

electronic tagging

That reminds me. The BBC have got some kind of proximity alarms for their staff to wear (to help with Social Distancing). Heard it on a podcast from months ago, dunno if they stuck with it.

 

[johnblack]

That reminds me. The BBC have got some kind of proximity alarms for their staff to wear (to help with Social Distancing). Heard it on a podcast from months ago, dunno if they stuck with it.

The MEN reported on it and said they cost between £8-£12 per month per user, the BBC took 2,250 of them.

 

[Ajax Bay]

There are two underlying assumptions in government strategy that I find worrisome.

• The first is the use of hospitalisations and deaths as the sole metric to judge the success of the vaccination program and inform the rapidity of exiting restrictions.
• The other assumption is that the virus won't mutate significantly. That is clearly untrue.

Regretfully, I'm coming to the conclusion that a third wave of a partially resistant variant in the late summer is becoming increasingly likely.

I thought much of that was useful (excuse me for reducing your post to a few lines).
1) What metric do you think might offer a better insight into whether the vaccination programme continues to have a positive effect? Given that the vaccines' efficacy in trials and to meet regulatory standards, had specific objectives of:
a) reducing symptomatic C19 (ie positive test with at least one symptom)
b) reducing hospitalisations and deaths by a percentage (?60%)
it seems reasonable to adopt that metric when the time comes to judge whether to reduce restrictions. The longer term affects of C19 (not just long-Covid) are indeed worrying, but not easy to use as a metric, I suggest.
2) Wrt new variants, I suggest that Government strategy assumes no such thing. In fact the 4th 'test' specifically includes that as an 'issue'. The virus is mutating all the time. The key concern is the emergence of a 'variant of concern' (VoC). It seems that the B.1.351 variant is around in small amounts but does not out-compete the B.1.1.7. Even then we don't really have evidence of any quality that the current vaccines are quasi-ineffective against the B.1.351, but we can't be sure, so it's a concern. The P.1 variant is of concern on two counts: science suggests it is more transmissible and also reports of reinfections suggest that it can overcome antibodies generated in people who had previously had the original strain (in Brazil), with the implication for the effectiveness of the current vaccines against it.
3) My opinion is that the likelihood of a partially resistant variant active in UK in the late summer is low. Given that you think it "increasingly likely" what changes to the current Government plan do you think would be beneficial?
4) There will be a third wave (fourth wave for @mjr) in UK no later than January 2022, thobut. The vaccination programme will roll out at pace (and it'll accelerate to previously unseen doses per day from mid March as supplies of vaccine will allow first doses to be delivered alongside the second doses needed). Restrictions will be released with prudence (and a beady eye on irreversibility). Given those two, and assuming no VoC against which the vaccines are less effective, that 'third wave' will be a wavelet. I do expect some light domestic restrictions to be needed next winter and the limitations on overseas travel are going to be here for many months (imo). UK's beaches and National Parks are set to be crowded (but outside so tranmission risk very low).

 

[classic33]

Is that new? Some test centres in England have an army presence but maybe that is purely for looks and logistical support and absolutely nothing to do with arson attacks, fights and attempted thefts of equipment following a social media myth spreading that the testing sites contain "active covid" to check each batch of tests works.

They're there for logistical support they're able to give.

 

[PK99]

This in the times, sourced from WHO via John Hopkins is starting in it clarity:

Article continues
In Britain 64 per cent of adults are overweight, including 28 per cent who are obese, the fourth-highest in the world. The country’s Covid death rates, at 182 deaths per 100,000, is third highest, according to data up to last month. Johnson has set out plans to ban advertising and promotional deals on unhealthy food and today he will commit further funding to NHS weight-loss schemes. “Being overweight increases the risk of becoming ill with Covid. If we all do our bit, we can reduce our own health risks — but also help take pressure off the NHS,” he said. “Losing weight is hard, but making small changes can make a big difference.”

 

[Ajax Bay]

COVID-19 surge date as a function of country mean temperature (A) and humidity (B) during the 2 preceding weeks and as a function of country's latitude (C), pointing to vitamin D as one of the primary factors (flags link countries between graphs).
What triggered the sudden surge of daily new COVID-19 cases arising in most European countries during the autumn of 2020? " The study proves no correlation between the country surge date and the 2 weeks' preceding temperature or humidity but shows an impressive linear correlation with latitude. The country surge date corresponds to the time when its sun UV daily dose drops below ≈ 34% of that of the equator. The date of the surge is an intrapopulation observation and has the benefit of being triggered only by a parameter globally affecting the population, i.e. decreases in the sun UV daily dose." (Goes on to posit that populations' reduced Vitamin D is correlated with susceptibility to severe C19 infection.)

Observed day of the second COVID-19 wave surge as a function of the day when the country sun UVB daily dose drops lower than 34% of that at latitude 0°.

 

[Eziemnaik]

Small offtopic regarding mentioned earlier Galicia. It seems local government there is trying hard to get the first prize in retarded anticovid measures. Wearing the face cover is obligatory all times on the bike
https://www.elperiodico.com/es/depo...a-obligatoria-correr-runners-galicia-11479088