There are increasing calls, not just from politicians but from scientists too for the daily update on COVID cases to end. Some countries have already moved to weekly reporting. The argument is that reading about exponentially growing cases serves to increase anxiety among the public. It also means we don’t look at COVID in perspective. How do COVID figures compare for example with data on flu and pneumonia, or come to think of it on the prevalence of anxiety and depression?
Whilst I can understand the argument, I don’t agree with it. I think we should keep publishing all the data because we do need those measurements in place to monitor how things are going as we move out of the pandemic. It is true that cases on their own increasingly are less helpful at telling us how things are going. When cases were at a comparable level at previous points in the pandemic, hospitalisations and mortality were much higher. That link between cases and admissions has been broken.
However, admissions and cases are still related. It’s not that you break the link and sever it for ever. It is obvious that admissions and deaths will always be in proportion to cases. So rather than saying that we are seeing the link between these things severed it is better to say that we’ve seen one link broken but that a new link will be formed. Six months ago there was a 9% link between cases and admissions, that broke and was replaced by a 5% link which in turn has been broken again as the vaccine protects older generations and is now at 2.5%. What this means is that the case data gives us an early warning sign if we have 25000 cases today we can expect 675 of them to be in hospital in 10 days time. On the other hand, if there are significantly less than 675 people in hospital on the 11th July that will be further evidence that vaccines are working.
Knowing all of that helps because currently hospital cases are at about 250 admissions per day. If these leap to 400 or more next week then people and the press will immediately panic. But in fact, on the current data we should expect that given the doubling of cases. If on the other hand admissions are closer to 300 then the news is extremely positive.
What this means is that we need to know three things. We need to know how all the data links together. It’s no good producing records and graphs for each item of data, the relationships between the data need to be shown. In other words, don’t just tell us the number of admissions tell us them as a proportion of cases. That of course means that the data gatherers need to do some work to make sure they aren’t making flawed assumptions about the lag time.
Secondly, we need to know what is expected. We have models that were produced weeks ago but as more data comes in we need to see the models updated and the data plotted against those models. 25000 cases and 250 hospitalisations sounds scary. It would be even scarier if the Government had planned for us to be seeing 10,000 cases per day by now but a lot less scary if they’d planned for 500 hospital admissions per day by now and/or double the number of cases.
Thirdly, we need to know what the success and decision making criteria looks like. This is going beyond “what they expected” to “what they wanted”. As well as the fear of catching COVID, there is as much anxiety, if not more, caused by people not knowing how the Government are making decisions. I frequently see people responding to the case numbers by saying “We need to lock down again immediately” but equally I see people responding by saying “I am worried these figures ill unnerve the Government and cause them to delay the end to restrictions or even bring new ones in.” In the light of that, the kind of cat and mouse game where SAGE members who are not themselves medics but behavioural scientists drop hints of winter lockdowns or where Boris blunders in and says that some measures may still remain without explaining which ones or on what basis, is intolerable. It leads to greater anxiety.
There’s no point publishing data if you don’t know how it relates to other measures, if you don’t know what you should be looking for/expecting and if you don’t know what the success data is. The result of doing that is you end up overwhelming people with numbers but don’t actually tell them anything. Furthermore, people can do a fantastic job of producing charts, graphs and predictions of their own but these also tell us little and may themselves risk being damaging or misleading.
So as soon as possible, I would like to see the COVID Dashboard communicating the following:
- Latest projections/forecasts for the next month for each key indicator
- Information about NHS capacity so that we know what hospitals can cope with
- The daily measures plotted against expected.
- Deaths and admissions shown as a % of cases.
Until such information is available, I am half inclined to suggest that those of us who like producing and analysing charts and graphs may do well to call a moratorium on doing so.
 In fact I suspect it would be better to say that the link was an overall sum of different links for different age groups, proportionally more over 65s were prone to serious disease than under. As cases are primarily are in the under 50s now who are not fully vaccinated we expect a lowe proportion of admissions and when that moves down to under 30s it will be lower still because it was always a smaller % of under 30s who got admitted after contracting COVID-19.