What is happening with COVID cases and should we be worried?

Over the past few weeks, we’ve seen COVID19 cases in the UK increase significantly again up to the kinds of levels we were seeing back in June/July. Here’s the UK wide picture.

Primarily the case growth has been driven by English case numbers. Here’s the plot of reported cases and the growth in reported cases based on the rolling seven day average.

However, notice two things here. First of all that we have also been seeing cases grow in Wales.

It also looks like we are beginning to see another uptick in the Scottish case cycle.

This matters because some have been quick to argue that the problem is with the lack of any restrictions, particularly with regards to mask wearing. However, in Scotland and Wales, such restrictions remain in place. It is also worth remembering that requirements to masks remained in place back in June when we last saw an exponential growth in cases. To be clear, I’m not questioning the expert advice that masks have had a part to play in responding to the pandemic by reducing the risk of transmission, particularly in crowded and poorly ventilated contexts. However, they have not been the primary means of defence against COVID and I suspect their usefulness will reduce as the context changes.

So, what has been happening? Well, it’s worth looking at the evidence and I think there are three things we may find it helpful to consider.  The first is that over the past few weeks a problem was identified with some of the PCCR testing leading to a high proportion of false positives particularly in the Southwest. There will have been three consequences to this. The first will have been a perceived more drastic increase in case numbers as the correct numbers began to be reported. The second will have been that some people will have been re-tested. The third will have been an actual increase in case numbers for that area due to people continuing to mix having wrongly been given the all clear. This graph from Andrew Lilico helpfully compares case numbers with the Southwest both include and excluded.

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https://twitter.com/andrew_lilico/status/1450479053560074246/photo/1

Another factor to consider is the case numbers among adolescents. Remember that back through the summer there was still ongoing debate about whether to vaccinate under 15s. JCVI were very cautious in the deliberations and concluded that on the narrow question of whether individual children benefited from the vaccine the benefits were not clear cut enough to recommend vaccine roll out. They did however give the Government the option of considering the benefits on a wider basis of social benefits and contribution to overall Herd Immunity.  This decision came late in the day and so we have been slow to roll out the vaccine to teens. Furthermore, the rollout is no longer happening through specialist centres but through the school nurse programme.

The English case epidemic therefore is now primarily amongst those aged 15 and under. 

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https://twitter.com/andrew_lilico/status/1450494614184599552/photo/1

There is also unsurprisingly a level of case increase amongst those in what Andrew Llilico refers to as the peak life bracket (I’m going to start using that term instead of “middle age)) i.e. aged 35-64. We might expect that as children take the virus home to parents, however I suspect the numbers are much lower than they would be if we did not have the vaccine. In that case, you might expect every child to infect at 2 or 3 adults who in turn would tranmist the virus to other adults

Whether or not that should be a cause for concern remains up for debate. We know that children are not individually at significant risk from the virus. The question is whether or not this might lead to a greater threat to vulnerable adults as vaccine efficacy wanes and whether the social cost of disrupted school time is worth paying. My personal view is that it is better for children to be vaccinated to reduce lost time but that it is not the end of the world if we don’t get case numbers among them down quickly.

Finally, we may want to consider the shape of the pandemic and it’s impact on experience in specific areas. It is worth comparing what has happened in England with Scotland. In England, we saw a significant wave of cases happen prior to the July stage 4 re-opening. At the time all legal restrictions were removed, there were substantial numbers of people self-isolating, university terms had ended and schools broke up the following week. Those factors together helped to dampen any potential exit wave.  In Scotland however, re-opening happened later.  This meant that at the point of re-opening there weren’t huge numbers in isolation through track and trace as the Euros spike had long diminished there, re-opening also coincided with festival season and schools re-opening. This led to case growth at times of greater than 100% in a day.  Cases spiked much higher than they had been previously before subsiding again as the herd immunity wall created by the vaccine kicked in.  I suspect that this will in turn have reduced the potential for serious growth in case numbers over the next few months.

Now it is England that as we enter the colder, darker months with schools and universities back that doesn’t have the benefit of a recent case wave behind it. There are still significant numbers of people who either have not had the vaccine or fall within the 20% plus risk of the vaccine not being effective against symptomatic infection and so we should not be surprised to see them testing positive in large numbers.

Should we be over anxious and begin to consider reintroducing restrictions? I suspect not. There are two reasons for this. First of all, the ratios for admissions and deaths continue to look healthy meaning the current high case numbers should not put too much pressure on the heath service.  Secondly, I suspect that as the virus finds less available people to infect we will see cases peak soon with the added benefit of half-term coming to provide a mini-firebreak. I also hope that we get our act together during that time with booster and adolescent vaccination.

We are also in a position now to look forward to where things might be towards the end of November as winter bites. Based on a mortality rate of 0.4% -0.5% of cases we are looking at around 126-158 deaths per day by late November. For comparison in November 2020 we were seeing about 460 deaths per day within 28 days of a COVID diagnosis.

Now, if we run the assumption that cases continue to grow at around 15% per week, then we might expect 60,000 cases per day in about a fortnight from now (early November). That would translate to between 1500 and 2100 hosptial admissions per day by the late November (compared with the worst case scenario of 7k per day that was circulating quite recently). We could also be looking at 240-300 deaths per day by late December.

Remember that such a projection assumes that cases continue to grow at the same rate. Of course, it is possible that case growth could accelerate. However, it looks more likely that we’ll see it fall and as we reach a level of Herd Immunity Threshold (HIT) in children (it is already reported that 76% of under 14s have had COVID and therefore will have significant iummunity to infection. This combined with half-term break is going to slow the progress of the virus significantly . That’s why optimists expect cases to be falling in November.

Obviously the current high number of cases will cause some anxiety and may affect the confidence of some to attend church.  So pastors need to be alert to that. We may find a few people hold back who have been returning and some of those who we expected to make the transition through October/November may delay a little longer. However, if my hunch is right and we see cases peak again over half term and begin to fall without a major impact on hospital admissions and deaths then actually that will give people greater confidence that we are now transitioning out of the pandemic and the worst fears have been overstated.

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