COVID19 update – will we need plan c?

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One of the concerns I’ve raised over the past week or two is that we now seem to be on a trajectory towards even stricter COVID19 restrictions in England and presumably then across the United Kingdom. My concern is two-fold. The first is that such measures might become urgently necessary because I’m not convinced that the current measures will do much to prevent case increases due to Omicron given that they are similar to measures in place across Europe which proved ineffective at preventing a Delta wave.

My other concern was that we may jump to implement measures that in fact prove unnecessary. This is because what matters is not just the number of cases but the impact they have on hospitalisations. This does mean that the Government and public health authorities are in a bit of a bind because until the data on vaccine efficacy firms up, they cannot be certain that a wave of new cases from the variant won’t lead to a similarly huge wave of hospital admissions.

To illustrate this, let’s have a look at the current hospital admission figures. Currently, we are looking at 1.87% of cases leading to admissions.

This would mean that with cases averaging 50,802 per day, we are looking at 914 admissions per day within a week or two from now. This would remain substantially below admissions during previous peaks.

Over the last few days, we did see cases fall briefly on the 9th by 5.7%compared to the previous Thursday. I suspect that this reflected the peak in the latest Delta case spike, however growth quickly returned on Friday 15.04% and Saturday 26.19%.

This may partly be driven by the seasonal effects of colder weather and behaviour but may also reflect that Omicron is beginning to replace the Delta variant.

Scotland has seen significant increases in cases over the past few days

And the view seems to be that this is being driven by an Omicron wave.

Now, if growth of 25% were to be maintained for the next few weeks, then we are looking at a doubling time of about 3 weeks meaning we’d be seeing 100k cases daily by the 2nd January. Of course we cannot assume that growth will stay the same, it may slow down but it’s also likely to speed up further. On current admission rates we are looking at 1800 hospitalisations per day by the 2nd week of January. If cases were to continue to double at that same rate, we’d be looking at 200k worth of cases by the 23rd January and that’s when we start to hit the kind of admission figures of 3.6k daily that were stretching the NHS in previous waves. That puts us in a challenging but not unchartered position and if cases peaked at around that point then the NHS would probably get through the winter in just about one piece although sadly there would be a serious toll to pay in terms of loss of life (around 600 deaths per day).

However, if we see a small drop in vaccine efficacy leading to an increase in severe disease then those figures could change dramatically. This doesn’t require complete vaccine escape, although if we did see that, then we’d be looking at 15% of cases being admitted or 30k hospitalisations per day by early February. However, even an increase to 3% per day means that we would expect to reach 3000 admissions per day by mid January and 6000 by early February. At this point you can begin to see why the Government, SAGE and UKHSA are concerned and why there’s mounting pressure for further measures.

The problem is that, we cannot be certain that this is the scenario that will play out. First of all, suppose that the early reports from South Africa hold and this variant is experienced as a milder form, not because it is less deadly but because people are experiencing it as a re-infection? We could in fact see a situation where the % of hospitalisations decreases keeping admissions under 2k per day even at the projected February peak.

This is why the crucial part of the puzzle is going to be plenty of solid data about vaccine efficacy against serious disease and death.

Furthermore, there are other positive indications coming through which may suggest that there is at least a reasonable chance that cases won’t sky rocket quite as badly as expected. First of all, there are very, very early signs from South Africa that the current wave there is slowing.

Now, one swallow doesn’t make a summer and what we sometimes see is an initial peak followed by further growth. So we may still be in the foothills there rather than approaching the summit. However, this does give a glimmer of hope. We will need to keep watching that data over the next week or two to be certain.

The other piece of positive news is that we have at least one study now pointing to the booster helping to restore vaccine efficacy to around 70-75% depending on the mix of vaccinations you have had.

This is where another piece of crucial data comes in -the vaccination rates.

As you can see, we’ve triple vaccinated just under 40% of the over 12s. This will primarily be amongst the clinically vulnerable and the over 50s. Assuming the third jab offers strong protection against severe disease this this is likely to dampen down hospitalisation numbers. Furthermore, if more studies uphold the figure of 70-75% efficacy against infection, that should significantly reduce transmission among the over 40s as the booster programme ramps up over the next few weeks.

We are still likely to see what has been happening through the Autumn, an epidemic primarily of the young and those eye wateringly high case number protections may still come true but that may be something we can live with just as we’ve lived with the situation through September – December.

Indeed, there would be a strong case for removing the age restrictions completely and allowing anyone to receive the 3rd dose now who wishes to so those in higher mobile age categories such as the 16-30s are fully vaccinated as quickly as possible. Certainly if there is to be a plan C, there’s a strong argument for making it “step up the vaccination programme even further). There’s a reason for that. Any measures come with cost. The cost for the Government includes financial costs such as funding the policing of restrictions, paying for free COVID tests and the economic impact of social distancing measures. It also costs political capital ans the Government seek to persuade and maintain. Personally, if I were in government I’d prefer to spend that money and political capital on getting jabs into arms especially if that proves the most effective way of reducing transmission, hospital admissions and deaths.

This means that the answer to the question “Do we need plan C” is “Not necessarily.” The problem is that we still cannot answer the question with a high degree of confidence. However, the Government may need to provide a decision sooner. My concern is that by bringing in measures with delays such as the COVID pass requirement, that the Government may well have encouraged a temporary spike in social activity over the weekend (I’m bracing for those tabloid pictures of people getting in their last days of freedom by heading to nightclubs before restrictions are tightened). This may well prompt a significant spike in cases over the next few days and this will be seen as strengthening the case for further lockdowns. At the same time, it will take a week or so for the measure most likely to have a significant impact (work from home guidance) to fully kick in.

So, whether or not we need plan c, I think there’s a high probability that plan c will be enacted and potentially as soon as this week as the Government seek to get ahead of the curve (I am also expecting stricter measures to come in for Scotland and Wales over the next week too).

So, prepare for the possibility that we will see some quite significant restrictions coming in. However in more optimistic news, there is a high probability that such measures won’t need to be retained in place for long.

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