I’ve been following the cases in South Africa and the headlines are that it does look like cases may have at least begun to peak there, although there is always the risk of a false dawn.
Before we get too excited, it is worth remembering two things. First that South Africa may not offer a direct comparison with the UK. Yes there are pluses in terms of the lower levels of vaccination but also minuses, it is a younger population and the history of prior viral exposure is different. However, I want to draw your attention to a couple of other things. The virus grew even more rapidly and from a lower base than here in the UK. Even still, we are looking at a month of substantial growth from when case figures started growing exponentially to when they began to fall. If our situation closely replicates the South African one then we might expect case numbers to keep growing at, for us, eye watering levels for a couple more weeks yet.
I do think there are some reasons for a little optimism there. First of all, we have now moved into the Christmas holidays. Although the family nature of the holiday does create opportunities for inter-generational mixing, schools and universities are now shut, a lot of people will either be working from home or taking extended holiday and some of the intergenerational mixing risk may be mitigated by people taking extra caution. That we seem to have a supply issue with LFTs is both a concern here in that it may affect testing and a cause for cautious optimism here as it suggests people are taking a level of responsibility.
The other factor is the rate at which the vaccination programme has been ramping up.
The result of this is that 48.8% of over 12s have now received their booster jab which I translates into 41% of the total population and by my reckoning, over 51% of the adult population. This puts us close to the situation we were in around about June of this year. At that stage we weren’t completely ready for full unlocking but we were at the stage of seeing a lot of freedoms returning. Indeed, case numbers were distorted to some extent by the Euros.
I suspect that we will be those vaccine figures begin to affect case numbers within the next week or two. In fact maybe, if we want to be very optimistic, maybe we can hope for the peak to start around about Christmas Day? Although I suspect it will take another week for the picture to become clearer due to the holiday effect on reporting.
What it also means is that the most vulnerable should now be protected against serious disease. This doesn’t mean that hospital admissions won’t go up significantly in line with increased cases. This will include incidental admissions (with COVID) as well as direct admissions (from COVID), however, those incidental admissions still have a detrimental impact on hospital capacity due to quarantine requirements. NHS capacity may also be hit by staff having to isolate due to contracting the virus too.
So, hospital numbers could go pretty high into early January. Even if we began to see case growth slow this week, then I suspect the optimistic view right now is that we’ll see a case peak of between 175000 -200,000 cases by the last week of December. Assuming admission and mortality rates stay at their current low level (and I suspect that with a lot of case growth being amongst the under-vaccinated that we’ll see a short term increase), that would translate into 3150+ admissions per day in the first week of January leading to 437 deaths per day by the end of the month. Remember, that does look close to the best case scenario to me, so things could be worse. There is an outside possibility that we are seeing case slow down already and perhaps the peak will be a little sooner and lower (in the 125-175 case range) but equally it could go longer and higher.
I will come back to that shortly, but first a look at the case numbers. As you can see, these are continuing to grow rapidly all across mainland Britain.
English cases continue to increase rapidly with the rolling average growing at 6.8% daily now.
There was a brief stutter in Scottish case growth on Friday but the increase seems to have continued at a similar rate to England
Here’s the Northern Irish view
Although cases do not appear to have taken off in Wales yet. However I would suggest that they are building up a head of steam.
Back to my point that we are likely to see high case numbers through to at least the end of the month leading to a significant wave of hospital admissions, it is worth talking a little about implications. I still suspect that the modelling going on right now is spooking the Government and further measures are likely to be brought in.
Regularly readers will know that I’m not keen on full lockdowns and I’m not convinced it will work here. I also think there are significant detrimental costs, economically, socially and psychologically. I have argued before that we should try and avoid a lockdown.
To be clear, that’s not a consequence of over optimism. I’m not saying that cases won’t rise significantly. Rather, my view is that we are unavoidably in a place where cases will rise high. My view is that to make a serious inroad into cases, you need very strict measures with minimal leakiness, those would probably need to be beyond what we have experienced before, making compliance challenging. I thought there was a window of opportunity if we were able to get ahead of community circulation at the border, but I think we already were starting to see that by the time travel restrictions came in. It remains my view that much stricter contact tracing would have helped. The problem with the current policy is that by the time people have been notified that it is omicron and/or tested themselves they they probably have already infected 5 other people.
So, my view is that we can’t do much to dampen cases now, we really do have to wait until the vaccines kick in. Some measures may be required in schools after Christmas to help with under 18 case circulation. However, most non pharmaceutical interventions will probably be too little too late.
That’s why I’ve argued for a different approach. Partly this arises out of pessimism not optimism about cases but it does also arise out of optimism about vaccine efficacy and it also arises out of a concern to see us plot our way out of short term epidemic response to long term endemic management.
It remains my view that we need to look at surge capacity to ensure that the NHS can cope with a surge in demand and that the economy continues to function. This means that we probably need to start getting those nightingale hospitals re-opened and finding ways to take the pressure off of our normal hospitals. Alongside asking retired doctors and nurses to come back to work, I’d also be looking at how we can mobilise the armed forces to support both the NHS and wider logistical needs.
Of course there is a difference between what I think could happen and what I think should happen just as both of those are different to what will happen.