Vaccine Progress, Approval, and Deployment

[Domh245]

But we are getting it into as many arms as possible, so that should considerably reduce the rate at which people present at hospital compared to the pre-vaccination scenario.

Oh definitely, and it's a great success. You have to remember though that the rate at which people have been presenting to hospital has been limited by the massive restrictions that have been placed on everyday life, so it's not a fair comparison. Government now has the impossibly tricky of job and deciding when & how much to ease restrictions, and I certainly wouldn't want to be making the call myself. The aim is to maintain hospitalisations below the rates we've seen, whilst minimising, if not eliminating NPIs. Trying to accomplish this amidst calls to accelerate the easing (justifiably, given how well metrics are at the moment), without the full picture of what happens afterwards is especially tricky. I certainly can't begrudge an overly cautious reopening if it means restrictions end and never have to be brought back

 

[Bikeman78]

Deaths & hospitalisations. As I've posted before, the maths is pretty easy: 95% take up of a vaccine that's 80% effective against death gives you 76% overall protection, or more aptly 24% of people still susceptible to dying from covid. Obviously the ~1% IFR means that most of them will still survive (though I would think that people who've failed to gain any benefit from the vaccine would be more likely to be strongly affected by covid) but that's still quite a large number of people (of the order of 100k)

They won't all catch it in the same week though. Also, a lot of vulnerable people are likely to steer clear of scenarios that are likely to be crowded. Plus many thousands have already recovered or died.

 

[yorksrob]

Oh definitely, and it's a great success. You have to remember though that the rate at which people have been presenting to hospital has been limited by the massive restrictions that have been placed on everyday life, so it's not a fair comparison. Government now has the impossibly tricky of job and deciding when & how much to ease restrictions, and I certainly wouldn't want to be making the call myself. The aim is to maintain hospitalisations below the rates we've seen, whilst minimising, if not eliminating NPIs. Trying to accomplish this amidst calls to accelerate the easing (justifiably, given how well metrics are at the moment), without the full picture of what happens afterwards is especially tricky. I certainly can't begrudge an overly cautious reopening if it means restrictions end and never have to be brought back

That is a big "if". I get the impression that the "restrictions never have to be brought back" is an empty promise. Would we have accepted longer restrictions in June last year if we'd been promised that they would never be brought back ? It's patently clear that there would have been a rise in infections in the Autumn anyway, so we were better off opening up when we did and have done with it, rather than pretending that holding out would prevent the resurgence later.

 

[Crossover]

Unfortunately, the papers have spent the last year pretending that this is some sort of super-virus, that is killing young healthy people in their droves, rather than the mild illness that it is for many (I believe Prof Woodhouse once said “For the non-vulnerable population, coronavirus carries no more risk than a "nasty flu")

Just looking at the deaths in hospital over the last year, up to yesterday, by age, it is quite telling, in my mind

 

[Mag_seven]

Just looking at the deaths in hospital over the last year, up to yesterday, by age, it is quite telling, in my mind
View attachment 92951

What on earth is "TBC 0" supposed to mean.

 

[Crossover]

What on earth is "TBC 0" supposed to mean.

Presumably any where the age hadn't been confirmed

 

[Domh245]

They won't all catch it in the same week though

No they won't, but when we've seen roughly the same sort of number of deaths spread out over a year, with moderate to heavy restrictions throughout, you can begin to see why this number is still cause for concern.

Also, a lot of vulnerable people are likely to steer clear of scenarios that are likely to be crowded

Unlikely I think. Not only will people not know if the vaccine has been ineffective for them until they actually catch it (and it's too late to start 'steering clear') but most of the deaths (and hospitalisation) come from the "vaccinated but ineffective" group than the "couldn't/wouldn't have the vaccine" group, with the high 95% takeup. And that's before considering that they are humans at the end of the day, and we can't just ask them all to stay away in case (speaking from personal experience - my 90 something year old grandma only got as far as the end of her driveway until she got her second jab a couple of weeks ago, now she's pestering my aunt to be taken shopping at every opportunity)

Plus many thousands have already recovered or died.

I did account for the deaths in my calculations, though they generally don't have a significant effect on the numbers (~2000 difference in deaths, a ~2% shift). It's not meant to be super accurate, but it's certainly accurate enough to be indicative of the potential trouble. Recoveries are a slightly different matter, there's no reason to believe that the immunity from natural infection is any better than immunity from vaccination, so can be assumed to fall under the vaccinated cohort. Seeing as a significant number of people who had covid will have a vaccine when it's available to them, it won't significantly change the numbers (ie there are possibly some who had covid, recovered, but can't/won't have the vaccine which aren't caught by the original calculation, but these will be insignificant in the scheme of things)

That is a big "if". I get the impression that the "restrictions never have to be brought back" is an empty promise. Would we have accepted longer restrictions in June last year if we'd been promised that they would never be brought back ? It's patently clear that there would have been a rise in infections in the Autumn anyway, so we were better off opening up when we did and have done with it, rather than pretending that holding out would prevent the resurgence later.

It's as sincere a promise as can be expected I think. There's quite clearly been no appetite to reintroduce restrictions once they lifted them last summer, and I don't see that changing going forward. All the "gotcha" questions to the PM when the roadmap was announced around reintroducing restrictions seemed to be entirely media driven - the nuanced "we have no intention of reintroducing restrictions if we can help it, but if we get covid-21 that starts rampaging through the population, we can't just stand back and do nothing" gets translated into "PM refuses to rule out more restrictions in the future"

Comparisons to last summer are a bit pointless, we didn't have vaccines on the horizon there, so all that drawing restrictions out would have done is fruitlessly chase zero-covid, something that's impossible at the best of times, and especially so in the UK. I agree that Last year's easing was the right thing to do, and with the benefit of hindsight from this point in time, I think the only major mess up was letting cases get as high as they did. Drawing restrictions out this year is different with the vaccines - At last year's easing (using data from 4th July) we had something like 0.37% immunity through infection for confirmed cases - even quintupling for the complete lack of testing in the first wave we'd have been at 2%, and even with the cross-immunity effects previously talked about by other posters, the population as a whole had practically no immunity. As it is now, we're at comfortably over 33% immunity amongst the whole population, and this number increases every day

 

[yorksrob]

It's as sincere a promise as can be expected I think. There's quite clearly been no appetite to reintroduce restrictions once they lifted them last summer, and I don't see that changing going forward. All the "gotcha" questions to the PM when the roadmap was announced around reintroducing restrictions seemed to be entirely media driven - the nuanced "we have no intention of reintroducing restrictions if we can help it, but if we get covid-21 that starts rampaging through the population, we can't just stand back and do nothing" gets translated into "PM refuses to rule out more restrictions in the future"

Comparisons to last summer are a bit pointless, we didn't have vaccines on the horizon there, so all that drawing restrictions out would have done is fruitlessly chase zero-covid, something that's impossible at the best of times, and especially so in the UK. I agree that Last year's easing was the right thing to do, and with the benefit of hindsight from this point in time, I think the only major mess up was letting cases get as high as they did. Drawing restrictions out this year is different with the vaccines - At last year's easing (using data from 4th July) we had something like 0.37% immunity through infection for confirmed cases - even quintupling for the complete lack of testing in the first wave we'd have been at 2%, and even with the cross-immunity effects previously talked about by other posters, the population as a whole had practically no immunity. As it is now, we're at comfortably over 33% immunity amongst the whole population, and this number increases every day

I suppose I would crystallise my key point as being that we're in a far better position now than last year, so we should be more confident of opening up - yet we seem to be more cautious !

 

[takno]

80% effective means it reduces the chance of death by 80% (consider it more that it prevents 80% of deaths) - it doesn't imply 20% of people dying, only 20% of people being susceptible to death

To give you an example (and also using the correct numbers, it was 85% effective against death, it was 80% effective for hospitalisations), looking at the 80-84 age range, there are ~1,690,000 people in that group in the UK - assuming a 95% takeup that gives ~84500 people with no protection from the vaccine. For the 1.6 million who do have the vaccine, it'll be effective against death in 85% of them, giving ~241,000 who have had "no protection" from the vaccine. Apply the IFR for that age range (5.3%) to those who have no vaccine protection (84500+24100)*0.053 = 17,250 people that you'd expect to die if they caught it. Repeat across the population and it quickly adds up

Agreed that there's no chance of everyone in that 24% being hospitalised, nor happening all at the same time, but the power of big numbers strikes again. Doing the same exercise, with a hospitalisation rate 3.5x higher than IFR (based on there being about that number more hospitalisations than deaths) gives 475,000 still susceptible to hospitalisation, down from almost 2m applying the hospitalisation rates used to a population with no immunity - to date there have been 454,000 people hospitalised with covid since the start of the pandemic.

The chance of them all being hospitalised at the same time is slim, but as we've seen from this year you don't need all of them hospitalised for it to be an issue. So long as covid can spread in the population (R>1, which it will be with no restrictions) then these people will continue to catch it and cause issues. The two* options therefore to maintain R close to 1 (to prevent rapid spread and ensuring that the unprotected people turn up in hospitals and mortuaries at a slow, manageable rate) are either continued baseline restrictions for a significant length of time, or getting vaccine into as many arms as possible to bring things closer to herd immunity thresholds to limit the extent of transmission

*bonus third option of saying "sod em" is not politically viable as an option

A few points:
- This analysis assumes zero non-vaccine immunity, and 100% spread, which are both wildly unlikely - probably more robust to halve the numbers, and quite possibly quarter them
- The deaths occurred during a period of high pressure in hospitals, where the measured group would not have been a priority for resources
- The 85% is the figure after the first round of vaccinations. All the evidence is that there is a reasonably significant further effect after the second jab
- The CFR figures for this age group are inherently less robust because of the much higher potential for death-with-Covid against death from Covid. This may also have fed into the effectiveness stats for the vaccines
- The number also doesn't quickly mount up as you add other age ranges. The over 85s add about the same number of vulnerable people again, but because of the exponential fall off in the CFR in other age ranges, even without as much vaccination the at-risk group for the entire remainder of the population is only another 10k or so.

So effectively there is a pretty much absolute ceiling of 40-50,000 who could even possibly die, having made some pretty heroic assumptions to get it that high, I reckon it's more likely to be a 10-20% of that, and spread over a fairly long time.

 

[Domh245]

I suppose I would crystallise my key point as being that we're in a far better position now than last year, so we should be more confident of opening up - yet we seem to be more cautious !

Last year however we were aiming for "manageable with restrictions", this year we're aiming for no restrictions though. Superficially it's similar in that we're "opening up", but all of the restrictions that were present last summer will be going as well (in due course) - it's already less cautious than last year in my eyes if those are planned to go!

A few points:
- This analysis assumes zero non-vaccine immunity, and 100% spread, which are both wildly unlikely - probably more robust to halve the numbers, and quite possibly quarter them
- The deaths occurred during a period of high pressure in hospitals, where the measured group would not have been a priority for resources
- The 85% is the figure after the first round of vaccinations. All the evidence is that there is a reasonably significant further effect after the second jab
- The CFR figures for this age group are inherently less robust because of the much higher potential for death-with-Covid against death from Covid. This may also have fed into the effectiveness stats for the vaccines
- The number also doesn't quickly mount up as you add other age ranges. The over 85s add about the same number of vulnerable people again, but because of the exponential fall off in the CFR in other age ranges, even without as much vaccination the at-risk group for the entire remainder of the population is only another 10k or so.

So effectively there is a pretty much absolute ceiling of 40-50,000 who could even possibly die, having made some pretty heroic assumptions to get it that high, I reckon it's more likely to be a 10-20% of that, and spread over a fairly long time.

-The non-vaccine immunity is largely self-controlling I would think? The base IFR would account for that natural immunity (likelihood of anyone that age being inf I'm not trying to say "100,000 will die", just that "100,000 can ected catching it and dying), as would the efficacy of the vaccine (representing improved performance over unvaccinated). The 100% spread figure is irrelevant asdie". I agree that all of them catching it is unlikely, but the point is that we can't just "jab the vulnerable & let them be" - with the high case rates that will result from removing all restrictions without high levels of immunity, these will inevitably spread to these people. And as pointed out previously, we only need a fraction of that population to be infected to start causing problems
If you are referring to immunity by prior infection and/or cross-immunity, these numbers quickly become irrelevant in the scheme of the vaccine rollout (plus of course, many with that previous immunity will have the vaccine regardless of this pre-existing immunity), and that's before considering anything around reinfection that further complicates any sort of immunity analysis

-Not really sure about your point about the previous death numbers? I'm using them to contextualise the scale of the mortality-risk population post vaccination, it's more or less the same again as the last year. Yes the hospitals have been under immense stress, and in the event of a resurgence in cases (and hospitalisations/deaths as a result) they would be similarly stressed (and so similar sort of triaging occurring as applicable)?

-I'm not sure about "significant" further effect from a second dose - certainly with the Pfizer vaccine the increased efficacy is not particularly large, and whilst the AZ vaccine does seem to have a more significant increase in efficacy from the second dose, I don't think it'll be significant enough to change the general gist of "post vaccine rollout, there's still a large population that if infected will be hospitalised/die"

-The IFR is certainly a big factor in this. The numbers I plugged in were taken from an Imperial Report estimating them from multiple seroprevalence studies, and plugging in their lower bound results using the same parameters elsewhere puts out a number of 40,000 people (down 63%) but this is just being optimistic for optimisms sake. (Using upper bounds suggests a total of 355,000 for comparison sake). The with vs of issue would swing things by around 10% based on other analysis, but again this does not change the gist of "there's a lot of people out there that are not immune"

-"quickly mounting up" possibly not the best turn of phrase on my half there - 95% of the risk comes from the over 50s, but again this feels like arguing about the deck chairs. As with most things related to covid there's a roughly exponential link between age & risk, but when on a population scale numbers get worryingly big quickly.

I'm happy to be better convinced otherwise that my rough & ready modelling is utterly wrong, but with the current data everything points to a reasonably large population of people without immunity post vaccination, hence the need for cautious reopening & ensuring maximum vaccine coverage to minimise population risk. It's highly susceptible to the data being input, but an overcautious approach at this point is preferable to an overly optimistic one IMO

 

[HSTEd]

I'm happy to be better convinced otherwise that my rough & ready modelling is utterly wrong, but with the current data everything points to a reasonably large population of people without immunity post vaccination, hence the need for cautious reopening & ensuring maximum vaccine coverage to minimise population risk. It's highly susceptible to the data being input, but an overcautious approach at this point is preferable to an overly optimistic one IMO

My understanding is that Vaccinating groups 1-9 cut hospitalisations by 80%, even allowing for non-perfect takeup and efficacy.

Which means we would need a case rate pentouple what happened in January to achieve similar hospitalisation figures.

We would have to be accumulating 300,000 positive test results per day, and proabbly something like 600,000 actual infections per day.

With only 30 million-ish people in the population actually susceptible, such a wave verges on being incredible, especially as vaccinations will have substantially reduced R.

EDIT:

If R is now 2.5 with the diseases 5 day cycle time, infections would increase by 20% per day.

That is fast, but in order to achieve the hospitalisation figure we are looking at 2% of the susceptible population infected per day.
The reduction in R, we only need 60% population immunity (hermetic equivalent), we get like 65%-equivalent from the vaccine, so we are looking at 35-ish now.

So R will hit one after about 25% of 67 million which is about 16 million infections.

So you need a wave that can infect 300-600k per day, and stops growing at 16 million infections.
From where we are this seems implausible

 

[Bikeman78]

No they won't, but when we've seen roughly the same sort of number of deaths spread out over a year, with moderate to heavy restrictions throughout, you can begin to see why this number is still cause for concern.


Unlikely I think. Not only will people not know if the vaccine has been ineffective for them until they actually catch it (and it's too late to start 'steering clear') but most of the deaths (and hospitalisation) come from the "vaccinated but ineffective" group than the "couldn't/wouldn't have the vaccine" group, with the high 95% takeup. And that's before considering that they are humans at the end of the day, and we can't just ask them all to stay away in case (speaking from personal experience - my 90 something year old grandma only got as far as the end of her driveway until she got her second jab a couple of weeks ago, now she's pestering my aunt to be taken shopping at every opportunity)

Okay, so what's the solution, if we rule out zero Covid? At the risk of sounding harsh, when did the deaths of people in their 80s become unacceptable? To put that into context, my other half has an extensive family. During her lifetime, no member of her family has made it to 80 years of age. Most of them seem to die of cancer from their mid 50s onwards. The oldest person is currently in her mid 70s.

 

[Philip Elliott]

Okay, so what's the solution, if we rule out zero Covid? At the risk of sounding harsh, when did the deaths of people in their 80s become unacceptable? To put that into context, my other half has an extensive family. During her lifetime, no member of her family has made it to 80 years of age. Most of them seem to die of cancer from their mid 50s onwards. The oldest person is currently in her mid 70s.

Ten of thousands of people under the age of 80 have died of Covid..

 

[Bikeman78]

Ten of thousands of people under the age of 80 have died of Covid..

Agreed, but tens of thousands of people have also died of other things. I've been to four funerals in the last decade, all before 2019; two of the departed were in their 40s. We cannot put our lives on hold forever once people have been vaccinated.

 

[Bantamzen]

Last year however we were aiming for "manageable with restrictions", this year we're aiming for no restrictions though. Superficially it's similar in that we're "opening up", but all of the restrictions that were present last summer will be going as well (in due course) - it's already less cautious than last year in my eyes if those are planned to go!



-The non-vaccine immunity is largely self-controlling I would think? The base IFR would account for that natural immunity (likelihood of anyone that age being inf I'm not trying to say "100,000 will die", just that "100,000 can ected catching it and dying), as would the efficacy of the vaccine (representing improved performance over unvaccinated). The 100% spread figure is irrelevant asdie". I agree that all of them catching it is unlikely, but the point is that we can't just "jab the vulnerable & let them be" - with the high case rates that will result from removing all restrictions without high levels of immunity, these will inevitably spread to these people. And as pointed out previously, we only need a fraction of that population to be infected to start causing problems
If you are referring to immunity by prior infection and/or cross-immunity, these numbers quickly become irrelevant in the scheme of the vaccine rollout (plus of course, many with that previous immunity will have the vaccine regardless of this pre-existing immunity), and that's before considering anything around reinfection that further complicates any sort of immunity analysis

-Not really sure about your point about the previous death numbers? I'm using them to contextualise the scale of the mortality-risk population post vaccination, it's more or less the same again as the last year. Yes the hospitals have been under immense stress, and in the event of a resurgence in cases (and hospitalisations/deaths as a result) they would be similarly stressed (and so similar sort of triaging occurring as applicable)?

-I'm not sure about "significant" further effect from a second dose - certainly with the Pfizer vaccine the increased efficacy is not particularly large, and whilst the AZ vaccine does seem to have a more significant increase in efficacy from the second dose, I don't think it'll be significant enough to change the general gist of "post vaccine rollout, there's still a large population that if infected will be hospitalised/die"

-The IFR is certainly a big factor in this. The numbers I plugged in were taken from an Imperial Report estimating them from multiple seroprevalence studies, and plugging in their lower bound results using the same parameters elsewhere puts out a number of 40,000 people (down 63%) but this is just being optimistic for optimisms sake. (Using upper bounds suggests a total of 355,000 for comparison sake). The with vs of issue would swing things by around 10% based on other analysis, but again this does not change the gist of "there's a lot of people out there that are not immune"

-"quickly mounting up" possibly not the best turn of phrase on my half there - 95% of the risk comes from the over 50s, but again this feels like arguing about the deck chairs. As with most things related to covid there's a roughly exponential link between age & risk, but when on a population scale numbers get worryingly big quickly.

I'm happy to be better convinced otherwise that my rough & ready modelling is utterly wrong, but with the current data everything points to a reasonably large population of people without immunity post vaccination, hence the need for cautious reopening & ensuring maximum vaccine coverage to minimise population risk. It's highly susceptible to the data being input, but an overcautious approach at this point is preferable to an overly optimistic one IMO

Forgive me if I have missed something here, but I see flaws in your modelling. For a start it appears that you assume that the risk of hospitalisation / death is evenly spread across all demographic groups, but that isn't the case. As you move through the younger generations the risk of hospitalisation or death reduces massively, to the point where it is statistically irrelevant. Also in terms of deaths, new improved treatment strategies are coming on line all the time, so modelling against previous deaths isn't going to be as accurate if you don't factor these treatments in. And what about pre-existing immunity, it has been discovered that some people appear to have had potential immunity even before covid was discovered thanks to exposure to other coronaviruses? Plus as is starting to emerge, other viruses have the potential to overpower SARS-CoV-2 in the human body. There are other flaws but by now I hope you get the point.

Now I know some of these factors are going to be impossible to model due to unknown variants, but it should demonstrate why rigidly sticking to a model that is not taking into account all potential factors should not in itself be the deciding factor as you seem to wish. Far from it in fact. There's nothing wrong with it feeding into the decision making process, but it cannot be used as a single reason for not lifting restrictions. We cannot continue on "just in case" modelling anymore, especially where the modelling is becoming potentially highly inaccurate, because there is a dire need to restart the economy to help fund future medical support, care and strategies.

 

[kristiang85]

Ten of thousands of people under the age of 80 have died of Covid..

1.35m people die in car accidents a year, the vast majority under 80.

 

[Richardr]

In Great Britain, there were 1,752 deaths on the road in 2019.

 

[kristiang85]

In Great Britain, there were 1,752 deaths on the road in 2019.

I presumed he was talking globally, so I was too.

 

[Domh245]

My understanding is that Vaccinating groups 1-9 cut hospitalisations by 80%, even allowing for non-perfect takeup and efficacy.

Which means we would need a case rate pentouple what happened in January to achieve similar hospitalisation figures.

We would have to be accumulating 300,000 positive test results per day, and proabbly something like 600,000 actual infections per day.

With only 30 million-ish people in the population actually susceptible, such a wave verges on being incredible, especially as vaccinations will have substantially reduced R.

EDIT:

If R is now 2.5 with the diseases 5 day cycle time, infections would increase by 20% per day.

That is fast, but in order to achieve the hospitalisation figure we are looking at 2% of the susceptible population infected per day.
The reduction in R, we only need 60% population immunity (hermetic equivalent), we get like 65%-equivalent from the vaccine, so we are looking at 35-ish now.

So R will hit one after about 25% of 67 million which is about 16 million infections.

So you need a wave that can infect 300-600k per day, and stops growing at 16 million infections.
From where we are this seems implausible

That's certainly a refreshingly optimistic view on things. Some points though:

Taking January just gone as the benchmark is probably not the best, as we absolutely blew past any semblance of even "bad winter" levels. The healthcare system can ill afford another such period, particularly with the huge waiting lists resulting from the last year of disrupted operation, so all the thresholds you've picked will be lower as a result
Hospitalisations are of course only half the picture - it's the total number of patients that causes the issue, and there's no reason to believe that average time in hospital won't decrease (improved treatment meaning it more likely that someone who may have died after a few days will instead now sit in a bed for a week before discharge, eg). The high hospitalisation rate in January was largely offset by discharges(& deaths) so that the net increase approaching peak-hospitalisation was around half of the admissions. The higher rate of increase that would come from no restrictions could be problematic, though I haven't done the maths on that.
The R of 2.5 seems on the lower side of estimates, but the general gist of infections likely burning out before getting near to critical numbers seems right (though this is something that becomes increasingly certain with each passing day of vaccine rollout).

Okay, so what's the solution, if we rule out zero Covid? At the risk of sounding harsh, when did the deaths of people in their 80s become unacceptable? To put that into context, my other half has an extensive family. During her lifetime, no member of her family has made it to 80 years of age. Most of them seem to die of cancer from their mid 50s onwards. The oldest person is currently in her mid 70s.

I'm quite happy for people to continue dying of covid, I'm just loathe for it all to happen in a short time frame, with corresponding healthcare capacity issues (and thus likely reimposition of restrictions). A more cautious reopening, with higher vaccine coverage helps ensure we won't find the healthcare system overwhelmed

Forgive me if I have missed something here, but I see flaws in your modelling. For a start it appears that you assume that the risk of hospitalisation / death is evenly spread across all demographic groups, but that isn't the case. As you move through the younger generations the risk of hospitalisation or death reduces massively, to the point where it is statistically irrelevant. Also in terms of deaths, new improved treatment strategies are coming on line all the time, so modelling against previous deaths isn't going to be as accurate if you don't factor these treatments in. And what about pre-existing immunity, it has been discovered that some people appear to have had potential immunity even before covid was discovered thanks to exposure to other coronaviruses? Plus as is starting to emerge, other viruses have the potential to overpower SARS-CoV-2 in the human body. There are other flaws but by now I hope you get the point.

Risk was not evenly spread - IFRs went from 0 below 4, hitting 1% at ~65YO, through to 16% above 90, the output by age group was this (for original values used)



The improved treatments aspect is certainly a fair point - I'm not aware of any miracle treatments that are massively cutting deaths, but for sure they'll lower the total number. The only concern is that unless they're a "prescribe & go" there's a risk that they'll just cause issues with healthcare capacity!

The pre-existing & cross immunity are as good as irrelevant in this context. These would contribute to the "vaccinated" group, which could be more widely considered as an immune group, though quite how the immunity from infection/cross-immunity and vaccination compares I am still unsure. They only become relevant in the context of that unvaccinated group, and even then only in the subgroup of that where people have refused to take the vaccine but are otherwise healthy. For the older age groups where a reasonable amount of the unvaccinated age group is because of other conditions that prevented them, these other immunity effects would likely be small

Now I know some of these factors are going to be impossible to model due to unknown variants, but it should demonstrate why rigidly sticking to a model that is not taking into account all potential factors should not in itself be the deciding factor as you seem to wish. Far from it in fact. There's nothing wrong with it feeding into the decision making process, but it cannot be used as a single reason for not lifting restrictions. We cannot continue on "just in case" modelling anymore, especially where the modelling is becoming potentially highly inaccurate, because there is a dire need to restart the economy to help fund future medical support, care and strategies.

I agree that this can only be one thing that feeds into the decision making, but at this point it is the "critical path" so to speak - the extent of the resurgence in hospitalisations is the the only important unknown risk that's preventing easing at this point. The anti-lockdown factors around economic damage (and more) will all no doubt be considered, and are arguably more certain than the covid modelling, yet we still see the hesitant approach. My view is that the first week of restrictions is always the most expensive, so stomaching the additional cost of several weeks now will be far less damaging than easing sooner and then having to reimpose them over the winter

Unfortunately we won't know whether we were far too cautious with the reopening for at least a year, when we can start "comparing notes" with other countries and the extent of any resurgences in them

 

[Yew]

That's certainly a refreshingly optimistic view on things. Some points though:

Taking January just gone as the benchmark is probably not the best, as we absolutely blew past any semblance of even "bad winter" levels. The healthcare system can ill afford another such period, particularly with the huge waiting lists resulting from the last year of disrupted operation, so all the thresholds you've picked will be lower as a result

It can certainly manage though, in a pandemic the standard we've chosen is 'not overwhelmed' it doesn't have to be sustainable in the long term, because it's not going to be required in the long term. The PHA requires the least restrictive means possible, therefore this is no a choice the government has.

 

[Bantamzen]

Risk was not evenly spread - IFRs went from 0 below 4, hitting 1% at ~65YO, through to 16% above 90, the output by age group was this (for original values used)

View attachment 93020

Fair enough, I must have missed that.

The improved treatments aspect is certainly a fair point - I'm not aware of any miracle treatments that are massively cutting deaths, but for sure they'll lower the total number. The only concern is that unless they're a "prescribe & go" there's a risk that they'll just cause issues with healthcare capacity!

Not necessarily. For example one drug that was trialled within Bradford Trust Hospitals not only reduced the risk of death quite substantially, but often resulted in much shorter recovery times & prevented the need for mechanical ventilation.

The pre-existing & cross immunity are as good as irrelevant in this context. These would contribute to the "vaccinated" group, which could be more widely considered as an immune group, though quite how the immunity from infection/cross-immunity and vaccination compares I am still unsure. They only become relevant in the context of that unvaccinated group, and even then only in the subgroup of that where people have refused to take the vaccine but are otherwise healthy. For the older age groups where a reasonable amount of the unvaccinated age group is because of other conditions that prevented them, these other immunity effects would likely be small

We cannot be certain of that. Most of the early models assumed zero pre-existing immunity, and little seems to have changed. But we are finding out that there is a strong possibility that exposures to other coronaviruses can lead to this, mainly because although a new variant in itself, it still requires a large number of protein that other of its family do, which some immune systems recognise when SARS-CoV-2 is detected. So without at least some mitigation for this, models could well be out by large enough factors to make them irrelevant. This is the danger of relying on them as single points of decision making.

I agree that this can only be one thing that feeds into the decision making, but at this point it is the "critical path" so to speak - the extent of the resurgence in hospitalisations is the the only important unknown risk that's preventing easing at this point. The anti-lockdown factors around economic damage (and more) will all no doubt be considered, and are arguably more certain than the covid modelling, yet we still see the hesitant approach. My view is that the first week of restrictions is always the most expensive, so stomaching the additional cost of several weeks now will be far less damaging than easing sooner and then having to reimpose them over the winter

And I would argue your view is incorrect. The more weeks we tack on, so the cost mounts and businesses that have until now been able to re-finance themselves to cope will start to run out of options. You only need to look at what's happening to many high street, hospitality and entertainment sectors. Many are quite literally on the brink. Once enough fall over, the effect down supply chains will by like a domino collapse, throwing the economy into turmoil & risking even more borrowing on even less revenue by the Treasury. You have already seen the effect on NHS staff pay offers. The longer this goes on, the deeper the cuts.

Unfortunately we won't know whether we were far too cautious with the reopening for at least a year, when we can start "comparing notes" with other countries and the extent of any resurgences in them

And unfortunately as above, we don't have the resources to wait and see let alone make comparisons. Just look at the reversal that Merkel had to make the other day, even in more stable economies the pressure is mounting fast.

It can certainly manage though, in a pandemic the standard we've chosen is 'not overwhelmed' it doesn't have to be sustainable in the long term, because it's not going to be required in the long term. The PHA requires the least restrictive means possible, therefore this is no a choice the government has.

Exactly. We are not aiming for zero / near zero impact, that's just not going to happen. But we do need to make sure that 12 months of financial stress does not lead to the NHS finding itself in an even deeper crisis in the coming years. Its going to take an awful lot of money to right a lot of things we found wrong with it, and we can't do that whilst we are paying people not to work & not collecting things like income & sales taxes. I have said this before, but no matter how economists try to talk around the issues of rapidly growing public sector debt, when push comes to shove governments quickly start to look for cuts when the pressure builds.

 

[Philip Elliott]

I presumed he was talking globally, so I was too.

No I was talking UK alone - from July to January there were over 25,000 deaths under the age of 80.

 

[YorkshireBear]

Just looking at the deaths in hospital over the last year, up to yesterday, by age, it is quite telling, in my mind
View attachment 92951

I know you are right but is this information readily available? Just want to look at the available data myself.

 

[Crossover]

I know you are right but is this information readily available? Just want to look at the available data myself.

It is - the screenshot is from the overall Excel file available here:

Statistics » COVID-19 Daily Deaths

Health and high quality care for all, <br />now and for future generations

www.england.nhs.uk

I should have stated in my original message that it is England only numbers

 

[YorkshireBear]

It is - the screenshot is from the overall Excel file available here:

Statistics » COVID-19 Daily Deaths

Health and high quality care for all, <br />now and for future generations

www.england.nhs.uk

I should have stated in my original message that it is England only numbers

Ah thank you!

 

[birchesgreen]

I seem to dimly recall the UK approved a third vaccine but wouldn't get any doses until April? Is this just a false memory dredged up by my diseased mind or is there indeed a third option coming soon?

 

[roversfan2001]

I seem to dimly recall the UK approved a third vaccine but wouldn't get any doses until April? Is this just a false memory dredged up by my diseased mind or is there indeed a third option coming soon?

I believe that is the single-dose J&J vaccine. Not heard anything about it since it was approved in February.

 

[ainsworth74]

I seem to dimly recall the UK approved a third vaccine but wouldn't get any doses until April? Is this just a false memory dredged up by my diseased mind or is there indeed a third option coming soon?

Yes I've been wondering about that. What's going on with Moderna, Novavax and Johnson & Johnson in terms UK usage considering I think we have orders for all three?

 

[Domh245]

I believe that is the single-dose J&J vaccine. Not heard anything about it since it was approved in February.

It was Moderna that we approved but have yet to receive any doses of (produced primarily in US at the moment and forming large part of their rollout. There's a RoW production facility in switzerland IIRC that's starting to supply EU). J&J we've not approved yet (though the EMA has) - it'll be between Novavax and J&J for which is next approved I expect, though no guarantee that these will be arrive in time to have any significant effect on the rollout

 

[nlogax]

Yes I've been wondering about that. What's going on with Moderna, Novavax and Johnson & Johnson in terms UK usage considering I think we have orders for all three?

I understand Moderna may start seeing a rollout from next month. J&J and Novavax are still in the MHRA approval sausage machine.