The govt set out 4 tests for proceeding each stage of the roadmap. Tests 1 & 2 relate to vaccination, test 3 is hospitals in no danger of being overwhelmed and test 4 is that there are no new variant concerns.
Test 1-3 have been (easily) met, but I don't think Test 4 has. 2/18
Last Friday, Public Health England designated B.1.617.2 (an "Indian" variant) as a variant of concern because of worries that it was more transmissible than B.1.1.7 ("Kent") and cos we didn't know much about its response to vaccines.
What has happened since? 3/18
Yesterday new modelling from SAGE SPI-M was released. While they showed that risks of stage 3 of roadmap was much lower with current Kent variant (given high efficacy of vaccines), those risks could *return* for a new variant. assets.publishing.service.gov.uk/government/upl… 4/18
In particular, Warwick model (link above) estimated that moving to step 3 of the roadmap risks hsopitals being overwhelmed as in January for a variant just as susceptible to the vaccines *but* 50% more transmissible than our dominant "Kent" variant. 5/18
Having some vaccine escape (even if still protective for severe disease) can also lead to damaging new surges.
SAGE SPI-M emphasise the importance of stopping the spread of any such variant.
There have been some estimates that B.1.617.2 is up to 60% more transmissible than Kent (B117)
Admittedly these are based on not great international sequencing data - but it is all we have to go on + we know that much of S Asia in a dire situation.
The UK Covid genomics consortium (COG UK) released latest data today. It includes sequenced cases from travellers to UK & surge testing, some duplicates & about half of community cases.
Week to 1 May in England, there were 678 cases compared to 365 prev week - almost double 8/18
Proportionally, B.1.617.2 was 14% of sequences cases in England. The incomplete data since 1 May is showing the same trend continuing.
In the last week B.1.617.2 was 4% cases in Scotland and 2% in Wales. (No data on NI). 9/18
The Sanger Institute takes COG UK data and removed traveller and surge testing data to try to get at what is happening in community. This removes c. half of cases of B.1.617.2.
But exactly the same pattern persists - over 10% of cases in England are B.1.617.2 w/e 1 May. 10/18
Regionally in England these are concentrated in NW, London and East of England.
Daily average cases in England overall have started consistently going up over the past week as well. 11/18
In areas where B.1.617.2 is most concentrated, cases are going up particularly rapidly - e.g. below is Bolton where in most recent week B.1.617.2 was almost 70% of cases.
(HT to @dgurdasani1 for highlighing this chart) 12/18
So England growth is entirely consistent with increased transmissibility & a situation where B.1.617.2 is rapidly gaining dominance.
We don't yet know enough about vax & B.1.617.2 but there are reports now of some breakthrough symptomatic cases channelnewsasia.com/news/singapore… 13/18
And @GuptaR_lab was quoted in Byline Times today suggesting a delay to the roadmap over concerns about vaccine effectiveness - he stressed that we need to learn more.
Meanwhile, same Warwick SAGE model estimated that if we stayed at stage 2 of roadmap (i.e now) any summer surge would be *much* lower (max ~200 hospital admissions a day instead of over 4000).
SAGE also emphasised that the more people are vaccinated, the lower any surge. 15/18
To me, this means that the assessment of the risks IS fundamentally changed by new variants of concern - and so test 4 is failed.
I think we need to either be sure that B.1.617.2 is not a threat OR stamp it out while (if) we still can & vax more quickly. 16/18
This means much stronger contact tracing and supported isolation, wider list of symptoms for PCR tests, support for local communities in tackling outbreaks inc maximising vax uptake there.
I also think moving to stage 3 of roadmap right now risks adding fuel to the fire. 17/18
Personally, I would like to slow down now to reduce chance of reversing the map later risking more uncertainty, more damaging closures and longer recovery from a worse situation.
We need to learn from previous experience. 18/18
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Quick thread on the Astra Zeneca (AZ) covid vaccine since it's been in the news today.
TLDR there isn't a new "smoking gun", the AZ vax was one of first and cheapest, it saved millions of lives globally, there are better vax out there now, adapted to new variants 1/9
the AZ vaccine was one of the first approved at the end of 2020, cheaper than Pfizer, and - importantly - easier to administer in lower resource settings as it didn't require super low temperatures for storage 2/9
In most countries it was first rolled out in older adults. As it was rolled out in younger adults, a *very rare*, serious, side effect was noticed - it could cause deadly blood clots
This was spotted quickly and studied. Vax monitoring did its job. 3/9
A short thread on why this is not a scary chart and why all the evidence suggests that there is not much Covid around right now. 1/6
the above chart is recorded covid hospital admissions / reported covid cases. It is close to 100% now *because basically only hospitals can report cases since Feb 2024*
It is to do with changes in case reporting and NOT hospital testing
2/6
The UKHSA have now published their modelled estimates of what percentage of English population has Covid. And as of a week ago it's high (4.3%) and rising.
It's highest in London, South East and East & in young and middle aged adults.
The main thing is it's going up and fast, so prevalence will already by significantly higher now than it was last week. 3/7
Short thread on what I said on Channel 4 news tonight.
1. Did I find Hancock a sympathetic witness?
A: I find it hard to have sympathy for someone who repeatedly claimed to have thrown protective ring around care homes, while discharging covid+ patients into them.
1/5
There were *28,000* excess deaths in care homes Apr-May 2020.
Harries thought it was "clinically reasonable" not to treat covid +ve residents in hospital. Even it was, it was NOT reasonable to return them somewhere they could infect so many other very vulnerable people. 2/5
2. Did I think scientists bear blame for not emphasising asymptomatic transmission?
A: No, because they very clearly did advise there could be asymptomic transmission before March 2020 - sources in next tweet. 3/5
Hancock: "there was no way we could allow the NHS to become overwhelmed"
Except, the NHS WAS overwhelmed
Here is what NHS staff said about that time - Pls read whole 🧵
"Heartbreaking"
"Horrific"
"It broke my soul"
"We cried, we came home exhausted. We were overwhelmed"
1/16
"Overnight we were told that all “safe working rules” were gone. There was no choice, we were forced to do it"
"It felt like a death sentence. It felt out of control"
"We were put on wards with no senior support, sometimes makeshift ... with little of the right equipment"
2/16
"Terrifying. A huge sense of duty ... but also terror. We were unprepared & ovt clearly had no plan"
"We had patients on wards on 19 litres of oxygen - this would never happen under normal circumstances - they’d have come to Intensive Care but we didn’t have the space"
TLDR: modest August wave with flatlining hospital admissions, but expect a bigger wave later this autumn 1/12
Hospital admissions with Covid in England are still quite flat for 3rd week in a row and at a level below previous troughs.
Number of people with covid in critical care & primaril yin hospital because of Covid also flat & low.
Deaths ⬆️, from case rises few weeks ago 2/12
However, Zoe symptom tracker app estimating significant increases recently. Very hard to know how reliable Zoe trends are, given far fewer people reporting, but it's worth bearing in mind.