Thinking about this a bit more, it seems very plausible that 1 won't happen (much*) and 2 and 3 will.
This would lead to a scenario where there are widespread infections across the country, but overwhelmingly in unvaccinated, younger, lower risk groups...
This would lead to a small rise in hospital admissions (as we're already starting to see in the NW) and deaths (relative to what has gone before), and potentially a bigger rise in other consequences like long COVID, although the evidence around that is much more uncertain (AIUI).
Which raises the question of how government would respond. They could either take action to try and limit the spread (be that local restrictions or national lockdowns), or they could just let the virus spread as the consequences will be far less severe than uncontrolled spread...
...back in March 2020, because vaccines.
I'm certainly not going to argue one way or another, and I can see big challenges with either approach (or anything in the middle), but I think it's a much more plausible proposition than it has been before.
Hopefully it won't come to that and we'll manage to restrict current outbreaks to some extent. I'm still cautiously optimistic that the race to vaccinate will win out over even the new variant (and newer variants to come beyond that), but really who knows 🤷.
*My bigger worry is that vaccination rates are lowest in areas with many other risk factors for COVID - high ethnic diversity, greater deprivation, lower rates of WFH etc. So these are the areas where you might expect to see case rates creeping into older age groups...
...where you *would* expect to see more substantial increases in hospital admissions and sadly deaths as a result. There is a real risk of a *big* inequality in any new wave of cases for exactly this reason.
Many have been advocating for proactive vaccination of younger age groups in these higher risk areas first, which seems like a very sensible approach to me.
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A conversation with @jburnmurdoch yesterday sparked an idea for a new plot to try and illustrate how different we'd expect the number of deaths due to the current COVID outbreak in Bolton to be compared to previous waves.
A lot going on here, so let's unpick it a bit...
Clever people like Dan Howden (formerly of this parish) have been using published data on COVID cases and deaths by age to estimate age-specific Case Fatality Rates - the % of cases in an age group which leads to a death within 28 days. cebm.net/covid-19/the-d…
For any day's newly announced cases, we can use these numbers to estimate how many deaths we'd expect to result from those cases, accounting for the age profile of cases.
I remembered that NHS England publish daily admissions data at regional level, so here's what those numbers look like.
Admissions have started to rise in the Midlands and North of England, and bed occupancy and ventilator use have risen in the NW. But the numbers are small.
What happens next depends on three things (I think):
1) Do cases in areas with high case rates just now spread into older age groups 2) Do vaccines lead to fewer admissions and deaths even if cases do spread to older age groups
3)Do cases start to rise widely elsewhere
I'm not going to make predictions, but I'm still not too pessimistic.
Scotland don't publish an age breakdown of COVID cases at Local Authority level (I don't think), but the national picture shows the same pattern as we see in parts of England where cases are rising - cases are only increasing in the under 45s.
This is a different pattern from both October (cases started in teenagers then moved up the ages) and January (cases rose in all age groups at once).
Vaccines, innit 💉💪
Here's a bonus streamgraph version, for those of you who like that sort of thing.
Because the profile of cases is much younger than previous waves, the expected mortality rate is much lower.
If there were no more cases, we'd expect 4 deaths over the next month or so.
Obviously 4 deaths is 4 more than we'd really like, but compared to the 738 deaths to date in Bolton, it's clear that this outbreak is (at the moment) nothing like what has come before.
Even over the whole of the North West the number of cases we've seen so far are expected to lead to just 24 further deaths.
COVID case numbers in Bolton do look rather scary.
BUT...
These cases are very heavily weighted towards younger age groups who are less likely to have been offered a vaccine and are less likely to end up in hospital.
There has been a rise in cases in people in their 50s/60s in the last few days of complete data, which we need to watch
Overall the age profile of cases in the current outbreak in Bolton is quite different to what we've seen before.
Some of this will be differences in testing, particularly among schoolchildren, but I doubt we're testing people aged 50+ less than we were back in January.