NEW: latest data now show a clear rise in hospital admissions in the UK, and numbers could climb rapidly.

Admissions & patient numbers in the North West are ~straight lines on a log-scale: exponential growth

Our story, with @mroliverbarnes & @AndyBounds:…
Let’s take a closer look at that chart
• Cases have been rising at a similar rate to previous waves for some time now
• What’s new is hospital admissions now undeniably following suit. In North West, admissions rose by 30% in week ending May 30th. Since then they’ve climbed 40%
This is despite vaccines that offer good protection against hospitalisation, so what’s going on?

As ever, age breakdowns tell the story. Hospital admissions remain low and flat among mostly-double-dosed older groups, but the increase is coming among younger adults.
Again, that increase among younger adults is tracing a ~straight path on a log scale, indicative of exponential growth. Further vaccines can flatten that curve, but as @BristOliver has pointed out, the additional cases over recent days and weeks already guarantee more admissions.
And as @_nickdavies explains in our story, the problem here is that even though the most vulnerable are now protected, there are still more than enough un(der)protected people to fuel exponential growth in hospital cases for a long time yet, which could send numbers much higher.
The big question is what this could mean for deaths. So far, there has *not* been a sustained rise in mortality, including in the North West where the deaths series remains bumpy (due to very low numbers) and lower than it was a couple of months ago.
There is good reason to believe a wave of younger cases and admissions will be a less lethal wave than those that came before vaccines, as I discussed here used age-specific-fatality rates. Nonetheless, more cases and more admissions will mean more deaths
Away from the North West, all of these patterns are also apparent on the national scale if we look at England as a whole.

Admissions and patient numbers have begun arcing upwards, and there’s no reason to believe they won’t follow the North West’s trajectory.
But again, this is being driven by younger admissions, so we still expect that for a given number of admissions, the number of deaths will be lower during this wave than previous ones. The link between cases, admissions and deaths is certainly not broken, but it is weaker.
One hope for this wave was that the climb in hospital admissions may be more gentle than in previous waves, making any delay in action less damaging.

But comparing the slopes of the red lines and the blue, I don’t think we can be sure the rate of increase *will* be slower.
However, we do have the tools available to change the slope:
• The latest data suggests that two doses of a vaccine offer very high protection against hospital admission, likely above 95%, and a single dose may also offer something in the region of 70% protection
• The postponement of full reopening on June 21 would also provide time for more people to be vaccinated, though as @BallouxFrancois and @JamesWard73 have noted, postponing too far risks pushing the wave into winter, where seasonality would make it much harder to deal with
• Third wave of hospital admissions clearly underway
• Further reopening on June 21 would accelerate already exponential growth
• Data still suggest this wave should be less lethal
• Vaccines work very well, including against Delta. They remain our way out
Finally a big thanks to everyone who spoke to us for this piece.

Detractors will be shocked to discover that, as usual, we spoke to more than a dozen epidemiologists, disease modellers, public health officials and hospital staff for this story.

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More from @jburnmurdoch

4 Jun
Excellent new study on how Pfizer fares against the different variants.

Conclusion remains: second dose is critical.
Some notes:
• Remember, antibody neutralisation is not the same as vaccine efficacy. 5.8-fold reduction in the former does not mean the same thing for the latter
• This paper shows a 2.2-fold reduction in neutralisation for Delta relative to Alpha (5.9 / 2.6). PHE data so far points to a ~10% drop in VE for Delta vs Alpha after two doses of Pfizer, so you can see how the two numbers are on very different scales
Read 7 tweets
27 May
NEW: B.1617.2 is fuelling a third wave in the UK, with not only cases but also hospital admissions rising.

Vaccines will make this wave different to those that have come before, but it remains a concern, and one that other countries will soon face.

Thread on everything we know:
First, cases in the UK.

It’s been clear for some time that B.1.617.2 has been driving local outbreaks in North West of England, but data suggest it’s now far more widespread.

By mapping sequence prevalence onto total cases, we can see how the new variant is behind recent spikes
If we plot B.1.1.7 and B.1.617.2 on a common baseline, most areas show a shrinking outbreak of B.1.1.7 alongside a growing one of B.1.617.2.

What looks like "cases are flat", is probably "one going down, other going up, and it has more room to grow than the other has to shrink".
Read 20 tweets
23 May
A side note: I’ve seen it said that the media is putting a positive spin on things despite SAGE members and other experts being much more worried.

This is a surprise to me, since the people we speak to for our reporting and quote in our articles are SAGE members and experts 🤔
We probably spent 20+ hours each reporting these stories, running well into Friday night and Saturday. This involved speaking to experts in immunology, epidemiology and broader public health, including the very people who did the analysis on vaccine efficacy and transmissibility.
I get why some think there’s not sufficient alarm. 150k have died in the UK, and a reluctance to act early has played a part.

But to accuse us of spinning when we’re working our asses off to get data & expert comment to the public as quickly as possible, is quite something.
Read 6 tweets
23 May
Lots of questions still bouncing around on vaccine efficacy vs B.1.617.2, so here are some follow-ups to our Saturday morning story:

Thread follows, and @SarahNev and I published a new story last night covering all the details including transmissibility:…
Following our original story, PHE later published more detailed data disaggregated by vaccine.

That data shows our pooled figure of 7% relative drop in two-dose efficacy against B.1.617.2 vs B.1.1.7 comprised a 6% drop for Pfizer, 10% drop for AstraZeneca. Very little difference
Similarly, the 35% relative drop in efficacy after one dose was virtually indistinguishable between the two vaccines.
Read 21 tweets
22 May

Public Health England has presented the first real-world data on vaccine efficacy against B.1.617.2, the variant first found in India.

Efficacy against symptomatic B.1.617.2 was 81% after two doses, much higher than many have feared.

I would ask people to read what follows carefully. Vaccine efficacy is a nuanced topic and the numbers here need to be interpreted in their proper context.
The data, which the FT has seen, suggest first dose offers around 35% less protection against symptomatic infection with B.1.617.2 compared to B.1.1.7, but after two doses the relative drop is only 7%.

The figures are based on pooled data from the Pfizer and AstraZeneca vaccines
Read 15 tweets
20 May
Just two quick charts on B.1.617.2 today:

Cases continue to climb in Bolton, Blackburn & Bedford, (known B.1.617.2 hotspots), though rate of acceleration in Bolton has slowed slightly, and test positivity there is flat, suggesting surge testing is playing a role in 📈
Continued increase in those areas would be a concern, and it’s worth noting rises in neighbouring Bury and Burnley too.

B.1.617.2 not believed to be dominant in either of these areas, but Sanger data is now 12 days old so that may have changed.
Nonetheless, the same chart shows that high prevalence of B.1.617.2 is by no means a guarantee of prolonged resurgence.

Hounslow, Nottingham and Sefton are all places where B.1.617.2 is believed to be dominant, and yet their upticks reversed and now appear as brief blips.
Read 8 tweets

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