NEW: UK’s full reopening is set to be postponed by a month due to resurgence in cases — and now hospitalisations — fuelled by the Delta variant.


Thread: first up, that core data: UK admissions, patients & ventilator bed numbers now all climbing
An obvious initial point to make: whilst the rate of increase in cases is just as steep as it was last autumn, the hospital metrics are climbing more slowly.

This is good news (!), but it comes with nuances that point in both an optimistic and pessimistic direction.
The pessimistic: until recently admissions in Wales and Northern Ireland were falling steeply, which was countering rises elsewhere and making UK totals flatter than they would otherwise be.

In the last week, admissions have risen in every UK region but one: the East of England.
If we look at the same metrics for England alone we get steeper rises. There’s no way of looking at the central three red lines on this chart and saying they’re not trending upwards. Shallower than cases, but rising nonetheless.
And here’s where it gets most pessimistic (don’t worry, optimism coming soon):

North West England has been UK’s canary down the coal mine as far as Delta is concerned, and the picture there is ... not good. Hospital metrics are rising almost as steeply as they did last year
If those trends spread to the rest of the country, the growth rate in hospitalisations elsewhere in the UK is also likely to pick up.

Now, that might not happen — it could be there are specific conditions in the NW that have made it fare especially badly — but it may well happen
I said there would also be optimism, and here it is:

The age profile of the current resurgence remains much younger than past waves, and we can see this with both cases and hospitalisations.
First, cases: so far in current resurgence, younger people have been far more likely to get infected than older (💉), and that alone means we would now expect far fewer deaths-per-case

75% fewer, to be precise, which may already mean ~750 lives saved in England in the last month
Next, hospital admissions.

Whereas during last autumn’s wave admissions initially rose at the same rate across all age groups, they’re now rising fast among young adults (age 25-44) but slowly if at all among the most elderly.
The result: a larger share of younger patients than last autumn, but far fewer elderly. An analysis of age-specific hospitalisation-fatality-rates across England’s epidemic to date suggests this will weaken the link between admission and death this time around, by about a third.
So for a given number of cases during this wave, we should see fewer hospitalisations, and for a given number of admissions, we should see fewer deaths.

The links are certainly not broken, but they are weaker.
The rise in hospitalisations on its own is clearly sufficient reason to re-evaluate the June 21 full reopening date, but there’s one more piece of information that I think shows why the postponement was justified:
Even though the UK’s vaccination rollout has been among the fastest and most comprehensive worldwide, there are gaps: around *2 million* over-50s in the UK have still not had a single dose. Many of these people are still highly vulnerable to the current wave.
Added to that are ~13 million unvaccinated younger adults, and another ~8m partially vaxxed younger adults (👋), so you can see a more transmissible variant still has plenty of fuel to prolong its spread.

With that in mind, I don’t see how June 21 could have gone ahead.
So, to conclude:
• Third wave of hospital admissions clearly underway
• Data still suggest this wave should be less lethal
• But no clear sign yet of current wave subsiding
• And still millions unvaccinated
• Postponement seems the logical move
Finally, some notes:
• Big thanks to Dan Howdon for guidance with the age-specific CFRs and HFRs that show this wave likely to be less lethal
• A nudge to @KasperKepp who will hopefully now accept that UK admissions are rising? We shall see...
I’ll keep tracking all of these metrics as we go on, and will also be taking a look at the situation with Delta away from the UK.

As ever, comments and questions welcome.

Enjoy your Fridays, folks.

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More from @jburnmurdoch

8 Jun
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.
Read 14 tweets
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

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