Thread by @michaelzlin

Claims of decoupling between cases, hospitalizations, and deaths in the UK have been premature.

No doubt we'll see lower death rates, but we'll also see (1) plenty of acute and likely long-term morbidity, and (2) breakthrough deaths in sick/elderly.

UK researchers weigh in...

Our sources will be two UK newspapers from opposite ends of the political spectrum: The conservative Daily Mail and the liberal Guardian. First up, the Daily Mail quotes the government for 100k daily cases and ICL epidemiologist Ferguson for a CFR of 0.1%.

100k looks plausible to me. With 50% not vaccinated, 20% of whom might be prev infected (based on total deaths so far), that makes 40% nonimmune. Half of those (20% of UK) might get Delta before herd immunity sets in. That's a similar number to all infections so far.

Makes sense then if the Delta peak adds the heights of the two prev peaks, given Delta's speed and lack of restrictions.

To understand the CFR of 0.1% (which is 10x lower than winter) we'd have to look at Ferguson's model, but it could be due to say 90% of patients in the Delta wave being young with CFR << 0.1% and 10% being older or having other medical conditions with CFR 1%.

If the Delta wave deaths peak at 100k and it's roughly a triangle 1mo wide in the center, then we expect about 3000 deaths. How's that compared to other events? It's ~2x the annual flu deaths in the UK. Whether that's good or terrible depends on your POV.
ons.gov.uk/aboutus/transp…

How about the claim that hospitalizations aren't following cases as much? Well I would expect that to be true due to the younger population, certainly.

We see at winter peak hosp/case ratio was 7%. Funny that the two hosp and case peaks align as hospitalization follows onset of illness by 1-2 weeks. Could be infections are recorded on test date rather than on first symptoms.

Anyway with 400 hospitalizations on 6/30, the hosp/case ratio is 2.5% using 6/30 cases, or 3.3% using 6/23 cases. I expect hosp/case ratio to be lower now due to vaccination, but so far it's just a several-fold reduction. For deaths, too early to say if CFR will really be 0.1%.

So you'd expect the Daily Mail as a conservative paper to have sympathies for the government, but they don't seem to be sugarcoating anything. We can go to the liberal Guardian for their take.

The Guardian also relays the 100k/day case numbers but report a more conservative estimate of 50 deaths/day. So that would put excess deaths in just the Delta wave at similar to flu. Again good or bad depends on your POV.
theguardian.com/society/2021/j…

So overall how would I sum it up? I think "decoupling" of cases to deaths is a misnomer, as it implies no relationship at all. I have no idea who came up with that terrible term. There will still be cause-effect, but there will be a large reduction in deaths due to vaccination.

Whether enough is being done to vaccinate before opening is a political question. It's again the economy vs. minimizing suffering and deaths. The vaccines work, but not perfectly in the vulnerable, and more vaccination is needed to reach herd immunity and put Delta into remission

The other questions are what are the long-term consequences for the ~3M who will get sick, and will the UK be able to protect children from Delta, and if not what effects will there be on their health? In opening quickly and completely, UK is hoping that the answers are not bad.

What does it mean for the US? We're similar to the UK in % vaccinated and lack of restrictions, and CDC has essentially laid out a similar strategy of lip service to vaccination and not much else. Do we really want to let CDC take us down that path, without a public discussion?

Grave concerns about UK reopening voiced by scientists

Mass infection is not an option: we must do more to protect our young
thelancet.com/journals/lance…