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
"I am a little surprised how quickly Delta has become widespread,” said Ashish Jha, dean of Brown's School of Public Health. “We’re one week into July and it is everywhere. It suggests that it is far, far more contagious than the Alpha variant."
We knew 10 days ago Delta was 50% of sequences in the US, so that realization is both late and not surprising. The below came to me via @ScottGottliebMD on 6/28, and if Jha wasn't following Gottlieb or Delta progress by then, he should have been
Health officials' oversimplistic message that vaccines were perfect and treatment of breakthroughs as taboo has, predictably, led to defensiveness/apologeticness upon local breakthroughs that undermines confidence in both officials and vaccines. sacbee.com/news/politics-…
Take this explanation by the CA senate secretary after a local outbreak: "Even fully vaccinated individuals can be infected with COVID-19. However, public health experts indicate that fully vaccinated individuals are less likely to suffer...
... the most serious symptoms of COVID-19, and for this reason, the Senate continues to encourage all staff to protect themselves by receiving the vaccine.”
Does one sense a little awkwardness here? Isn't the way the outbreak is discussed sound like an apology for vaccines?
Must always consider mechanism and data quality in COVID19 curve. Factors Topol misses: (1) UK cases started rising early June, and deaths lag by 1mo (2) cases in the other countries cited may be underreported, increasing the death/case ratio (Russia curves esp make no sense)
Another thing to consider is if Topol included precisely those countries that have the highest death/case ratios to make a contrast with UK, then he would have filtered in exactly those countries that are underreporting their cases.
Kind of frustrating that Topol would continue to make the same mistakes in data interpretation (no mechanism, no awareness of data quality, no awareness of selection bias)
CDC advice that vaccinated should feel comfortable spending all the time they want indoors and unmasked with the 50% unvaccinated population while Delta surges through their communities doesn't sound so reassuring now, does it?
This thread, and probably the one it refers to by Topol, should be pulled. The study did not look at transmission from vaxxed people at all. Topol wrote "91% efficacy of blocking transmission of infection" when he should have just written "91% efficacy of blocking infection"
Actual results: 91% refers to the reduced infection of vaxxed people, similar to the 95% in clinical trials. All of this is pre-Delta. So kind of non-news.
Sorry gotta go against Fauci on this one, just as I did in March 2020 on masks. If you don't want to be a breakthrough infection and pass on the virus (vaxxed still have ~20% the chance of unvaxxed with Delta) and you're highly exposed, then wear a mask. Simple, cheap, convenient
👏LA's Ferrer "We have enough risk and enough unvaccinated people for Delta to pose a threat to our recovery. And masking up now could help prevent a resurgence in transmission. This is a precautionary recommendation, given that we don’t have all the information we wish we had.”
Ferrer said there’s “increasing evidence that a very small number of fully vaccinated individuals can become infected with the Delta variant and may be able to infect others.”