Thread on Covid & UK (mainly England).

TLDR the two epidemics theme continues and the impact of summer infections on long covid is becoming evident... 1/13
On vaccination, we've started on 12-15s but roll out is slower than it was for 16-17s... and in younger age groups we are substantially behind Scotland who have been using walk in clinics for teens.2/13
For boosters, we've now given a quarter of 80+ their booster and rollout is progressing. When the programme started, 3.5m people were already elgibile for their booster - we've got a bit of work to catch up to all the eligibles as soon as we can! 3/13
In terms of cases, UK has gone quite a bit last 2 days. Age, region etc are lagged by a few days (date of test) so I'm not sure why at the moment!
By nation for date of test (lagged), looks like cases flattening in all countries.
Positivity flattening in NI and England. 4/13
For hospitalisations, occupancy is declining in each nation (good).

For admissions, the persistent much higher admissions in the North & Midlands vs the South East continues. As we go into winter the NHS covid pressures are not being felt equally. 5/13
Deaths have started going down now which is good news. This reflects the shift of cases into children who are at much lower risk of death.

Case rates have been declining/flat in 60+ for past few weeks and this is now leading to fewer deaths. 6/13
Cases in children remain far higher than in adults. It looks as if cases might have peaked for now but they are still incredibly high - the most recent ONS infection survey (random testing) found *7%* of secondary school kids had Covid in week to 2nd Oct.
7/13
We are also seeing climbing hospital admissions in 6-17 year olds (but rates much much less than adults).

That said, children are in the eye of the pandemic still from their point of view. 8/13
ONS released its latest long covid report of people self-reporting symptoms for longer than 4 weeks after getting Covid.

ons.gov.uk/peoplepopulati… 9/13
There has been a big jump in people reporting Long Covid who were infected over the summer (<8 weeks before 5 September).

This is the consequence of high cases over July & early August 10/13
Age group that has seen the biggest rise are 17-24 yr olds - the exact group that had the higest infections in July.

People working in hospitality also reported big increases - hospitality is high risk and people working their have little control over their environment. 11/13
Unfortunately with continued high cases, we are likely to see more increases in people reporting Long Covid, and will be disproportionately in people exposed to infection. Risky workplaces are part of that.
That said, hopefully increasing vax rates will reduce long covid. 12/13
Internationally, case and death rates are much lower in much of West & Northern Europe than in UK / England.

@martinmckee & I discuss possible reasons here
theguardian.com/commentisfree/… 13/13
PS thanks as ever to Bob Hawkins for his help in collating data and preparing charts!

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More from @chrischirp

9 Oct
Nick Triggle did his version of the article @martinmckee & I wrote in the Guardian about how UK has much higher case rates (& death rates) than West & North Europe...

Of course there are different views, but here are some areas I see differently... 1/9

bbc.co.uk/news/health-58…
That Europe is doing "vaccine plus" - high vax coverage and some measures such as masks indoors, school mitigations, covid passports is the entire point- it works much better than "vaccine just" in keeping cases (and all their bad consequences) down

And...
2/9 Image
not clear that contact rates are higher here than in Europe - contacts in Europe are SAFER because they've take additional precautions.

In fact SAGE says we are still not close to pre pandemic contact rates in England. Many do not feel able to "be normal" due to high cases. 3/9
Read 10 tweets
8 Oct
A conversation with @adamhamdy prompted me to look at how different home nations are dealing with reinfections (people testing positive with Covid more than once, at least several weeks apart)

There are differences that will matter more over time as Covid keeps going 1/7
England only counts the *first* time someone tests positive. So if I tested positive last summer and then tested positive again now, I'd only appear in last summer's numbers.

This means England is undercounting cases (but not by much as long as reinfections are rare) 2/7
Wales *does* allow for reinfections as long as they are 6 weeks apart. So if I tested positive last summer and again today, I would count as a Covid case twice - once last year and once again this year. 3/7
Read 8 tweets
7 Oct
This story by @samueljlovett about the lack of transparency around JCVI decision making is excellent - clearly the lack of transparency is worrying *JCVI members* too...

Meeting minutes should be published within 6 weeks - no Covid ones since Feb.
1/4

independent.co.uk/news/science/c…
We raised this issue in our @IndependentSage statement last Friday
independentsage.org/call-for-more-…

and wrote to the Chair this week asking for the minutes to be published
independentsage.org/independent-sa… 2/4
In the article, JCVI seemed to blame lack of admin support - although minutes of a June non Covid meeting are public.

There has also been a Freedom of Information Request to ask for minutes - this was denied but JCVI seemed to confirm that the minutes *were* available. 3/4
Read 4 tweets
3 Oct
I am a (minor) co-author on this agent-based modelling study looking at return to school in England (not yet reviewed)

Most important are relative differences in size for outcomes to compare diff strategies rather than absolute numbers.

Take aways are

medrxiv.org/content/10.110…
1. Vaccinating 12-17yr olds has a lot more impact than just vaccinating 16 & 17 year olds.

Note vaxxing all children is not currently possible (no authorised vax<12 yrs) but shows theoretical best case.
2. You can get significant reductions in cases & outcomes by using public health protections in schools - and given current situation (late & slow vax roll out) - these are a super important tool we could use right now.
Read 5 tweets
2 Oct
1. THREAD on transparency & JCVI statements on teen vaccination.

This is *not* about the results of the risk benefit analysis but about the fact that 4 weeks after 3 Sept statement, the information we need to interpret & understand their analysis is missing.

14 Tweets (+2)
2. First off - in JCVI code of conduct, openess and transparency are required.

The code states that in any mathematical modelling (which risk/benefit is), the *full assumptions* should be given in sufficient detail to allow *full assessment*.

assets.publishing.service.gov.uk/government/upl…
3. The recommendations also say that the minutes of meetings should be published. While some delay is allowed, there have been NO minutes of JCVI meetings about Covid 19 since a February meeting, published in April.
app.box.com/s/iddfb4ppwkmt…
Read 16 tweets
1 Oct
THREAD on a quick Covid update (mainly England):

TLDR: two epidemics really - one in under 18s (and their parents) which is bad and getting worse and the other in everyone else which is getting better.
First - vaccine uptake in 12-15 year olds in England hasn't really started. With such high rates in teens right now this feels like a missed opportunity :-/

1/12
Looking at cases by date of test for each home nation, England and Wales are going up and NI and Scotland coming down. NI seems to be plateauing though.

England and Wales might be peaking (for now at least) 2/12
Read 15 tweets

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