Hard to avoid noticing that the relationship between cases and deaths in the UK has not been severed, but nor has it been constant. The big delta spike in July had relatively few immediate severe consequences, that's no longer the case 1/? 
The most recent data are showing a decline in case counts (when was the half term break?) and a slackening in the pace of hospitalizations, but it is clear that even if things slow (at least temporarily) the country is still in a bad place headed into the winter 2/?
Obviously the consequences of infections depend on who has been getting infected - even vaccinated older people are at higher risk than unvaccinated younger people (who are themselves not at zero risk. And even rare outcomes can add up when enormous numbers are infected) 3/?
and they have been, especially in schools. 7% or so of high schoolers infected for the last several weeks! This is the consequence of opening schools without mitigations. In contrast schools have been fully open in my town in MA since early Sept with no large outbreaks (yet) 4/?
Kids can also transmit and so lead to infections including breakthroughs. I just eyeballed the data from the @ONS and there are not obvious differences in the age distribution of deaths between now and July. But it does look that there are more serious breakthrough infections 5/?
So best guess right now would be waning of protection in older age groups. Can't get boosters into them quickly enough. Of course we should not ignore that this is happening when there is a very high force of infection in the community which will continue to pose a risk 6/?
Worth noting that you don't *have* to have a high force of infection. Where I am right now there is about 1/5th the daily incidence. This has been a choice. Once more the @GOVUK tried to blow the final whistle on the pandemic only for the virus to force extra time 7/?
The UK did an excellent job vaccinating in the face of the B.1.1.7/Alpha surge. As a result until recently those huge case numbers have not been coming with concomitant costs. But that is changing. 8/?
Like @jsm2334 says there is also AY.4.2 on the scene which is another part of the mix. This variant has mildly increased transmissibility (looks like about 10-20% more than regular delta) but… 9/?
https://twitter.com/jsm2334/status/1456641139457593350
The most recent technical briefing has not found an association between AY.4.2 and more severe outcomes. Caveat - there are lots of things that get in the way of estimating this accurately. Need to account for age, vaccination status etc. 10/? assets.publishing.service.gov.uk/government/upl…
eg if AY.4.2 is mostly in younger people, you expect less severe disease in that age group. Watch for the next briefing as sure we will get better data. It's not like there's a shortage of infections to study 11/?
This was longer than I expected. In closing I just want to say that with all this 👆🏼and the perennial foot dragging of the @GOVUK this move shouldn't come as a surprise 12/end theguardian.com/world/2021/nov…
ps might have time to write something later about what "vaccine plus" might look like, but gotta dash now
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