NEW: detailed thread on Europe’s winter wave and the contrast vs UK

What’s happening? Why the difference? Can boosters help?

First, the wave itself: cases, hospitalisations & deaths surging in Europe, several western countries shooting past UK 📈

The situation is even clearer when plotted on a log scale:

UK is broadly a flat line, with European countries cutting up steeply through it. France, Italy & Spain all on course to pass UK for cases. Germany now above UK for daily deaths and Netherlands set to follow.
So why these exponential surges across Europe but not in the UK?

There’s increasingly little difference in social mixing behaviour between the countries, and where we do see differences e.g in mask-wearing, they’re generally more virus-friendly in the UK 🤔
The answer:

UK’s July reopening led to much more of its population being infected than elsewhere in western Europe. Between vax and infection-acquired immunity, UK has more protection, Europe has more susceptible people.

Source: @lloyd_chapman_ paper…
Despite UK having lower vax coverage than e.g Belgium & France, the difference in share of people previously infected is larger (UK 30%, FRA 15%), meaning that going into this winter, the UK had fewer people still exposed to the virus, less scope for a wave of hospitalisations.
This filled gaps in the UK’s vax coverage, leaving very few completely unprotected.

In Germany, lower vax rates and less infection-acq immunity mean far more ongoing exposure.

In Romania, despite huge numbers of past infections, gaps in elderly vax coverage left huge exposure.
But of course, that infection-acquired immunity comes at a grim cost. The UK has recorded more than 15,000 new Covid deaths since reopening no July 19.

That’s more over that period than any European country except Romania in absolute terms, and now around 10th highest per-capita
The big question is how that number will compare once winter is done?

In July UK’s running toll was highest in Europe. Several eastern European countries have since overtaken, and plotting the same on a log scale shows that others further west are heading the same way
But will the UK’s western European peers pass that same grim toll, or could they still avoid the worst?

A big part of the answer lies in boosters, where we now have extremely clear signals from the UK...
Let’s start with cases in England.

Look at the first half of October: all age groups rising in lockstep.

November? Not so much. Cases have risen among under-60s, but fallen fast among older groups.

Let’s take a closer look...
Here we focus only on the two mini-waves — first half of Oct, and middle of Nov. Spot the difference...

In Oct rates rose in the elderly just like everyone else. In recent weeks, there is a stark divergence.

But what makes me say that this is boosters and not behaviour? Well...
This is a new chart format I’ve been working on for a few days. Lines still show age-groups, but they now change colour as people get boosters.

In October booster coverage was still low even in elderly. But by late Nov you can clearly see how boosters drive cases down 💉📉
And if you thought that was impressive, take a look at the same thing for hospital admissions:

Admissions in England have been relatively stable among people aged 18-64 in England over recent weeks, but they’re falling precipitously in the mostly-boosted over-65s 💉🏥📉
To reiterate, cases among under-60s in England have risen in recent weeks, but among mostly-boosted elderly they have not merely risen more slowly, they’ve *fallen*.

Strong evidence that with a fast rollout, boosters can change the slope of a wave, especially for severe outcomes
Here’s a reworking of a brilliant @PaulMainwood chart using the same format:

As boosters roll out, lines turns red, and then arc upwards as waning immunity is reversed.

You can already see early signs of 50-69s beginning to turn as they go from blue to ... I wanna say lavender?
Good news for western Europe is there are early signs of a booster effect there too 🎉

Compare Belgium (started boosters in Sept) to Netherlands (started last week):

Cases among Belgium’s mostly-boosted elderly are no longer tracking younger groups. Netherlands? Not so much...
So good reason to think that with fast booster rollouts, western European countries should see:
• Cases begin to flatten and fall among the most vulnerable
• Meaning a steep rise in cases no longer necessarily translates into a steep rise in hosp/death

But there are caveats...
Specifically, boosters can only help those who’ve already had two doses, and in many countries that number is too low.

Austria illustrates this well:

Almost everyone second dosed 6 months ago has had a booster...
But its high unvaxxed rates mean that this booster surge has merely taken its share of people without vaccination protection down from being far higher than all of its peers, to only far higher than *some*.

Plus rollout was too late to get ahead of the wave.
There’s a stark warning here for the US, too.

Whilst the US’ summer wave will have — like the UK — generated a lot of infection-acquired immunity, that is offset by very poor vaccination rates (both second doses and third).

Read @caitlinsgilbert here:…
One key tool for accelerating uptake could be to do what @nicolamlow said to @samgadjones: "we should stop calling them boosters, and start calling them third doses".

As @PaulMainwood has demonstrated, there is a growing body of evidence for that view
So to conclude (1/2)
• UK’s July reopening likely generated enough infection-acquired immunity to shield it from continent’s winter wave
• But that came at a cost of thousands of deaths, far higher rate than peer countries [so far]
• Boosters also key to UK’s current successes
• If western European countries can accelerate booster rollout they can blunt the wave, esp in terms of hospitalisations & deaths
• But some, like Austria, are hamstrung by low uptake of the primary course. You can’t boosted the unvaxxed, and Austria has a lot of them.
A big thanks on this one to my Covid collaborator-in-chief @mroliverbarnes, to @samgadjones & @Sam1Fleming for gathering news on the ground in Europe, and to @robertrcorr for editing.

As always, please share any thoughts, questions, comments, [constructive] criticism etc 🙂

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More from @jburnmurdoch

25 Nov
Five quick tweets on the new variant B.1.1.529

Caveat first: data here is *very* preliminary, so everything could change. Nonetheless, better safe than sorry.

1) Based on the data we have, this variant is out-competing others *far* faster than Beta and even Delta did 🚩🚩 Image
2) This is coinciding with a wider rise in cases in South Africa.

Again, currently we’re talking about small numbers (both of B.1.1.529 and of cases in SA overall), but there’s a clear upward trend. This may be a blip, but this is how waves start. Image
3) Aside from its rapid rise in South Africa, the other key reason for concern here is that the specific mutations that B.1.1.529 has are — based on what we’ve seen with other variants — known to be associated with greater transmissibility & immune evasion
Read 9 tweets
18 Nov
The good thing about this story is that any time I see someone sharing it as evidence that wearing masks cuts Covid incidence by 53%, I know they haven’t read the paper it’s based on and aren’t fussed about the quality of evidence as long as it produces the right number 🙃
What do I mean by this?

Let’s start by saying that yes, we have good evidence that masks reduce Covid incidence 😷🦠📉😀

BUT it points to nowhere near a 53% reduction. As today’s @bmj_latest states, the best evidence — randomised controlled trials — point to more like a 10% cut
Indeed, here is the BMJ’s take on today’s paper:
• Most of the studies included in the meta-analysis from the Guardian story are poor quality and subject to major biases
• We need more & better research [like the mask-wearing RCTs which have consistently found a smaller effect]
Read 6 tweets
15 Nov
NEW: @UKHSA study finds Pfizer booster is extremely effective against symptomatic infection, both compared to the unvaccinated and to those with 2 doses…

Whether first 2 doses were AZ or Pfizer, a Pfizer booster sends vaccine efficacy up to 93-94% 💪 Image
Study was on people aged 50+, comparing those boosted ~5+ months after dose 2, to those @ 5+ months unboosted.

AZ efficacy was 61% after dose 2, waning to 44% @ 5 months.

Pfizer was 82% after dose 2, waning to 63% @ 5 months.

2 wks after Pfizer booster, both groups -> 93-94%!
Best way to think about booster impact is not to look at going from 44 to 93 with AZ, i.e roughly doubling, but invert the numbers and go from (100-44) to (100-93), i.e from relative risk vs unvaxxed of 56% to just 7%

That’s an 87% increase in protection *relative to two doses!* Image
Read 8 tweets
11 Nov
NEW: England has recorded 18 successive days of week-on-week declines in cases, its longest sequence of declines since February, suggesting its autumn/winter wave may have peaked…
Crucially, hospital admissions, patient numbers and deaths are now also trending downwards, as the fall in case numbers has shifted from being youth-driven into all age groups.

These acute indicators look to be topping out at 10-20% of last winter’s peak levels.
A key factor here has been England’s booster rollout.

Antibody levels in the oldest groups (vaccinated the earliest) had been slowly eroding as the months passed, but in the last 5 weeks they have shot back up as third doses have gone into arms 💉💉💉💪💪💪
Read 18 tweets
5 Nov
NEW: Covid cases, hospitalisations & deaths on the rise again across Europe, with rates of all three metrics surpassing the UK in many countries

Starting in the west: Belgium, Netherlands & Germany in particular experiencing sharp increases in not only cases but ICU & deaths too
And the picture worsens as we move further east.

In central Europe, cases were a fraction of UK levels over summer, but have now rocketed past, with ICU occupancy and deaths also climbing fast.

Vaccine coverage is generally lower here than in western Europe.
In eastern Europe, the situation is dire.

Romania, Bulgaria & Latvia all set new records for daily deaths in recent weeks, and deaths are 10x current UK levels.

In much of western Europe it can feel like the pandemic is an echo of its past self. Try telling that to the east
Read 8 tweets
3 Nov
🚨all of is free to read today, so if you like the glimpses you see on Twitter but want to go deeper, now's your chance!

Beyond Covid, read our best work on climate, politics, inequality & culture. Apparently there's even stuff on economics & finance! 🚨
Throughout the day I'll be sharing links to some of the pieces I've enjoyed most this year, starting with this brilliantly clear column by @TimHarford demonstrating how a carbon tax would be a game-changer in the battle to curb emissions
Another great piece to read 🔓#FTfreetoday:

Off the back of Squid Game and Parasite, @crsdavies took a deep dive into the huge success story that is South Korea’s entertainment export industry, and the decades of strategising that led to this point…
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