THREAD on England & Omicron and what is going on.

My take on it.

TLDR: things are pretty bad and I'm sad & bewildered at lack of govt action and general levels of hopium. 1/18
First off cases... reported levels in England now more than twice as high as previous peak last January and more than three times higher than at start of December.

Latest numbers reflect infections *before* Christmas mixing.

These numbers are an underestimate.

2/18
Positivity rates are also rising v steeply - testing is not keeping up with cases.

All regions rising fast, London highest and earliest. Do not take London small case drop too seriously - drop in pre xmas tests & positivity still rising. Plus xmas likely to boost again. 3/18
As I (+ many others) warned a few weeks ago, we are now at limit of how many tests we can do - and that means case numbers increasingly poor indicator of spread. Positivity is what we need to watch out for.

Lack of tests also increases transmission - esp over New Year. 4/18
Infections still highest in 20-29 year olds, but rising fast in all other age groups apart from under 10s.

Rise in 60+ esp worrying - now approaching level last seen in Jan peak. Obv vax will make a massive difference - but how much higher will cases go - esp with Xmas? 5/18
And yes - cases ARE feeding into rapid rises in hospital admissions. I said we should expect increases after Xmas and that is what we are seeing.

Admissions are rising in *all* age groups.

Again, these admissions are from infections pre-xmas & just after Omicron dominant 6/18
And to 21 Dec, 70-75% Covid admissions *for* Covid. Many of rest caught it in hospital - which is not a good thing.

data available here
england.nhs.uk/statistics/sta…

7/18
It *does* seem as if fewer admissions need intensive care (good) but needing hospital is not a good thing and massively restricts NHS ability to treat other conditions - esp with so many staff sick.

An NHS crisis based on the wards instead of ICU is still an NHS crisis. 8/18
So what next? Firstly, cases have NOT peaked yet. With Xmas and then New Year mixing, likely to peak in early(ish) Jan. Admissions will keep going up steeply.

So far, admissions higher than recent LSHTM projections and have met SAGE prediction of >2K by end of year. 9/18
Warwick (also feeding into SAGE) published their projections today over a range of scenarios. I think we are in their "Omicron 80% less severe than Delta & Plan B only" scenario.

This gives peak hospital admissions *higher* than last January (but with fewer deaths). 10/18
Putting in a short circuit break before Christmas or even on Boxing day could have greatly reduced this peak. Returning slowly to normal from mid Jan would have minimised resurgence.

But govt has missed that boat and ignored the science. 11/18
Note that admissions are already higher than Warwick peak in best case "Plan B" scenario of 90% less severe.

NHS is planning for mini Nightingales and tents in car parks. Staff shortages are causing massive problems for all care. 12/18
We've recorded 1.4m cases in England in last 2 weeks alone.

Even if Omicron less severe we know *nothing* about its long term impact. Even if less likely to cause long covid, *hundreds of thousands* more people likely to suffer long covid - affecting them *and* economy. 13/18
We've also done nothing to protect schools - which will prolong Omicron wave & put kids at risk.

New York is warning of rising admissions in young kids - they can't be vaxxed & rely on LOW community transmission to protect them. 14/18

The usual people are out there saying all will be fine soon - we just have to let people get infected and it will be done. Just as they did at previous waves.

Mass prior infection have *not* stopped the Omicron wave. Nor has mass vax. Omicron is not last variant. 15/18
We have made a tremendous progress in boosting adults - 75% eligible now boosted. Our booster programme will turn an absolute tragedy into a "mere" terrible period.

But when will we realise that (current) vaccines cannot do it all on their own?! 16/18
We *could* have prevented the NHS strain over the next weeks. We *could* have prevented the economic damage of mass sickness in businesses. We *could* have invested in ventilation like Japan. We have not.

Instead of prevention we are planning hospital tents in car parks. 17/18
Many from govt to scientists to the media to the public have decided that 100,000s cases a day are fine. We are dangerously weakening our NHS & its staff.

Too many people will end up with chronic illness & too many will die.

All I can do is keep saying it's not fine. 18/18
PS some have asked why I've not shown death data. Firstly holiday reporting backlogs have made recent data non informative and secondly any increases from Omicron wave won't show up for at least another week, likely longer.

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More from @chrischirp

29 Dec 21
I wrote this with @adsquires because next term is coming quickly and we need to plan for how to *minimise* infection in kids & teachers and *minimise* disruption to education.

Govt still not doing anything - so this thread summarises what I am afraid will happen:

1/9
We've recorded over *1.2 million* infections in 5-14 yr olds in England since 1 Sept 2021. The real number will be much higher.

Over 2,500 6-17 year olds have been admitted to hospital with Covid since then too and ten 5-14 yr olds have died due to Covid. 2/9
Thousands more children are reporting long covid through ONS infection survey.

V big disruption to education, with 1000s of children missing school every day & teachers off sick.

Hardly any under 12s & *fewer than half* of 12-15 yr olds have received a single vaccine dose. 3/9
Read 10 tweets
24 Dec 21
Was going to do a quick pre-xmas thread on where we are but SAGE minutes from their meeting yesterday covers all my points!

So here is a whistestop tour of the main bits

Omicron Growth might be slowing, but only from ~2 day doubling to ~3 day doubling. So still growing fast.
Not clear why growth is slowing: likely combo of more cautious behaviours, Plan B (e.g. work from home), moving to different age groups, more reluctance to test
Number of people in hospital with Omicron doubling every 4 to 5 days – this is rapid and so far they are younger. Also increases in transmission within hospitals. SAGE expects large increase in admissions as older people get infected over Christmas ☹
Read 9 tweets
21 Dec 21
THREAD on cases, hospital admissions and why so many scientists & NHS leaders are worried.

Case study of London - and what is behind the alarm!

1/10
The key bit is that it takes about 10-14 days from infection to needing hospital. And if you have symptoms, you'll probably test positive 4-7 days into infection.

So there's roughly a week from testing positive to becoming a hospital admission. 2/10
So - cases in London have risen *very steeply* - but *mainly* in the last week. And only in the most recent week has Omicron been dominant.

But cases to 19 Dec (incomplete!) are already more than double previous week. 3/10
Read 10 tweets
19 Dec 21
Short THREAD on log scales and why I tend not to use them.

I've been criticised at times for not plotting case numbers etc on a log scale. I want to explain why.

TLDR: essentially it's because the burden of covid ill health and on NHS is people not log people. 1/8
When you've got exponential growth (e.g. in new covid cases or hospital admissions, it will be a straight line if you put the vertical axis on a "log scale" (normally equally spaced powers of 10).

Charts show same exponential growth on a normal scale and a log scale. 2/8
Log scales are really useful for e.g:

a) seeing if growth is exponential (straight line?)
b) looking for acceleration or slow down in growth
c) comparing growth between countries at different stages of epidemic 3/8
Read 8 tweets
17 Dec 21
THREAD: on omicron, UK cases, London & what to do next...

Last post-briefing tweet thread of the year! 1/18
First Omicron... as of 11 December, Omicron was most common in Scotland and England but starting its growth in Wales & N Ireland. With its growth speed, shares of cases will now be much higher in all regions. 2/18
In England, UKHSA "S gene dropout" data shows it was 40% of cases by 13 DEcember. It will be dominant in England by now.

WHO first designated it a variant of concern & named it Omicron 3 weeks ago today. Crazy. 3/18
Read 18 tweets
16 Dec 21
SHORT THREAD: Some basic musings about hospital admissions and exponential growth.

88K cases reported today - let's assume just under half are Omicron - so ~40K. Delta hospital admissions have been running at about 1.7% of reported cases in last month. 1/5
Let's assume Omicron was half as likely to cause hospital admission as Delta. So 0.8% of reported cases end up in hospital. From 40K cases today that would result 340 admissions.

just FOUR doublings takes you to 5,440 admissions - far higher than last January peak. 2/5
The 40K cases today represent people infected about a week ago. Omicron has been doubling every 2 days. Even if that's slowed this week to 3 days, that's likely 2 more doubling baked into admissions. That means that FROM NOW we there'd be two more doublings exceeding jan peak 3/5
Read 6 tweets

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