Update on Covid providing information on prevalence and hospital admissions for England and its regions. This post is best viewed using the browser or Substack app.
Re: Chart: The frequency and magnitude of peaks in Covid hospital admissions have decreased over time:
Daily Covid hospital admissions (7DMA) in England: Apr 2022 to Mar 2024.
I would really appreciate your expertise and view on the cause of a distinct lowering in July 2024 (Chart) of Covid hospital admissions (after changes to testing) compared to a distinct spike in admissions for July 2022. What happened? I have too many unqualified reasons in my mind!
This struck me: Whilst I had seen spikes before, away from the seasonal affect, maybe (?) attributable to the lifting of lockdowns and subsequent behaviours causing issues, I am a little mystified by what I describe initially.
Thank you for all the work you do and the fantastically informative way you convey your analysis!
Thanks for your comment and glad that you find the reports helpful.
Regarding your question about hospital admissions, the observed pattern of waves in 2022 was most likely due to the emergence of new lineages of the Omicron variant, each being more virulent and outcompeting its predecessors.
Whilst the change to testing in April 2023 undoubtedly reduced the count of hospital admissions there was also a reduction in the number of new variants. In fact for long periods there was no dominant variant which probably explains why there are no sharp peaks. This changed in December 2023 when the more virulent Juno variant became dominant.
Clearly although new. more virulent, variants are a large part in the story other factors like immunity waning and seasonality also play a role.
This comment highlights a number of high level, general issues that merit wider attention. The author of the latest post uses the term I, so one must assume it is written by an individual. So, how does it represent the opinion of ‘Sage’? Sage has always been a varying rag tag of clever professionals, with little evidence of adequate or increasing coordination and organisation. Maybe because of this there is little evidence of any effectiveness. One such piece of evidence might have been if the government’s own scientific advisory group, or the top scientists or medics had ever admitted regularly viewing it AND changing their minds on a significant point in relation to it. Or a Minister had changed their action versus the inside advice they had taken. I am aware of an international group who regularly meet to review evidence, to produce a guideline on a rare disease, with weighted evidence and weighted recommendations. They update one document. This group seems serious to me, seriously well organised. In response this latest lengthy, verbose, academic covid post, there is no clear weighted advice, no coordinated professional advice. Two commentators already make relevant comments, that should have e merited serious group consideration. That there seems to be little covid about now, and that the variants seem similar. Sage, if it were a serious body should have considered these ‘en group’ and commented. Quickly.
A new paradigm of organisation is needed. Virologists, en masse, seem to have failed since 1919. A group history, a ‘Monograph’, an ‘ Operations Manual’ should be started, worldwide, for compilation, covering all aspects, with the expert advice referred to, but not obscuring the main points. Here’s a simple example of what it should include. My impression is that evidence supports that higher standard masks, not necessarily expertly fitted, but definitely covering the nose and mouth ( not even apparent in health settings…still), make very significant differences in reducing transmission. If true and implanted properly it could make a difference next time. Who has the ability, now, to scale up production in DAYS of such masks. please note this is just an illustrative point to show how poor the scientific advise, organisation remains.
Wikipedia has an open(ish) form of documenting matters. A shared, open, covid, respiratory disease Manual or even decent history is needed now. Maybe Taiwan had one at January 1st 2030. What does the .u.K. have NOW? A cumulative graph of excess deaths would highlight which countries had significantly greater success. Material should be drawn from these. New Zealand appears to have been exceptional, almost.
Thanks for the informative post. It is suggested in the post that the lower waves could be due to emergence of less severe variants. Is there any evidence to support this hypothesis? So far all the data I've seen have put all the variants at equal severity once vaccination status is taken into account. I would be happy to learn otherwise.
Thanks for your kind comment and you are right to point out that there is no published evidence that variants are becoming less severe over time as far as I am aware. As you say it was only a suggestion on my part and I'm sure that vaccination is by far the largest factor.
The original report from the UKHSA on the latest Juno variant said it was no more severe than other variants but was more infectious. Interestingly, the ONS did report an infection hospitality rate based on linking data from the Winter Infection Survey with hospital records.
They reported that between 14 Nov 2023 and 29 Feb 2024, the risk of an individual being hospitalised with a Covid infection was approximately 0.45%. This corresponds to a 1 in 224 chance of those infected being hospitalized but increased to 1 in 30 for those 65 years and older.
Unfortunately, the ONS have not published a similar study based on data from the earlier Covid Infection Survey which would have provided some comparative data.
One query (perhaps for a future post): why is there so little Covid around now?
After all, many people have not had vaccinations for 12+ months, no children vaccinated and it's been very wet so people must have been indoors a lot.
At the same time there are few mitigations in place. I was in hospital in Feb, I reckon only ~ 15-20% staff were masked and then not N95 standard. GPs not wearing them either and virtually nobody wears one in supermarkets etc.
Since I understand that vaccination potency declines after ~6 months, and new variants have replaced the former ones, I just cannot understand why there is not more Covid around.
I've queried experts a few times on Twitter about it, but nobody wants to answer!
Thanks for comment and it's good to hear you find the post of helpful. Answering your question is not straightforward but let me give you my thoughts.
While there was a decrease in Covid cases during the winter months, it wouldn't be accurate to say there was 'so little.' The Winter Infection survey data estimated that approximately 25% of England's population was infected between 11 November 2023 to 3 March 2024. It's likely that this, combined with the Autumn booster campaign, has increased population immunity levels enough to slow the spread.
I'm sure that this is only part of the story as other elements, especially self-isolation when infected, will also play a significant role. Having said that I do not understand why effective masks are not used in hospital where the risks are higher.
To clarify, I do not support the idea of promoting infection as a means to increase immunity levels in the population because of the risks associated with 'Long Covid'. In my opinion, vaccination is a much safer approach.
Re: Chart: The frequency and magnitude of peaks in Covid hospital admissions have decreased over time:
Daily Covid hospital admissions (7DMA) in England: Apr 2022 to Mar 2024.
I would really appreciate your expertise and view on the cause of a distinct lowering in July 2024 (Chart) of Covid hospital admissions (after changes to testing) compared to a distinct spike in admissions for July 2022. What happened? I have too many unqualified reasons in my mind!
This struck me: Whilst I had seen spikes before, away from the seasonal affect, maybe (?) attributable to the lifting of lockdowns and subsequent behaviours causing issues, I am a little mystified by what I describe initially.
Thank you for all the work you do and the fantastically informative way you convey your analysis!
Steven,
Thanks for your comment and glad that you find the reports helpful.
Regarding your question about hospital admissions, the observed pattern of waves in 2022 was most likely due to the emergence of new lineages of the Omicron variant, each being more virulent and outcompeting its predecessors.
Whilst the change to testing in April 2023 undoubtedly reduced the count of hospital admissions there was also a reduction in the number of new variants. In fact for long periods there was no dominant variant which probably explains why there are no sharp peaks. This changed in December 2023 when the more virulent Juno variant became dominant.
Clearly although new. more virulent, variants are a large part in the story other factors like immunity waning and seasonality also play a role.
This comment highlights a number of high level, general issues that merit wider attention. The author of the latest post uses the term I, so one must assume it is written by an individual. So, how does it represent the opinion of ‘Sage’? Sage has always been a varying rag tag of clever professionals, with little evidence of adequate or increasing coordination and organisation. Maybe because of this there is little evidence of any effectiveness. One such piece of evidence might have been if the government’s own scientific advisory group, or the top scientists or medics had ever admitted regularly viewing it AND changing their minds on a significant point in relation to it. Or a Minister had changed their action versus the inside advice they had taken. I am aware of an international group who regularly meet to review evidence, to produce a guideline on a rare disease, with weighted evidence and weighted recommendations. They update one document. This group seems serious to me, seriously well organised. In response this latest lengthy, verbose, academic covid post, there is no clear weighted advice, no coordinated professional advice. Two commentators already make relevant comments, that should have e merited serious group consideration. That there seems to be little covid about now, and that the variants seem similar. Sage, if it were a serious body should have considered these ‘en group’ and commented. Quickly.
A new paradigm of organisation is needed. Virologists, en masse, seem to have failed since 1919. A group history, a ‘Monograph’, an ‘ Operations Manual’ should be started, worldwide, for compilation, covering all aspects, with the expert advice referred to, but not obscuring the main points. Here’s a simple example of what it should include. My impression is that evidence supports that higher standard masks, not necessarily expertly fitted, but definitely covering the nose and mouth ( not even apparent in health settings…still), make very significant differences in reducing transmission. If true and implanted properly it could make a difference next time. Who has the ability, now, to scale up production in DAYS of such masks. please note this is just an illustrative point to show how poor the scientific advise, organisation remains.
Wikipedia has an open(ish) form of documenting matters. A shared, open, covid, respiratory disease Manual or even decent history is needed now. Maybe Taiwan had one at January 1st 2030. What does the .u.K. have NOW? A cumulative graph of excess deaths would highlight which countries had significantly greater success. Material should be drawn from these. New Zealand appears to have been exceptional, almost.
Thanks for the informative post. It is suggested in the post that the lower waves could be due to emergence of less severe variants. Is there any evidence to support this hypothesis? So far all the data I've seen have put all the variants at equal severity once vaccination status is taken into account. I would be happy to learn otherwise.
Thanks for your kind comment and you are right to point out that there is no published evidence that variants are becoming less severe over time as far as I am aware. As you say it was only a suggestion on my part and I'm sure that vaccination is by far the largest factor.
The original report from the UKHSA on the latest Juno variant said it was no more severe than other variants but was more infectious. Interestingly, the ONS did report an infection hospitality rate based on linking data from the Winter Infection Survey with hospital records.
They reported that between 14 Nov 2023 and 29 Feb 2024, the risk of an individual being hospitalised with a Covid infection was approximately 0.45%. This corresponds to a 1 in 224 chance of those infected being hospitalized but increased to 1 in 30 for those 65 years and older.
Unfortunately, the ONS have not published a similar study based on data from the earlier Covid Infection Survey which would have provided some comparative data.
This is extremely clear and helpful -thank you!
One query (perhaps for a future post): why is there so little Covid around now?
After all, many people have not had vaccinations for 12+ months, no children vaccinated and it's been very wet so people must have been indoors a lot.
At the same time there are few mitigations in place. I was in hospital in Feb, I reckon only ~ 15-20% staff were masked and then not N95 standard. GPs not wearing them either and virtually nobody wears one in supermarkets etc.
Since I understand that vaccination potency declines after ~6 months, and new variants have replaced the former ones, I just cannot understand why there is not more Covid around.
I've queried experts a few times on Twitter about it, but nobody wants to answer!
Thanks for comment and it's good to hear you find the post of helpful. Answering your question is not straightforward but let me give you my thoughts.
While there was a decrease in Covid cases during the winter months, it wouldn't be accurate to say there was 'so little.' The Winter Infection survey data estimated that approximately 25% of England's population was infected between 11 November 2023 to 3 March 2024. It's likely that this, combined with the Autumn booster campaign, has increased population immunity levels enough to slow the spread.
I'm sure that this is only part of the story as other elements, especially self-isolation when infected, will also play a significant role. Having said that I do not understand why effective masks are not used in hospital where the risks are higher.
To clarify, I do not support the idea of promoting infection as a means to increase immunity levels in the population because of the risks associated with 'Long Covid'. In my opinion, vaccination is a much safer approach.
Many thanks, that's very helpful information.