July 9, 2021

expert reaction to latest data from the ONS infection survey

The Office for National Statistics (ONS) have released the latest data from their COVID-19 Infection Survey.

Dr Julian Tang, Honorary Associate Professor/ Clinical Virologist, University of Leicester, said:

“COVID-19 case numbers are still rising despite the ongoing vaccine rollout – why?

– most under 30s (including children) are not yet vaccinated

– single doses of vaccine are much less effective against the delta variant – only 33%: https://www.bmj.com/content/373/bmj.n1346  

– about 5% of vaccinees will just not respond to the COVID-19 vaccines anyway – and this is general for any vaccine – but we won’t know who they are as we don’t routinely test people post vaccination

– vaccine hesitancy/refusal is still quite high in some groups – particularly BAME populations – for various historical/cultural reasons – and we know the virus can spread more cause more severe disease in these populations 

– those vaccinated earlier may now be losing some of their antibodies – which may allow them to be infected by the delta variant – hence the plan for 3rd dose boosters in the autumn

“These rising case numbers may also result in long COVID in some unlucky individuals – more in those infected with no prior immunity compared to those who have been vaccinated or naturally infected – passing an increased healthcare burden to GPs and hospital specialist clinics.

“So on this basis – if we relax all restrictions on 19 July, and don’t vaccinate children, we may see increasing COVID-19 case numbers into the Autumn/Winter – pending any 3rd dose COVID-19 booster vaccination.

 – even though there will be fewer hospitalisations and deaths, the healthcare burden across both community and hospitals will increase from COVID-19.

“To this, we may have to include flu and other winter respiratory viruses, if they appear again once all restrictions are lifted – along with the usual winter exacerbations of chronic diseases – and all of this on top of the backlog of other non-COVID diseases that the NHS is catching up with now.

“An increased COVID-19 healthcare burden, built up over the summer may, unfortunately, then require diversion of NHS healthcare resources, yet again, to COVID-19, away from these other medical conditions.

“But as usual in the NHS, we will just have to deal with all of this, somehow.”

Prof James Naismith, Director of the Rosalind Franklin Institute, and University of Oxford, said:

“Today’s figures from the ONS (cover up to up to 3rd July ) shows that number of infections of covid19 from the third wave has continued to grow rapidly in the UK in younger age groups and especially in some areas.

“In Scotland prevalence has reached 1 %, England is not far behind with a shade over 0.6 %.

In the North East and West over 10 people in every thousand are currently infected, in the South East and East of England 3 people in every thousand. In older teenagers (school year 12) and young adults (up to 24) over 20 in every thousand are infected. Increases (albeit to a lower level) in infection are also seen up to age 50. Mercifully, the prevalence remains low in the over the 60’s.

“With the data from REACT earlier in the week, there is a consistent story. The virus is firmly established in younger people and growing rapidly. Although the vast majority of younger people will have very mild (if any) symptoms, a small percentage will have more serious illness. A small percentage of a very large number, is still quite a lot of people.

“Interestingly, ZOE and the daily test totals give almost identical results (around 33000 cases reported Thursday). This is a notable slowdown in the rate of increase and would be a hint of good news that the spread is levelling off.

“I do not believe we can draw this conclusion yet, in previous waves, at some points the trajectory of the daily test numbers was uncoupled from that seen in the survey data. The ONS survey data are the most reliable measure of the disease but these data have a delay. I realise this is incredibly frustrating but this is the trade off, you can immediate data with large uncertainties or more certain data but which is not up to the minute. Next week’s survey will be especially important.

“Irrespective of the trajectory, the delayed full opening has bought some time and more people are now doubly vaccinated. This is good news, the vaccines are highly effective and overwhelming safe. Without the vaccination campaign, this third wave would be require even stricter lockdowns in the UK to avoid a third catastrophic wave of deaths coupled to overloading of hospitals. Tragically, this is the fate that awaits less developed countries with low vaccination coverage.

“The uncertainty about trajectory as we head to the deadline is unsettling to the public and no doubt our politicians, who just want a “straight “answer. However, those who express absolute certainty about the future UK case number trajectory are misleading the public. It is important that politicians are informed by expert advice which highlights uncertainty on both “up” and “down” sides. The SAGE papers show robust analysis of the potential scenarios and I am confident our politicians are well informed. Quite properly, decisions about unlocking in the UK are (and must be) taken to be taken by our politicians.

“Our politicians have weighed the costs of two different courses of actions

–       delaying opening up / imposing further restrictions to allow more complete vaccine coverage without a large third wave

–       encouraging a large third large wave by removing restrictions

“The government has decided on the later course. In effect, the UK is going to use a combination of viral infection and vaccination to immunise the young.

“The government has said its course of action could lead to 100, 000 cases a day before the end of August. Given the planned relaxation on July 19, today’s ONS data and the REACT survey this seems a very plausible estimate. In fact, reaching 100, 000 is quite easy, it is less than two complete doubling cycles from yesterday’s number of positive cases. In the world that existed before covid19, delta would be expected to double in less than 4 days. Due to vaccination and altered behaviours, the virus is extremely unlikely to get close to this speed of doubling.

“It might be useful to outline some of the likely consequences of immunising by infecting large numbers of young people.

“We will create thousands of long covid suffers. Long covid is a debilitating and life altering condition which we poorly understand. We do not have a good estimates of who is most likely to suffer and how severity correlates with age and other characteristics. There seem to be few treatments nor am I aware of any good modelling which estimates the consequences of creating thousands of long covid sufferers.

“A very high circulating level of the virus, increases the opportunity for new variants. Chronically infected patients (infected but unable to rid themselves of the virus) present a high risk of generating new variants.

“Track and trace will remain an infective means of control, it will stop or break down if we are on a journey to 100, 000 a day. No system can usefully operate at this scale.

“Should we reach these high numbers the virus will spill over into some portion of the vaccinated elderly, no vaccine is 100 %.

“The extent to which hospitals become dangerously stressed is uncertain. The current rates suggest they will face serious difficulties but not impossibilities. I do not think we know enough to be confident of the outcome, but I am confident that we are going to find out.

 “What can we do?

“First, most importantly, unless you are extremely careful AND lucky, we will all be exposed to the virus. If you are not immune from vaccination or previous infection, then you are likely to catch the virus. From this it follows, that the unvaccinated vulnerable really need to get themselves vaccinated urgently. For young people, the vaccine essentially eliminates the risk to you for and is a “no brainer”. For the vulnerable who either can’t be vaccinated or know they have a poor immune response, they should consider shielding themselves until this wave burns out.

“Second, if you develop any symptoms stay and home, get tested. This is now about time, the more of us who isolate when infected, the more we slow the virus. As a result, more people will be immunised by vaccine and fewer by than infection.

“Thirdly ventilate indoor areas. It’s not possible to have too much fresh air with regard to the virus.

“Finally, as a doubly vaccinated 53 year old, the risk of me suffering serious covid19 is negligible and the mask offers me no direct protection. I dislike wearing it and will be happy never to do so again. However, I will remain masked at work, on the train and in shops to reduce the risk I pose to other less fortunate people because it is possible that I am infected without any symptoms. I also test myself twice a week, for the same reason. I will continue do so until the delta wave has passed. I hope others will do the same.”

https://www.ons.gov.uk/releases/coronaviruscovid19infectionsurveyuk9july2021

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.