Covid reader: 23 July

The great leap forward?

More or less: the freedom day gamble, BBC podcast

As restrictions were relaxed this week, accompanied by footage of joyous dancers in England going back to clubs for the first time in months, many people will be bracing for a subsequent rise in infections and hospitalisations. Cases in England are already rising, but what’s next after unlocking? Will we have to return to a cycle of lockdowns and restrictions on daily life followed by easing as case numbers fall, or something else – perhaps more akin to an endemic disease with much of the population given some protection through vaccination or post viral immunity?

More or less sought to answer the questions of where we are and where we will be in a series of interviews with eminent scientists, though ultimately the answer to the latter question seemed to be that it could go really well, or it could go really badly.

Julia Gog, deputy chair of the government advisory group SPI-M (Scientific Pandemic Influenza group on Modelling), said that unlocking now was a little bit of a leap in the dark. The position in January at the height of the second wave was like being at the top of a mountain, with high numbers of cases and hospitalisations, she said.

Through the vaccination programme and the gradual unlocking this year, the country had carefully descended the mountain and was near the bottom. Fully unlocking meant taking a chance and jumping the rest of the way – but that leap could be 10cm or 10 metres, she said. Continuing the metaphor, she said if it turns out to be the latter we would ‘pointlessly twist an ankle or break limbs when we could have climbed down carefully. The thing is, we just don’t know how high that last drop is. The distance left to fall is the number of people left to catch Covid until we reach population immunity level.’

Population immunity level is another way of saying herd immunity. In an interview with BBC2’s Newsnight on 19 July, New Zealand government advisor Michael Baker said that the relaxation of Covid rules in England ‘could be characterised as herd immunity by mass infection’. However, the government has repeatedly denied this is its aim.  

Back at More or less, Muge Cevik, who advises the Scottish government and sits on the Department of Health and Social Care’s expert committee Nervtag (New and emerging respiratory virus threats advisory group), also mentioned the h word.

Dr Cevik said there was a misunderstanding of the efficacy of vaccinations, which reduce rather than eradicate the chances of contracting the virus. Continued exposure to the virus could offset the protection afforded by the vaccine, and the vaccine does not necessarily reduce transmission, she added. ‘If there’s ongoing infection in the community, people will continue to be exposed to the virus. That’s the reason, I think, [why] it’s very difficult to meet the herd immunity threshold.’  

When asked how the pandemic would unfold in the autumn, winter and into 2022, she replied: ‘It’s a difficult question, but I think we will come to a point where at least we will have just sporadic, little flare-ups in the community, and be able to detect them with test and trace. It will basically become a manageable threat, and will continue to circulate in the community.’

It seems Covid will be with us for years to come, but the majority of cases will be in the vaccinated population – More or less host Tim Harford said this was ‘difficult to get your head around’, but it is exactly what would be expected with nearly 90% of adults currently having received at least one dose of vaccine.

Childhood vaccinations concern

WHO and Unicef statement

Much of the coverage of the effects of Covid-19 has been on its impact on routine healthcare – the growing backlog in elective activity, or increasing demand for mental healthcare, for example – but little has been said to date about the effect on childhood immunisations.

This week the World Health Organization and Unicef reported that 23 million children worldwide missed out on basic vaccines. In their first figures on the disruption to vaccination caused by the pandemic, the bodies said that most countries experienced drops in childhood vaccination rates in 2020, and it was likely that 17 million children did not receive a dose of a single vaccine last year.

These children – who often live in under-served areas with limited access to basic healthcare – were at risk of preventable diseases such as measles, polio and meningitis, having missed first or follow-on vaccinations.

Closer to home, the Department of Health and Social Care’s latest figures (up to week six of 2021) also show a drop in vaccination rates compared with 2019 and 2020. Uptake of the hexavalent vaccine (or six-in-one vaccine, which includes protection against hepatitis B, diptheria and tetanus) was down almost 20% compared with 2019. There was a similar figure for first MMR vaccine doses.

Turning the corner?

Scottish government, trends in daily data

To Scotland, where a recent spike in Covid positives appears to be on the way down, and this is backed by a range of data. Information collated by the Scottish government shows a gradual decline of patients in hospital over the last week – on 15 July 548 Covid patients were in hospital (five of whom had been in intensive care for more than 28 days). But by 22 July, the figure had dropped to 490, including two in intensive care for more than 28 days.

Medical and nursing staff absence due to Covid fell from more than 1,500 in the week ending 6 July to 1,165 in the week to 20 July.

However, ICU numbers continued to rise – up from 52 patients to 60 – and, unfortunately, deaths increased, with Scotland recording its highest daily deaths (22) in four months on 22 July.