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Friday 1 January 2021

The darkest hour is just before the dawn

Plague year

The UK saw another record daily high of 55,982 COVID-19 cases yesterday, following on from more than 50,000 cases reported on each of the previous two days, and this is in spite of seemingly endless tiered restrictions (essentially months of lockdown, in all but name). 

In spite of this, and the mounting reported death toll, the darkest hour is just before the dawn, and there will soon be some light at the end of the tunnel.

The views on this year and the unprecedented restrictions on civil liberties have tended to range from the 'scamdemic' or 'casedemic' conspiracy theorists to outright Armageddonists.

There's enough data out there for 2020 now to make some kind of worthwhile assessment or review, and as is often the case, the reality lies somewhere in the middle of the two extremes.

Deaths up 7 per cent 

The official toll of 73,912 dying with COVID or within 28 days of a positive test result sounds utterly catastrophic, and this year will certainly outstrip the nasty winter bouts of the 'flu of recent years (in January 2018 there were 66,000 total deaths, with 22,000 deaths associated with the 'flu in the 2017/18 season, for example). 

The median age of UK COVID death has been 82.4 years, being a coronavirus which is most deadly to the elderly. 

The UK government itself has suggested that excess deaths are a key metric to follow. 

Hearteningly excess deaths have not been anywhere near as striking through the second wave as they were during April and May, but still deaths are running above their 5-year average. 


Source: BBC

Total deaths over the calendar year were 71,200 or 7 per cent higher than expected, with 10,400 of those occurring during the second wave, so 2020 will go down the worst year for mortality in a dozen years. 


Source: ONS

It's true that life expectancy has increased consistently over the past few decades, so in a broader context 2020 will only rank as somewhere in the middle of the pack in terms of registered deaths per 100,000.


Source: ONS

Jabs army

The Office for National Statistics reported yesterday that 944,539 first doses of the vaccine had been administered by the December 27 cut-off, accounting for about 1.39 doses per 100 people, and implying that by the end of calendar year 2020 about 1.1 million doses will have been administered. 


This is a great start, although Israel is by far and away the undisputed gold standard performer, crunching through 1 million doses and reaching an astonishing 12 per cent of its entire population by New Year's Eve.

The figures for UK deaths within 28 days a positive test help to explain why priority is being given to those aged over 80, moving down through the age brackets thereafter.

Vaccinating the population aged over 70 would remove almost all COVID reported deaths, and vaccinating all those aged over 65 would also take out most COVID hospitalisations, thus freeing up healthcare capacity in the NHS.


Source: ONS

Oxford approval

The brighter news is that this week the UK government approved emergency use of the AstraZeneca Oxford vaccine, although Health Secretary Hancock looked a little sheepish when asked whether the doses would be delivered at the widely expected two million per week. 

The reason for the evasive answers soon became clear, that being that only 530,000 doses were ready to go, rather than the millions of doses previously promised (although it was announced yesterday that a further 407,000 will be good to go on Monday, bringing the total up to 937,000 doses). 

AstraZeneca has reportedly pledged that two million doses per week will become available by mid-January as vial manufacturing bottlenecks are overcome, and the NHS purportedly stands ready to administer doses as fast as they're delivered, assisted by a "jabs army" of volunteers (Brits tend to be very good at volunteering cf. the London Olympics, of which the 70,000 heroic volunteers were the lifeblood of the Games). 

Dicing up the UK's population pyramid by age cohort and risk it becomes clear how this is now a race against the clock to save lives and get the economy reopened without tiered restrictions by Easter Monday on April 5.


A race against time

Given that UK borrowing is now projected to blow out to a mind-boggling £400 billion this financial year as the endless cycle of lockdowns and tiered restrictions continues, almost any cost can be justified to accelerate a vaccine rollout. 

Vaccinating just once all of the over 70s, residents in care homes and aged care workers, and healthcare workers, will likely require about 12 million doses.

Include all of those aged over 65 to limit hospitalisations and the figure increases to about 15 million doses.

At the current rate of progress this would take at least until the third quarter of the calendar year, but ramping up to two million per week by mid-January would likely see COVID deaths (and then hospitalisations) dropping away sharply by the end of February, even after allowing for a lag effect. 


Easter Monday is 94 days or 13.4 weeks away, thus delivering 15 million initial doses would require 1.1 million doses per week, or more than tripling the rate of administration to 160,000 per day, so there's much work to be done. 

It's also worth remembering that pandemics don't last forever, and the virus itself is now potentially 'immunising' at least 100,000 plus people per day. 

Officially there have already been 2½ million known UK positive cases of COVID this year, but the real number cannot be known - extrapolating from deaths the figure could be nearer to 10 million, while anywhere from zero per cent to a quarter of the population may already have immunity or protective T-cells (depending upon which study you believe). 

The darkest hour is just before the dawn, and whatever the reality it's now become a real race against the clock for the UK to get vaccines rolled out as swiftly and effectively as possible.