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Coronavirus (COVID-19) epidemic weekly update for Malvern Seniors

COVID LOCKDOWN in ENGLAND

Alert Level dropped to 4 on February 25th

DAILY INFECTION RATE STILL HIGH

PM says 'STAY AT HOME'

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Preamble

We keep an eye on the published government figures to asses the level of risk in the Malvern Hills district, if there is an uptick in cases we will tell you.

This page is updated every Sunday between 1800 and 2400 hours GMT.

Information about Coronavirus can be found on the NHS website:

https://www.nhs.uk/coronavirus

How to request a test

In order to protect others it is important to book a test and self isolate if you feel unwell with COVID symptoms.

Click the link below for information on how to get a free NHS test if you think you have Coronavirus:

https://www.gov.uk/get-coronavirus-test

In case of difficulty you can try phoning the Coronavirus contact centre by dialing 119.

There is a 'walk through' COVID testing station at County Hall next to the Countrywide Centre; one has been set up at the Worcester Arena car park on the University of Worcester site in Hylton Road to serve the residents of St Johns; and there is also a drive through pod at the Worcester Royal Hospital.

The nearest COVID testing station is on the upper level of the car park below Great Malvern library on the corner of Victoria Road and Como Road.

These are not drop-ins and you will need to book - but it is said there is good availability and you should get the result back in 24 hours.

About the COVID Symptom Study app (Zoe)

Please consider helping others by downloading the COVID Symptom Study app onto your smart phone or Ipad and reporting how you feel either daily, or as you are able. Note that currently there is no desktop PC version for Windows.

For further details click this link: https://covid19.joinzoe.com

The Zoe app, which is easy to use, allows you to report whether or not you are feeling well and if you have had a test for COVID. This helps Kings College London monitor the spread and symptoms of the disease and give advice to government.

If you have had a jab there are new questions allowing you to enter the vaccine type and any side effects. If you do not see these questions you will need to update the app.

NHS COVID-19 contact tracing app (England)

Release of the long promised NHS COVID-19 contact tracing app for Apple and Android smartphones was announced on 24th September.

Click this link for NHS Coronavirus app information

The app provides a means for warning people who have unknowingly been in the presence of someone who has tested COVID positive

28th February 2021

Summary

Despite vaccination, Seniors are being asked to continue to comply with the lockdown restrictions. This is because the proportion of people vaccinated is not yet enough to suppress transmission of the virus. A return to near normal is not expected before mid June.

On average there are still about 9,000 new cases of COVID every day in the UK and ideally that needs to fall below 1,000 so that Test and Trace can better identify contacts through Local Public Health, and the likelihood of overseas travel is increased.

If you have not been vaccinated you need to be particularly careful in Malvern Link where cases have flared up in the last fortnight.

The complex road map out of the third lockdown announced by the Prime Minister last Monday has four steps which are summarised in our commentary.

The PM hopes to make an announcement about global travel by 12th April so that people can plan their summer holidays.

A summary of COVID cases in Worcestershire can be found on the improved Worcestershire Coronavirus Dashboard.

Note: use the arrow <> buttons at the bottom of the Dashboard screen to move between pages.

Click for Worcestershire County Council COVID-19 news

Click to skip to our commentary

Vaccination

COVID vaccine is being trickled out to GP surgeries (Primary Care Networks) and all of those aged 70+ years in Malvern should have been vaccinated by now. If not, contact your GP surgery to book an appointment

The group now being vaccinated includes those in the 50 - 69 years age band; if you are aged 65 - 70 you should already have had a letter from the NHS inviting you either to book an appointment at a vaccination centre, via the Internet, or to wait to be contacted by your GP surgery. The target is now to vaccinate those aged 50 - 69 by the 15th of April; if you are 50 you may not hear from the NHS before April.

Some good news is the planned mass vaccination centre at the Three Counties Showground will open next week.

If you are housebound and cannot get out you should contact your GP surgery to ask for a home visit.

According to the Zoe Symptom Study the vaccine offers no protection for the first two weeks but after 3 weeks most vaccinated individuals are protected. Remember that vaccines don't offer 100% protection so you may still become ill though hopefully not seriously.

The government's target is now to vaccinate all those aged 18+ by the end of July.

The bar chart below shows the population of the UK by age band, and the number of first jabs given, so that you can monitor progress of the vaccination programme.

Vaccinometer as of 27th February 2021

Total first jabs are reported 20,089,551 to the 27th February. Second jabs are reported 796,132.

NHS England publishes a daily tally of the number of people vaccinated in England on an Excel spreadsheet but it lags behind the numbers you will see reported on TV and doesn't provide a simple indication of the percentage of people vaccinated by age group in each district:-

Click for numbers of people vaccinated in England reported by NHS

Number of cases

This week the average rate of people testing COVID positive in the UK reported by PHE on the 'Coronavirus Dashboard'  fell from  11,602 new cases per day to 8,721. The chart below shows how the daily rate has varied since 1st September.

UK daily confirmed COVID cases 1st September to 28th February 2021

The good news is the average number of daily cases, which began levelling off last week, fell further this week. The bad news is that in some parts of the country, such as Malvern Link, cases are either staying level or going up.

During the last week the cumulative total of confirmed UK COVID cases reported by PHE rose by 61,045 to 4,176,554.

In Worcestershire there have now been 31,379 confirmed cases of COVID-19, an increase of 725 on the week. The daily number of new cases fell slightly from 117 to 104.

The breakdown by Worcestershire Lower Tier Local Authorities (LTLA) is shown in the following table, together with comparisons for Herefordshire, a more sparsely populated county, and the city of Leicester.

Note: these figures are based on the 'Cases by area' (whole pandemic) data set of the Coronavirus Dashboard.

Cumulative cases reported by PHE  in Worcestershire to 28th February 2021

Interactive map

At the bottom of the Coronavirus Dashboard (daily update) page there is an Interactive Map which is coloured to show the variation in infection rate across the country. This shows how the rate of infection has fallen across the UK since the start of the lockdown.

Click for Interactive Map of COVID cases

Note: the Interactive Map works on desktop PCs but it's possible you may encounter difficulties using a tablet or smartphone.

Recent weekly cases to 23rd February are: North Malvern 10; Malvern Link 26; Pickersleigh 7; Barnards Green 5; Malvern Wells and Priory 3; Callow End and Hanley 3; Upton and Welland 6. The picture changes daily.

Alfrick and Leigh, North Malvern and particularly Malvern Link are COVID hotspots.

Number of deaths

Statistics on COVID deaths are published by Public Health England, The Office of National Statistics, and NHS England; these show the third wave daily death rate has passed its peak and begun to fall.

PHE figures

Public Health England reports that the cumulative total of COVID (28) deaths in UK hospitals and care homes has risen by 2,269 in the last week to 122,849 while the daily average has fallen from 488 to 324; see chart below which shows the actual daily death rate in red, and our old forecast to the 7th March in blue.

Daily UK death rate from 27th Dec to 28th February 2021 and forecast

The blue curve shows the expected direction of travel; actual cases are a tad higher.

Click to view the UK government Coronavirus Dashboard

In comparison averaged over recent years 1,700 people die daily from all causes.

ONS figures

The Office of National Statistics (ONS) separately reports registered deaths in England and Wales where COVID-19 is mentioned on the death certificate. The ONS figures lag the PHE figures by 10 - 14 days and do not include NI and Scotland, so are lower than the figures published by PHE.

The ONS figures are broken down by District providing a glimpse where deaths are occurring. The cumulative total of COVID related deaths in Worcestershire reported by the ONS up to 12th February 2021 (week 6 of 2021) is shown below.

Cumulative COVID deaths registered by ONS to 12th February 2021

In the week ending 12th February, there were 54 COVID related deaths in Worcestershire, of which 15 were in care homes, 3 at home, 1 in a hospice and 34 in hospital; a fall of 35 on last week.

In total in England and Wales 5,896 COVID related deaths were reported by the ONS in the week to 12th February, a fall of 1,722 (22%) on the week before.

The highest number of hospital deaths (>29) by Lower Tier Local Authority were:

Leicester 30, Cheshire West 34, Bournemouth Christchurch and Poole 48, Dorset 40, Buckinghamshire 33, Tendring 35, Manchester 33, Liverpool 36, Sefton 36, Wirral 40, Sheffield 33, Sunderland, 37, Birmingham 113, Dudley 30, Sandwell 49, Walsall 42, Leeds 36, Croydon 32, Betsi Cadwaladr University Health Board 46, Cardiff and Vale University Health Board 30.

Once again Birmingham had by far the highest death rate.

The cumulative total of COVID related deaths in England and Wales recorded by the ONS for all weeks of the epidemic rose to 131,041.

COVID death toll in England and Wales to 12th February 2021 (source: ONS)

Click for national ONS data on deaths (Excel spreadsheet)

NHS England figures

More recently in the seven days ending 28th February NHS England reported the cumulative total of deaths in Worcestershire hospitals rose by 24 to 825.

Click for NHS COVID-19 Daily Deaths

Healthcare numbers

The UK government Coronavirus Dashboard includes important information about healthcare statistics.

Headline summary of patients in hospital as reported 28th February 2021

These headline figures show the number of COVID patients in hospital has continued to fall and is now roughly 35% of the peak.

The number of patients on ventilators is gradually falling.

Daily admissions are down only slightly this week. The steady state number of COVID patients in hospital seems to be roughly ten time the number of patients admitted daily, suggesting a fall to 11,000 patients is on the way.

Tabulated figures for  bed occupancy in Worcestershire Acute and Care hospitals can be found on the NHS England website, but it is quicker to look at a graph at the bottom of the Worcestershire Coronavirus Dashboard homepage which shows at a glance the number of beds occupied by COVID patients in Worcestershire Acute hospitals.

Click for NHS England COVID-19 Hospital bed Activity

Click for Worcestershire Coronavirus Dashboard

Notes on projected figures for deaths

Statistician Sir David Spiegelhalter of Cambridge University speaking on BBC TV last year said that, using his rule of thumb, hospital admissions were likely to be about 10% of reported new cases, one week after symptoms; and deaths were likely to be about 2% of new cases, 2 to 3 weeks after that - which would point to about 175 hospital deaths per day by the middle of March.

Once a large proportion of the population has been vaccinated this rule of thumb will no longer apply, and COVID deaths should fall sharply.

Forecast for the week ahead

Trends suggest that during the next seven days (up to 7th March) the cumulative total of new UK COVID-19 cases reported by PHE on the Coronavirus Dashboard could increase by about  54,000 towards 4,231,000.

In Worcestershire up to 700 new cases of COVID-19 can be expected, and possibly up to 90 cases in the Malvern Hills district.

We estimate the number of COVID (28) deaths could increase by about 1,850 nationally towards 124,700 during the 7 days ending 7th March 2021.

In the county of Worcestershire, assuming a 2.4% death rate, the 725 new cases this week could translate to about 17 Worcestershire deaths per week by mid March, but if cases are mostly confined to younger age groups it could be less.

Longer term forecast

It is once again impossible to provide a long term forecast this week due to uncertainty about how much the relaxation of government restrictions will put up the Effective Reproduction Rate of the virus and the extent to which vaccines will reduce the transmission of COVID-19. The best we can do is speculate about what might happen.

Though the drop in daily cases faltered last week, the curve is once again approaching an exponential fall so that a further decline to 7,000 new cases per day is possible by the time children return to school on 8th March.

Before vaccination, 7,000 new cases per day would have led to 700 daily admissions to hospital, occupation of 7,000 hospital beds, later followed by 140 deaths per day. Vaccination should reduce these numbers further, but by how much we are not sure.

Easing of the lockdown is likely to push the Reproduction Rate above one causing the daily infection rate to rise in some parts of the country, as illustrated in the chart below, leading to a fourth wave of the epidemic. Let's hope rapid rollout of the vaccine, frequent testing of school children and their families, hand washing, masks and physical distancing will keep COVID under control without the need for a fourth lockdown.

By mid April only half the population will have been vaccinated. Now we have seen no official estimate of the basic reproduction rate of the Kent virus, but were it to be as high as 5, vaccination alone would only reduce the effective reproduction rate to 2.5 and so the wearing of masks and physical distancing beyond April could still be needed, possibly up to and beyond the ending of the third lockdown in June.

Projected new daily cases to 20th April 2021

The chart above shows the falling number of daily new cases in red and an exponential curve, which was our forecast 2 weeks ago, in blue. The green projection is an illustration of what might happen next. We have assumed cases fall to about 7,000 per day when schools go back on 8th March and then rise exponentially but at a rate half that of the third wave. An adjustment has been made for vaccination, including take up of the vaccine (85% allowing for those under 18), and effectiveness (80%). Based on these assumptions you will see towards the end of April new daily cases could either fall to 1,000 a day in the very best case, or rise towards 20,000.

If the vaccine breaks the link with hospitalizations and deaths then such figures may be of no great concern. We'll just have to wait and see what happens.

The death toll will continue to mount until the vaccination programme eventually draws the UK COVID-19 epidemic to a close. We now expect the UK COVID death toll to reach 131,000 by the end of April 2021; see commentary.

Exactly what happens will depend on how carefully the government relaxes the restrictions, the effectiveness of test and trace, any change in the lethality of new variants of the virus, and most importantly the speed of the vaccine rollout.

Advice for Seniors

The daily number of new  cases of Coronavirus is still unacceptably high, and we judge the risk remains MODERATE to HIGH for Seniors living in the Malvern Hills district who have not been vaccinated; see our annex and riskometer opposite.

Recent cases have been particularly high in North Malvern and Malvern Link.

The risk could be approaching LOW for most Seniors who have been jabbed more than 3 weeks ago.

If you have not been vaccinated and catch COVID there is a significant chance that you will either die or your long term health may be seriously damaged, so take care to protect yourself and those you love. 90% of COVID deaths are in those aged over 60 years according to NHS England statistics.

Click for our risk of death table

So if you are offered a jab you should grasp the opportunity with both hands.

The simple safeguards to remember are still to:

• wash your HANDS thoroughly, using soap and hot water, for 20 seconds, including after handling deliveries to your home, to kill virus picked up from contaminated surfaces see note 1;

• wear a FACE mask when unavoidably near other people for example when shopping, visiting hospital or the chemist;

• SPACE at least 2 metres apart from others see note 2;

• keep TIME near others as short as possible, see note 3;

• self-isolate and book a test if you have COVID-19 symptoms (new continuous cough, fever or loss of, or change in, sense of smell or taste).

Hence the mantra:-

 HANDS, FACE, SPACE, TIME - GET A TEST if you feel unwell.

Pulse Oximeter

A doctor in Bournemouth speaking on the evening news suggested that if you were sick with COVID at home it would be a good idea to have a little device known as a Pulse Oximeter handy (see photo on right). This measures the oxygen saturation in the blood and pulse rate by clipping the device on a finger and pressing a button; the reading should normally be at least 97%.

If the reading falls to about 93% you should call your doctor for advice, and if the reading is consistently below 92% you should consider calling an ambulance or visiting A&E.

Pulse Oximeters can be purchased from Amazon for £18 to £25; alternatively your doctor's surgery might loan you one if you are unwell and have tested COVID positive.

Remember, if you have symptoms of COVID-19 at home and can't count from one to ten out loud due to shortness of breath, you should immediately call your GP, 111 or 999 for advice.

Click for UK government Coronavirus guidance on what you can and cannot do

Notes:

1) Wash your hands thoroughly before touching your face to avoid transferring virus from contaminated surfaces to your mouth, eyes and nose. If outdoors use hand gel.

2) Two metres is further than you think - roughly an arm and a walking stick away.

3) During the National Lockdown you should not mix with other households.

Minimise exposure time if you unavoidably find yourself mixing in a confined setting - an invisible mist of virus can build up in the air if the space is shared with an infectious person; imagine people exhaling cigarette smoke. Unless you wear a well fitting FFP3 hospital grade face mask you can breath this in; a face covering will offer little protection. The likelihood and extent you get sick will depend on the density of the airborne virus, which can be reduced by ventilation, and the duration of your exposure.

Annex to 28th February update

Commentary

Discussion in the media has been focused on the route out of lockdown, vaccination certificates and expectations for summer holidays.

The main news this week has been the Prime Minister's announcement of the much awaited Road Map out of the third lockdown on Monday evening.

Click to read PM's statement on cautiously easing lockdown restrictions

This was followed by a briefing by the Education Secretary on Wednesday about children going back to school. On Thursday the COVID Alert level was reduced to 4 meaning that hospitals were no longer at risk of being overwhelmed.

On Friday there was a press briefing by the Health Secretary and Professor Van Tam expressing concern that in some areas cases of COVID had stopped falling and were rising in others.

The Road Map is rather complicated involving 4 tests, 4 steps, and 4 reviews. Here is our summary:-

Road map tests

These are essentially the assumptions made by government:

• The vaccine deployment programme continues successfully.
• Evidence shows vaccines are sufficiently effective in reducing hospitalizations and deaths in those vaccinated.
• Infection rates do not risk a surge in hospitalizations which would put unsustainable pressure on the NHS.
• Our assessment of the risks is not fundamentally changed by new Variants of Concern.

Road map steps

The four steps are described in a summary statement.

Click for summary of road map out of lockdown

You will have to read the guidance and decide what it means for you.

Click to read guidance

The road map suggests despite being vaccinated Seniors can't stay overnight with grandchildren for another 2 to 3 months.

Road map reviews

The PM said there would be four associated reviews to answer these questions:-

• To assess for how long it will be necessary to wear face masks and maintain social distancing.
• To  review global travel and report by 12 April so people can plan for the summer.
• To review the possibility of COVID status certification.
• To review the safe return of large events.

Vaccines

The target now is to vaccinate those aged 50 - 69 by the 15th April, but from mid March the priority will be to give second jabs to those aged 70+ years. Obviously the government think there will be enough vaccine to do both.

The target for vaccination of those aged 18-49 has been brought forward to the end of July 2021 and this will be facilitated by the opening of the mass vaccination centre at The Three Counties Showground

Here is a list of the vaccines ordered by the UK.

Table of vaccines ordered by the UK government

Recent deaths in Worcestershire hospitals

The table below shows all COVID deaths in Worcestershire hospitals reported by NHS England to 27th February.

In the last week 24 additional deaths have been recorded compared to 20 the week before.

Present rate of new cases

This week, the average rate of infection per 100,000 population per week in England fell from 128 to 108. In comparison the figure for Worcestershire is 136 and that in the Malvern Hills 132.

The rise in the Malvern figure reflects clusters of recent cases in Alfrick, North Malvern and Malvern Link - it's not over yet. Seniors awaiting vaccination should continue to be careful.

The probability of catching Coronavirus in the Malvern Hills is moderate, but combined with the significant risk of death makes us view the overall risk to Seniors, prior to inoculation,  as MODERATE to HIGH.

The risk of death from Coronavirus for healthy teenagers is exceedingly small so for them the risk is LOW, whereas the middle aged can suffer from Long COVID so for them the risk might be assessed MODERATE.

Forecast of death rate during March and April

The average UK COVID daily death rate peaked at 1,200 deaths per day about 25th January and has begun to fall principally due to physical distancing. In coming weeks the vaccination programme should lead to a slightly faster fall in the death rate with deaths possibly tailing off to 100 deaths per day or less by the end of March.

The rolling 7 day average death rate was 324 deaths per day at the end of February. Assuming the death rate falls linearly to 100 deaths per day by the end of March, then there could be 6,500 further deaths in March, and if the death rate fell to 40 deaths per day by the end of April, another 2,100 deaths in April.

Adding these 'back of the envelope' numbers suggests the UK COVID-19 death toll could reach 131,449 by the end of April.

Forecast UK COVID-19 epidemic death toll by the end April 2021

Another projection of the future COVID-19 death toll and daily deaths can be found on The Institute for Health Metrics and Evaluation website:

Click for IHME projection of COVID-19 deaths

The latest projection is for 148,000 deaths by the end of April which probably won't be far off the figure reported by the ONS.

At the start of the epidemic in March the Chief Scientific Adviser, Sir Patrick Valance, suggested a death toll of 20,000 would be a good outcome; on the other hand, Professor Neil Ferguson of Imperial College warned in some scenarios the death toll might be as high as 250,000; while we thought, in the very worst case assuming up to 1% of the UK population died the outcome might have been nearer 400,000 taking into account some build up of herd immunity.

So how well will the UK have done? When Sir Patrick Valance spoke off the top of his head there had been few deaths and he clearly did not want to 'scare the horses'. Professor Neil Ferguson was nearest the mark. A few might consider an outcome of 131,000 deaths a fair result compared to a greater number of people dying in a very short space of time, more being permanently disabled by Long COVID, and temporary collapse of the NHS. Members of the Labour Party and others will no doubt say the UK has done very poorly compared to the best performing countries such as Australia, New Zealand and Singapore where deaths have been much lower, not to mention the enormous expense of supporting those out of work and huge damage to the economy.

Ultimately there can be no winners or losers, but there must eventually be a thorough inquiry to learn lessons for the future.

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Summary of Links

Symptoms

About COVID symptoms

Article about the effects of Coronavirus on the human body

Reporting and how to obtain a test

How to get a test

https://www.nhs.uk/coronavirus

About joining the Zoe COVID Symptom Study:

 https://covid19.joinzoe.com

Guidance

UK government Coronavirus guidance

Tiers

Guidance on tiers: what you need to know

Government postcode checker to find tier for other areas

Statistics

UK government Coronavirus Dashboard

Coronavirus Dashboard Interactive Map

ONS data on deaths in England and Wales (Excel spreadsheet)

NHS England COVID-19 Daily Deaths

NHS England COVID-19 Hospital Admissions

NHS England vaccination statistics

Reports

ONS Coronavirus (COVID-19) Roundup

The bigger picture

Worldometer summary of coronavirus cases worldwide

European Centre for Disease Prevention and Control info

https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases

World Health Organisation info

https://covid19.who.int/

Window on the USA

Centre for Disease Control (CDC)

American Association of Retired People (AARP)

Worcestershire

Help:

http://www.worcestershire.gov.uk/here2help

Worcestershire County Council COVID-19 information:

http://www.worcestershire.gov.uk/coronavirus

Here you will find a useful link,

'Website: Number of new cases by date in Worcestershire'

which displays interesting COVID charts and statistics for Worcestershire

COVID Outbreak Control Plan

Miscellaneous

Spanish Flu

Dr Jeff Kildea's commentary about the 1919 outbreak of Spanish Flu in Australia

Views of Martin McKee, Professor of European Public Health

Follow Martin McKee on Twitter

SAGE membership

Scientific Advisory Group for Emergencies (SAGE)

Scottish government:

Link to Scottish Government website

Link to Postcode checker for COVID restrictions by protection level in areas of Scotland

Welsh Government:

Guidance on COVID alert levels in Wales

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The interpretations and opinions expressed are our own