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

28th March 2021

COVID LOCKDOWN in ENGLAND

EXIT STEP 1B,  CASES FLAT-LINING

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Preamble

We keep an eye on the published government figures and monitor the media to asses the level of risk for Seniors in the Malvern Hills district.

This page is currently 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 COVID test (updated)

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

There are now two types of test you can get. The accurate PCR test involving a throat and nose swab which is sent off to a laboratory for analysis and the quicker Lateral Flow test.

Click for government guidance on types of tests

Getting a PCR test

Click the link below for information on how to get a free NHS PCR 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 there is said to be good availability and you should get the result back in about 24 hours.

Getting a Lateral Flow test (new)

Lateral Flow tests can now be obtained at Great Malvern Library. This test is chiefly intended to screen working people who may be infected but show no symptoms and can either be pre-booked or you can walk in.

Click for WCC info about Lateral Flow Tests

Click for report in Malvern Gazette

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 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 March 2021

Summary

With the Easter holiday approaching, days lengthening, and the weather improving, people are beginning to feel in a cheery mood.

The vaccination programme has been going well and the COVID death rate and daily hospital admissions have continued to fall. However a return to near normal is not expected before mid June. Despite vaccination, Seniors are being asked to continue to comply with the lockdown restrictions. 

Since 8th March England has been in STEP 1A of the exit from lockdown which means children are back at school, and you could meet one other person outdoors. You can also visit a relative in a care home subject to a lateral flow test and wearing PPE.

The Prime Minister has signalled the 'stay at home' rule will be relaxed tomorrow (29th March) as STEP 1B of the gradual move out of lockdown begins. This allows either two households or a group of up to six friends to meet outdoors spaced 2 metres apart. So you will for example be able to meet grandchildren and friends outdoors and play golf and tennis.

Click for Easy Read Road Map out of Lockdown

A useful local summary of COVID cases can be found on the 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

Vaccinations

You can now see at a glance the percentage of people vaccinated by age group on the Worcestershire COVID-19 Vaccinations Dashboard.

Click to view Worcestershire COVID-19 Vaccinations Dashboard

The COVID vaccination programme has stepped up a gear with the opening of the mass vaccination centre at The Three Counties Showground. All those aged 50+ years should be able to book a jab on-line without having to wait for a call from their GP surgery.  Here is the link:

Click to book a Coronavirus vaccination - NHS (www.nhs.uk)

The target is to vaccinate all those aged 50+ with a first jab by the 15th of April.

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 a first jab only offers about 80% protection so you may still become ill though in most cases not seriously.

Despite deliveries of vaccine possibly slowing during April the governments still expects to vaccinate all those aged 18+ with a first jab by the end of July.

Newspapers report delivery of 17M Moderna jabs from the USA should start in April.

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

Vaccinometer as of 28th March 2021

Total first jabs are reported 30,151,287 to the 27th March. Second jabs are reported 3,527,481.

You will find this information summarised on the Vaccination tab of the Coronavirus Dashboard.

Number of cases

This week the average rate of people testing COVID positive in the UK reported by PHE on the 'Coronavirus Dashboard'  has flat-lined at about 5,500 new cases per day. The chart below shows how the daily rate has varied since 1st September.

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

During the last week the cumulative total of confirmed UK COVID cases reported by PHE rose by 36,459 to 4,333,042. A correction of -850 cases was made to the cumulative total on 27th March by PHE.

In Worcestershire there have now been 32,988 confirmed cases of COVID-19, an increase of 298 on the week. The average number of new cases fell from 57 to 47 cases per day suggesting the effective Reproduction Rate is below 1. Cases are higher in districts close to Birmingham such as Redditch, and lowest in the Malvern Hills.

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 March 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. The light green areas show how the rate of infection has fallen steadily across the UK since the start of the third 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.

Cases in Malvern have been falling steadily -  weekly cases to 23rd March are: North Malvern <3; Malvern Link <3; Pickersleigh <3; Barnards Green <3; Malvern Wells and Priory 5; Callow End and Hanley <3; Upton and Welland <3. The picture changes daily; it only takes one person to start a flare up.

Number of deaths

Statistics on COVID deaths are published by Public Health England, The Office of National Statistics, and NHS England; the daily death rate continues to fall steadily.

PHE figures

Public Health England reports that the cumulative total of COVID (28) deaths in UK hospitals and care homes has risen by 437 in the last week to 126,592 while the daily average has fallen from 91 to 62; see chart below which shows the actual daily death rate in red, and our forecast to 16th April in blue.

Daily UK death rate from 7th February to 28th March 2021 in red

Forecast to 16th April in blue

The forecast is based on an exponential function multiplied by a factor to take account of vaccinations.

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.

The ONS figures are broken down by District providing a glimpse of where deaths are occurring. The provisional cumulative total of COVID related deaths in Worcestershire reported by the ONS up to 12th March 2021 (week 10 of 2021) is shown below.

Provisional cumulative COVID deaths registered by ONS to 12th March 2021

Note: the ONS weekly death figures provide provisional counts of the number of deaths registered in England and Wales for which data are available. Numbers will rise as more death registrations are received. Consequently great care has to be exercised comparing one week's figures with another.

For example last week (week 9) 534 cumulative deaths were recorded in Worcestershire in 2021, and this week (week 10) 571 suggesting there had been a weekly increase of 37 deaths. However the arrival of late figures has updated the week 9 total to 556 so the increase this week (week 10) is reported as just 15 so far - but that figure will in turn increase due to late reports dribbling in.

In England and Wales 1,564 COVID related deaths have been reported by the ONS in the week to 12th March so far. Of these 256 were in a care home, 138 at home, 31 in a hospice, 1,127 in hospital and 12 elsewhere.

The highest number of hospital deaths (>19) by Lower Tier Local Authority were:

Birmingham 27, and Betsi Cadwaladr University Health Board 21.

The provisional COVID death toll for all weeks of the epidemic is shown in the following table for England and Wales. (The UK total is about 10% higher as deaths for Scotland and Northern Ireland have to be added).

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

Click for national ONS data on deaths (Excel spreadsheet)

NHS England figures

More recently in the seven days ending 27th March NHS England reported the cumulative total of deaths in Worcestershire hospitals rose by just 4 to 860.

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 March 2021

These headline figures show the number of COVID patients in hospital has continued to fall and is now 11% of the peak.

Daily admissions are continuing to fall slowly. In the past the steady state number of COVID patients in hospital has been roughly ten time the number of patients admitted daily, suggesting a fall to 3,400 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 Worcestershire Coronavirus Dashboard

Click for NHS England COVID-19 Hospital bed Activity

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 no more than 100 deaths per day in UK hospitals by the second week in April. COVID deaths as a percentage of new cases are already beginning to fall to very roughly 1% of new cases as a result of vaccination so a figure of 50 deaths per day is more likely.

Forecast for the week ahead

Trends suggest that during the next seven days (up to 4th April) the cumulative total of new UK COVID-19 cases reported by PHE on the Coronavirus Dashboard could increase by about  40,000 towards 4,374,000.

In Worcestershire up to 300 new cases of COVID-19 can be expected, and possibly up to 20 cases in the Malvern Hills district.

We estimate the number of COVID (28) deaths could increase by about 370 nationally towards 126,970 during the 7 days ending 4th April 2021.

In the county of Worcestershire, assuming a 1% death rate, the 298 new cases this week should translate to no more than 3 Worcestershire deaths per week by mid April.

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 and the behaviour of the public will put up the Effective Reproduction Rate of the virus, and how effective the vaccines will be at reducing the transmission of COVID-19. The best we can do is speculate about what might happen.

This week the effective Reproduction Rate of the virus is reported on the Coronavirus Dashboard between 0.7 and 0.9 suggesting rapid rollout of the vaccine, frequent testing of school children and their families, hand washing, masks, and physical distancing has been largely keeping COVID under control during STEP 1A of the exit from lockdown.

The picture varies across the country - the Zoe study reports cases have either flat-lined or started creeping up in parts of Wales, Scotland and the Midlands, while cases have been falling in London and the South. Infections are now mainly in those aged under 50 including teenagers.

Boris Johnson has signalled the government will proceed to STEP 1B on 29th March which permits either two households, or groups of up to 6 people to meet outdoors while keeping 2 metres apart - this could put up the COVID-19 Reproduction Rate, especially if people start disobeying the rules now the weather is improving.

COVID rule of six

Just over half the adult population has been vaccinated with one jab. 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 may 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 number of daily new cases in red and a falling exponential curve which was our forecast more than a month ago in blue, (assuming R<1).

The green projection is an illustration of what might happen if R rises a little above one causing daily cases to start rising 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 (R<1), or rise towards 12,000 (R>1).

By next Sunday 4th April the chart suggests the average number of daily new cases could lie in the range 2,000 to 8,000. In the last ten days cases have roughly flat-lined at about 5,500 and we are guessing that number is going to start rising.

Consequently we have chosen to apply a weighted average 60% in favour of districts rising, and 40% of districts falling next week giving a projection of 5,800 new cases per day by next Sunday - it will be interesting to see what actually happens.

If the vaccine breaks the link with hospitalizations and deaths then the level of daily cases should be of no great concern, providing cases do not spiral out of control.

The death toll will continue to mount until the vaccination programme eventually draws the UK COVID-19 epidemic to a close. We still expect the UK COVID death toll to reach 128,000 by the end of April 2021; see commentary. This estimate has changed little over the last month.

Advice for Seniors

The daily number of new  cases of Coronavirus has fallen a long way from the peak so we judge the risk to be approaching LOW for most Seniors in the Malvern Hills district who have been vaccinated more than 3 weeks ago; see our annex and riskometer opposite.

But remember, if you are elderly, 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 continue to 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 (for those who have not been vaccinated)

It's possible, despite a first jab, for up to 20% of Seniors to become ill with COVID, though not seriously in most cases, so it makes sense to continue taking reasonable precautions until the epidemic fizzles out.

The simple safeguards to remember are 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 lockdown you should not mix with other households indoors.

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 March update

Commentary

Apart from froth in the media, there has been little of importance to report this week as COVID deaths and hospital admissions continued to fall.

Tuesday was the anniversary of the first COVID lockdown and a one minute's silence was held in memory of the 126,000 victims of the epidemic. Boris Johnson held a COVID press briefing.

We read in the Worcester News that Lateral Flow Tests are now available from Great Malvern Library, and spotted there is a new Worcestershire Vaccination Dashboard showing how many people have been vaccinated - the figures are encouraging.

Earlier in the week there had been violent protests in Bristol by mobs complaining about proposed new police powers.

Labour MP Nadia Whittome proposed there should be a 'National Care Service'. That seems a good idea, but it's something the Gordon Brown government suggested more than 10 years ago.

Click for 2010 government paper on building a National Care Service

David Cameron also thought something should be done but little has happened. Perhaps the COVID epidemic will spark the Johnson government to initiate change.

The spat with the EU about vaccine deliveries has gone quiet.

Click for Bloomberg article about vaccine diplomacy

Labour MP Yvette Cooper argued for hauliers to be tested and from a BBC report it seems that is being considered.

There has been heated discussion in the media about vaccination certificates, but it seems to us the problem will go away once most people are vaccinated.

Vaccines

We wondered exactly what the efficacy numbers for the vaccine meant, and it appears to be simply a ratio of the protection compared to a person who has not been vaccinated.

Click for PHE blog analysing first vaccine effectiveness in the UK

So for example, using the efficacy numbers mentioned last week, after first vaccination you could be roughly half as likely to be infected, the likelihood you fall sick and have to be treated in hospital could be reduced by a factor of 5, and the chance you die from COVID could be reduced by a factor of 7.

Nationwide this is a useful protection, but in the short term while Coronavirus is still prevalent, the risk of death is not reduced to zero for the elderly. For example the risk of dying from COVID could still be approaching 1 in 15 for Seniors mixing freely in the community after a first jab. Hence the government's advice to continue observing the lockdown and social distancing until the prevalence of COVID fizzles out.

The vaccines can be expected to reduce the Effective Reproduction Rate of the present virus so that eventually COVID almost disappears in the UK; and once the prevalence is low the chance of Seniors catching COVID and dying from it in the UK should be small.

However if vaccinated Seniors were to go on holiday abroad this summer, to a country where COVID is prevalent, we think the chance of catching COVID and dying could be up to ~  5%; possibly even higher if  the South African and Brazilian variants were to be involved. Not a risk we would like to take, but some might happily accept.

There have been rumours a first jab only offers 10% protection against some new variants of concern. That figure seems to emanate from a South African study which looked at a number of young people becoming infected. Professor Tim Spector anticipates the present vaccines could nevertheless provide significant protection from severe illness. But even if they don't there is no need to worry as the government is planning booster jabs for the over 70s in the Autumn if needed.

Click for BBC story - Oxford jab offers less S Africa variant protection

Here again is the list of vaccines ordered by the UK -  you will see there is plenty of vaccine in the pipeline for delivery later in the year.

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 March.

In the last week just 4 additional deaths have been recorded compared to 4 the week before.

Present rate of new cases

This week, the average rate of infection per 100,000 population per week in England fell only slightly from 57 to 55. In comparison the figure for Worcestershire is 61, and that in the Malvern Hills 27. Redditch remains a hotspot at 131.

The probability of catching Coronavirus in the Malvern Hills district is now low, and as most Seniors have been vaccinated we judge the risk LOW (except possibly for the especially vulnerable).

The risk of death from Coronavirus for unvaccinated healthy teenagers is small so for them the risk is also LOW. The middle aged can suffer from debilitating Long COVID so for those that have not been vaccinated and live in an area where rates are not falling the risk might be judged LOW to MODERATE.

Forecast of death toll to the end of April

The rolling 7 day average death rate was 62 deaths per day on 28th March and the rate is continuing to fall steadily.

Assuming the death rate falls linearly to 16 deaths per day by the end of April, another 1,287 deaths can be expected by the end of April, which suggests the UK COVID-19 death toll will reach approximately 128,000.

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 128,000 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. But this pandemic is not played out and it could be a further 1 to 2 years before the 'dust' settles.

At the appropriate time there will no doubt be a full 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