Angus and Rosemary's Miscellany

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

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.

There is also a new mental health questionnaire.

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.

NHS app

You will need the NHS app installed on your smartphone and be registered with the NHS in order to display your vaccination status.

Note: this is not the NHS COVID-19 app

13th June 2021

Summary

England moved to STEP 3 out of lockdown on Monday 17th May 2021 and over the Spring Bank Holiday people mixed more freely and travelled all over the country.

The situation is similar to that which sparked the second wave after the Autumn Bank Holiday and the third wave after the Christmas Holiday, except this time the population is partway through being vaccinated.

Despite vaccination and due to the more transmissible Indian or Delta variant cases of COVID-19 have begun to rise exponentially in some parts of the country, though this week there is some evidence surge testing is beginning to dampen this down. Cases in the Malvern Hills remain low.

The COVID vaccination programme continues to advance steadily but the recent rate of just 160,000 first jabs per day will not be enough to vaccinate all those aged 18+ by the end of July so we must hope the government quickly ramps up the vaccination rate.

The BBC 'hints' there are large unused stocks of Astrazeneca vaccine which could be given to the under 40s to speed up the vaccination process were this thought to be necessary.

We are now in the fourth wave of the epidemic which we speculate started on or about 14th May seeded from a 'couple of hundred' cases of the Indian or Delta variant. It's possible this could peak at about 11,000 cases per day in the next fortnight and then start falling due to vaccination and surge testing; unlike last January when cases reached 60,000 per day resulting in the UK going into a third lockdown.

Because of the fourth wave, it seems likely the government will announce tomorrow that exit from the present measures on 21st June will be delayed for a few weeks until more people are vaccinated.

Some good news is that the average COVID-19 death rate has remained low at just 9 deaths per day so far, but an increase to 50 deaths per day cannot be ruled out during the next two months.

No doubt the government will be keeping a very close eye on daily hospital admissions which though small have been creeping up over the last three weeks.

For the time being life seems very much back to normal in the rural Malvern Hills where cases are low.

Click for guidance on what you can and cannot do

Vaccinations

The average daily UK vaccination rate (of first plus second jabs) has remained fairly flat at about 500,000 jabs per day for several weeks, whilst we imagined vaccinations would ramp up.

You can 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

There is a mass vaccination centre at The Three Counties Showground.

While the government still hopes to offer a first jab to all those aged 18+by the end of July 2021 it seems to us that first vaccinations should ideally be stepped up towards 300,000 jabs per day to be certain of meeting the 18+ target.

Extension of vaccination to children aged 12+ in the summer is likely to follow adults aged 18+.

Those aged over 25 years on 1st July can now 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)

Alternatively you can wait to be contacted by your GP surgery - this may either be by a phone call, or a text message on your mobile.

Our GP surgery is now offering jabs to those aged 20+

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

If it is 8 weeks since your first jab and you haven't been offered an appointment for your second jab, contact your GP surgery.

Two jabs are now thought necessary to protect against the Indian or Delta variant of COVID-19.

Two jabs are said to give 88% protection from symptomatic illness using the Pfizer vaccine, and just 60% with Astrazeneca; so it's possible vaccinated Seniors could become ill, though not seriously in most cases.

Tourists may have to wait until 2 weeks after their second jab before going abroad.

The bar chart below shows the population of the UK by age band (1), and the number of first (2) and second jabs (3) given, so that you can see overall progress of the vaccination programme in the UK.

COVID vaccination bar chart

Vaccinometer as of 13th June 2021

Total first jabs are reported 41,551,201 to the 13th June. Second jabs are reported 29,792,658.

In comparison the population of the UK, including children, is about 66,000,000

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

Vaccinations Worldwide

A glimpse of the worldwide vaccination situation can be found on the Our World in Data website.

Click for worldwide statistics

There are many charts which some may find confusing, but look for the chart showing share of people who have received at least one dose of COVID-vaccine.

Click for chart showing % vaccinated

Hint: click TABLE tab to see more countries.

Vaccination programmes in the EU are ramping up. The share of people who have received at least one dose to 12th June are Germany 48%, Belgium 48%, Spain 45%, Italy 48% and France 45%. In comparison 61% of the UK population (including children) has received at least one dose.

India 14%, Russia 12% and Japan, 12% are lagging behind, whilst in Africa few have been vaccinated.

Number of cases

During the last week the average rate of people testing COVID positive in the UK reported by PHE on the 'Coronavirus Dashboard' rose from 4,785 new cases per day to 7,145. The chart below shows broadly how the daily rate has varied since 1st September.

COVID daily new cases

UK daily confirmed COVID cases 1st September to 13th June 2021

The chart below shows in more detail how daily cases have varied between 1st March and the 12th June.

Daily COVID cases to 2nd May 2021

UK daily new confirmed COVID cases 1st March to 12th June 2021

Currently there seems to be a background level of about 2,000 cases per day spread across much of the country, with cases recently rising exponentially in COVID hotspots such as Bolton and Blackburn where higher levels of vaccination are needed, although there seems to have been some slowing down possibly due to surge testing in the last few days.

During the last week the cumulative total of confirmed UK COVID cases reported by PHE rose by 48,921 to 4,565,813.

In Worcestershire there have now been 33,951 confirmed cases of COVID-19 an increase of 152 on last week.

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: the cumulative cases are copied from the 'Cases by area' (whole pandemic) data set of the Coronavirus Dashboard. The weekly increase is the difference between this week and last week's total.

Districts of Worcs	Cases	Weekly increase	Population
Bromsgrove	6,353	+58	98,529
Malvern Hills	2,848	+8	77,545
Redditch	6,340	+28	85,317
Worcester	6,269	+22	103,542
Wychavon	6,503	+19	126,240
Wyre Forest	5,638	+17	100,957
TOTAL	33,951	+152	592,130
COMPARE WITH
County of Hereford	7,262	+56	195,000
Leicester (city of)	38,360	+449	400,000

Cumulative cases reported by PHE in Worcestershire to 13th June 2021

The weekly increase is indicative; the seven day average by area, which varies day to day, is an alternative metric that can be found on the Coronavirus dashboard.

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.

More of the map is turning from yellow to pale green suggesting infection rates have been creeping up across the country. There are hotspots particularly around Blackurn, Bolton and Manchester in the NW; also Bedford, South Ayrshire, Glasgow, Edinburgh and Dundee.

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.

New cases in Malvern are currently too low to register on the map.

Number of deaths

Statistics on COVID deaths are published by Public Health England, The Office of National Statistics, and NHS England.

PHE figures

Public Health England reports that the cumulative total of COVID (28) deaths in UK hospitals and care homes has risen by 64 in the last week to 127,904 while the daily average has flat-lined at about 9 deaths per day.

UK COVID death rate

COVID-19 death rate 1st April to 13th June 2021

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 Northern Ireland and Scotland.

Click for national ONS data on deaths (Excel spreadsheet)

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 28th May 2021 (week 21 of 2021) is shown below.

Note: the numbers are from the ONS Death Registrations-Pivot table

Districts of Worcs	Deaths 2020	Deaths 2021	Week 21	Population
Bromsgrove	164	101	0	98,529
Malvern Hills	61	83	0	77,545
Redditch	108	85	0	85,317
Worcester	87	116	1	103,542
Wychavon	157	119	0	126,240
Wyre Forest	171	105	1	100,957
TOTAL	748	609	2	592,130

Provisional cumulative COVID-19 deaths registered by ONS to 28th May 2021

In the last week reported there has been one COVID death in hospital in Worcester, and a further death in a care home in Wyre Forest.

In England and Wales 95 COVID-19 related deaths were reported by the ONS in the week to 28th May; 12 less than last week. Of these 10 were in a care home, 22 at home, 1 in a hospice, 60 in hospital and 2 elsewhere.

Note: summation of rows 9 to 339 of the ONS deaths Registrations-Pivot table; the ONS spreadsheet has been revised due to boundary changes.

The provisional UK COVID-19 death toll for all weeks of the epidemic can be found on the Deaths tab of the Coronavirus Dashboard.

NHS England figures

The table below shows latest COVID deaths in Worcestershire hospitals reported by NHS England to 12th June.

Worcestershire	Cumulative deaths	Past week
Acute hospitals	808	0
Care hospitals	63	0
TOTAL	871	0

Click for NHS COVID-19 Daily Deaths

Healthcare numbers

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

Hospital cases (UK)	Number	Change since last week
Patients currently in hospital	1,089	+157
Patients on ventilation	154	+20
Patients admitted daily	187	+33 (last week amended to 154)

Headline summary of patients in hospital as reported 13th June 2021

Daily hospital admissions expressed as a 7 day average fell to 100 about 20th May but has crept up to 157 and can be expected to increase further as a result of new cases. Previously hospitals only admitted very sick COVID patients and it could be less sick patients are now being admitted.

In the past, the steady state number of COVID patients in hospital has been roughly ten time the number of patients admitted daily. This ratio should fall as fewer patients require intensive care and are discharged earlier due to vaccination.

Last year roughly 10% of new cases were admitted to hospital and of those at least 1 in 5 died.

The latest figures suggest about 5% of new cases are being admitted to hospital. If it is assumed that due to vaccination just 1 in 15 of these now dies then 157 hospital admissions per day may suggest up to 10 UK deaths per day in the second half of June.

Note: these ratios are very rough and ready and should change as more of the population is vaccinated.

Tabulated figures for bed occupancy in Worcestershire Acute and Care hospitals can be found on the NHS England website.

Click for NHS England COVID-19 Hospital bed Activity

You can also obtain a snapshot of bed occupancy from the Coronavirus Dashboard daily update page, by entering your postcode at the bottom of the page, which will show data for Worcestershire; then find and click All Health Data to see bed occupancy. This information has returned to the Worcestershire Coronavirus Dashboard.

Click to view Worcestershire Coronavirus Dashboard.

Recently there have been 6 COVID patients in Worcestershire Acute Hospitals of which one was on a ventilator.

The main point to note is that the number of Worcestershire COVID-19 beds occupied is very much lower than the peak of about 300 beds.

Forecast for the week ahead

Trends suggest that during the next seven days (up to 20th June) the cumulative total of new UK COVID-19 cases reported by PHE on the Coronavirus Dashboard could increase by up to 62,000 towards 4,628,000 followed by a consequential increase in daily hospital admissions.

In Worcestershire 160 new cases of COVID-19 can be expected, and possibly up to 12 cases in the Malvern Hills district.

We estimate the number of COVID (28) deaths will increase by about 70 nationally towards 127,974 during the 7 days ending 20th June 2021.

In the county of Worcestershire, assuming a 0.3% death rate, the 152 new cases this week should translate to no more than two COVID deaths per month in June/July.

Longer term forecast

Commentators have suggested that the UK could be approaching herd immunity due to both the success of the vaccination programme, and immunity of those who have already been infected by COVID-19.

The huge flare up of cases in the north casts some doubt on this and suggests a higher level of vaccination will be needed to counter Indian Coronavirus. Matt Hancock says most of those in hospital in Bolton had been offered the vaccine but had not taken it.

The chart below based on a logistic function illustrates how daily cases could further increase if surge testing can dampen the fourth wave and the UK remains in exit STEP 3.

COVID cases forecast

Actual and projected UK daily cases to 31st July 2021

Remember that currently only 61% of the UK population (of all ages) has received a first COVID vaccination and only 45% have had two jabs, so there is more work to do.

Scientists warn against letting new cases 'rip' as the virus would quickly 'weed out' the frail and unvaccinated.

Advice for Seniors

COVID risk high The daily number of new cases of Coronavirus has fallen a long way from the peak of the third wave so we judge the risk to be LOW for most Seniors in the Malvern Hills district who have had 2 jabs; see our annex and riskometer opposite.

But remember, if you are elderly, have not been vaccinated, and were to catch COVID there is a significant chance that you will either die or your long term health may be seriously damaged, so get your vaccine and continue to take care of yourself and those you love. 90% of COVID deaths have been 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 second jab, for some Seniors to become ill with COVID, though for most this is likely to be a mild illness.

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, and using public transport;
SPACE at least 2 metres from people outside your bubble see note 2;
preferably meet friends and other households outdoors in the FRESH AIR, else keep the windows open if you are indoors;
minimise TIME near strangers;
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).
keep away from areas where the infection rate is known to be high.

Hence the PMs mantra:-

HANDS, FACE, SPACE, FRESH AIR

We are moving from a regime where the government tells us what to do to one where it is up to us to take personal responsibility for assessing the risk to ourselves and our loved ones.

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) If possible keep windows and doors open to improve ventilation when meeting others.

4) If you have been vaccinated and are infected by COVID-19 you may not get the classic symptoms; you could for example have no symptoms or feel like you have a common cold. If in doubt get a test.

Japanese advice has been to avoid the three Cs, see poster below:

Crowded spaces with poor ventilation
Crowded places with many people nearby
Close-contact settings such as close range conversations

The three Cs - Covid advice in Japan

COVID advice in Japan

Most of us who have received two jabs probably now feel safe mingling with friends and family!

Annex to 13th June update

Commentary

The main speculation in the media this week has been whether or not the PM will delay exit from lockdown on 21st June. The consensus seems to be a delay of 2 to 4 weeks can be expected.

On Tuesday it was announced the vaccine would be offered to those aged 25+ and surge testing would be introduced in Greater Manchester, Blackburn, Lancashire and surrounds.

On Thursday Matt Hancock appeared before the Science and Technology Committee and Health and Social Care Committee and had the opportunity to contest Dominic Cumming's accusations. Dominic Cummings had agreed to provide documentary evidence to back up his verbal claims but none had been provided to the committees so far.

Click to watch committee proceedings on 10th June

On Friday the BBC said PHE had assessed the Indian virus 64% more transmissible than the Kent virus and Professor Tim Spector in this week's Zoe update said the Reproduction Rate of the Indian or Delta virus was thought to be about 6. That leads us to think that for herd immunity we should ideally be looking for at least 80% of the population to be double jabbed, whereas only 45% are double jabbed to date.

Tim Spector said the latest COVID symptoms amongst young people were headache, sore throat, runny nose and fever which could be confused with a bad cold; he exhorted everyone who felt unwell to take a Lateral Flow Test.

Click to watch Zoe COVID update on YouTube

Overseas travel (unchanged)

The situation is confused and could remain so until the world is more fully vaccinated.

The UK government would rather people did not travel overseas this year, but the regulations do not prevent it. The main question is will the country you want to visit let you in.

Returning travellers to the UK must quarantine according to the UK Traffic Light system (see below).

Travellers should take account of Foreign, Commonwealth & Development Office advice and check, in the light of this, whether their travel insurance will cover the intended journey.

If you are planning to go on an overseas holiday, you should check things out extremely carefully, ideally make bookings that can be changed, and be prepared to quarantine if circumstances change.

The UK 'Traffic Light' system specifies the quarantine measures those entering the UK from abroad must undergo.

Click for guidance on travel during the COVID pandemic

Click for press statement - Global Travel Taskforce sets out framework to safely reopen international travel

Click for Report of the Global Travel Taskforce - The Safe Return of International Travel

In essence the plan is that you will need to pass a COVID test before being allowed to fly back to the UK and take another test upon arrival. If you return from a 'green' list country you are free to circulate if both tests are clear. If you return from an 'amber' list country you must quarantine for ten days and take two COVID tests following arrival. If you arrive from a red list country you must quarantine for ten days in an approved government hotel and take two tests booked before departure.

Click for Red, Amber and Green list rules for entering England

The cost of getting tests is likely to be a significant burden on travellers, who may also have to provide evidence of vaccination for example by either providing a vaccination certificate or by means of the NHS app on their smartphone.

Note: this is not the NHS COVID-19 app

Click for NHS info on Coronavirus vaccination status for travelling abroad

The situation is fast moving. France, Spain and Portugal now appear keen to attract vaccinated British tourists, and is it really necessary for vaccinated individuals to have to quarantine on return to the UK?

List of vaccines (unchanged)

Here 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.

COVID-19 vaccine	Doses ordered (million)	Status
Pfizer BioNTech, two dose, -70 deg C	40+60	Approved, deliveries continuing, made in Belgium (EU). An additional 60M doses have been ordered for booster shots for the most vulnerable in the autumn.
Astrazeneca, two dose, fridge	100	Approved for those aged 30+ years; deliveries continuing. Batches made in UK, Belgium and India.
Moderna, two dose, -20 deg C	7+10	Approved. First deliveries to Wales and Scotland 7th April 2021 then England 13th April; mainly for those aged under 50 years awaiting vaccination.
Valneva, two dose	60+40	A jab from French company Valneva will be made in Livingston, West Lothian, Scotland. Delivery to start in second half of 2021.
Janssen, single dose	20	Approved, a jab from Belgian firm Janssen, owned by Johnson and Johnson; UK approval 28th May. Order reduced from 30 to 20M.
Novavax	60	A jab manufactured by US firm Novavax is being made in Stockton-on-Tees UK; phase III trials complete, awaiting approval. Should be available later this year. Glaxo Smith Kline (GSK) has been contracted to fill and package vials.
GSK Sanoft	60	Some delay due to adjusting the formula to give better protection to the elderly; possible availability late 2021.
Curevac	50	Contract placed with German company Feb 2021. Possible source of new variant vaccine later in 2021

Table of vaccines ordered by the UK government

Present rate of new cases and risk

The average rate of infection per 100,000 population per week in England has risen from 37 to 64 while in comparison the figure for Worcestershire is 21 and the Malvern Hills 5.

High infection areas include Blackburn 648, Ribble Valley 430, Rossendale 373, Bolton 311, and Salford 310.

Birmingham, Bedford, Leicester and Ledbury are also areas best avoided.

The probability of catching Coronavirus in the Malvern Hills district remains low, and as most Seniors have been vaccinated with 2 jabs we judge the risk LOW.

The risk of death from Coronavirus for unvaccinated children and 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 may be visiting areas where rates are spiking the risk might be judged MODERATE to HIGH.

About the final UK COVID-19 death toll

At the start of the epidemic on 17th March 2020 the Chief Scientific Adviser, Sir Patrick Valance, questioned by the Health Select Committee, did not disagree with Jeremy Hunt's suggestion that a death toll of 20,000 might be a reasonable outcome.

Click for YouTube video of Coronavirus: Health Committee questions Government Chief Scientific Adviser and NHS England 17 March 2020

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 Jeremy Hunt and Sir Patrick Valance spoke there had been few deaths and they clearly underestimated what was to come. Professor Neil Ferguson was nearer the mark. A few might consider an outcome of about 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, temporary collapse of the NHS and patients dying at home or queued in ambulances outside hospitals. You have only to look at the recent situation in India to imagine what could have happened.

Members of the Labour Party and others will no doubt say the UK has done 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.

With hindsight, deaths might have been much lower if the second lockdown had been continued into December and January, but that would have meant cancelling Christmas, and who knows to what extent the public would have complied.

Worldwide, this pandemic is not played out and it could be a further 1 to 2 years before the 'dust' finally settles. The PM has promised an independent inquiry in Spring 2022 to learn lessons for the future.