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

27th June 2021

Summary

Life appears very much back to normal in the rural Malvern Hills, despite daily cases of COVID-19 more than doubling in Worcestershire in the last week.

There have been no COVID deaths in Worcestershire this week and only 4 hospital beds are occupied by COVID patients.

Some may still catch COVID-19 and become very poorly despite being fully vaccinated, though not needing treatment in hospital in most cases. So remember that, although we are being offered new freedoms, it is our decision how cautious to be.

Click for guidance on what you can and cannot do

A 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 for Simple Summary of Malvern numbers on the Coronavirus dashboard

Click to go to our annex/commentary

Vaccinations

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

Adults aged 18+ can now book a jab on-line without having to wait for a call from their GP surgery.

Note: there is a mass vaccination centre at The Three Counties Showground.

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

Alternatively, if you are registered, 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.

Extension of vaccination to children aged 12+ may follow in the summer, but no decision has yet been made.

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

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 27th June 2021

Total first jabs are reported 44,314,799 to the 27th June. Second jabs are reported 32,460,191.

In comparison the adult population of the UK aged 18+ is 54,000,000 and if children are included the total is about 66,000,000

You can find vaccination 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 numbers in the EU are slowly building up. The share of people who have received at least one dose to 25th June are Germany 53%, Belgium 58%, Spain 52%, Italy 54% and France 49%. In comparison 64% of the UK population (including children) has received at least one dose.

New Zealand 13%, Australia 23%, India 18%, Russia 14% and Japan 20% 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 9,248 new cases per day to 14,865. 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 27th June 2021

The chart below shows in more detail how daily cases have varied between 1st March and the 27th June. Most cases are now said to be unvaccinated individuals aged under 30 years.

Daily COVID cases to 2nd May 2021

UK daily new confirmed COVID cases 1st March to 27th June 2021

The shape of the curve suggests that new hot-spots have begun flaring up in the past week, as the old hot-spots are damping down; by 19th July it should be clearer what restrictions will be needed to bring the fourth wave under control.

During the last week the cumulative total of confirmed UK COVID-19 cases reported by PHE rose by 102,394 to 4,732,434.

In Worcestershire there have now been 34,631 confirmed cases of COVID-19 an increase of 461 on last week. The number of daily cases has risen from 31 to 66 suggesting the Effective COVID Reproduction Rate in the county is 2 and it needs to be <1.

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	6,547	+130	98,529
Malvern Hills	2,949	+73	77,545
Redditch	6,411	+50	85,317
Worcester	6,389	+82	103,542
Wychavon	6,615	+75	126,240
Wyre Forest	5,720	+51	100,957
TOTAL	34,631	+461	592,130
COMPARE WITH
County of Hereford	7,341	+74	195,000
Leicester (city of)	38,786	+478	400,000

Cumulative cases reported by PHE in Worcestershire to 27th 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.

Cases in the Malvern Hills are rising and are now ten times the rate in early May.

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 map shows that, in addition to hot spots, infection rates have continued to creep up across the UK.

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.

Ripples of the fourth wave are now being imported from outside Worcestershire. Recent weekly cases to 22nd June are: North Malvern 3; Malvern Link <3; Pickersleigh 5; Barnards Green <3; Malvern Wells and Priory 4; Callow End and Hanley 4; Upton and Welland 6. Not far away a hot-spot seems to be developing in Tewkesbury

The present level of cases should be nothing to worry about as vaccination levels are high amongst adults.

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 124 in the last week to 128,100 while the daily average has risen from 10 to 18.

UK COVID death rate

COVID-19 death rate 1st April to 27th 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 11th June 2021 (week 23 of 2021) is shown below.

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

Districts of Worcs	Deaths 2020	Deaths 2021	Week 23	Population
Bromsgrove	164	101	0	98,529
Malvern Hills	61	83	0	77,545
Redditch	108	85	0	85,317
Worcester	87	116	0	103,542
Wychavon	157	119	0	126,240
Wyre Forest	171	106	0	100,957
TOTAL	748	610	0	592,130

Provisional cumulative COVID-19 deaths registered by ONS to 11th June 2021

In the last week reported no COVID deaths were recorded in Worcestershire.

So far in England and Wales 84 COVID-19 related deaths have been reported by the ONS in the week to 14th June; 14 less than last week. Of these 12 were in a care home, 9 at home, 1 in a hospice, 61 in hospital and 1 elsewhere.

Note: summation of rows 9 to 339 of the ONS deaths Registrations-Pivot table.

The provisional UK COVID-19 death toll (as reported by PHE and ONS) 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 25th 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	1,505	+189
Patients on ventilation	259	+49
Patients admitted daily	227	+1

Headline summary of patients in hospital as reported 27th June 2021

The daily number of hospital admissions expressed as a 7 day average fell to 100 about 20th May but has crept up to 221 and might be expected to increase further in proportion to the rise in daily cases. If roughly 2,000 new cases per day last month led to 100 daily admissions, then the current 14,000 or so cases per day could see daily admissions rising towards 700. That said daily hospital admissions are growing more slowly suggesting fewer cases now require hospital admission.

In the past, the steady state number of COVID patients in hospital has been roughly ten time the number of patients admitted daily, so we could see the number of COVID patients in hospital rising towards 2,200 in the next week or so.

Recently we had assumed that due to vaccination just 1 in 15 of those admitted to hospital now dies (whereas last year it was 1 in 5). If we relate the latest average of 18 deaths per day to hospital admissions two weeks ago the figure may be nearer 1 in 10. In which case the present 221 hospital admissions per day could point to a COVID daily death rate of about 22 by mid July.

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

An easy to read summary can be found on the Worcestershire Coronavirus Dashboard.

Click to view Worcestershire Coronavirus Dashboard.

Recently there have been 4 COVID patients in Worcestershire Acute Hospitals, 2 les than last week.

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 4th July) the cumulative total of new UK COVID-19 cases reported by PHE on the Coronavirus Dashboard could increase by 105,000 towards 4,838,000.

In Worcestershire up to 500 new cases of COVID-19 can be expected, and possibly 100 cases in the Malvern Hills district.

We estimate the number of COVID (28) deaths will increase by about 125 nationally towards 128,230 during the 7 days ending 4th July 2021.

In the county of Worcestershire, assuming a 0.3% death rate, the 461 new cases this week should translate to no more than 2 COVID deaths per week in July.

Longer term forecast

When the Alpha (Kent) variant was predominant commentators suggested that the UK could be approaching herd immunity due to both the success of the vaccination programme, and immunity of those who had already been infected by COVID-19.

The flare up of cases in the north, caused by the more transmissible Delta variant, indicates a higher level of vaccination is needed to counter a Reproduction Rate of 6 to 7.

The bell shaped chart below, based on a logistic function, shows how we thought future UK daily cases might vary as surge testing and the ramping up of vaccinations dampened the fourth wave of the virus during the remainder of June and July. This week's figures now suggest to us there are broadly three components: a background level of infection of about 2,000 cases per day, a 'bump' as shown in the chart, representing suppression of the first hot-spots of the Delta variant in the North, and newly emerging hot-spots which will be rising exponentially to start with.

COVID cases forecast

Actual and last week's projection of UK daily cases to 31st July 2021

Daily cases have been rising since England moved to STEP 3 out of lockdown on 17th May, allowing more social mingling, so it's clear that so far vaccination and Test and Trace have been unable to contain the Delta variant of COVID-19.

What happens next is very uncertain and will depend on the extent to which the public continues to embrace physical distancing and the wearing of face masks, and whether the NHS has enough vaccine to say double the present rate of vaccination - which might make it possible for cases to fall in July roughly as shown by the blue curve. What we fear is that individuals will tire of the restrictions, while MPs and business managers will clamour for an end to all restrictions by 19th July which could lead to new daily cases rising towards 30,000 by the end of July, and in consequence the death rate rising towards 100 deaths per day, and COVID patients in hospital rising to say 7,000.

In addition a ripple of cases amongst unvaccinated children and teenagers in early August cannot be ruled out once restrictions cease.

Some scientists expect a bumpy ride as the UK emerges from lockdown.

Advice for Seniors

COVID risk high The daily number of new cases of Coronavirus in the Malvern Hills district is rising but as most Seniors should have had 2 jabs we judge the risk of death from COVID-19 for most to be LOW; 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 both doses of your vaccine and continue to take care of yourself and those you love. Last year, 90% of COVID deaths were 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 quite possible, despite a second jab, for Seniors to become ill with COVID-19; some might have mild symptoms like hay fever, while others could feel very poorly, but it is unlikely you will need to be admitted to hospital.

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 (the top five symptoms amongst the vaccinated are now said to be headache, runny nose, sore throat, sneezing and persistent cough).
keep away from areas where the infection rate is known to be high.

Hence the PMs mantra:-

HANDS, FACE, SPACE, FRESH AIR

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.

Annex to 27th June update

Commentary

On Wednesday Nadhim Zahawi gave an update on the vaccine rollout. 80% of adults have now received a first dose of vaccine and 60% have had two doses. Those over 40 years can expect to get their second dose within 8 weeks of the first.

Click for transcript of the vaccine update briefing

The REACT-2 study by Imperial College suggests up to 30% of those infected by COVID-19 may suffer Long COVID symptoms.

Click for BBC report on Long COVID

There are rumours a COVID DELTA plus variant has been detected in India; no details so far.

Click for BBC report on DELTA plus

On Thursday the BBC reported that vaccinated tourists returning to the UK might not need to quarantine.

In the evening the list of green, amber and red countries was updated.

Click to view government travel update

Surprisingly the government made no announcement about fully vaccinated tourists entering the UK from amber list countries not having to quarantine, effectively kicking the issue into the long grass.

The BBC reports up to 140,000 people are expected to attend the Silverstone Grand Prix in July. Allegedly this is one of a series of government experiments to assess the feasibility of return to normal.

On Friday the Zoe COVID Study weekly update on YouTube was published.

Daily cases have risen sharply this week and the Zoe team estimate there are currently 15,000 cases per day amongst the unvaccinated compared to 4,000 amongst those that have had either one or two doses of a vaccine. The protection factor for fully vaccinated individuals compared to the unvaccinated is thought to be about 20.

Infection rates are going up in Cornwall driven by unvaccinated younger people which could be due to a combination of holidays, half term, and the influx of press, police and others supporting the G7 Summit.

Click to watch Tim Spector's weekly Zoe COVID update on YouTube

Complacency and increased mingling sparked by the Euro football competition could also be contributing to the surge in daily cases across the UK.

Now if the basic reproduction rate of the Delta variant is 6.5 then ideally 85% of the UK population needs to be double jabbed to achieve herd immunity. In comparison currently only 50% of the UK population is fully vaccinated if children and teenagers are taken into account. So in the next month or so more flare-ups of the virus can be expected mostly amongst unvaccinated individuals particularly those reluctant to wear masks and maintain physical distancing.

The question is will these flare-ups matter? The ratio of daily hospital admissions and deaths to daily new cases is much lower than it was last year, due to vaccination of the elderly; even so deaths and hospital admissions could rise significantly in the summer were cases to rise out of control.

Ideally the proportion of vaccinated individuals needs to be increased markedly before restrictions are removed - however we doubt the present vaccination rate is fast enough to stop a surge of COVID-19 cases amongst the frail and unvaccinated after 19th July. Consequently we anticipate COVID daily hospital admissions and deaths could rise markedly during July and August, but not to the level seen last January.

On Saturday poor Matt Hancock resigned as Health Secretary following a photograph appearing in the Sun Newspaper showing him in an embrace with Gina Coladangelo whom he appointed last year to be a non-executive director at the Department of Health and Social Care.

A disgruntled employee is said to have put a spy camera in the Health Secretary's office!

Sajid Javid has been appointed the new Health Secretary.

Click for BBC article about the new Health Secretary

On Sunday Andrew Marr said he had caught COVID-19 despite two jabs earlier in the year and he felt very poorly.

The NHS reported that 50% of 18 to 29 year olds had received a first jab.

Overseas travel

The situation is becoming increasingly confused as both the UK and other nations change the rules.

If you are worried about either having to change plans or getting on a busy flight it might be best to take your holiday in the UK this year.

List of vaccines

Here is the list of vaccines ordered by the UK - a shortage of vaccine has been limiting the vaccination rate in the UK, while plenty of vaccine is on order 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 85 to 120 while in comparison the figure for Worcestershire has risen to 55 and the Malvern Hills to 67.

As a yardstick we suggest a figure of below 10 can be considered LOW.

Areas of high infection, mostly now falling, include Blackburn 486, Ribble Valley 366, Rossendale 384, Bolton 255, and Salford 367.

Other areas with many cases include Birmingham, Leeds, Liverpool, Wigan, Manchester, County Durham, Newcastle on Tyne, Glasgow and Edinburgh

The probability of catching Coronavirus within the Malvern Hills district remains moderate, but as most Seniors have been vaccinated with 2 jabs we judge the risk of death LOW for all except the 'frail'.

The risk of death from Coronavirus for unvaccinated children and healthy teenagers is said to be 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 high 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.