Covid is making a comeback, in Hastings as elsewhere

Remember Covid-19? Remember lockdown? Although the virus that shook the world has receded into the background for most of us, it has by no means gone, and is currently enjoying a resurgence in the number of cases. As new subvariants emerge, experts are debating whether we now have the disease under control. Text by Nick Terdre, research and graphics by Russell Hall.

We are over the worst of the pandemic, and life appears to be back to normal for most of us – we take few if any precautions, and face masks are not much seen in public.

But Covid-19 is still with us, and not only for the two million UK people living in private households estimated to be suffering from long Covid, often with debilitating effect. The virus is still a killer – in the week to 16 September 374 died with Covid on their death certificate in the UK. Since the pandemic took hold in early 2020, the total number of deaths in the UK has reached just over 200,000.

In July the number of infections went into decline, but since early September it has been on the rise again, though from a low base, as the graph above shows. According to the latest infection survey by the Office of National Statistics, for the week ending 17 September in England and 20 September in the other home nations, cases increased in England and Wales and were slightly up in Scotland and Northern Ireland. In this period an estimated one in 65 people in England tested positive and one in 50 in Wales.

The proportion however was highest in Scotland, at one in 45, and lowest in Northern Ireland, at one in 80.

According to the UK Health Security Agency Covid dashboard updated on 29 September, 43,016 new cases were recorded in England in the seven days to that date, an increase of 8,367 or 24% on the previous seven-day period (the number includes reinfections, which account for just over 6% of the 20m cases registered during the course of the pandemic).

Cases rise in Hastings and Rother

For Hastings 111 new cases were confirmed, a 63% increase over the previous seven days, while Rother saw 136 new cases, an 81% increase.

However, because testing has dropped to very low levels, figures based on test results are almost certainly a significant underestimate of the true number of cases. However, they do show the trend, and that is upwards.

The trend to growth in Hastings and Rother is also clearly visible in the positivity rate – the proportion of positive results in the total number of tests administered. As the interactive graph below shows, the rate has shot up during September.

According to Alastair Grant, professor of Ecology at the University of East Anglia, infections are on the rise in 304 of the 315 local authority areas in England, and the outlook now is for a significant wave of Covid-19 infections in October likely to peak around the end of the month.

Fast growth

An analysis of UK Heath Security Agency data up to 27 September indicates relatively fast growth in cases in East Sussex, with an R-value or reproductive rate of 1.3 (a number above one indicates growth and below one decline).

In the week ending 27 September, Rother's R-value came in at 1.49, Lewes at 1.52 and Wealden at 1.56 – putting all three in the top 15% of lower tier local authorities with the fastest growing number of cases. Eastbourne was not far behind , at 1.33, though Hastings, at 1.09, was only marginally in growth.

A good uptake in the autumn booster vaccination recently offered to those aged 50 or more, along with various vulnerable groups, will help restrain the resurgence of the virus. In the past Hastings has not had a good record in this respect, but take-up of the autumn booster so far has been encouraging, with 28.7% of the town’s eligible population aged 65+ having received it according to data available up to 28 September, putting it in 123^th place out of England's 315 lower tier local authorities.

Uptake has been slightly better than in Rother, which, with 26.5% of its eligible 65+ population having had the jab, was in 161^st place.

The number of Covid patients admitted to hospital in England is also on the rise - 5,930 in the last seven days according to the NHS, a 48% increase, with 998 admitted on 26 September. In the East Sussex Healthcare NHS Trust, the number of new patients was 104, an 89% rise. Currently the trust has no Covid patients on mechanical ventilators, and bed occupancy by Covid patients is low, as the graph below shows.

Waning immunity and the return to school have both been indicated as factors in Covid’s resurgence. But the constant evolution of the virus is also a cause. Following earlier waves spearheaded by the Alpha and Delta variants, we are now in the age of Omicron. In fact it has been the dominant type since December last year, leading some experts to wonder if we have passed the stage of major new variants supplanting the dominant type every few months.

Significant growth advantage

Omicron has itself spawned multiple sub-lineages, of which a small number stand out as having a significant growth advantage and thus the potential to drive an increase in infections. In particular the currently dominant Omicron sub-lineage BA.5.2 is projected to be overtaken over the next month by sub-lineage BQ.1.1, which is currently showing a 15% per day growth advantage - which means in effect that the number of infections it causes increases by 2.66 times a week.

The combined growth advantage of the sub-lineages that are increasing gives a current central projection of infections doubling every week sometime in the second half of October.

These sub lineages, identified in the open-source GISAID global virus genome sequence repository, form part of the Omicron soup of over a hundred sub-lineages currently circulating in the UK. Recently evolved and faster growing than the others, they share a key group of mutations that make them better at evading our current immunity and hence look set to increase infections when, as looks likely, they become dominant in a few weeks' time.

Though we may be over the worst, how bad can it get? The fact that a large proportion of the population is vaccinated will help to limit the number of cases and deaths. But there could be growing pressure on healthcare services if hospital admissions return to around 2,000 a day as seen at the peaks of previous waves, while at the same time the demands of other winter illnesses such as flu are making themselves felt.

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