Upturn in Covid infections but Christmas looks safe

Covid-19 infections are picking up again, though not at a rate that looks like threatening Christmas. But precautions seem advisable in crowded places and on public transport, as does getting the autumn booster for those who are eligible. Meanwhile health experts have voiced concerns about the government’s vaccine policy. Text by Nick Terdre, research and graphics by Russell Hall.

Covid-19 infections are on the rise after falling in late October and early November. According to the weekly Office of National Statistics survey, the upturn occurred around 15 November, when the estimated number of Covid cases in England rose from 809,200 to hit an estimated 873,200 on 21 November.

In the South-East an estimated 1 in 55 people were infected on 21 November, up from 1 in 65 on 15 November, whereas the figures for England were 1 in 60 (1 in 65) and for London also 1 in 60 (previously 1 in 70).

UK Health Security Agency data indicate a relatively strong upturn in Hastings, with a 56.5% increase in infections in the week ending 28 November.

This was well above Rother’s 16.2%, East Sussex’s 9.2% and England’s 7.3%. But R values indicating reproductive rates calculated from the same data show slightly slower growth for Hastings, at 1.13, than Rother at 1.23, while East Sussex, at  1.02, and England at 1.03, were barely in growth.

The numbers are reasonably modest compared to, say, the July peak when an average 44.7 new cases were recorded by UKHSA in the week to 8 July. The latest data for Hastings indicate an average of 5.1 and 6.1 in Rother in the week to 25 November.

While pressure on hospitals in some places in England is a source of concern, it remains low in East Sussex. Weekly Covid hospital admissions in England were up 10.9% in the week to 28 November, but in East Sussex they fell back by 73.1% to just seven. At that time there were only 18 Covid patients in the county’s hospitals, down from 19 the week before.

Christmas is on

So for the first time since 2019 Christmas looks unlikely to be cancelled or disrupted due to Covid-19. Nevertheless, as shops get busy and crowds gather in pubs to watch the football world cup, precautions such as wearing face masks would seem to be in order, as well as getting the autumn booster vaccine.

Driving the upturn in cases are the latest top performers from within the fertile Omicron virus family, which is now on the cusp of its first anniversary as the dominant type. While not generally causing serious infection, the Omicron sub-lineages derive their growth advantage from an enhanced ability to evade our bodies’ immune systems.

The currently dominant Omicron sub-lineage is BQ.1, including BQ.1.1, which as of 21 November was identified in 49.3% of all sequenced cases. It has supplanted sub-lineage BA.5, which on that date accounted for 32.3%, but back in late August was responsible for just over 90% of sequenced cases.

Only a small proportion of all cases are sequenced, so these percentages may not completely reflect those in the whole population.

BQ.1 is not expected to lead the charge for long, as other Omicron sub-lineages with rapid growth potential are coming up fast behind, notably CH.1.1, which is forecast to overtake BQ.1 later this month or in early January.

The authorities still promote the vaccine as the best defence against the virus. The autumn booster introduced in September and now available to all aged 50 years and older is the fifth jab (though the spring booster was only offered to the 75+ age group).

First bivalent vaccine

On 15 August the MHRA - Medicines and Healthcare Products Regulatory Agency - approved the first use in the UK of a bivalent anti-Covid vaccine — whose composition enables it to tackle two targets, the original Wuhan variant and Omicron BA.1. Previous vaccines were monovalent, targeting only the Wuhan variant.

Early feedback from the UKHSA on the efficacy of the bivalent vaccine indicated promising results - incremental protection of 57% for a study group restricted to those who before 5 September had had at least two anti-Covid vaccines at least six months before.

Vaccine efficacy in terms of preventing symptomatic infection is substantially lower against the Omicron variant than the previously dominant Delta variant, according to the UKHSA. For example, after two doses of the AstraZeneca vaccine, efficacy against Omicron dropped from 45-50% to almost no effect from 25 weeks after the second dose, while after two doses of Pfizer or Moderna it dropped from 65-70% down to around 15% in the same period

This looks like a good argument for having the booster once you are eligible. But although take-up of the autumn booster by older age groups in Hastings was on a par with other parts of East Sussex when it became available, it has latterly fallen back.

Hastings uptake lags

Uptake to 30 November, according to the UKHSA, was 58.1% in Hastings compared with 68.1% in Rother, 66.3% in East Sussex and 68.1% in the South-East. Hastings lagged Rother and East Sussex in all age groups, but mainly the younger ages — for example 33.7% among 50-54 year-olds compared with 39.2% in Rother and 39.9% in East Sussex.

Interactive chart showing a lag developing in Hastings' uptake of the autumn booster during November compared with Rother and England. There was also a sizeable lag in October when the booster was only available to those of 65+.

We haven’t heard from the East Sussex director of public health, Darrell Gale, for a long time, but his Leeds counterpart Victoria Eaton last week warned councillors there of “an element of vaccine complacency” among younger age groups at a time when modelling suggested a new wave of Covid was to be expected.

In its weekly announcement on 2 December Hastings Borough Council urged eligible residents to get the autumn booster, while stating rather inaccurately that only about half had done so — as stated above, it was already well above half.

Meanwhile prominent health experts have expressed concerns at the government’s vaccine policy. Dame Kate Bingham, former head of the vaccines taskforce, last week told a parliamentary inquiry into lessons to be learned from the pandemic, that "Our vaccines currently are not good enough.

"We need to improve the quality of the vaccines, the durability, the ability to stop transmission, the way in which we give vaccines.

"Lots of things need to be improved. Our approach seems to have been to go backwards rather than to continue the momentum."

The inquiry was also told by Prof Sir John Bell, the University of Oxford Regius Professor of Medicine, that boosters were “not really providing any prolonged protection against transmission.” A rethink of the booster vaccination strategy was needed, he said.

Bingham’s comments were contested by a government spokesman.

 

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