Government launches rejig of vaccination programme

As the Covid-19 pandemic moves into a new phase, the vaccination programme is being rejigged towards a more targeted campaign. Meanwhile, infections have begun to rise again, as emerging Omicron sub-variants prove increasingly effective. East Sussex hospitals are top of the league for bed-blocking. Text by Nick Terdre, research and graphics by Russell Hall.

We are now in a transition phase from pandemic emergency response to pandemic recovery, says the Joint Committee on Vaccination and Immunisation (JCVI) in interim advice to the government on rejigging the Covid-19 vaccination programme for 2023.

On its recommendation, the Department for Health and Social Care (DHSC) has announced that the autumn 2022 booster campaign will close on 12 February, along with the initial booster offer for 16-49 year-olds not in a clinical risk group – anyone eligible who has not yet taken up this offer is advised to do so while they still can.

Following the two-dose primary vaccination course with either the Pfizer or AstraZeneca vaccines, there have been three booster offers, in late 2021, and spring and autumn 2022.

The DHSC has also accepted a recommendation to offer a further booster in autumn this year to people at higher risk of severe disease, to increase their protection against infection in winter 2023/34. The JCVI is also mulling a spring booster offer for those at greatest risk – the older age groups and those who are immunosuppressed.

Vaccination levels

It is estimated that at end August 2022, over 97% of adults in England, as well as 93-99% of children aged 12-15 and 74-98% of children aged eight-11 in Great Britain, had antibodies against Covid due to infection or vaccination. The JCVI therefore envisages a more targeted campaign, though it warns that: “emergency surge vaccine responses may be required should a novel variant of concern emerge with clinically significant biological differences compared to the Omicron variant.”

Omicron has been the dominant variant for well over a year, as sub-variants come and go in the battle to be top dog.

BQ.1, which has held that position in recent weeks, is now giving way to a number of other sub-variants with greater growth advantage. Genomic sequencing in the two weeks to 30 January showed BQ.1 to be responsible for 43.9% of cases sequenced (admittedly only a fraction of all cases), while BA.2.75, together with a group of recombinant sub-variants, combining features of more than one sub-variant, accounted for 53.3%.

BA.2.75, which includes CH.1.1, was responsible for 34% and XBB, including XBB.1.5, 15.14%. XBB.1.5 at one point looked likely to become dominant on its own, and still may – it is currently estimated to be the most common sub-variant in every region of the US, where it was first detected.

Upturn in infections

BQ.1 has presided over a period of declining infections since Christmas. This trend now looks to have run its course as the emerging sub-variants prove increasingly influential and the latest data shows an upturn in cases. The Zoe Health Study, extrapolating from the data submitted by its participants, shows the turnaround at 28 January, when the predicted number of infections was 835,704, rising to 876,389 on 2 February.

According to the UK Health Security Agency, infections are rising faster locally than nationally. The week-on-week change for the week to 30 January indicates a 188.5% increase for Hastings, 114.7% for Rother and 67.1% for East Sussex, compared with 24.8% for England. In other words, the number of infections in Hastings and Rother more than doubled.

The R value, or average reproduction rate per infected person, as calculated from the data for this period, shows 2.08 for Hastings, 1.61 for Rother and 1.33 for East Sussex, against 1.14 for England.

The Office for National Statistics weekly infection survey, which lags the UKHSA data, shows numbers still falling in the week to 24 January, when an estimated 1.42% of the population of England tested positive, equivalent to 1 in 70. In the South East the positivity ratio was 1.29%, or 1 in 80.

But the rate of decline appears to be slowing - it was 1.62% the previous week, but 2.61% the week before that.

Interestingly positivity was lowest, at 1.3%, in the 70+ age group, but 1.94% in children aged two to school year 6 (10-11), which was second highest only to the 1.95% of the 35-49 age group.

Bed-blocking bottleneck

Hospital admissions in England are also on the rise, up 18% in the week to 30 January over the previous week. This trend has yet to be reflected in East Sussex, where after a period of decline, Covid admissions have levelled out, fluctuating between 47 in the week to 25 January, 52 in the week to 28 January and 36 in the week to 1 February.

One reason why admissions may not be rising is that the problem of bed-blocking in the county is much worse than nationally. For England, as of 29 January, the proportion of all patients who had been in hospital for three weeks or more and were medically fit to be discharged but could not be was 36.2%, while in the East Sussex Hospital Trust it was 70%, the highest for any trust in the country.

In fact the average daily number of patients medically fit to be discharged but who could not be has been continuously rising since late December and currently represents about a third of all patients in East Sussex hospitals.

The major cause of bed-blocking is the lack of capacity of the social care sector to receive patients discharged from hospital. It appears that the government’s emergency grant of £2.15m to East Sussex County Council, the body responsible for the social care sector, in early January, and £10.5m for the NHS Sussex Integrated Care Board, as well as the recruitment of 200 social care staff from abroad, has so far made little difference.

Meanwhile, the number of Covid patients in East Sussex hospitals remains low, at 36 on 1 February, while on 29 January there was only one flu patient. There have been no Covid patients on mechanical ventilation since late November, which accords with the JCVI’s assessment of the lower disease severity offered by the Omicron variants compared with previous variants.

Like the JCVI, the World Health Organisation also reckons a new phase may have been reached in the battle against Covid. On 30 January it reported that the “pandemic may be approaching an inflexion point,” though it continues to “constitute a public health emergency of international concern.”

Its Covid-19 technical lead, Dr Maria van Verkhove, noted, "We're in a much better situation than we were three years ago...now we have so many tools that can actually reduce the impact of Covid-19 in terms of hospitalisations and deaths."

 

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