India variant

[murraypaul]

Case rate has started to tick up, but not by a huge amount.
Hospitalisations and deaths have not increased, although they lag behind cases, so might not be expected to yet.

[zico]

Very disappointing press conference. Virtually nothing is being done, apart from surge testing in high-outbreak areas, and reducing 2nd dose wait time from 12 weeks to 8 weeks. Just the obvious admission that 21st June data may need to be deferred if India variant spreads widely.

No change on the "data, not dates" plan to drop requirements for schoolkids to wear masks. Fortunately, some local authories plan to ignore the government guidance.

Here's what SAGE said in their report yesterday. It's only 2 pages long, so worth reading through, but here's the important points - in particular the first quote. I've bolded what I think are the most important bits. I've moved the first quote from later in the report - this is SAGE saying "we keep telling you to get a grip early, and we're going to keep reminding you about it, even though you always ignore us until it's way too late".

The “earlier, harder, broader” principles of responding quickly, taking strong measures, and doing so over a wider geography than where the issues have been identified in response to outbreaks,remain relevant. Testing, tracing and, in particular, isolating cases remains very important.

There are local areas in all nations where the number of new infections is increasing. Some local areas have had continued rapid growth in variants, and of particular concern is the B.1.617.2 variant (a variant first identified in India, where it is now widespread). There are now multiple fast-growing clusters of this variant in the UK, with the largest in the Northwestof England.

Transmission of this variant is currently faster than .. the Kent variant (high confidence).This is based on observed growth in sequenced cases, and in S-gene positive cases...Observed doubling times are around a week or shorter for some of the largest clusters but slower in others.

This is unlikely to be wholly due to inherently higher transmission in the communities within which B.1.617.2 is currently circulating(i.e.,this faster transmission cannot be explained entirely by contact patterns or behaviours).The places where transmission of this variant is occurring have
different characteristics to each other, and donot appear to be experiencing similar growth of other variants(i.e.,B.1.1.7).

It is therefore highly likely that this variant is more transmissible than B.1.1.7 (high confidence), and it is a realistic possibility that it is as much as 50% more transmissible. There are also plausible biological reasons as to why some of the mutations present could make this variant more transmissible

In the areas where numbers of infections are increasing rapidly under the measures currently in place, an even faster increase can be expected if measures are relaxed(high confidence)

If this variant were to have a 40-50% transmission advantage nationally compared to Kent variant, sensitivity analyses in the modelling of the roadmap in England(SAGE 88)indicate that it is likely that progressing with step3 alone(with no other local, regional,or national changes to measures)would lead to a substantial resurgence of hospitalisations(similar to,or largerthan,previous peaks).Progressing with both steps 3 and 4 at the earliest dates could lead to a much larger peak. Smaller transmission advantage would lead to smaller peaks.

Early indications are that there is some antigenic distance between B.1.617.2 and wild-type virus, and that this distance is greater than that for B.1.1.7, but less than for B.1.351, and similar to that for B.1.617.1(low confidence). This means that there may be some reduction in protection given by vaccines or by naturally acquired immunity from past infection, though data on this are still mixed.

Any such reduction is likely to affect protection against infection more than protection against severe disease or death. If protection against infection were reduced it could contribute to a transmission advantage over B.1.1.7. PHE has linked data on vaccinations and variants and is monitoring for any signals of an impacton vaccine efficacy.

If vaccination reduces the likelihood of transmission for this variant,increasing regional vaccination in areas where it is prevalent could dampen growth in infections,although it takes several weeks for vaccines to provide protection. The benefits would need to be balanced against the costs of moving vaccines from elsewhere. JCVI continues to review the evidence on different vaccination strategies

https://assets.publishing.service.gov.u ... eeting.pdf

[zico]

Case rate has started to tick up, but not by a huge amount.
Hospitalisations and deaths have not increased, although they lag behind cases, so might not be expected to yet.

It'll probably be yet another case of people being surprised by exponential curves and how they work.
Groundhog Day again in all its stages
- cases are extremely low, so let's open up even faster
- cases are increasing but still low - so need to avoid being over-cautious, let's wait and see
- cases are increasing, quite a lot now - but no need to worry because there's always a "this time it's different" argument (herd immunity, most vulnerable already died, vaccine mutating to be milder, vaccinations, take your pick)
- cases are very high with lots of deaths - "well, nobody could have possibly predicted that".

[Lootman]

When you returned to the UK, did you follow government guidance and travel directly to the place you were staying and not leave until 10 consecutive days had passed? I bet you didn't, and I know we didn't, though we were careful to avoid social contacts.

Like you, I followed the spirit of the rules. At this point, having been fully vaccinated, having had a negative test immediately prior to flying along with two further tests, and wearing a mask where appropriate, I do not believe that more than that is justified.

It does strike me as a bit odd to be arguing for enforced quarantine at the same time as easing travel restrictions. Sounds almost paradoxical. Or at least a mixed message.

My son is currently under quarantine at our home. He has been phoned everyday since his arrival to ensure he is conforming.

Others we have spoken to have been visited at the address given for quarantine. So I think things have been tightened recently.

Interesting. I had heard that you only get a visit if you have not been successfully reached by phone. There is obviously a limit to how much time the police can devote to checking up on people in this way, so it was my understanding that checkups were more spot checks.

Anyway I will find out again soon.

[Sorcery]

Case rate has started to tick up, but not by a huge amount.
Hospitalisations and deaths have not increased, although they lag behind cases, so might not be expected to yet.

It'll probably be yet another case of people being surprised by exponential curves and how they work.
Groundhog Day again in all its stages
- cases are extremely low, so let's open up even faster
- cases are increasing but still low - so need to avoid being over-cautious, let's wait and see
- cases are increasing, quite a lot now - but no need to worry because there's always a "this time it's different" argument (herd immunity, most vulnerable already died, vaccine mutating to be milder, vaccinations, take your pick)
- cases are very high with lots of deaths - "well, nobody could have possibly predicted that".

I would say this time is different. 5-6 months in most of the vulnerable are vaccinated at least once. When would you accept the vaccinations had proved their worth? If there is any evidence of the India variant affecting vaccinated people then you might have a case for "groundhog day".

[murraypaul]

It is certainly difficult timing for the government, having set the date for next week and then having this spike? surge? whatever you want to call it happen right now.
Infections now wouldn't become hospitalisations for probably another two to three weeks, so they have to try to make the decision to postpone what they have already announced, without being able to see how it is unfolding.

[zico]

When you returned to the UK, did you follow government guidance and travel directly to the place you were staying and not leave until 10 consecutive days had passed? I bet you didn't, and I know we didn't, though we were careful to avoid social contacts.

Like you, I followed the spirit of the rules. At this point, having been fully vaccinated, having had a negative test immediately prior to flying along with two further tests, and wearing a mask where appropriate, I do not believe that more than that is justified.

It does strike me as a bit odd to be arguing for enforced quarantine at the same time as easing travel restrictions. Sounds almost paradoxical. Or at least a mixed message.

We're both fairly responsible adults, but what about all the irresponsible people? The ones who went straight back to work the day after returning to the UK? That's why you need properly enforced quarantine, otherwise it's just PR - the low-risk responsible people act responsibly, the high-risk irresponsible people spread it about.

[zico]

I would say this time is different. 5-6 months in most of the vulnerable are vaccinated at least once. When would you accept the vaccinations had proved their worth? If there is any evidence of the India variant affecting vaccinated people then you might have a case for "groundhog day".

We already know vaccinations don't give 100% protection, but 80-90% (great, but not perfect).
The vaccinations will mean that in the next wave, we'll only get 10-20% of the deaths we would have had without vaccination (assuming vaccine is equally effective against India variant). But still there will be deaths that could easily have been avoided by earlier, firmer government action.

[Sorcery]

I would say this time is different. 5-6 months in most of the vulnerable are vaccinated at least once. When would you accept the vaccinations had proved their worth? If there is any evidence of the India variant affecting vaccinated people then you might have a case for "groundhog day".

We already know vaccinations don't give 100% protection, but 80-90% (great, but not perfect).
The vaccinations will mean that in the next wave, we'll only get 10-20% of the deaths we would have had without vaccination (assuming vaccine is equally effective against India variant). But still there will be deaths that could easily have been avoided by earlier, firmer government action.

If vaccinations don't prevent further waves especially among the vaccinated then we are wasting time and money.

From the telegraph earlier today :

Coronavirus vaccines are "almost certainly less effective" at reducing transmission of the Indian variant, the deputy chair of the Joint Committee on Vaccination and Immunisation (JCVI) has said.

Professor Anthony Harnden told BBC Radio 4's Today programme: "The vaccines may be less effective against mild disease but we don't think they're less effective against severe disease.

"But in combination with being less effective against mild disease, they're almost certainly less effective against transmission."

However, "all the evidence so far suggests there is no evidence of increased severity of illness or that [the Indian variant] evades the vaccine," he added.

It comes as England moves to the next stage of the lockdown roadmap on Monday, with pubs and restaurants able to serve people indoors again.

I don't think we will ever not see Covid-19 deaths in future but a wave implies a lot of new infections and we know vaccinated people don't normally catch it, there will be fewer people to infect and thus get the exponential growth. Need to keep an eye on the indian variant to see what it's capable of but in India it's acting on an unvaccinated population.

[9873210]

It is certainly difficult timing for the government, having set the date for next week and then having this spike? surge? whatever you want to call it happen right now.
Infections now wouldn't become hospitalisations for probably another two to three weeks, so they have to try to make the decision to postpone what they have already announced, without being able to see how it is unfolding.

Welcome to the world of Control of Unstable Systems with Large Lag.

They really need some control engineers or mathematicians in the cabinet. This is pretty basic stuff, the right people know a lot about it.

[9873210]

If vaccinations don't prevent further waves especially among the vaccinated then we are wasting time and money.

I don't think we will ever not see Covid-19 deaths in future but a wave implies a lot of new infections and we know vaccinated people don't normally catch it, there will be fewer people to infect and thus get the exponential growth

The "old anything that is not perfect is useless" refrain. Reducing the size of future waves, reducing illness and death, are worthwhile. One death is not as bad as two deaths and both are better than a thousand deaths.

You don't understand exponential growth. It does not mean "big" it means "growing fast".
You can have exponential growth when even a small slice of the population is susceptible. E.g. measles outbreaks. It's still good to spare the bulk of the population and it makes it easier to control and stop exponential growth because you can focus your efforts.

[Mike4]

If vaccinations don't prevent further waves especially among the vaccinated then we are wasting time and money.

I don't think we will ever not see Covid-19 deaths in future but a wave implies a lot of new infections and we know vaccinated people don't normally catch it, there will be fewer people to infect and thus get the exponential growth

The "old anything that is not perfect is useless" refrain. Reducing the size of future waves, reducing illness and death, are worthwhile. One death is not as bad as two deaths and both are better than a thousand deaths.

You don't understand exponential growth. It does not mean "big" it means "growing fast".
You can have exponential growth when even a small slice of the population is susceptible. E.g. measles outbreaks. It's still good to spare the bulk of the population and it makes it easier to control and stop exponential growth because you can focus your efforts.

The parallel that everyone on these boards will appreciate is the old TMF term "the miracle of compound interest". It is exactly the same thing as the exponential growth in the prevalence of a virus when R is higher than unity.

An R higher than 1 is the same as your money growing with a positive interest rate. Even values only slightly higher than 1 compound up surprisingly rapidly as we all know.

I've often thought this but never seen it spelled out on any of these boards.

[88V8]

Justin Webb on the Today programme this morning gave some govt minister a good grilling about the delays in closing the border to Indians as opposed to Bangladeshis and Pakis..... woffle response as one might expect.
One of the points he made was that a high proportion of those India returnees just before the closure would have been infected, yet there was no compulsory quarantine... and many of them will have travelled home on public transport .... woffle response.

Australia even shut the door on its own nationals who were overseas. Good. Shame we hadn't the spine to do the same.

ISTM that the govt has lost interest in pretty much everything except the vaccination programme. But that of course more so than even Brexit is what this govt will be remembered for.

V8

[zico]

If vaccinations don't prevent further waves especially among the vaccinated then we are wasting time and money.

From the telegraph earlier today :

Coronavirus vaccines are "almost certainly less effective" at reducing transmission of the Indian variant, the deputy chair of the Joint Committee on Vaccination and Immunisation (JCVI) has said.

Professor Anthony Harnden told BBC Radio 4's Today programme: "The vaccines may be less effective against mild disease but we don't think they're less effective against severe disease.

"But in combination with being less effective against mild disease, they're almost certainly less effective against transmission."

However, "all the evidence so far suggests there is no evidence of increased severity of illness or that [the Indian variant] evades the vaccine," he added.

It comes as England moves to the next stage of the lockdown roadmap on Monday, with pubs and restaurants able to serve people indoors again.

I don't think we will ever not see Covid-19 deaths in future but a wave implies a lot of new infections and we know vaccinated people don't normally catch it, there will be fewer people to infect and thus get the exponential growth. Need to keep an eye on the indian variant to see what it's capable of but in India it's acting on an unvaccinated population.

The India variant will be spreading amongst the mostly unvaccinated in the UK (under 40's and ethnic minorities) so there will be a lot of infections.
Danger is that when the younger people get vaccinated, the most vaccine-resistant strains are the ones that survive, so UK ends up being a petri dish for the worst Covid variants - we started out with the Wuhan strain, Kent variant was 70% more transmissible, and India variant likely to be even more tranmissible.

There have also been a lot of young people in India dying from the India variant - from our point of view, hopefully this is due to them experiencing very high viral loads rather than the variant being more deadly for young people.

It's possible the UK may get lucky, and get away with re-opening on schedule, but because the data is so limited, it's a huge risk that we're taking and there's simply no need to take it. We could delay Monday's re-opening for 2 weeks and then be in a much better position to make a decision.

[Sorcery]

If vaccinations don't prevent further waves especially among the vaccinated then we are wasting time and money.

I don't think we will ever not see Covid-19 deaths in future but a wave implies a lot of new infections and we know vaccinated people don't normally catch it, there will be fewer people to infect and thus get the exponential growth

The "old anything that is not perfect is useless" refrain. Reducing the size of future waves, reducing illness and death, are worthwhile. One death is not as bad as two deaths and both are better than a thousand deaths.

You don't understand exponential growth. It does not mean "big" it means "growing fast".
You can have exponential growth when even a small slice of the population is susceptible. E.g. measles outbreaks. It's still good to spare the bulk of the population and it makes it easier to control and stop exponential growth because you can focus your efforts.

I am fairly sure I do understand exponential growth. I was trying to link the idea of waves and high ones being particularly damaging with the concept that if the R is under 1 (from vaccinations) exponential growth won't be happening in future, except among the unvaccinated and assuming there are no variants that the vaccines cannot protect one from.

[murraypaul]

I am fairly sure I do understand exponential growth. I was trying to link the idea of waves and high ones being particularly damaging with the concept that if the R is under 1 (from vaccinations) exponential growth won't be happening in future, except among the unvaccinated and assuming there are no variants that the vaccines cannot protect one from.

We aren't there yet (at least we can't be confident we are):

https://www.gov.uk/guidance/the-r-value-and-growth-rate

Latest R and growth rate for England
Latest R range for England
0.8 to 1.1

Latest growth rate range for England
-3% to +1%
per day

and

these estimates represent the transmission of COVID-19 2 to 3 weeks ago, due to the time delay between someone being infected, developing symptoms, and needing healthcare.

So before the Indian variant.

[Mike4]

It's possible the UK may get lucky, and get away with re-opening on schedule, but because the data is so limited, it's a huge risk that we're taking and there's simply no need to take it. We could delay Monday's re-opening for 2 weeks and then be in a much better position to make a decision.

This won't happen because government policy is dates not data, despite their assertions to the contrary.

The next thing to happen I predict, will be the emergence of a variant that really does evade the vaccines we have. And I also predict the government will trot out the same old "no need to take any action as numbers are small, keep an eye on it", watch the numbers get bigger, sit on hands waiting for more data, then when far too late for effective suppression panic and claim nobody saw it coming.

[Sorcery]

It's possible the UK may get lucky, and get away with re-opening on schedule, but because the data is so limited, it's a huge risk that we're taking and there's simply no need to take it. We could delay Monday's re-opening for 2 weeks and then be in a much better position to make a decision.

This won't happen because government policy is dates not data, despite their assertions to the contrary.

The next thing to happen I predict, will be the emergence of a variant that really does evade the vaccines we have. And I also predict the government will trot out the same old "no need to take any action as numbers are small, keep an eye on it", watch the numbers get bigger, sit on hands waiting for more data, then when far too late for effective suppression panic and claim nobody saw it coming.

I am a little more sanguine about politicans. Most want to do "good" but lack the imagination to work out a way of doing it. Saving a trillion a year in added debt (from lockdowns) would seem to have it's advantages. The UK can lock down again at any time, if the indian variant looks like it can defeat vaccinations.

[Nimrod103]

Danger is that when the younger people get vaccinated, the most vaccine-resistant strains are the ones that survive, so UK ends up being a petri dish for the worst Covid variants - we started out with the Wuhan strain, Kent variant was 70% more transmissible, and India variant likely to be even more tranmissible.

I don't think that is how it works. These strains are not vaccine resistant, at least AIUI all the vaccines reduce the severity of the illness due to all strains, and eliminate death almost entirely.
However, the different infectivities of the variants means that there is an evolutionary competition set up, whereby the most easy to catch outguns the most difficult to catch. AIUI the India variant is much easier to catch than the other variants, so is rapidly increasing among those who are susceptible. This will be mainly the unvaccinated, but there is a chance the vaccinated will catch it (as they could catch any other variant), but their infection will not be fatal, and parhaps not even serious.

[zico]

Danger is that when the younger people get vaccinated, the most vaccine-resistant strains are the ones that survive, so UK ends up being a petri dish for the worst Covid variants - we started out with the Wuhan strain, Kent variant was 70% more transmissible, and India variant likely to be even more tranmissible.

I don't think that is how it works. These strains are not vaccine resistant, at least AIUI all the vaccines reduce the severity of the illness due to all strains, and eliminate death almost entirely.
However, the different infectivities of the variants means that there is an evolutionary competition set up, whereby the most easy to catch outguns the most difficult to catch. AIUI the India variant is much easier to catch than the other variants, so is rapidly increasing among those who are susceptible. This will be mainly the unvaccinated, but there is a chance the vaccinated will catch it (as they could catch any other variant), but their infection will not be fatal, and parhaps not even serious.

You're right about the process - I just simplified it. If there are millions of cases, there will also be lots of variants, some better/worse at spreading, some more/less deadly, some more/less susceptible to vaccine. Over time, the variants that thrive and cause a problem are the most transmissible and (to a lesser degree) the most resistant. (More deadly doesn't help a variant to spread, in fact, quite the opposite if people get very sick and die more quickly.) Because of exponential growth, more transmissibility is the biggest advantage for a variant - certainly at this stage of the pandemic.

The big problem with Covid is its long infectivity period before symptoms (if any) appear. If it was more like Ebola, with people bleeding profusely within a very short space of time after infection, the spread would be far more obvious and government would have acted much more firmly and quickly.