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Major infectious diseases – England (and Scotland) update, week 12

New week, new data, but the old story. TL&DR: Covid is still a problem in England (and elsewhere), although the increase in cases and hospitalisation might be slowing down.

Other diseases I routinely monitor here follow their seasonal, pre-pandemic patterns, although Rhinoviruses remain high.

Rhinoviruses

I have not looked at Rhinoviruses for a while. The UKHSA does not provide readily-available electronic data so I need to resort to scanning and digitizing.

Rhinoviruses are the primary cause of the common cold. They prefer temperatures 33-35C, typically found in human noses. Their spread is seasonal, but unlike flu or RSV they tend to peak twice a year, in Spring and in Autumn.

Initially suppressed in March/April 2020, they came back later in 2020 and were largely unaffected by subsequent lockdowns. In the 2022/23 season, the Autumn peak was followed by a drop in positivity but a large increase in the number of positive samples.

The positivity stays high, so there is indeed a lot of sniffing and sneezing around. It will be interesting to see how the Spring wave will develop, but we will likely continue with a lot of rhinoviruses around.

Covid

The hospitalisation numbers are slightly down, but there is probably no reason to celebrate yet. A high number of cases and positivity are sadly bound to be translated into a jump in hospital admission next week.

As mentioned in my earlier posts, this wave is different to the previous ones, and so it is difficult to make any predictions. I am worried about the rapid growth in India, as what affects the largest country in the world is bound to make its way here.

Similar increases have been seen elsewhere, for example, in Denmark, as excellent reporting by @BarclayBenedict shows:

Flu, RSV and Scarlet fever

I am lumping these three together, as they now follow a similar, pre-pandemic, seasonal pattern.

Pre-pandemic, both influenza and RSV peaked in late Autumn and Winter. Flu is a bit more complicated due to different Influenza A and B behaviours, but it was always strongly seasonal.

Both flu and RSV epidemics are now generally over, although flu seems to be lingering at low levels.

Scarlet fever is also seasonal, but the before the pandemic, the peaks were later and more spread out. This season was, of course, different due to the unprecedented outbreak levels in November and December.

But, when the top values are ignored, the current levels of Scarlet fever are within the pre-pandemic range – which encompassed such different epidemics as 2017-18 (peaking at over 2000 cases per week) and 2018-19 (peaking at 500 cases per week).

I expect the Scarlet fever numbers to linger near the current level for a few more weeks before slowly disappearing over Summer.

Living with Covid

COVID-19 – back to normal life after coronavirus

Covid pandemic is not over in the UK, and we are in the middle of a new wave with significant increases in 0-14 and 75+ age classes (data from the UKHSA).

Society response

YouGov – the UK’s primary opinion pollster – has just published the results of their survey on “living with Covid” attitudes. 59% of Britons supported the statement:

We need to learn to live with it and get back to normal

whereas only 31% felt close to the opinion that

We need to do more to vaccinate, wear masks and test

YouGov survey, March 2023

Only 26% in NRS Social Grade C2/D/E (most deprived) are content that life returned back to normal, compared with 31% A/B/C1 (least deprived), whereas 65% and 62%, respectively, think that it did not.

When it comes to choosing between “doing nothing” and “taking action”, the Social Grade does not make a huge impact – among A/B/C1, 57% wants to do nothing and 33% want to take action. For C2/D/E, it is 61% to 28%.

For 74% of those in 75+ category, life is still not back to normal, compared with 55% in 18-24 year-olds. But, interestingly, 22% of 18-24 do not know whether to choose between “doing nothing” (43%) and “taking action” (35%). For 65+, 59% is for “doing nothing”, 34% for “taking action”, and 7% do not know.

Are these fair questions?

I actually do not think these are fair questions. In my opinion, the two options are not exclusive, as I believe that we need to “learn to live with it” and do more to protect ourselves and others.

It is probably better to think of these two questions as: “doing little” vs. “going back to the dark ages of Covid”. I am not surprised by what most people chose.

I think that in order to “live with it”, we must do more to protect ourselves and others. Covid is not finished, and it is only going to get worse over months as the next wave sweeps through and generates more #LongCovid cases.

And yet, I am amazed that the society managed to get together so well during the lockdowns and to sacrifice so much, and yet is unwilling to engage in such easy and risk-free activities as wearing masks (when needed), testing, and arranging ventilation.

Vaccination is perhaps in a different category and I fully respect those who decide not to. And yet, the impact of vaccination on the reduction in death levels is without a doubt.

Major infectious diseases – England (and Scotland) update, week 11

TL&DR: In the first week of Spring, England’s Covid continues to cause problems with high hospitalisation numbers, although the cases and positivity are going down. Cases in Scotland continue to go up. Other diseases (flu, RSV, Scarlet fever) are following the “normal” pre-pandemic course, although RSV is still relatively high.

And, no, Covid is not flu.

It is correct that at one point in November 2022 more people were admitted to hospital for flu than for Covid. But, as the graph above shows, Covid epidemic is as having the worst month of flu but five times in a year.

Covid and flu might now have similar Infection Fatality Ratios or Case Fatality Ratios, but there are so many more Covid cases that they dwarf the risk of flu complications.

Little is known about long-term effects of viral infections such as the flu, but there is no doubt that there are much more frequent and severe long-term effects of Covid.

Covid

The cases are more or less stable, positivity is going down, but hospitalisation is going up. The “new” wave, which does not look like any previous wave, is continuing to spread.

Looking in more detail at the recent case data, there is a clear pattern of increase in both England and Scotland across all age groups.

Finally, looking at deaths shows that this wave has a different pattern to the previous five waves – shallower but perhaps longer.

Influenza and RSV

Influenza and RSV cases continue on their way down, and I suspect will disappear when Spring weather gets warmer and people move outside.

Scarlet fever

Scarlet fever continues at about the same level as in previous weeks, again in agreement with the pre-pandemic years. Based on the analogy with previous years, expect a continuation at a similar level until the schools disband for summer.