COVID-19 and what to expect from the Scottish Government today

https://twitter.com/aklecz/status/1496063817037590532?s=20&t=Xi_TrdYCK1NbHyenJ7ofjQ

The Scottish Government will today (February 22nd, 2022) announce its response to the scrapping of (almost) all restrictions in England about which we heard last night. So here are some thoughts @mark_mclaughlin @HMcArdleHT @HelenPuttick @NicolaSturgeon

I expect that as in the past, the Scottish Government will follow a more cautious approach to the one in London and be more “socially oriented”. This is in line with other initiatives, for example, providing free feminine care products in education settings.

  • Continuing to provide free tests, at least to some extend;
  • Self-isolation requirement, perhaps scaled down;
  • Scrapping vaccine passport schemes;
  • Continuing a requirement to wear masks, although possibly not in pubs.

For this limited removal of the restrictions, the SG and @NicolaSturgeon personally will be thrashed in the news and possibly by other, local, politicians and members of the public.

I think this is unfair. There are many things on which I disagree with Ms Sturgeon, but I am supportive of most recent public health measures.

There is a lot to improve, such as the clarity and consistency of the measures, but overall they seem to be more science-guided and safer as opposed to Westminster’s politics.

The number of cases in age groups

A context: The pandemic is not over.

Comparison of the number of reported cases at wave peaks. Note log scale.

Even with significantly reduced testing, the number of reported cases in both Scotland and in England is still very high, much higher than during the previous waves! Yes, it is true – there are more reported cases now than at the peaks of previous waves!

Comparison of the number of reported deaths at wave peaks. Note log scale

There are fewer COVID-19 related deaths now than during winter 2020-21 when we did not have vaccines, but we are still at similar levels than at the peak in autumn 2021.

So, declaring the end of the pandemic now is premature – to put it mildly.

Free tests: I know they cost money, but they are also necessary, both from a societal and from an individual point of view. Public health managers need to know how many people are infected because this is how they can estimate the pressure on the NHS.

Individuals need to know when they should refrain from going to work or school, or visiting their vulnerable Granma.

Telling people they need to pay for the test puts a barrier on their availability – even those who can afford to pay £20 per pack of 7 tests are unlikely to spend it.

And, it creates another inequality, as those most vulnerable are less likely to afford the testing.

Self-isolation: Support for self-isolation is necessary for testing to work properly. Remember that the UK has significantly lower sick pay than many countries, like Germany. And, again, it will disproportionally affect those who are already disadvantaged.

Passports: They do not seem to make much difference, so I support these. The vaccination levels are stalling anyway, Omicron is spreading anyway so protecting against superspreaders is less important.

Masks: We all probably hate masks, but they work! The public should be encouraged to wear them and they should be made available cheaper. I will definitely continue wearing a mask, to protect others – and to protect myself. Removing mask requirements in hospitals is crazy.

Should masks be worn in churches, pubs, and in concert halls/events? From an epidemiological point of view, no – but there is a strong social pressure and so I can understand why they need to go.

COVID-19 reporting, or why it is stupid to stop testing

As part of a transition to “living with the virus”, many countries are abandoning mass testing. COVID-19 is losing the status of a “notifiable disease” and so it is becoming increasingly more difficult to actually draw any conclusions on what is actually going on.

Looking first at the number of reported cases in countries like the UK, Denmark, Sweden, Israel and the US, the severity of the COVID-19 outbreak seems to be rapidly declining across the board:

Even in Denmark, which experienced a large Omicron wave earlier this year and was one of the first countries to abandon all non-pharmaceutical measures, the numbers start to go down. Sweden and Israel both exhibit a huge decline in reported cases.

The decline in the UK and the US is much slower, but noticeable – and the UK is world-leading in the removal of all restrictions.

While the cases are declining, so is the number of tests:

The resulting proportion of positive tests seems to tell a very different story to the one told by the number of cases:

Norway and Sweden still experience a rapid increase in the share of positive tests, reaching the levels of 60%-70% which basically suggest that only those who know are ill and are willing to test – and report the test results – are bothered to do so.

Denmark sees a slightly slower growth and Israel appears to have plateaued. The UK has been seeing constant levels since the beginning of the year and certainly does not see any decline, so trumped up in the news. It is only the US that shows consistency between the two measures of disease severity.

The share of daily COVID-19 tests is a less intuitive but more robust measure of the severity of the outbreak, as the – more intuitive – reported number of cases depends on testing intensity.

So, is the epidemic still rising in these countries? What can we learn from studying the number of deaths reported?

WHO recommends that when the share of positive tests exceeds 5%, this means not enough is being done to detect and report the disease levels. At 70%, the reporting results become completely unreliable.

The deaths time series is delayed compared to the number of cases, sometimes by many weeks. The rapid increase in reported cases seen in Israel peaked around January 24th. In contrast, the wave of deaths was only starting then and peaked around 3rd February – a 2 weeks delay.

So, we will have to wait a bit to see what the trends are. Nevertheless, deaths seem to be still on the rise in Sweden and Denmark, plateauing in Israel in Norway, and slowly declining in the US and the UK.

Why do we bother? With ridiculously low testing levels the reported number of cases simple becomes completely irrelevant. Soon in countries like Israel, Sweden, Norway and the UK, we will have no idea what the virus is doing.

When a new variant emerges, we will have abandoned one of the key elements of our strategy to fight it off. What a stupid thing to do.