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A quick update on Covid and other infectious diseases

Another week, another update. TL&DR: all indicators are going down. We are not out of the woods yet, I think, but it is all good news for Covid, flu, RSV and even Scarlet fever.

COVID-19

Admissions and cases are both going down. As described in a previous post, the deaths basically followed the same shape as the last few waves, reoccurring roughly every 3 months.

A big wave has not materialised yet, so I expect this wave to peter out for another 2-3 weeks until it starts growing again.

Influenza

The numbers are definitely down, and it certainly looks like the 2019-20 season. I fully expect the numbers to continue falling down (although there might still be some upward correction to this and last week’s reading).

RSV

The rate and positivity are declining, and the wave starts looking like another pre-pandemic year. Hopefully, this means that the 2022 summer and autumn outbreak is now finished, and we are back to the seasonal pattern.

Scarlet fever

Scarlet fever cases are still high (note the logarithmic scale below), but dropping down. This decline from very high numbers might mask the fact that the disease usually peaks in late winter and early spring (or at least it was doing this pre-pandemic).

But I still expect we will struggle with it for at least several months before the big drop in summer.

COVID deaths comparison

Since the COVID-19 epidemic started just over three years ago, a large number of people have died either directly from the disease or in combination with other factors. The exact number will never be known and will always be a matter of controversy because of an unclear definition of what constitutes COVID-19-related death or the lack of reliable data.

One way of looking at it is to look at excess deaths, with estimates ranging from just over 15 million to nearly 30 million, while nearly 7 million are classified as “confirmed”.

For comparison, the Great Chinese Famine of 1959-61 caused between 15 million and 55 million, due to starvation. Both can be seen on the plot below as comparable peaks in the annual number of deaths:

A similar point has just been made on Twitter, with another striking graph:

Black death pandemic at perhaps 75-200 million and Spanish flu pandemic at 50-100 million still dwarf the COVID-19 outbreak, as does the Second World War at 70-85 million.

But, in the First World War, total casualties are listed as 15 million to 22 million, including both military and civilian deaths as well as malnutrition and diseases, but excluding Spanish flu.

Going back in time, the Napoleonic wars might have caused between 2.4 and 6 million deaths.

But the COVID-19 pandemic has not finished yet…

COVID-19 winter wave

Since the beginning of December, the UK has been experiencing another COVID-19 wave. In my The Conversation article published on 13th December, I predicted:

Predictions of a large COVID wave as we head into winter have so far not materialised. The most likely scenario is that the small-scale outbreaks will continue throughout winter as COVID becomes “endemic”. 

https://theconversation.com/our-third-covid-christmas-heres-how-things-might-play-out-195837

At the time of writing, there was considerable uncertainty about what was likely to happen over Christmas, both associated with new variants (particularly XBB), loss of immunity, and behaviour (mainly the effect of Christmas mixing). This is an England prediction by IHME dated 16th December

My expectations, briefly discussed here on the blog, were that the wave would be limited, both in size and duration. I was expecting the wave to either be similar to the most recent one – the Autumn wave – or perhaps a slightly larger one, like the Spring 2022 wave.

Although the current wave starting in December 2022 is not yet over, the numbers have started to go down. Comparing the last five waves, it looks like England is simply following the same pattern again and again.

We had about the same outbreak roughly every 3 months (January, April, July, October 2022), peaking around the middle of the month. But the shape of each outbreak is almost exactly the same:

I find this picture amazing (the most recent 3-4 points in the current wave should be ignored as they will be revised upwards). The earlier two waves are very similar as well, except the magnitude is higher. If scaled down by 1.5, they look almost exactly the same.

So, is this how the “endemic” COVID-19 will look like in the future?

The recent two papers speculate that in the future, it will be endemicity that will determine the outbreaks.