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Coronavirus (COVID-19) epidemic weekly update for Malvern Seniors

COVID LOCKDOWN REPLACED BY TIER 2 CONTROL MEASURES on 2nd December

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T'is the Season to be Jolly Careful - says the Prime Minister

Preamble

We keep an eye on the published government figures to asses the level of risk in the Malvern Hills district, if there is an uptick in cases we will tell you.

This page is updated every Sunday between 1800 and 2400 hours GMT.

Information about Coronavirus can be found on the NHS website:

https://www.nhs.uk/coronavirus

How to request a test

It is important to book a test if you feel unwell with COVID symptoms.

Click the new link below for information on how to get a free NHS test if you think you have Coronavirus:

https://www.gov.uk/get-coronavirus-test

In case of difficulty you can try phoning the Coronavirus contact centre by dialing 119.

We are told there is a 'walk through' COVID testing station at County Hall next to the Countrywide Centre; one has been set up at the Worcester Arena car park on the University of Worcester site in Hylton Road to serve the residents of St Johns; and another has been set up at the Three Counties Showground near Malvern.

The Malvern Gazette reports a new COVID testing station has opened in the car park below Great Malvern library on the corner of Victoria Road and Como Road.

These are not drop-ins and you will need to book.

About the COVID Symptom Study app (Zoe)

Please consider helping others by downloading the COVID Symptom Study app onto your smart phone or Ipad and reporting how you feel either daily, or as you are able. Note that currently there is no desktop PC version.

For further details click this link: https://covid19.joinzoe.com

The Zoe app, which is easy to use, allows you to report whether or not you are feeling well and if you have had a test for COVID. This helps Kings College London monitor the spread and symptoms of the disease and give advice to government.

Those who sign up for the app have the opportunity to register to participate in vaccine trials.

NHS COVID-19 contact tracing app (England)

Release of the long promised NHS COVID-19 contact tracing app for Apple and Android smartphones was announced on 24th September.

Click this link for NHS Coronavirus app information

The app provides a means for warning people who have unknowingly been in the presence of someone who has tested COVID positive.

29th November 2020

Summary

The good news is the daily number of new cases has begun to fall and a faint 'toot' can be heard of the cavalry arriving with a programme of vaccination.

However, Coronavirus remains widespread across Worcestershire so Seniors need to continue taking special care by washing hands, wearing face masks and avoiding crowded places, especially indoors.

When the second lockdown ends TIER 2 restrictions will apply to Worcestershire. Shops, cinemas, theatres, restaurants and hairdressers can reopen. The only significant restriction appears to be that there should be no mixing with other households indoors before Christmas except in an emergency.

Click for guidance on tiers: what you need to know

Click for government postcode checker to find tier for other areas

Click to read our commentary

Click for latest Worcestershire County Council COVID-19 news

Although the government will be easing restrictions over Christmas, Seniors should carefully weigh up the pros and cons of attending family gatherings.

Number of cases

This week the average rate of people testing COVID positive in the UK reported by PHE on the 'Coronavirus Dashboard' has fallen from 20,390 to 15,040 new cases per day; see chart below.

COVID daily new cases

UK daily confirmed COVID cases 1st September to 29th November

During the last week the cumulative total of confirmed UK COVID cases reported by PHE rose by 105,202 to 1,617,327.

In Worcestershire there have now been 10,912 confirmed cases of COVID-19, an increase of 714 on the week. The rolling average fell from 159 to 102 new cases per day indicating that the Reproduction Rate (R) is below 1.

The breakdown by Worcestershire Lower Tier Local Authorities (LTLA) is shown in the following table, together with comparisons for Herefordshire, a more sparsely populated county, and the city of Leicester.

Districts of Worcs	Cases	Weekly increase	Population
Bromsgrove	2,274	+142	98,529
Malvern Hills	921	+54	77,545
Redditch	1,984	+171	85,317
Worcester	1,866	+92	103,542
Wychavon	1,856	+103	126,240
Wyre Forest	1,859	+152	100,957
TOTAL	10,912	+714	592,130
COMPARE WITH
County of Hereford	2,440	+131	195,000
Leicester (city of)	17,421	+1,072	400,000

Cumulative cases reported by PHE in Worcestershire to 29th November 2020

At the bottom of the Coronavirus Dashboard there is an Interactive Map which is coloured to show the variation in infection rates across the country. The rapidly shrinking patches of purple suggest the infection has begun reducing in the north, counterbalanced by newly emerging hotspots in Bristol and Swale in Kent.

If you keep clicking the plus sign (+) to enlarge the map eventually you will see for example areas of Malvern, Guarlford and Madresfield; if you click each of these a box pops up which shows the number of cases in the last reported seven days, and a rolling average normalised to 100,000 population per week so rates can be compared across the country.

Note: the Interactive Map works on desktop PCs but you may encounter difficulties using a tablet or smartphone.

Click for Interactive Map of COVID cases

Recent weekly cases to 24th Nov have been: Malvern Wells and Priory 6; North Malvern 3; Malvern Link 5; Callow End, Colletts Green and Hanley 4; Upton and Welland 9; the picture changes daily.

Number of deaths

Statistics on deaths are published by Public Health England, The Office of National Statistics, and NHS England.

PHE figures

Public Health England reports that the cumulative total of COVID (28) deaths in UK hospitals and care homes has risen by 3,221 this week to 58,245 while the rolling 7 day average has risen only slightly from 440 to 460 deaths per day; in comparison averaged over recent years 1,700 people die daily from all causes.

Most of these COVID deaths are currently in the north of England and South Wales where infection rates are highest.

The second wave COVID-19 death rate appears to be nearing its peak and we shortly expect it to begin falling.

Click to view the UK government Coronavirus Dashboard

ONS figures

The Office of National Statistics (ONS) separately reports registered deaths in England and Wales where COVID-19 is mentioned on the death certificate. The ONS figures lag the PHE figures by 10 - 14 days and do not include NI and Scotland, so are lower than the figures published by PHE.

The figures are broken down by District so one can glimpse where deaths are occurring. The cumulative total of COVID related deaths in Worcestershire reported by the ONS up to 13th November is shown below.

Districts of Worcs	Deaths	Weekly increase	Population
Bromsgrove	136	0	98,529
Malvern Hills	49	+1	77,545
Redditch	64	+2	85,317
Worcester	67	+2	103,542
Wychavon	119	+3	126,240
Wyre Forest	129	+2	100,957
TOTAL	564	+10	592,130

Cumulative COVID deaths registered by ONS to 13th November 2020

In the week ending 13th November, there were 10 COVID deaths in Worcestershire, of which 1 was in a hospice and 9 in hospital.

In total in England and Wales 2,654 COVID related deaths were reported by ONS in the week to 13th November, an increase of 551 (26%) on the week before showing the death rate continued to rise, though not so fast as the week before. Of these 461 were in Care Homes, 122 at home, and 2,033 in hospital. The highest number of hospital deaths (>19) by Lower Tier Local Authority were:

Stoke on Trent 27, County Durham 25, Manchester 26, Oldham 35, Rochdale 31, Salford 20, Wigan 47, Liverpool 32, Sefton 27, Barnsely 24, Doncaster 34, Rotherham 22, Sheffield 34, Birmingham 54, Sandwell 24, Walsall 22, Bradford 30, Kirklees 28, Leeds 40, Wakefield 30, Havering 24, Aneurin Bevin University Health Board 45, Cwm Taf Morgannwg University Health Board 44, Swansea Bay University Health Board 23.

Click for national ONS data on deaths (Excel spreadsheet)

NHS England figures

More recently in the seven days ending 27th November NHS England reported 20 deaths in Worcestershire hospitals.

Click for NHS COVID-19 Daily Deaths

Healthcare numbers

The UK government Coronavirus Dashboard includes important information about COVID-19 patients currently in hospital.

Hospital cases (UK)	Number	Weekly change
Patients in hospital	15,712	-678
Patients on ventilation	1,417	-4
Patients admitted daily	1,571	-175

Headline summary of patients in hospital as of 29th November 2020

Although these headline figures are not updated regularly, they are useful indicators.

The number of patients in hospital reflects beds that are not available to 'elective' NHS patients; this appears to have reached a peak and has fallen slightly.
At the height of the epidemic in April the number of patients occupying mechanically ventilated beds reached 3,000 and on average forty seven percent of that number are now being used; the good news is the number of ventilators in use has stopped rising.
The number of COVID patients admitted daily gives both a measure of how quickly hospitals are filling and more importantly an indication of the death rate to be anticipated in the following month (see next section).

Very sick COVID patients are said to arrive in hospital 7 to 10 days after first symptoms, and either die or are discharged 15 to 30 days after first symptoms in most cases. Hospital beds are occupied by suspected COVID patients, very sick COVID patients, and a few suffering from 'Long COVID' who may remain in hospital for much longer than 30 days.

Notes on projected figures

It appears hospitals are only admitting very sick COVID-19 patients, for example those with breathing difficulties, which is probably why Professor Peter Horby of Oxford University said on the Andrew Marr show that up to 20% of COVID patients in hospital could die.

If this is correct, the current admission rate of 1,571 new COVID patients per day points to about 314 hospital deaths per day, to which must be added forecast COVID deaths in other settings such as Care Homes. Adding 25% for the latter suggests an estimate of the order of 393 deaths per day around Christmas.

Statistician Sir David Spiegelhalter of Cambridge University speaking separately on BBC TV said that, using his rule of thumb, hospital admissions were likely to be about 10% of reported new cases, one week after symptoms; and deaths were likely to be about 2% of new cases, 2 to 3 weeks after that - which would point towards about 300 deaths per day in the second half of December.

During September and October the actual second wave numbers fitted a truncated exponential series which we used to forecast a week ahead. Since then the rate has slowed - approximating more closely to an S shaped Logistic curve which we have used as a guide in producing the forecast below.

Forecast for the week ahead

Trends suggest that during the next seven days (up to 6th December) the cumulative total of new UK COVID-19 cases reported by PHE on the Coronavirus Dashboard can be expected to increase by about 85,000 towards 1,703,000 cases.

In Worcestershire up to 700 new cases of COVID-19 can be expected, and possibly up to 60 cases in the Malvern Hills district.

As the (average) daily death rate seems to be nearing a peak of about 460 deaths per day we estimate the number of COVID (28) deaths will increase by about 3,100 nationally towards 61,345 during the 7 days ending 6th December

In the county of Worcestershire, assuming a 2% death rate, the 714 new cases this week could translate to a maximum of 15 Worcestershire deaths per week in the latter half of December, but if cases are mostly confined to younger age groups it could be less.

Longer term forecast

Looking to the longer term, based on the recent fall in daily new cases and using the 'rules of thumb' mentioned above, we anticipate the national daily death rate will gradually decline during December (see commentary).

The chart below shows deaths to date in red and a revised projection of future COVID deaths up to the end of December in blue which assumes the death rate falls progressively towards 200 deaths per day by the end of the year.

Forecast COVID UK deaths

Revised forecast of cumulative COVID deaths to 31st December

For a short period, while the second wave death rate is near its peak, the storing of bodies in temporary mortuaries and some delay to funeral services cannot be ruled out between now and early January.

Providing people continue to act sensibly following the end of the second lockdown and over Christmas there could be a further reduction of daily new cases in December with a consequential further slowing of the daily death rate in January 2021, by which time the first vaccines may begin to come on stream for small numbers of NHS staff, care workers, and the elderly. That is the rosy picture.

More likely however there could be a third wave of the COVID epidemic in January, caused by excessive travel and mingling over Christmas, leading to a possible extension of restrictions, which many MPs and business leaders attempt to resist.

Realistically, it may take until the summer to vaccinate a significant fraction of the UK population, but Seniors should take heart that they are likely to be near the front of the queue.

Advice for Seniors

COVID risk high

COVID is still widespread and there are pockets of infection across the Malvern Hills and Worcestershire so we consider the risk to be HIGH for Seniors living in the Malvern Hills district, though not very high; see our commentary and riskometer opposite.

If you catch COVID there is a significant chance that you will either die or your long term health may be seriously damaged, so take care to protect yourself and those you love. 90% of COVID deaths are in those aged over 60 years according to NHS England statistics.

Prior to Christmas you must not mix with other households.

Although the government will be easing restrictions over Christmas, risk averse Seniors should consider not mixing indoors in large family groups. Instead, perhaps consider inviting a lonely friend round for Christmas lunch and communicating with family using either Skype, Facetime or Zoom.

The simple safeguards to remember are still to:

wash your hands thoroughly, using soap and hot water, for 20 seconds, including after handling deliveries to your home (HANDS) see note 1;
wear a face mask when appropriate for example when shopping or visiting the chemist (FACE);
avoid mingling especially in crowded places, and continue with precautions such as physical distancing by 2 metres (SPACE) keeping proximity with others brief (TIME) see notes 2 and 3.

Hence the mantra:-

HANDS, FACE, SPACE, TIME - GET A TEST if you feel unwell.

Click for UK government Coronavirus guidance on what you can and cannot do

Remember, if you have symptoms of COVID-19 and can't count from one to ten out loud due to shortness of breath, you should immediately call your GP, 111 or 999 for advice.

Notes:

1) Wash your hands thoroughly before touching your face to avoid transferring virus from surfaces to your mouth, eyes and nose. If outdoors use hand gel.

2) Minimise time spent mixing with people outside your household in indoor settings - an invisible mist of virus can build up in the air if the space is shared with an infectious person; imagine people exhaling cigarette smoke. Unless you wear a hospital grade face mask you can breath this in; a face covering will offer little or no protection. The likelihood and extent you get sick will depend on the density of the airborne virus, which can be reduced by ventilation, and your exposure time.

3) Two metres is further than you think, and roughly an arm and a walking stick away - difficult to chat if the person you are talking to is hard of hearing!

Annex to 29th November update

Commentary

Speculation in the media this week has been about the timing of the COVID vaccination programme, the introduction of the new TIERS of control following the ending of the second lockdown in England, and the relaxation of restrictions over the Christmas holiday.

Tiers of control

As expected Worcestershire will move into Tier 2 when the present lockdown ends; that means we must not mix with other households, which could make visiting grand children difficult. Otherwise we can do very much everything else, whilst observing the Hands, Face, Space guidance.

Relaxation of controls over Christmas

The debate over trading people's lives for a roast dinner looks to have been settled.

The government and devolved administrations have accepted that families will get together at Christmas whatever they say and are proposing relaxation of the restrictions hoping to limit the damage. See press release:

UK-wide Christmas arrangements agreed by the UK Government and the Devolved Administrations

The main points are:

1) Travel restrictions across the four administrations and between tiers will be lifted to provide a window for households to come together between the 23rd and 27th of December.

2) Up to three households can form an exclusive ‘bubble’ to meet at home during this period. When a bubble is formed it is fixed, and must not be changed or extended further at any point.

3) Each Christmas bubble can meet at home, at a place of worship or an outdoor public place, but existing, more restrictive rules on hospitality and meeting in other venues will be maintained throughout this period.

Joint statement on UK-wide Christmas arrangements from the UK Government and Devolved Administrations

However, freedom to travel across the country for coronavirus parties has potential to spark a third wave of the epidemic, leading to more deaths especially in the 60+ age band (see below).

The government seems largely to have relinquished responsibility, so it is ultimately for us Seniors to decide, based on personal circumstances, how much risk to take this Christmas.

Quantifying the danger of mingling at Christmas

Relaxation of restrictions over Christmas will lead to additional deaths and likely a third wave of the epidemic. Here is a back of the envelope worst case calculation:

Assume 66 million people in the UK, who divide into bubbles of 10 creating 6.6 million bubbles. Assuming an infection rate of 100 per 100,000 then 1% of bubbles will contain at least one infectious person, that is 66,000 bubbles. Cooped up indoors together assume the other 9 in the bubble are infected, suggesting a worst case of 600,000 new 'index' COVID cases due to relaxation of the COVID restrictions - a huge number.

If people of all ages mix then 2% can be expected to die, perhaps 12,000 immediate additional deaths in the second half of January, of which 90% would be aged 60+ years, to which would have to be added later deaths amongst their contacts.

The message seems clear: the easing of restrictions over Christmas would very likely lead to a third wave of the epidemic and a significant number of deaths.

However looked at from another angle the majority of family gatherings (>99%) would probably be infection free.

Our recommendation is that risk averse Seniors should consider declining Christmas gatherings this year, unless they have a life limiting condition and feel that this may be their last. That would not in itself prevent a third wave of the epidemic but could reduce additional deaths to 1,000 in those aged under 60 years.

Vaccination

The Pfizer, Moderna and Oxford vaccines are showing promise but still need to be approved, manufactured, distributed and a programme of vaccination rolled out. The government hints that vaccination could start in early January with significant progress being made by the spring, whilst other commentators suggest that more realistically it may take until the summer to vaccinate say 50% of the UK population.

Recent deaths in Worcestershire hospitals

The table below shows an uplift in COVID deaths in Worcestershire Acute Hospitals Trust reported by NHS England to 27th November.

Date	Number
21st November	1
22nd November	2
23rd November	5
24th November	1
25th November	4
26th November	5
27th November	1
Total	19

Worcester Acute Trust hospitals COVID deaths in 7 days to 27th November

1 death was reported in Worcestershire Health and Care Trust hospitals during this period, making a total of 20 deaths in all.

To date a total of 339 COVID deaths have been reported in Worcester Acute hospitals and 31 in 'Care' hospitals.

Present rate of new cases

This week, the average rate of infection per 100,000 population per week in England fell from 259 to 175. In comparison the figure for Worcestershire is 143 and that in the Malvern Hills 66. So the Malvern Hills remains the safest district in Worcestershire and compares well with the city of Leicester where the rate of infection is seven times higher.

Nevertheless in normal times a figure of 50 would be considered too high, so Seniors should continue to be careful.

The probability of catching Coronavirus in the Malvern Hills is moderate, and falling this week, but combined with the significant risk of death makes us view the overall risk to Seniors as still HIGH. If Seniors were to visit hotspots such as Bristol, Staffordshire, Leicester or Hull we would assess the risk VERY HIGH.

The risk of death from Coronavirus for healthy teenagers is exceedingly small so for them the risk is LOW, whereas the middle aged can suffer from Long COVID so for them the risk might be assessed MODERATE.

Forecast of death rate during December

Last week we made a rough estimate of the future daily death rate - emphasising that while one can't go far wrong extrapolating a week ahead, forecasting the death rate one month ahead is little more than a shot in the dark.

Using an Excel spreadsheet, we fitted the actual death rate to an S shaped curve (or logistic function) and used that to project how the death rate might fall in December. However during the last week the actual death rate roughly flat-lined rather than declining so we have delayed the peak in the curve; see chart below.

COVID death rate in UK

Illustration of possible death rate to 31st December

The present COVID death rate of 460 deaths per day will fall, but there is considerable uncertainty about how fast and whether there will be bumps in the road for example caused by a third wave of Coronavirus due to restrictions being eased over Christmas. We will just have to wait and see what actually happens!