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

COVID LOCKDOWN in ENGLAND

Alert Level raised to 5 on January 4th

INFECTION RATE HIGH

PM says 'STAY AT HOME'

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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

In order to protect others 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 had 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. There is also a drive through pod at the Worcester Royal Hospital.

These are not drop-ins and you will need to book - but it is said there is good availability and you should get the result back in 24 hours. At the Worcester Royal we were told the testers would only get in touch if the test was positive.

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.

There is a new question allowing any side effects of vaccination to be recorded. If you do not see this you will need to update the app.

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

31st January 2021

Summary

The COVID-19 infection rate has slowed but is still too high in Worcestershire so you need to continue to be careful for the next month or so.

There are signs the pressure on hospitals is beginning to ease slightly, but Dr Susan Hopkins speaking on the Andrew Marr show said hospitals would likely remain very busy treating COVID patients throughout February and into March.

We must continue to play our part by staying at home, isolating if unwell, and enthusiastically adopting the HANDS, FACE, SPACE regime in order to keep the Reproduction Rate below 1 so that the daily number of new cases progressively falls to at least half what it is now. Daily new cases still exceed 20,000 whilst in Singapore the rate has dropped to about 2; adjusting for population our target would be 20 so there is a long way to go.

It will be several months before enough people are immunised to keep infection low were restrictions totally relaxed. Consequently it is likely the lockdown will be relaxed in stages during the spring and summer as the daily number of new COVID cases and hospital admissions fall. Do not expect a return to 'normal' in February and consider taking your summer holiday in the UK this year, if travel overseas proves difficult.

Government advice is unchanged. Where possible:

WE MUST WASH OUR HANDS THOROUGHLY OR USE AN ALCOHOL BASED HAND GEL TO STOP THE TRANSFER OF THE VIRUS FROM CONTAMINATED SURFACES SUCH AS SUPERMARKET TROLLEYS TO OUR EYES, NOSE OR THROAT.

WE MUST WEAR A FACE MASK WHEN UNAVOIDABLY NEAR OTHER PEOPLE TO REDUCE VIRUS TRANSMISSION THROUGH THE AIR.

WE MUST KEEP AT LEAST 2 METRES AWAY FROM OTHER PEOPLE EXCEPT WHEN IN OUR OWN HOUSEHOLD BUBBLE .

DURING LOCKDOWN WE MUST NOT MEET WITH OTHER HOUSEHOLDS.

Number watchers can find summarised information about COVID cases in Worcestershire on the new Worcestershire Coronavirus Dashboard. Use the arrow <> buttons at the bottom of the screen to move between pages.

An interactive map, showing the receding march of COVID across the country, can be found on the national Coronavirus Dashboard

Click for Worcestershire County Council COVID-19 news

Click to skip to our commentary

Vaccination

COVID vaccine is being trickled out to GP surgeries and most of those aged 80+ years in Malvern should have been vaccinated by now; if not contact your surgery.

Doctors' surgeries are used to carrying out vaccinations and we are told they have stepped up wonderfully well, with many volunteers coming forward to help. Because of this, and the limited supply of vaccine, the opening of the planned mass vaccination centre at the Three Counties Showground could be delayed until the end of February.

Those in the 70-79 age band should expect a letter from the NHS by the end of next week inviting them either to book an appointment at a vaccination centre outside Malvern, via the Internet, or wait to be contacted by their local GP surgery.

Click for illustration of COVID vaccination centres offered by the NHS

According to the Zoe Symptom Study the vaccine offers no protection for the first two weeks but after 3 weeks vaccinated individuals should develop useful immunity.

See advice from Professor Van Tam in the Daily Mail about continuing to follow the lockdown rules after vaccination

The government's current target is to vaccinate those aged 70+ by 15th February, those aged 50+ by the end of April and those aged 18+ by September.

Worcestershire and MHDC are said to be doing very well and on track to achieve vaccination of all those aged 70+ by the 15th February.

The bar chart below shows the population of the UK by age band, and the number of first jabs given, so that you can see progress of the vaccination programme.

COVID vaccination bar chart

Vaccinometer as of 30th January

Total first jabs are reported 8,977,329 to the 30th January. You will see from the bar chart that should be enough to vaccinate most of those aged 70+. However we suspect little more than half those jabs have been given to the elderly, with the remainder going to younger vulnerable persons, doctors, nurses, carers and 'key workers'.

NHS England publishes a daily tally of the number of people vaccinated in England on an Excel spreadsheet but it lags behind the numbers you will see on TV:-

Click for numbers of people vaccinated in England reported by NHS

Number of cases

This week the average rate of people testing COVID positive in the UK reported by PHE on the 'Coronavirus Dashboard' fell sharply from 35,929 new cases per day to 24,245; see chart below.

COVID daily new cases

UK daily confirmed COVID cases 1st September to 31st January 2021

We expect daily cases to fall further as the lockdown bites.

During the last week the cumulative total of confirmed UK COVID cases reported by PHE rose by 169,713 to 3,817,176.

In Worcestershire there have now been 27,634 confirmed cases of COVID-19, an increase of 1,761 on the week. The daily number of new cases fell from 369 to 252.

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.

Note: these figures are based on the 'Cases by area' (whole pandemic) data set of the Coronavirus Dashboard.

Districts of Worcs	Cases	Weekly increase	Population
Bromsgrove	5,485	+250	98,529
Malvern Hills	2,242	+138	77,545
Redditch	4,920	+325	85,317
Worcester	5,127	+323	103,542
Wychavon	5,313	+449	126,240
Wyre Forest	4,547	+276	100,957
TOTAL	27,634	+1,761	592,130
COMPARE WITH
County of Hereford	5,956	+279	195,000
Leicester (city of)	30,276	+1,327	400,000

Cumulative cases reported by PHE in Worcestershire to 31st January 2021

Interactive map

At the bottom of the Coronavirus Dashboard (daily update) page there is an Interactive Map which is coloured to show the variation in infection rate across the country. The areas of highest infection coloured purple have mostly gone.

Click for Interactive Map of COVID cases

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

The number of cases fell slightly this week. Recent weekly cases to 26th January are: North Malvern 15; Malvern Link 18; Pickersleigh 15; Barnards Green 8; Malvern Wells and Priory 13; Callow End and Hanley 9; Upton and Welland 15. The picture changes daily.

Number of deaths

Statistics on COVID 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 8,219 in the last week to 106,158 while the daily average has fallen slightly from 1,242 to 1,174; see chart below which show the actual daily death rate in red, and our forecast to 14th February in blue.

Forecast of daily COVID death rate UK

Actual daily UK death rate from 27th Dec to 31st Jan 2021 and forecast

It looks as though the death rate has peaked and should fall slightly next week.

Click to view the UK government Coronavirus Dashboard

In comparison averaged over recent years 1,700 people die daily from all causes.

In those districts where the COVID death rate is highest the storing of bodies in temporary mortuaries and delay to funeral services can be expected between now and the end of February.

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 value of the ONS figures is that they 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 15th January 2021 (week 2 of 2021)) is shown below.

Districts of Worcs	Deaths	Weekly increase	Population
Bromsgrove	187	+12	98,529
Malvern Hills	86	+16	77,545
Redditch	121	+5	85,317
Worcester	125	+22	103,542
Wychavon	176	+10	126,240
Wyre Forest	191	+10	100,957
TOTAL	886	+75	592,130

Cumulative COVID deaths registered by ONS to 15th January 2021

In the week ending 15th January, there were 75 COVID related deaths in Worcestershire, of which 14 were in care homes, 2 at home, and 59 in hospital.

In total in England and Wales 7,701 COVID related deaths were reported by the ONS in the week to 15th January, an increase of 1,196 (18%) on the week before.

The grim reaper in particular visited South Wales, Birmingham and South East England.

The highest number of hospital deaths (>29) by Lower Tier Local Authority were:

Kingston upon Hull 32, Leicester 33, Stoke on Trent 45, Southend on Sea 54, Thurrock 30, Medway (Kent) 68, Milton Keynes 32, County Durham 49, Cheshire East 34, Cheshire West 36, Bedford 40, Central Bedfordshire 34, Bournemouth Christchurch and Poole 42, Buckinghamshire 45, Basildon 35, Castle point 33, Epping Forest 33, Tendring 31, Liverpool 43, Sheffield 39, Swale 34, Birmingham 102, Walsall 30, Wolverhampton 39, Barking and Dagenham 37, Barnet 49, Bexley 35, Brent 30, Bromley 34, Croydon 51, Ealing 43, Enfield 57, Hackney 34, Havering 65, Hillingdon 41, Lambeth 32, Newham 52, Redbridge 54, Tower Hamlets 31, Waltham Forest 35, Carmarthenshire 31, Bridgend 49, Cardiff 35, Rhondda Cynon Taf 33, Betsi Cadwaladr University Health Board 57, Hywel Dda University Health Board 41, Aneurin Bevan University Health Board 61, Cardiff and Vale University Health Board 49, Cwm Taf Morgannwg University Health Board 88.

The cumulative total of COVID related deaths in England and Wales recorded by the ONS for all weeks of the epidemic rose to 99,892.

Year	Cumulative COVID related deaths in England and Wales
2020	85,686
2021	14,206
TOTAL	99,892

COVID death toll in England and Wales to 15th January 2021

Click for national ONS data on deaths (Excel spreadsheet)

NHS England figures

More recently in the seven days ending 30th January NHS England reported the cumulative total of deaths in Worcestershire hospitals rose by 50 to 705.

Click for NHS COVID-19 Daily Deaths

Healthcare numbers

The UK government Coronavirus Dashboard includes important information about healthcare statistics.

Hospital cases (UK)	Number	Weekly change
Patients currently in hospital	34,783	-3,116
Patients on ventilation	3,832	-244
Patients admitted daily	3,039	-974

Headline summary of patients in hospital as reported 31st January 2021

These headline figures show the number of COVID patients in hospital has fallen slightly but we need to see the number falling further as hospitals are still under pressure.

Despite a fall, the number of patients on ventilators is 28% greater than in the first wave which is bad news as the outcome for patients on ventilators is poor.

Daily admissions have fallen by about 25% which is encouraging.

Figures for bed occupancy in Worcestershire hospitals can be found on the NHS England website:

Click for NHS England COVID-19 Hospital Activity

On 26th January there were 253 COVID patients occupying beds in Worcestershire Acute Hospitals at Worcester, Kidderminster and Redditch (an increase of 6% on last week), and a further 44 in 'care' hospitals. In England a total of 32,337 COVID beds were occupied a fall of 5% on last week.

Note: The Welsh First Minister said some time ago that very sick COVID patients 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.

The death rate compared to a percentage of daily hospital admissions, which has been higher than expected during the last 3 to 4 weeks, is reverting to the norm. The shape of the curve suggests the awful daily death rate has reached a peak so should begin to fall, slowly at first, within the next fortnight.

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 to about 480 hospital deaths per day in the second half of February.

Forecast for the week ahead

Trends suggest that during the next seven days (up to 7th February) the cumulative total of new UK COVID-19 cases reported by PHE on the Coronavirus Dashboard could increase by about 150,000 towards 3,970,000.

In Worcestershire up to 1,700 new cases of COVID-19 can be expected, and possibly up to 120 cases in the Malvern Hills district.

We estimate the number of COVID (28) deaths could increase by about 7,000 nationally towards 113,000 during the 7 days ending 7th February 2021.

In the county of Worcestershire, assuming a 2.4% death rate, the 1,761 new cases this week could translate to about 42 Worcestershire deaths per week by the middle of February, but if cases are mostly confined to younger age groups it could be less.

Longer term forecast

Ending of the third wave of the COVID-19 epidemic in the UK

Daily new cases of Coronavirus have been falling steadily since the introduction of the third lockdown due to physical distancing. Once all the population has been vaccinated (currently September) the restrictions can be relaxed. Relaxing the controls too early say in March, as the government probably intends, could lead to a wave of sickness, but vaccination of those aged 60+ should prevent an excessive death rate.

For the time being the death toll will continue to mount until the vaccination programme eventually draws this COVID-19 epidemic to a close. We expect the UK COVID death toll to reach 130,000 by the end of March 2021; see commentary.

Exactly what happens will depend on the public's compliance with the lockdown, the effectiveness of test and trace, any change in the lethality of emerging strains of the virus, future government policy, and most importantly the speed of the vaccine rollout.

Advice for Seniors

COVID risk high The daily number of new cases of Coronavirus is still unacceptable but we judge the risk has reduced from 'Very High' to HIGH for Seniors living in the Malvern Hills district; see our annex and riskometer opposite.

If you are unlucky and 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.

So if you are offered a jab grasp the opportunity with both hands.

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, to kill virus picked up from contaminated surfaces see note 1;
wear a FACE mask when unavoidably near other people for example when shopping, visiting hospital or the chemist;
SPACE at least 2 metres apart from others see note 2;
keep TIME near others as short as possible, see note 3;
self-isolate and book a test if you have COVID-19 symptoms (new continuous cough, fever or loss of, or change in, sense of smell or taste).

Hence the mantra:-

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

Pulse Oximeter

A doctor in Bournemouth speaking on the evening news on Thursday suggested that if you were sick with COVID at home it would be a good idea to have a little device known as a Pulse Oximeter handy (see photo on right). This measures the oxygen saturation in the blood and pulse rate by clipping the device on a finger and pressing a button; the reading should normally be at least 97%.

If the reading falls to about 93% you should call your doctor for advice, and if the reading drops below 92% you should consider calling an ambulance or visiting A&E.

Pulse Oximeters can be purchased from Amazon for £18 to £25; alternatively your doctor's surgery might loan you one if you are unwell and have tested COVID positive.

Remember, if you have symptoms of COVID-19 at home 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.

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

Notes:

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

2) Two metres is further than you think - roughly an arm and a walking stick away.

3) During the National Lockdown you should not mix with other households.

Minimise exposure time if you unavoidably find yourself mixing in a confined setting - 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 well fitting FFP3 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 the duration of your exposure.

Annex to 31st January update

Commentary

In the first half of the week the media went into hysterics about the COVID death toll reaching 100,000 and called for a road map out of lockdown, and for schools restarting; there was debate on the radio about vaccinating teachers. Statistician Sir David Spiegelhalter criticised the media for exaggerating headlines.

On Monday 25th January Matt Hancock gave a press briefing; he said ending of the lockdown would depend on hospital admissions and the daily death rate coming down, otherwise little new.

Click for 25th January statement

On Tuesday the PM gave a press briefing acknowledging the death toll reaching 100,000 and hinted at some form of national memorial.

Click for 26th January statement

Prof Calum Semple, a member of the Scientific Advisory Group for Emergencies, said on BBC2 Newsnight:

It would really not surprise me if we're looking at another 40-50,000 deaths before this burns out. The deaths on the way up are likely to be mirrored by the number of deaths on the way down in this wave. Each one again is a tragedy and each one represents probably four or five people who survive but are damaged by COVID.

On Wednesday the PM gave another press briefing announcing schools would restart no earlier than the 8th March; a road map would be presented when MPs returned after the half term holiday (22nd Feb). The route out of lockdown would depend on hospital admissions and the death rate falling, there being no interruptions to the vaccine rollout, and no increased threat from New Variant COVID.

Though not formally announced, we assume the third lockdown in England will now last to at least 8th March.

Click for 27th January statement

Sir Kier Starmer proposed that teachers should be vaccinated during half term, which seems a good idea to address the concerns of the Trade Unions, while Labour also wanted to see workers in critical professions such as police officers, firefighters and transport workers, vaccinated alongside those aged 50 - 69 years.

So far the PM has ignored this proposal. A problem is that the NHS computer which calls people for vaccination does not hold patients' professions in its database, so calling people by age is much easier.

However it should be easy to organise a scheme whereby teachers, for example those aged over 50 years, could attend special vaccination sessions at schools (subject perhaps to having a form signed by their head teacher and NHS number) - in a similar manner to vaccination of care home residents. Tony Blair speaking on Sky News on Sunday supported the idea of vaccinating teachers and suggested it might only delay the issue of vaccine to others by two days.

Towards the end of the week the BBC reported on a furious row brewing up between Astrazeneca and the EU concerning delay to the delivery of COVID vaccine caused by commissioning problems at new facilities. Bureaucrats in the EU hinted at vaccine being diverted from the British AstraZeneca factory, and threatened imposing measures on the export of eg Pfizer vaccine from the EU.

EU officials seemed to be attempting to blame others for their poor procurement decisions.

Click for BBC report on EU vaccine row

The PM said he was confident of UK supplies.

In Parliament, the Home Secretary, Pritti Patel, announced further travel restrictions:

Travellers returning to the UK from 'new variant COVID zones' would be sent to quarantine hotels for 10 days. The Commons were told that passengers would be met at the airport and transported directly into quarantine; countries include South America, South Africa and Portugal. There was also talk of travel from the UK being banned unless written good reason; which seems fair enough given people are supposed to be staying at home!

Recent deaths in Worcestershire hospitals

The table below shows COVID deaths in Worcester hospitals reported by NHS England in the 7 days to 30th January.

Worcestershire	Cumulative deaths	Weekly increase
Acute hospitals	655	+48
Care hospitals	50	+2
TOTAL	705	+50

Present rate of new cases

This week, the average rate of infection per 100,000 population per week in England fell slightly from 437 to 309. In comparison the figure for Worcestershire is 329 and that in the Malvern Hills 219.

As a guide we would expect the third lockdown to continue until the infection rate falls below 50 cases per 100,000 per week.

In the meantime seniors need to continue to be careful.

The probability of catching Coronavirus in the Malvern Hills is moderate to high, and combined with the significant risk of death makes us view the overall risk to Seniors, prior to inoculation, as 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 February and March

The average daily death rate appears to have peaked at 1,200 deaths per day and within the next week the lockdown and rollout of vaccines should begin to reduce the daily death rate, leading to a slow but steady fall during February, with deaths possibly tailing off to about 100 deaths per day during March. We predict the rolling 7 day average death rate could fall to about 900 deaths per day by 7th February and 650 by 14th.

Assuming the daily death rate is 1,200 at the beginning of February and falls to 200 by the end of February as a result of the vaccination of over 70 year olds, then the average will be 700 deaths per day leading to 19,600 additional deaths in February.

Then assuming the death rate falls further to 100 deaths per day by the end of March as a result of the vaccination of over 60 year olds, the average could be 150 deaths per day in March leading to 4,650 additional deaths.

Adding these 'back of the envelope' numbers suggests the UK COVID-19 death toll could reach 130,408 by the end of March.

Date	Forecast UK COVID-19 death toll
January 31st	106,158
February 28th	+19,600
March 31st	+4,650
Total	130,408

Forecast UK COVID-19 epidemic death toll

Another projection of the future COVID-19 death toll and daily deaths can be found on The Institute for Health Metrics and Evaluation website:

Click for IHME projection of COVID-19 deaths

Last month the UK projection was for 116,000 COVID deaths by the end of March, last week it was 123,000 and this week the projection has been increased to 162,000 which seems a little high to us.

At the start of the epidemic in March the Chief Scientific Adviser, Sir Patrick Valance, suggested a death toll of 20,000 would be a good outcome; on the other hand, Professor Neil Ferguson of Imperial College warned in some scenarios the death toll might be as high as 250,000; while we thought, in the very worst case assuming up to 1% of the UK population died the outcome might have been nearer 400,000 taking into account some build up of herd immunity.

So how well will the UK have done? When Sir Patrick Valance spoke off the top of his head there had been few deaths and he clearly did not want to 'scare the horses'. Professor Neil Ferguson was nearest the mark. A few might consider an outcome of 130,000 deaths a fair result compared to a greater number of people dying in a very short space of time, more being permanently disabled by Long COVID, and temporary collapse of the NHS. Members of the Labour Party and others will no doubt say the UK has done very poorly compared to the best performing countries such as Australia, New Zealand and Singapore where deaths have been much lower, not to mention the enormous expense of supporting those out of work and huge damage to the economy.

Ultimately there can be no winners or losers, but there must eventually be a thorough inquiry to learn lessons for the future.