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

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15th January 2023

COVID TURNS OUT TO BE JUST ANOTHER WINTER VIRUS

Prevalence still high but daily cases falling

Preamble

For nearly three years we have been keeping an eye on the published government figures and monitoring the media to asses the likely level of risk for Seniors in the Malvern Hills district and providing links to where further information could be found.

During the epidemic Public Health England was split into the UK Health Security Agency and Office for Health Improvements and Disparities. However for simplicity, in this blog, we have continued to refer to this as PHE data.

Testing was run down many months ago and the public can no longer record the result of Lateral Flow tests so those daily cases reported on the Coronavirus Dashboard greatly underestimate the actual situation.

The chief remaining sources of data indicating direction of travel are:

• The ONS infection survey (all nations of UK) funded to March 2023;

• The Zoe Health Study;

• Registered deaths in England and Wales reported by ONS;

• Hospital deaths reported by NHS England, and;

• Hospital admissions and bed occupancy reported by NHS England.

We'll carry on with our blog for a little while longer as the epidemic passes and life returns to normal.

As sections become no longer relevant we have been deleting them, but you can always refer back to archived pages.

This page will continue to be updated weekly nominally with Sunday's date.

Contents

Summary

What happens if you get sick

Booster shots

Vaccination Sites

Number of cases

Number of deaths

Healthcare numbers

Forecast for the week ahead

Longer term outlook

Advice for seniors

Annex/commentary

Summary of links

Bibliography

Menu of archived pages

Summary

The Winter Wave appears to have peaked earlier than expected and, in the last week, NHS COVID bed occupancy and daily hospital admissions have begun to fall.

The COVID death rate remains relatively low so there is little to be concerned about.

Jump to forecast

What happens if you get sick with COVID

If you are feeling poorly there is now a fair chance it won't be COVID but some other winter respiratory illness; according to the Zoe Health Study only 30% or so of respiratory infections are currently COVID related.

If you have a stash of Lateral Flow Tests you can test yourself at home. However be aware that a negative test does not guarantee you don't have COVID. Whatever the virus best stay at home until you feel better, and wear a face mask to protect others if you do have to go out.

Do not be surprised if you catch COVID because prevalence is still high and vaccination, while protecting from severe illness, rarely prevents infection.

Some may either show no symptoms or have a mild fever, sore throat, general aches and pains, and quickly get over it; while others could feel quite poorly and spend between two and five days in bed, with it taking five to ten days or so to recover.

Some of those who have caught COVID report either getting easily tired or suffering from shortness of breath for some weeks afterwards; if so patients are advised to take it easy until fully recovered.

A small number of patients report debilitating symptoms for months after so-called recovery. For example see Dez Medinger and Danny Altmann's book The Long COVID Handbook in bibliography.

Precautions

Nowadays few people are taking precautions - for many months that has been a personal decision.

Click to view our advice

The bookmark below will take you  to the Worcestershire County Council webpage links at the end - there is little new to see.

Click for Worcestershire Dashboard and associated links

Booster shots

An Autumn booster jab is being offered to all those aged 50+ years and patients designated Clinically Extremely Vulnerable, such as with a severely weakened immune system.

Note: you should not book if it is less than 3 months since your last vaccination or you have had COVID within the last 2 weeks.

Seniors are advised to get both the COVID booster and flu jabs in order to reduce the likelyhood of severe illness and hospitalization. The NHS advises it is safe to have both jabs at the same time, but to minimise side effects you might want to consider having them a week apart.

Lately there seems to have been little government push to get more of the over 50s boosted and vaccination has come to a standstill.

Either the NHS or your GP Surgery (or both) should contact you when it is your turn to book; either by email, text message or letter. You should not need to contact them.

The arrangements for getting vaccinated have changed slightly with the rollout of Autumn boosters.

According to SW Healthcare, representing GP Surgeries, the centre at the Three Counties Showground has closed and vaccinations will either be at GP Surgeries, or at walk-in 'Pop-Up' Clinics, else roving 'Vaccine Vans' which are otherwise known as 'Jab-Vans'.

That is not the complete picture as some pharmacies such as Claremont House in Barnards Green and Evans in Malvern Link may be offering walk-in and timed appointments.

To book an Autumn Booster on-line:-

Click for NHS National Booking Service

Note: you may sometimes have to travel out of town to get an Autumn booster appointment, depending on vaccine availability.

Alternatively you can wait to be contacted by your GP Surgery and in due course get your Flu vaccine at the same time.

Don't forget to check the mobile phone you have registered with your GP surgery for text messages.

If you think you have been forgotten or don't have a mobile phone, phone your GP surgery to book an appointment.

Our email from the NHS included a link for finding walk-in centres:

Click this NHS link to find a walk-in coronavirus (COVID-19) vaccination site

Depending on availability you could be offered either of the original Pfizer and Moderna vaccines, or the new Pfizer and Moderna bivalent vaccines which protect against both the original Wuhan strain and Omicron BA.1.

The SW Healthcare website explains the Worcestershire arrangements that are gradually being put in place by GPs in conjunction with NHS Herefordshire and Worcestershire.

Click for SW Healthcare information about where to get your vaccination in Worcestershire

Hint: click Vaccine Rollout on the navigation bar at the top of the page and then Vaccine Van for pop-ups.

In summary, if you want to get your Autumn booster you can either book an on-line appointment, possibly having to travel out of town, look for a local walk-in centre such as Claremont House and Evans Pharmacies, look for a pop-up, or perhaps easiest contact your GP Surgery and book your flu jab at the same time.

Vaccination Sites

The NHS England website has a spreadsheet updated 5th October 2022 listing vaccination centres under the categories:

• Pharmacies

• GP led vaccination services

• Vaccination centres

• Hospital Hubs

Note: this does not mention plans for pop-ups or vaccination-vans.

Click for NHS England Vaccination Sites

Two pharmacies in Malvern are listed Evans in Malvern Link, and Claremont House in Barnards Green.

Prospect View is the only GP Health centre listed in Malvern.

(No information listed for Whiteacres Medical Centre, Malvern Link; do tell us if you know)

 Upton Surgery is used by some residents of Malvern and surrounds.

The Malvern Showground remains listed as a Vaccination Centre despite SW Healthcare saying it has closed. If you know the situation there do please let us know.

No hospital hubs are listed for Worcestershire.

Note: for historical information about how to get vaccinated, which may be out of date, select an archived report eg

Go to 'How to Get Vaccinated' section of the 7th August 2022 blog

Number of cases

There are now two sources reporting the prevalence of COVID-19 in the UK.

• The ONS which conducts a weekly random survey by collecting nose and throat swabs from the public for PCR tests, and analysis for variants.

• The ZOE Health Study, whereby participating members of the public log their symptoms, tests and vaccines.

PHE data, gathered from PCR testing, is mostly now in hospitals. Hospitals have stopped surveillance and are only testing patients showing symptoms.

Now the government has declared the pandemic over, PHE no longer offers nationwide testing.

ONS infection survey

ONS estimates that 2,189,300 people in England tested positive for COVID-19 in the week ending 3rd January 2023; a fall of 11% on the previous week.

Click for latest Coronavirus (COVID-19) Infection Survey, UK

Prevalence of COVID-19 in England estimated by ONS

Prevalence is estimated 1:19 in Wales; 1:25 in Scotland; and 1:14 in Northern Ireland.

Zoe Health Study

The ZOE Health Study estimates are shown in the following table.

Prevalence of COVID-19 in UK estimated by the Zoe Health Study

According to the more recent Zoe figures, estimated prevalence has fallen by 10% while daily cases have fallen by 22% during the last week, suggesting the winter wave may have peaked.

The downwards direction of travel, indicated by Zoe, is confirmed by Hospital bed occupancy dipping.

Number of deaths

Statistics on COVID deaths are published by Public Health England, The Office of National Statistics, and NHS England. These can't be directly compared as  they cover different periods, but together the figures paint a picture of the direction of travel - which is that the death rate in real-time has probably peaked, though that may not be apparent in ONS figures for a week or two.

PHE figures

The Dashboard chart of COVID (28) deaths, following a positive test, by date of death shows that the 7 day average peaked in England at about 148 on 19th October, then gradually falling, and levelling off at about 60 deaths per day during 10 days proceeding 5th December. Since peaking at 154 deaths per day as of 31st December and falling to 150 deaths per day on 2nd January 2023 (add a further 5 deaths per day for Wales).

The Coronavirus Dashboard charts suggest 31st December could mark the peak of Winter Wave deaths.

The PHE figures include people who die with COVID but not from it so are higher than the ONS numbers.

Click to view the UK government Coronavirus Dashboard

ONS figures

The Office of National Statistics (ONS) reports registered deaths in England and Wales where COVID-19 is mentioned somewhere on the death certificate. The ONS figures lag real time by 10 - 14 days due to the administrative delay in submitting and processing reports, and do not include Northern Ireland and Scotland.

Note: the figures include cases where COVID may have been a secondary cause of death.

Click for ONS data on deaths (Excel spreadsheet)

The ONS figures are broken down by Local Authority providing a glimpse of where deaths are occurring. The provisional cumulative total of COVID related deaths in Worcestershire reported by the ONS up to 30th December (week 52 of 2022) is shown below.

Note: the numbers are now derived from  Table 1 of the ONS Death Registrations spreadsheet using the in-built filters. This gives the provisional total of deaths registered in any week, which can be distorted by delayed reporting, for example, due to public holidays.

Deaths by Welsh Health Boards are excluded to avoid duplication as these are totals of Local authorities.

Death occurrences by 'date of death' is the most accurate metric but takes longer to be confirmed.

Provisional cumulative COVID-19 deaths in Worcestershire registered by ONS to 30th December 2022.

In England and Wales 392 COVID-19 related deaths were reported in the week to 30th December, 37 less than the week before and a fall of 8.6%. Of these 66 were in care homes, 26 at home, 24 in a hospice, 274 in hospital and 2 elsewhere.

Note: deaths in week 52 may been under-reported due to the Christmas and New Year holiday.

During 2023 in England and Wales 33,064 people are reported to have died with COVID mentioned on their death certificate.

ONS provisional deaths 'by week reported' in England and Wales 2022

You will see from the chart that this year deaths have presented as a series of waves each lower than the one before; please do let us know if you think you can explain this periodicity.

The figures on the Coronavirus Dashboard of ONS deaths by date on the death certificate show ONS England deaths rose to 448 per week as of 16th December (add 28 for Wales) with the curve suggesting a little higher to go.

In comparison averaged over recent years roughly 1,700 people die daily from all causes in the UK, so current COVID deaths represent about 4% of all deaths.

Click for ONS Coronavirus (COVID-19) latest insights: Deaths

NHS England figures

Daily COVID hospital death figures in England  have shown considerable scatter over the Christmas and New Year holiday so are omitted this week.

NHS England figures for Worcestershire

The table below shows the latest COVID deaths in Worcestershire hospitals reported by NHS England on 12th January 2022.

Excludes deaths in care homes, deaths at home and deaths in hospices.

Note: the increase is the difference between this week's cumulative total and that last reported.

Click for NHS COVID-19 total announced deaths

Look for COVID Total announced deaths file, then select tab Deaths by Trust.

Note: NHS say all deaths are recorded against the date of death rather than the date the deaths were announced. As from 1st July 2022 reporting has moved to publication once per week on a Thursday, rather than every weekday.

Risk of COVID-19 death by age band

NHS England provides an analysis of COVID-19 deaths in hospital in England and Wales by age band. Shown below is a snapshot of 2,898 recent deaths for the period 6th May 2022 to 6th July 2022 when most of these deaths will have been from the Omicron variants.

Relative risk of COVID-19 death by age band May - July 2022

The main point to note is those aged 60+ still account for 93% of deaths despite young people being more likely to catch COVID-19.

The risk profile for Omicron appears to be the same as for Delta. Age is still the greatest risk factor; perhaps reflecting that older people have more health problems.

According to the Coronavirus Dashboard sex is an additional risk factor - males are roughly 50% more likely to die than women.

Healthcare numbers

The UK government Coronavirus Dashboard includes information about healthcare statistics and NHS bed occupancy.

Headline summary of patients in hospital reported on 12th January 2023

Note: 'Patients admitted daily' is the weekly total divided by 7. This number includes both patients admitted to hospital with COVID-19 from the community, and those diagnosed with COVID-19 in hospital.

Daily admissions peaked at 992 on the 3rd January, and were 737 on 9th January 2023.

See charts on the Coronavirus Dashboard and below.

Bed numbers by region in England

Tabulated figures for COVID bed occupancy in England can be found on the NHS England website providing another indicator of the prevalence of COVID.

Click for NHS England COVID-19 Hospital bed Activity statistics

Note: see the latest Daily Admissions and Beds spreadsheets, then look for all COVID beds.

Comparison of All beds COVID data for England, London and Midlands

In the last week the number of COVID-19 General and Acute beds fell by 17% in England, 10% in London and 18% in the Midlands.

For comparison, the number of beds occupied during the peak of the epidemic in January 2021 is shown in red in the right hand column of the table.

The chart below shows how COVID bed occupancy has peaked and begun to fall in recent days.

Note: the peak in beds is usually one week delayed on the peak in daily admissions, and deaths roughly lag beds by a further week.

COVID bed occupancy in England from 1st October to 11th January 2023

Worcestershire hospital beds

Between 3 January 2023 and 9 January 2023, 54 patients went into hospital with coronavirus. This shows a decrease of 5% compared to the previous 7 days. There were 85 patients in hospital with coronavirus on 11 January 2023 eight less than the week before; one on a ventilator.

Click for Summary of Malvern numbers on the Coronavirus dashboard

This link also reports deaths.

Deaths in Malvern Hills

Between 1 January 2023 and 7 January 2023, there have been 2 deaths within 28 days of a positive coronavirus test.

Forecast for the week ahead

We expect COVID related deaths registered in England and Wales to rise towards 500 deaths per week  in week 1 of 2023 to be reported by the ONS on 17th January.

In the county of Worcestershire, based on 54 new hospital cases last week and assuming the ratio of all deaths (including those in care homes and at home) to be 1:11 of admissions, then there should be no more than 5 COVID deaths per week in the second half of January 2023.

NHS COVID bed occupancy in England is expected to drop by a further 15% next week.

Longer term outlook (up to the end of January 2023)

Given that COVID hospital bed occupancy peaked at 10,608 beds in England in October; has further peaked at 9,332 at the end of December and since fallen to 7,743 it's likely that the ONS death rate will head towards 600 deaths per week in England and Wales during the next fortnight; before falling back to 500 deaths per week towards the end of January.

UCL modelling

The latest UCL projection is that the 7-day average of daily (certified) deaths per day may rise slowly, peaking in late January at around 140 per day or 980 deaths per week.

On present evidence and allowing for deaths in Scotland and NI that seems to us about 50% higher than the likely outcome, but watch this space.

Click for UCL Long-term forecasting of the COVID-19 epidemic

Advice for Seniors

We judge the risk of exposure to COVID-19 remains HIGH in England, but remember there are other respiratory viruses circulating that could make you feel just as sick.

See our riskometer opposite.

Many, perhaps most, healthy people are taking the view that COVID is no longer a critical threat to their health.

For the more cautious the simple safeguards to protect against all respiratory infections, are to:

• make sure your COVID and FLU vaccinations are fully up to date

• 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);

• ideally wear either a well fitting FACE covering,  or better still an FFP2 (N95) face mask when in crowded settings for example when in shops, theatres, health-care settings, and when using public transport;

• SPACE at least 2 metres from people you don't feel safe with (see note 2);

• preferably socialise with friends and other households outdoors in the FRESH AIR else, if you are indoors, either ventilate by keeping windows open as far as is practicable or consider putting a HEPA air purifier in the room;

• avoid crowded indoor settings and friends and colleagues with cold and flu like symptoms;

• stay at home to protect others if you yourself feel unwell with cold or flu like symptoms;

• respect others and give them space;

 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, for example filling the car up with fuel, either wash hands with an alcohol based hand gel or wear gloves.

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

3) If you are 'clinically vulnerable' consult your GP or specialist; you may need to take a test and consider anti viral drugs if testing positive.

4) However careful you are, don't be too surprised if you catch COVID as it's highly infectious and vaccines only prevent severe illness.

Annex

Commentary

The figures from the Zoe Health Study, based on self reporting, suggest daily new cases of COVID have been falling for about a week and there has been a corresponding downturn in daily hospital admissions and COVID bed occupancy.

That leads us to believe that COVID deaths in England and Wales due to the Winter Wave could peak at no more than 600 deaths per week.

However we cannot totally rule out an upturn in the figures next week due to New Year celebrations.

A highly infectious new variant XBB1.5, which only causes mild illness, is rapidly spreading in the USA which many of us are likely to catch in due course whether or not we have been vaccinated (see video below).

COVID video updates

Links to updates by Professor Tim Spector of the Zoe Health Study, Independent SAGE  and pundit Dr John Campbell can sometimes be found here:-

There have been no recent COVID updates from the Zoe Health Study. Prof Tim Spector seems to have moved on to monitoring other health issues and food science.

Click to watch Independent SAGE weekly update on 13th January 2023

Join Independent SAGE for a discussion on immunology, hybrid immunity and vaccines, with guests Dr Elizabeth Mann, Dr Lance Turtle and Prof Carl Goodyear; hosted by Prof Sheena Cruickshank and Prof Danny Altmann, chaired by Dr Helen Salisbury and numbers by Prof Christina Pagel.

In his latest video Dr John Campbell talks about new variant XBB1.5 which is extremely infectious and taking a hold in the USA. Expect most of us to catch it in due course. Symptoms are likely to be mild, like a common cold.

Click for Dr John Campbell's video: XBB 1 5, expect to catch this soon

Also see:

https://covid.cdc.gov/covid-data-tracker/#variant-proportions

List of vaccines

Autumn bivalent boosters

A second bivalent vaccine has been approved 3rd September 2022 as a booster by the Medicines and Healthcare products Regulatory Agency (MHRA) after it was found to meet the UK regulator’s standards of safety, quality and effectiveness. The updated booster vaccine made by Pfizer/BioNTech, targeting the Wuhan virus and Omicron BA.1 variant, has been approved for use in individuals aged 12 years and above.

An updated version of the COVID-19 vaccine made by Moderna that targets two coronavirus variants (known as a bivalent vaccine) has been approved for adult booster doses by the Medicines and Healthcare products Regulatory Agency (MHRA) after it was found to meet the UK regulator’s standards of safety, quality and effectiveness.

Click for government press release - First bivalent COVID-19 booster vaccine approved by UK medicines regulator

The earlier vaccine story

Here is the updated list of COVID-19 vaccines ordered by the UK. It looks as though the government has settled on the use of Pfizer and Moderna with Astrazeneca now held in reserve.

Moderna has been offered for Spring Boosters at the Three Counties Showground.

The order for Valneva has been cancelled, but nevertheless it has now been approved for use by MHRA.

Click for BBC report - Valneva Covid vaccine approved for use in UK

 Nuvaxoid (Novavax) was approved in February.

 The government has signed deals to buy 114 million additional doses of the Pfizer (54M) and Moderna (60M) vaccines to use in 2022 and 2023.

Click for press announcement - Government agrees new deals to future proof vaccine rollout in light of new variant

The press announcement goes on to say that 60M doses of Novavax vaccine are expected to be delivered in 2022 and 7.5M doses of GSK/Sanofi, so there seems no intention to cancel these late arrivals.

Click for Guardian report - Novavax expected to be become fourth Covid vaccine available in UK

Table of vaccines ordered by the UK government

Summary of Links

Some of this information is now out of date but provides a historical context to the epidemic.

Information about Coronavirus can be found on the NHS website:

https://www.nhs.uk/coronavirus

Symptoms

About COVID symptoms

Note: the list of symptoms was updated on 1st April 2022

Article about the effects of Wuhan Coronavirus on the human body

Reporting and how to obtain a test

How to get a test

https://www.nhs.uk/coronavirus

About joining the Zoe COVID Symptom Study:

 https://covid19.joinzoe.com

Guidance

UK government Coronavirus guidance

See also - government sets out next steps for living with COVID

COVID-19 Response: Autumn and Winter Plan 2021 for England

UK Health and Security Agency (UKHSA) website

COVID Alert states

Guidance on UK COVID-19 alert level methodology: an overview

COVID-19 Alert Level lowered to 3 on 10th May 2021

Tiers

Guidance on tiers: what you need to know

Government postcode checker to find tier for other areas

Statistics

UK government COVID-19: Omicron daily overview

UK government Coronavirus Dashboard

Coronavirus Dashboard Interactive Map

ONS data on deaths in England and Wales (Excel spreadsheet)

NHS England COVID-19 Daily Deaths

NHS England COVID-19 Hospital Admissions

NHS England vaccination statistics

Reports on COVID intensive care beds - see intensive care national audit and research centre (ICNARC) website

Worcestershire Coronavirus Dashboard

Worcestershire COVID-19 Vaccinations Dashboard

HSA COVID-19 vaccine weekly surveillance reports

Information about NHS hospital bed numbers: past, present, future

A glimpse of the worldwide vaccination situation can be found on the Our World in Data website.

Click for chart showing % vaccinated

A video with Dr John Campbell and mathematician Professor Fenton explaining the various ways in which RISK can be specified.

Risks and benefits with Professor Fenton

Modelling

A forecast of the progression of the COVID-19 epidemic can be found on a University College London (UCL) website.

Click for UCL Long-term forecasting of the COVID-19 epidemic

A 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

Reports

Coronavirus (COVID-19) latest insights by ONS

A live roundup of the latest data and trends about the coronavirus (COVID-19) pandemic from the ONS and other sources.

https://www.medrxiv.org/

MedRxiv is a US preprint server for Health Sciences. A depository for reports which have still to be peer reviewed.

COVID-19 rapid guideline: managing the long-term effects of COVID-19

NICE guidance on managing Long COVID

The bigger picture

Worldometer summary of coronavirus cases worldwide

European Centre for Disease Prevention and Control info

https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases

World Health Organisation info

https://covid19.who.int/

Window on the USA

Centre for Disease Control (CDC)

CDC COVID Data Tracker

Find maps and charts tracking cases, deaths, and trends of COVID-19 in the United States.

American Association of Retired People (AARP)

Worcestershire

A local summary of COVID data can be found on the Worcestershire Coronavirus Dashboard.

Note 1: use the arrow <> buttons at the bottom of the Dashboard screen to move between pages.

Note 2: the figures for COVID cases are becoming meaningless as testing is run down.

Note 3:  deaths are on page 7, and hospital beds on page 9.

Click for Worcestershire County Council COVID-19 news

There is a colourful webpage offering advice on learning to live with COVID for those aged under 30 years. 'Rona' is slang for Coronavirus.

Click for The Worcestershire 'Rona' Hub

COVID Outbreak Control Plan

Click for Simple Summary of Malvern numbers on the Coronavirus dashboard

Miscellaneous

Spanish Flu

Dr Jeff Kildea's commentary about the 1919 outbreak of Spanish Flu in Australia

Views of Martin McKee, Professor of European Public Health

Follow Martin McKee on Twitter

Views of Prof Christina Pagel, a member of Independent SAGE

Follow Christina Pagel on Twitter

SAGE membership

Scientific Advisory Group for Emergencies (SAGE)

Scottish government:

Link to Scottish Government website

Link to Postcode checker for COVID restrictions by protection level in areas of Scotland

Welsh Government:

Guidance on COVID alert levels in Wales

Bibliography

Woolhouse, Professor Mark, The Year the World went Mad, published 2022 by Sandstone Press Ltd, ISBN: 978-1-913207-94-3

Medinger Dez, Altmann Danny, The Long Covid Handbook, Penguin Books, 2022. Kindle version available.

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The interpretations and opinions expressed are our own