Covid: the London problem

By Richard North - December 30, 2021

As diverse news organs hyperventilate over the new daily record of what they describe as Covid “cases” – currently standing at 183,037 – we need constantly to remind ourselves that Dr Susan Hopkins on 15 December was warning that a million people a day could be being infected by the end of December. We are one day away from the end of December.

Furthermore, she, Whitty, Harries and others were all claiming that omicron numbers would be doubling every two days, or less, whereas we have only seen a 41 percent increase over the last seven days.

One should also note that testing levels remain high, with 1,476,216 tests recorded on 28 December. But it is also important to note that there has been a significant change in testing procedure.

Since early this month, families of school-age children, secondary school pupils, and people going out to the workplace have been encouraged routinely to take a lateral flow test and, if they are positive, to self-isolate.

Those people (and contacts) must then get confirmation via a PCR test but, if they test negative on PCR, administered within two days of a positive LFT, are allowed to stop isolating. There is, therefore, some incentive to take the PCR.

I don’t think the impact of this has been generally realised, but it represents a significant change in the overall methodology. The outcome is that not only are PCR test numbers increasing but, logically – since much of the increase is triggered by positive LFTs – the proportion of positive PCR tests has probably increased.

The combination of these effects is, in itself, likely to be responsible for part of the recorded increase in positive results, on top of which PCR tests are now being administered for a wider range of symptoms, casting the net wider.

To a certain – but unknown – extent, therefore, the overall increase in positive test results must be attributed to the changes in testing methodology, further highlighting the error in the panicky response of Hopkins and others just over two weeks ago. With the real world level over 800,000 short of the projection – despite the inherent inflation of results – we have a long, long way to go before we reach Armageddon.

If the testing is picking up proportionately more positive results, though, much of the increase is likely to represent symptomless subjects, and those with illness at the milder end of the spectrum.

Thus, while South African data continue to show lower rates of hospital admissions and reduced death rates, in regimes – such as in the UK – where there is enhanced and more focused testing – both admission and death rates as a proportion of positive tests recorded – can be expected to be even lower.

As regards South Africa, researchers at the University of Pretoria and the National Institute of Communicable Diseases in South Africa, report that omicron causes only a quarter of the deaths of patients compared to previous Covid waves – a death rate of 4.5 percent of patients admitted compared with 21.3 percent before the variant took hold.

These researchers say that, if their findings were reproduced globally, there would be a “complete decoupling of case and death rates” that would end the epidemic and usher in an endemic phase.

Not only will there have been differences in sampling methodology – with the South African system less sensitive – it is likely that those admitted to hospital are likely to have been more severely ill (and for longer) than in the UK, so it is reasonable to assume that the UK will deliver an even lower death rate than that experienced in South Africa.

Given also the mildness of the symptoms experienced by the majority of sufferers, the reduced severity of even cases at the more severe end of the spectrum, better patient management and the availability of anti-virals and other therapeutics – all on top of increased vaccination levels – it is not at all untoward to suggest that we might indeed be moving from the epidemic to endemic stage.

What we could be seeing, therefore, is the living embodiment of that timeless observation that it is always darkest just before they dawn. Just as the Covid Mafia move to high-wibble mode, we may be seeing, if not the beginning of the end, the end of the beginning of the UK epidemic. By summer, community controls could be on their way out.

So profound are recent developments that even the panic-stricken Guardian is asking: “How can we measure the true scale of UK Covid hospital admissions?”, a tacit admission that recorded figures overstate the severity of the current omicron wave.

Almost sheepishly, the paper acknowledges that, while [case] numbers are increasing, admissions are not rising as fast as cases, even taking into account the time lags between infection and becoming severely ill. Then noting that hospital admissions data is (sic) not separated into those admitted with Covid or because of it, it concedes that, “This means that getting a true handle on the proportion of hospital admissions because of Covid is tricky”.

The last thing we would dream of doing here is indulge in any level of schadenfreude but it would be uncharitable to not to recall that, on 19 December, this same paper headlined: “The science is clear: the case for more Covid restrictions is overwhelming”. This may not be the only time we will draw attention to this.

In the meantime, if there are to be additional controls for a short period (although that looks increasingly unlikely), The Times is asserting that: “London’s low vaccination rate may punish the rest of the UK”.

The fallout from London’s soaring hospital admissions, the paper says, is likely to affect the rest of the country as ministers have privately ruled out returning to regional restrictions.

Although almost a third of the 9,546 people in hospital with coronavirus are in London, in contrast with previous lockdowns, when regions such as Greater Manchester faced tougher curbs than London, ministers have decided not to impose measures on a regional basis. A government source has told The Times: “We are not looking at doing regional restrictions. That is not on the table”.

Another government source said: “There are big downsides to doing anything regionally and we saw the difficulties they posed when we did it last time. It is difficult for people to understand because of different sets of rules. We want one set of rules for everyone in the country”.

Yet, I don’t think it is that difficult for people to understand that the shithole that much of London has become, with the lowest rate of vaccination in the country – corresponding with the much-lauded “diversity” – marks the capital out for special “regional” attention.

I don’t suppose anyone outside the capital would be too worried if its population was confined to within the M25, with exits sealed off and any residents attempting to escape sent to re-education camps – until vaccination rates hit national averages and the hospital admissions had stabilised. If they ask us very nicely, I am sure no-one would object to the RAF airdropping medical supplies.

On the other hand, if London-centric ministers do seek to impose nation-wide controls, simply to address a problem in London, they may find they need the RAF to drop something more potent than medical supplies on the rest of the country.

That notwithstanding, there is talk of creating new small-scale “Nightingale” facilities with up to 100 beds each at eight hospitals across the country. The health service has said it had asked trusts to identify empty spaces to accommodate beds in places such as gyms or teaching areas. NHS managers, we are told, are aiming to create up to 4,000 beds as surge capacity if needed, with work on the first tranche, in temporary structures, starting this week.

It remains to be seen whether this is institutional over-reaction, with managers fighting the last war, or just prudent planning. Still, if there are to be extra beds and the Covid surge does not materialise, there will be no shortage of ideas of what to do with them. They might even use them for “ordinary” patients.