Are we at the start of a third Covid wave? The data suggest a brighter picture

For months, people across England have optimistically looked ahead to June 21 – "Freedom Day" – and the lifting of the final Covid restrictions. 

Yet as Boris Johnson prepares to announce his decision on Monday, his mantra of "data not dates" is being put to the test by an increasingly choppy outlook in the nation’s Covid numbers.

Both cases and hospital admissions are once again on the rise, prompting fears that the country is seeing the beginning of a third wave. 

But not every sign in the data gives reason for pessimism. Clear trends have emerged that paint a much brighter picture than previous surges of the virus in 2020, suggesting any third wave will look much different to what went before.

Cases down amongst older people

It is indisputable that cases are now rising rapidly in the UK, spurred by the more transmissible delta variant and the relaxation of lockdown restrictions. 

If the daily number of reported infections were to continue increasing at the average rate of the past week – around seven per cent each day –then within the month the UK’s daily totals would reach levels not seen since the worst days of January.

Covid cases projection – June 21

Such is the nature of Covid’s exponential growth and, whilst cases remain relatively low for now, England’s case rate has increased by two-thirds in the past week alone.

In the North-West, where the delta variant first became the dominant strain in areas like Bolton and Blackburn, case rates are now the highest they have been since Feb 22, at the tail end of the second wave. 

Yet the worrying headline figures hide cause for optimism in the detail: those in the most vulnerable age groups are not testing positive at the rate they were at the start of the second wave in the summer. 

For example, one month after cases started increasing in the region, the 80 to 84 age group – one of the first to be prioritised in the UK’s vaccination rollout – had a case rate of 16.4 per 100,000 people. Case rates for this group were as high as 62.5 at the same point in the second wave.

Nonetheless cases are still increasing amongst these older age groups, albeit at a slower rate, especially when compared to younger counterparts.  

Caution might dictate that delaying "freedom day" by a matter of weeks could be a measure of whether this is a continuing trend or a delayed filtering down of cases from the young to the old. 

Slower hospital admissions growth

Even if cases are rising in the UK, the Government’s scientific advisers hope a surge in infections will not translate into a surge in hospital admissions thanks to the protection afforded by the vaccine.

Studies are increasingly suggesting that the link between cases and serious illness has been broken among the vaccinated, which in turn could allow the NHS to cope with extra patients despite rising infections overall.

This broken link may now be reflected in the North-West – though admissions are now clearly rising, they are doing so at a much slower rate than in the autumn.

Admissions in the NW

When admissions to hospitals in the North-West began to rise again after the first wave in August, they were doubling at a rough rate of every 12 days, yet this time round this growth rate has an interval of every 30 days.

In addition, those who are in hospital now are more likely to be unvaccinated, a point repeatedly stressed by Matt Hancock, the Health Secretary. Of the 223 people hospitalised with the Delta variant, just one in 10 had been fully vaccinated. 

Whilst this figure seems high, it is still expected that many older people will be admitted to hospital despite having both vaccines, as no jab currently offer 100 per cent effectiveness against the virus. 

Hospital patients are younger

The positive impact of the vaccine has been clearly reflected in the age profiles of who is going to hospital. 

For the first time throughout the entire pandemic, working age adults in the North-West are more likely to be admitted to hospital than those aged 65-84, who are far more likely to be vaccinated. 

Hospitalisations per one million people, North West England

And whilst the rate for the over-85s is increasing -– a clear sign that the vaccine is not 100 percent effective – the admission rate is at just one fifth of where it was at the same point during the second wave. 

In all, hospitals in the Covid hotspots of Bolton and Blackburn have seen the proportion of admissions attributable to this age group decline from around 12 per cent in January to just two per cent in May. 

This is important because, throughout the pandemic, over 40 per cent of all deaths have been apportioned to this group alone. 

Bolton: The light on the horizon? 

In fact data from Bolton, which in mid-May was the epicentre of the delta variant, can also offer some optimism and hopefully a sign of where things might go in the broader North-West.

Cases in the town have now started to decline after weekly rates went as high as 450 cases per 100,000 in mid-May – more than 20 times the national average.

But analysis shows that whilst reported cases increased to levels seen during the January peak, hospitalisations rose to just six percent of that level before starting to decline. They have now levelled out, whilst cases continue to drop. 

Hospitalisations and cases relative to the highest point in the pandemic, Bolton

Cases in Blackburn have not seen a sustained decline yet, but even here hospitalisations appear to be levelling off. Hospital cases in the East Lancashire Hospitals NHS Trust were at nine per cent of their January peak as of the start of June.

Last week, Chris Hopson, the chief executive of NHS Providers, said: "It’s particularly interesting that leaders in ‘front of wave’ hotspots are now seeing community infection and Covid-19 inpatient numbers declining. They feel they’ve coped well with this latest surge.

"Nobody wants to be too definitive at this point, understandably, but increasing confidence that, in ‘front of wave’ hotspots, for this pattern of variant, vaccines have broken the chain between Covid-19 infection and high levels of hospitalisations and then mortality in previous waves."

With all the data pointing towards a vaccination programme able to break, or at least reduce, the link between infection, hospitalisations and death, the main goal will now be to ensure that as many people can receive both doses as soon as possible. 

Many experts are now suggesting that delaying freedom for just a little longer will help vaccinate those vulnerable people who haven’t received their second dose and help mitigate the worst that another wave could bring.

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