FREEDOM Day could still spark a third wave of hospitalisations higher than the second peak, Sage documents have warned.

And it largely comes down to how much people voluntarily stick with measures that will be scrapped by Boris Johnson, such as face-mask wearing.

People's behaviour after July 19 will largely influence how the third wave pans out

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People’s behaviour after July 19 will largely influence how the third wave pans outCredit: Rex

The PM today announced that July 19 will be going ahead, with the majority of legal restrictions dropped.

But Boris Johnson has said mask use will be advised in crowded and enclosed spaces.

He told a Downing Street press conference: “It is absolutely vital that we proceed now with caution and I cannot say this powerfully or emphatically enough: this pandemic is not over.

“We cannot simply revert instantly from Monday July 19 to life as it was before Covid.”

A batch of documents published by the Government today detail what scientists believe will happen from July 19 onwards.

They come from SAGE – the panel of scientists that have been advising the government throughout the pandemic. 

Three universities – Imperial, Warwick, and London School of Hygiene and Tropical Medicine (LSHTM) gave modelling to SAGE.

All showed an extremely high level of infection until at least the end of August.

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The size and timing of the peak is still unknown and depends on a number of factors, such as how quickly people return to pre-pandemic ways.

But Sage has said hospital admissions are likely to reach 1,000 per day – lower than previous peaks of 3,100 (April 2020) and 4,200 (January 2021).

SPI-M-O combines estimates from several models to suggest what could happen in the next few weeks. This graph shows how hospital admissions could change in the next eight weeks as a result of the R increasing from July 19. The first wave saw 3,100 peak daily hospital admissions, and the second saw 4,200

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SPI-M-O combines estimates from several models to suggest what could happen in the next few weeks. This graph shows how hospital admissions could change in the next eight weeks as a result of the R increasing from July 19. The first wave saw 3,100 peak daily hospital admissions, and the second saw 4,200

It could be significantly higher under “worst case scenarios” whereby vaccines are not as effective as thought, for example. 

But “it is almost certain” that deaths will be well below the levels seen in January 2021 – peaking at 1,300 per day – thanks to successful jabs.

Even though by law, people will be able to stop wearing face masks, work from home or social distance, SAGE recommends people continue to take caution.

Ultimately, all the universities’ models showed this could help drive infection rates down, and therefore hospitalisations that put pressure on the NHS.

A summary of the modelling by a Sage subgroup called SPI-M-O made similar warnings.

But it said if people remain wary of the virus, and practise measures that have been in place since March 2020, it could push the third wave peak more into autumn/winter.

SPI-M-O said it will take several weeks for it to become clear if hospitals are coming under pressure as a result of July 19.

Here is a summary of the best and worst case scenarios presented by each university.

IMPERIAL 

Imperial’s modelling found that with optimistic assumptions on vaccine efficacy and R number, hospitalisations and deaths are likely to be much lower than in the winter 2021 wave.

But even in this positive scenario, there still could be a total of 9,400 extra deaths and 77,500 hospital admissions by June 2022. 

Figures could exceed the winter wave with more pessimistic assumptions, with 115,800 deaths and 820,000 hospitalisations over the next year.

Their most central scenario sees “hospitalisation numbers comparable with, but deaths substantially lower than, the second wave”.

It means with their most realistic or “best guess” model, there are an additional 36,700 deaths by next June, and 283,500 hospital admissions. 

Imperials estimates with a low (light blue), high (dark blue) and central (blue) R rate after July 19. Left is optimistic vaccine efficacy, central is default and right is pessimistic

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Imperials estimates with a low (light blue), high (dark blue) and central (blue) R rate after July 19. Left is optimistic vaccine efficacy, central is default and right is pessimistic

The team said encouraging people to carry on with measures like face mask wearing would play an important role in bringing these figures down. 

If people carried on how they were behaving now, slowly changing to September, a third wave would be delayed from the summer to September.

“And hospitalisations and deaths are dampened compared to the scenario with a steep increase in transmission on 19th July”, the paper said. 

In this case, a booster campaign may be “critical”.

LSHTM

LSHTM looked at dozens of factors that will influence the third wave including vaccine uptake, waning immunity, whether Delta is more deadly and if people voluntarily continue protecting themselves.

The university said under all models, there would be a peak of transmission in August.

Some showed another weave in the autumn and winter as schools return and Covid is expected to spread easier in colder weather.

These two graphs show how vastly different the third wave will be under two different scenarios explored by LSHTM. The blue line is a high level of mobility after July 19 with waning immunity. While red is a slower return to normal

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These two graphs show how vastly different the third wave will be under two different scenarios explored by LSHTM. The blue line is a high level of mobility after July 19 with waning immunity. While red is a slower return to normal

Like Imperial, the more pessimistic outlooks – with people largely returning to pre-pandemic behaviour – “hospital admissions and hospital bed occupancy may exceed the peak levels recorded during the previous wave in January 2021”.

If things snapped back to normal, self-protective measures dropped by 60 per cent, and immunity started waning within a year, hospital admissions could quite easily reach 3,500 per day.

Deaths could peak at around 500-600 a day.

At a slower pace, with only 20 per cent reduction in face-mask wearing and the like, and no waning immunity, there could be just under 1,000 admissions a day.

The burden on mortality “will be lower”, the paper said. 

The team considered that even if people were to return to their usual behaviours, such as going to work, there would still be some mitigating factors like Test and Trace which did not exist in the first wave. 

If these reduce transmission by at least 20 per cent, peak daily hospital admissions could stay well below 2,000 and deaths 250.

Why are scientists unclear on the size of the third wave?

There are uncertainties on how severe the third wave will be because:

  • It’s not possible to predict how people will behave after July 19
  • There are not conclusive figures for how well vaccines work against Delta, with more work needed
  • The exact number of unvaccinated people is unclear and changes every day
  • The proportion of people who have previously had Covid cannot be determined, but plays a large role in how the outbreak can grow due to immunity
  • Scientists don’t yet know how long immunity from vaccines will last

WARWICK

Warwick University took a different approach because it did not assume a dramatic change in transmission on July 19.

It instead looked at how many hospitalisations and deaths could be staved by taking a slower approach to lifting restrictions over time.

Assuming default vaccine efficacy, peak daily hospital admissions could peak at around 700 a day and deaths 100 with most cautious and slowest return to pre-pandemic behaviours – taking five months.

This compares to a peak of around 1,800 daily hospitalisations and 500 deaths for the most rapid return to pre-pandemic behaviours, over the course of one month. 

With additional pessimistic assumptions about vaccine efficacy, hospital admissions could peak at almost 7,000 per day – double the first and second wave.

Most scenarios result in smaller resurgences than January 2021 unless there is a rapid return to normality.

Warwick's work looked at how many hospitalisations and deaths could be staved by taking a slower approach to lifting restrictions over time. The dark blue line is the slowest and most catious while the purple line is sudden and "back to normal" within a month

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Warwick’s work looked at how many hospitalisations and deaths could be staved by taking a slower approach to lifting restrictions over time. The dark blue line is the slowest and most catious while the purple line is sudden and “back to normal” within a month

Warwick said it thought it was unlikely there would be a sudden change in behaviour after Step 4, even if the rules permit  it.

And the team said the one-month delay of “Freedom Day” had made projections far more positive. 

But hospitalisations per day could still be enough to cause severe disruption to the NHS, SPI-M-O noted.

Under Warwick’s central/best guess scenarios, “half of the scenarios generate extended periods with more than 1,000 hospital admissions a day” – which would put pressure on the NHS. 

Some, but not all, of Warwick’s scenarios see a further resurgence in autumn or winter with the potential to be worse than the current wave.

Health Secretary Sajid Javid confirms Step 4 of govt’s covid restrictions roadmap will start on July 19

Post source: The Sun

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