The UK COVID-19 outbreak: what’s behind it now?

  • UK COVID-19 cases have risen sharply in recent weeks, but deaths remain below last winter’s peak.
  • The increase has been largely attributed to the premature relaxation of restrictions, less adherence to COVID-19 best practices, greater mixing and uneven vaccine coverage among different age groups.
  • The US progress against COVID-19 showed parallels with the UK, with the delta push affecting the country months later.
  • While most experts agree that the United States likely had its peak for the year, an increase in the number of cases like the United Kingdom could occur around Thanksgiving and Christmas.

The UK has done relatively well with its COVID-19 vaccination program, but has recently seen the number of cases increase.

The number of daily cases exceeded 50,000 on October 19.The 7-day average is around 45,000 cases, according to official figures. This is an increase from 28,000 in mid-September.

Schools in the UK have a mid-term break in the fall. With schools on hiatus right now, experts are divided over what the COVID-19 photo will look like over the next few weeks.

While some predict the number of cases could drop as the chain of transmission is broken with families on vacation, some believe mixing with other populations could fuel another increase.

Dr Monica Gandhi, an infectious disease specialist at the University of California at San Francisco, said the decrease in cases over the past week supported the first argument.

“[I]It is possible that less mixing in schools during the holidays is driving this trend. However, with mitigation procedures in schools (like testing), more transmission typically occurs in the community than in schools, ”she said.

This means that the flare cannot be attributed to children alone.

The recent upward trend in business in the UK can probably be explained by a combination of factors.

One factor may be related to decreased immunity due to vaccines.

The UK was one of the first countries to roll out vaccines, delivering them as early as december 2020. About 70 percent of the population had received their first dose on July 1.

Data Israel shows that vaccine immunity can wane after about 5-6 months, although this does not mean that vaccines offer no protection. They appear to offer less protection from when the initial dose was given.

The country has since stepped up its booster program, vaccinating more than 7 million people.

However, despite an enthusiastic start to mass vaccination, progress in vaccination has stalled. September and the first 2 weeks of October in particular saw a slowdown, with relatively few people over the age of 12 vaccinated.

Suboptimal immunization coverage in children could also contribute to this increase.

Over the past week, the majority of COVID-19 cases have affected people under the age of 20. The vaccination rate in children aged 12 to 15 remains low, at less than 20%.

The United States is similar, with about 5% of 12 to 15 year olds fully immunized so far.

In the UK, 12 to 15 year olds started receiving 1 dose of the vaccine from September 20. Whether through vaccination or natural immunity, this lack of protection in children makes flare-ups more likely.

Dr Eric Cioe-Peña, director of global health at Northwell Health in New Hyde Park, New York, said the outbreak in the UK was likely due to the country not yet breaking through the barrier. herd immunity, which has led him to still navigate occasional peaks. .

Gandhi said it was probably for two reasons:

“One is that the UK has just started vaccinating 12-15 year olds, and I think controlling the Delta variant requires higher levels of immunity which requires the younger ones to be vaccinated,” she declared.

The second, she said, was a low seroprevalence rate, or the percentage of people who had antibodies at the start of the vaccination campaign.

“Although the UK had high vaccination rates before it opened in mid-July, it was probably not high enough to get control with a 9.8 percent natural immunity rate before vaccination, ”she noted.

According to epidemiologists such as Professor Tim Spector of King’s College London, the outbreak is most likely stemming from the UK’s ‘state of appeasement’, meaning authorities have taken no further action to stop the disease apart from relying solely on vaccines and boosters since July 19.

Since that date, dubbed “Freedom Day,” social distancing guidelines and other restrictions have been relaxed. It marked an earlier easing of these measures compared to other countries such as Germany and Portugal. This also happened when the most infectious Delta variant accounted for over 90% of cases.

Recent research has shown that fully vaccinated people who develop COVID-19 can still transmit the coronavirus in their homes, which means wearing a mask remains crucial in stopping the spread.

The 7-day average of cases in the United States fell to just over 68,000 per day. This is well below the 161,000 cases recorded in early September at the height of the Delta wave, according to the CDC.

“We are seeing a sustained downward trend in new cases, hospitalizations and deaths across most of the country, even in states like Tennessee, mine, which is an under-vaccinated state,” Dr. William said. Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville.

He attributes this decrease to two developments:

“The first is that, day after day, we are vaccinating more people. We are about to start immunizing young children. In addition to the advancement of the vaccination program, this virus continues to spread. And whenever it infects a new person, whether it is symptomless, with mild symptoms, or serious illness, once those people have recovered, they are given a protective measure. Thus, the vaccine and the virus immunize our population. ”
– Dr William Schaffner

Cioe-Peña agreed:

“[The recent decrease is] likely the natural ebb and flow of COVID-19 – we saw it burn a population around this time. “

Cioe-Peña said the United States should look for an increase in cases in children in the future.

“There is evidence of increased transmissibility with the Delta variant in children. Flare-ups of positive cases can also be asymptomatic or not very symptomatic. So [in the United Kindgom], hospitalization and death [rates] are flat, but new infections are on the rise, ”he said.

Schaffner explained further:

“[D]elta is so contagious that she is now looking for sensitive people who are young adults, adolescents and increasingly children. So, it clearly has such a contagious capacity that it is spreading in those groups, which had not been substantially affected earlier, say 6 to 8 months ago. So it’s about finding those individuals in our society who are not vaccinated, and there are many more young adults, adolescents and even children.
– Dr William Schaffner

Cioe-Peña, however, pointed out that a high vaccination rate was preventing an increase in hospitalizations and deaths in the UK.

“The virus continues to cross populations, although causing much less damage due to high vaccination rates in vulnerable populations,” he said.

Cioe-Peña warned that another post-holiday spike was likely in the UK, which could be seen in the US during Thanksgiving.

“Whenever we’ve seen a lot of movement with children or adults, we’ve seen spikes in COVID-19,” he told Healthline.

Schaffner made the same prediction:

“As we’ve seen (in the US), COVID-19 benefits from being moved, being introduced to new populations, and being offered new opportunities for a sprint. So I would be more concerned, rather than more relaxed, about the impact of out-of-school children, and now them in new environments. “

However, for the United States, he was more optimistic.

“I think vacations may increase rates because of all of this, but I don’t think we’ll have another big increase. It will be more local, confined. But there could be bumps from travel and mixing while on vacation, ”Schaffner told Healthline.

Gandhi said the rate of people over the age of 12 who have received at least one dose of COVID-19 vaccines is now nearly 78% in the United States. With tens of millions of new COVID-19 cases recorded during the delta outbreak, the United States is likely to move closer to the level of collective immunity faster than the United Kingdom.

“Most experts say that between 80 and 90 percent of the population needs immunity to get Delta under control. [W]with 34 million new shots and probably over 30 million new infections, we could reach over 85% seroprevalence now. With over 80% or even 90% to control Delta, we may be approaching that level now and may not see an increase in cases over the winter, ”she explained.

The UK’s latest wave is likely due to school-aged children socializing and mingling with other populations during their mid-term vacation.

The UK Health Safety Agency (UKHSA) has since recommended that children undergo lateral flow (rapid antigen) testing before returning to school after the mid-term break.

The lack of mask wearing and containment measures also play a role in the spread of the coronavirus.

Decreased immunity to vaccines and slow roll-out of boosters, coupled with low immunization coverage in children, are also likely contributing to the recent increase.

We could expect COVID-19 infections to rebound or peak after mid-session, and the United States could experience a similar situation around Thanksgiving, experts say.

However, as Gandhi points out, a future increase depends mainly on the immunity generated by vaccination and the natural immunity resulting from exposure to SARS-CoV-2.

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