COVID-19: The Beginning of the End?

Today, I’m going to look in a bit more depth at the COVID situation in the UK. And I’ll contrast it with the differing situations of some of its neighbours.

At the outset, I’ll say that the UK right now appears to be at least as well positioned against the virus as any other major Western European country. My informed gut feel is that we’re now not so far away from reaching herd immunity, and so beating the damned thing. Oh, and European countries like Germany, Austria and France, that have implemented high lockdown strategies recently, are starting to look a bit silly.

I took the data for this paper on January 16^th, 2022 from the following sources:

·       Our World in Data – [[1]].

·       The Blavatnik School of Government – [[2]].

·       The UK government’s coronavirus data pages:

o   “Cases by date reported” at [[3]].

o   “Deaths within 28 days of positive test by date reported” at [[4]].

o   “Patients in hospital” and “Patients in mechanical ventilation beds” at [[5]].

All the data runs up to and including January 15^th 2022. Although the most recent data will necessarily be subject to change as late reports and adjustments come in.

Cases

The graph at the head of this paper tells a story. From a base level of between 500 and 1,000 new cases per day (weekly averaged) per million population in the first half of December, case counts shot up to between 2,500 and 3,000 per day per million in England and Scotland, almost 4,000 in Wales and nearly 5,000 in Northern Ireland.

The peak individual days were: In England, 162,572 new cases reported on January 1^st. In Northern Ireland, 30,423 cases covering the four days from January 1^st to 4^th inclusive. In Scotland, 20,217 cases on January 3^rd. And in Wales, 22,317 cases covering January 2^nd and 3^rd. The UK wide peak was 221,222 cases on January 4^th.

Since then, though, new cases have plummeted in all four countries. The latest figures in new cases per day (weekly averaged) per million population are as follows:

Because I’m going a bit later to look at the prospects for herd immunity, I’ll also show the total cases per million for each country:

Here is the graph of new cases and deaths for the UK as a whole (the figures will not match exactly, because I am using Our World in Data’s population estimate for the UK as a whole, as opposed to estimates for the constituent countries from [[6]]):

That’s quite a decline – from a peak of 182,891 new cases per day for the week centred on January 2^nd, down to a mere 116,689 for the week centred on January 12^th. A drop of more than 36% in 10 days! Since then, the drop has continued – Worldometers is showing the weekly averaged new cases for the week ending January 17^th as 99,259. And, as you can see from that first graph, new cases have plummeted in all four of the constituent countries.

Here is the UK wide data looked at in terms of weekly case growth:

That’s amazing. The weekly growth (in new case counts which are already centrally weekly averaged – blue line) has fallen from a local peak of plus 51.8% on December 28^th to minus 34.0% on the latest date for which I have data to calculate, January 8^th. And the calculated reproduction rate of the virus (grey line) has fallen from a local peak of 1.46 on December 29^th to 0.73 on January 13^th. That’s a halving in the R-rate over the course of 15 days!

Tests

Some have suggested that the recent drop in cases may be due to a shortage of test kits, particularly PCR tests. But here are the graphs of the total tests conducted in the last month, and of PCR test numbers and capacity, from the UK government’s site [[7]]:

There was a clear peak in testing on January 4^th, the first working day after the holiday period. Since then, testing has dropped back to pre-Christmas levels, though there are still results, positive or negative, yet to come in. Resources to process PCR tests were in relatively short supply for a few days around January 8^th-10^th, but this appears to have been made good since. And when I google “PCR test availability crisis,” the hits I get are media scares dated December 29^th or 30^th. So, it seems to me that there is no reason to ascribe a significant role in the continued drop in new cases to shortage of test kits, or of resources to evaluate them.

Lockdowns

The textual description of the latest UK national lockdown status (as of December 26^th) is as follows: Schools: Recommended closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to 11-100 (Regional), Public transport: Recommended closed (Regional), Stay at home: No measures, Travel: No restrictions, International: Quarantine high-risk, Face covering: Required when with others (Regional).

The UK national level lockdown information has not been updated in the Blavatnik School of Government data feed since December 26^th (which is why the dark red stringency line in the weekly case growth graph cuts off at that point). However, the data for the individual constituent countries, which goes up to January 10^th in all four, shows no changes since this date. This means that it cannot possibly have been fresh lockdowns which caused the declines in the new case counts!

Here are the latest reported lockdown levels in the four constituent countries:

Hospital Occupancy

Here is the COVID hospital occupancy per million for the four constituent countries:

These figures are based on actual counts of patients in hospital who have recent positive COVID tests – not quite the proverbial “bums on seats,” but close. The figures should, therefore, be complete and accurate for all but the very latest couple of days. The “signature” of omicron is visible in the very steep rise in late December in all four countries, just as the “signature” of delta was visible in July in England and Northern Ireland, and August in Wales and Scotland.

In Northern Ireland (red line) there has been a clear downward trend in COVID hospital occupancy each day, from a peak of 500 on January 5^th and 6^th to a latest count of 402 on January 13^th – a 19.6% reduction. This provides evidence that the drop in new cases in Northern Ireland is real, and not merely caused by a shortage of PCR tests. After all, if you can’t get a PCR test when you’re in a hospital, where else can you get one?

In England the peak was 17,120 on January 10^th, had gone down to 16,716 by January 13^th – only a 2.4% reduction, but a consistent one over the course of three days. By January 15^th, it had gone down again to 16,281, a 4.9% reduction from the peak. In Wales, the peak was 890 on January 11^th, which by the 13^th had gone down to 861 – a 3.3% reduction. In Scotland, there is as yet no clear evidence of a downturn, but I expect one in the next few days.

Here is the graph of hospital occupancy per case, with the new cases offset by 7 days to allow for the gap between confirmed infection and hospitalization:

Those bumps at the end of December in Northern Ireland and Wales look a bit strange; but they may well be due to their case reporting systems not being as timely over holiday periods as the English or the Scots. Otherwise, this metric seems to have been trending consistently downwards since at least the middle of November. That’s very good news – it confirms that omicron really does cause less hospitalizations per case than its predecessors.

Intensive Care Units

Here’s the ICU occupancy per million population:

It was the ICU situation that triggered the January 2021 lockdown. So, it’s good to see that, in all the countries except Scotland, ICU patients have dropped since late November. Current ICU occupancy in England is only 14% of its peak in January/February 2021. In Northern Ireland it is 40%, in Scotland 23% and in Wales 19%. There is plenty of margin in there, particularly considering the dropping new case levels in all four countries.

And here’s the ICU occupancy per case, with the new cases offset by 14 days:

Again, a steady drop since November. That’s more good news.

Deaths

Here are the deaths per million:

Yes, deaths are going up. But this is a consequence of the recent surge of cases, into which some proportion of deaths is necessarily “baked.” Since the mean time between infection confirmation and death if it comes is 21 days, we should see COVID deaths starting to drop off about 3 weeks after the peak of cases – that is, before the end of January.

Here are the deaths per case, with the cases offset by 21 days:

These percentages are tiny, compared to the death tolls earlier in the epidemic. And if you squint a bit, you can see a decline in deaths per case, except in Wales, since early November.

In a European context

I’ll now put the UK’s recent performance into a European context, by showing some of the graphs and lists from my “Europe 14” group of countries. First, cumulative cases per million over the whole epidemic:

The UK, Ireland and Belgium all seem to have taken the “let’s get to herd immunity as quickly as possible” strategy. The Dutch were doing the same, until they decided to lock down just before Christmas; presumably, for fear of filling up the ICUs. Whether the recent high level of French new cases was planned or not, I wouldn’t like to guess.

Next, daily new cases per million:

The UK (pink line) is the only one displaying clear evidence of a “right hook” towards falling new cases. Ireland (green line second from the top) may have almost peaked, but the rest look still to be headed in a distinctly northerly direction. The UK is now third from bottom in daily cases per million; and case numbers are dropping.

How about lockdowns? Here’s the current list:

Germany and Austria, the two countries below the UK in current cases per million, seem to have achieved that status through heavy lockdowns. Italy, as so often, is heavily locked down, but still doing badly. And while the UK as a whole is in eighth place out of 14 in stringency, only Denmark is more lightly locked down than England. As to France, it is in top spot in daily cases per million, and third in lockdown stringency. That isn’t good at all.

Here are the average lockdown stringencies for each country through the course of the epidemic:

Austria, France, Germany, Ireland and Italy are all in the top six in both current and average lockdown stringency. These countries seem to have a yen to lock people down (though less so in Ireland recently); while Denmark, Sweden and Luxembourg tend to go the other way. Beyond the UK, only Portugal and perhaps Spain seem to be treating this as an “end game” – keep lockdowns low, as long as you don’t risk running out of medical resources, in order to get omicron through the population as fast as possible, and so achieve herd immunity. This is, in my view, the only sane strategy at this point.

Here are the current lockdown statuses of the five most heavily locked down countries:

·       Germany (since December 2^nd): Schools: Some closed (Regional), Workplaces: Mandatory closed, Events: Mandatory cancelled, Gatherings: Up to <=10, Public transport: Mandatory closed, Stay at home: Recommended, Travel: Mandatory restrictions, International: Ban some arrivals, Face covering: Required in some places.

·       Italy (since December 6^th): Schools: Some closed, Workplaces: Mandatory closed, Events: Mandatory cancelled, Gatherings: Up to >1000, Public transport: Mandatory closed, Stay at home: Required with exceptions (Regional), Travel: Mandatory restrictions (Regional), International: Ban some arrivals, Face covering: Required when with others (Regional).

·       France (since January 9^th): Schools: Recommended closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to 101-1000, Public transport: Mandatory closed, Stay at home: No measures, Travel: Mandatory restrictions, International: Ban some arrivals, Face covering: Required when with others. From December 4^th, the lockdowns were the same as above, plus a restriction on gatherings to up to 11-100.

·       Netherlands (since January 10^th): Schools: Some closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to <=10, Public transport: Open, Stay at home: Recommended, Travel: Recommended not to travel, International: Ban some arrivals, Face covering: Required when with others. The stringency has been above 60% continuously since December 19^th.

·       Austria: Schools: Recommended closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to 11-100 (Regional), Public transport: Recommended closed (Regional), Stay at home: No measures, Travel: No restrictions, International: Quarantine high-risk, Face covering: Required when with others (Regional). The stringency has been above 60% continuously since November 22^nd.

Here are the current weekly case growths:

Oh, my! Despite the high lockdown stringency, Austrian cases have more than doubled in a week! That runaway case growth – as well as growth of nearly 40% weekly in the Netherlands and Germany, and over 20% in France and Italy – suggests that lockdowns don’t control the spread of omicron. Or, at least, that these particular lockdowns don’t – even though they cover almost the whole spectrum of lockdown options. Meanwhile, Ireland and the UK are the only two countries currently showing negative case growth.

Here are the current hospital and ICU occupancies, both expressed as percentages of the available capacity:

You can see why the French locked down relatively hard; they were worried about running out of ICU capacity. This may also be true for the Dutch, whose peak ICU occupancy in the first wave was over 100% of capacity. (They were able to send patients to Germany, which at the time was less hard hit than neighbouring countries, due to early closure of their borders).

It’s a pity the Germans aren’t reporting hospital occupancy. But those ICU numbers suggest that they and the Austrians may have lost the plot. The German lockdown stringency has been above 70% since late November, and the Austrian above 60%. Why such heavy and sustained lockdowns, when they don’t seem to be in any danger of running out of medical resources? Could it be no more than “We have ways of making you obey the Vorschriften der Weltgesundheitsorganisation?” (That last word, German for the UN’s World Health Organization, is 27 letters long. Only one less than the longest accredited word in English, “antidisestablishmentarianism”).

The WHO’s 200 per million per day threshold, at which the virus is to be considered “endemic” and unlocking is frowned on, looks to be well on the low side. And to be serious for a moment, why didn’t anyone see that beforehand? For historically recent (since 1900) pandemics like the “Spanish ’flu” have burned themselves out in two, three or at most four years. Four years at 200 new cases per million per day would infect 29.2% of a population – not nearly enough to get to herd immunity against a virus like omicron, or even delta.

Lastly, the lists of cumulative deaths per case, and of current deaths per case with a 21-day offset:

That’s interesting, again. Germany and Austria are both near the top in current deaths per case, and Italy and Germany have the two highest cumulative deaths per case. Lockdowns may control cases (even if only sometimes), but at what cost in eventual deaths?

Oh, and the UK is now not far from the bottom in this particular league; as it has been for some time. Right now, it looks to me as if the UK is at least as well positioned against the virus than any of the other countries; even Denmark, Sweden and Luxembourg.

Comparison with South Africa

Another country worth comparing the UK with is South Africa, the first to report the omicron variant:

You can see the ramp-up of omicron in late November 2021, and what look like earlier ramp-ups of other variants (beta in December 2020? delta in June 2021?) The apparently regular spawning of a new variant every six months is a pattern I haven’t noticed before; I wonder if it has epidemiological significance? If you look with a rather jaundiced eye, you can see something a little bit similar in the UK data too, although the six-month periodicity is not nearly as regular. Oh, and I hear that SAGE, advisors of the UK government on these matters, are predicting another omicron wave in early summer: [[8]].

Vaccinations are not a major feature in South Africa, with only 27% of the population fully vaccinated, and another 5% vaccinated once.

Recent lockdown history:

·       From September 13^th 2021: Schools: Recommended closed, Workplaces: Recommended closed, Events: Recommended cancelled, Gatherings: Up to 101-1000, Public transport: Recommended closed, Stay at home: Required with exceptions, Travel: No restrictions, International: Screening, Face covering: Required when with others.

·       On December 6^th: Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to >1000, Public transport: Mandatory closed.

·       On December 21^st: Public transport: Recommended closed, Stay at home: No measures.

The South Africans seem to have got over their “omicron wave” with only one somewhat panicked-looking lockdown, and that for 15 days only. Otherwise, their recent lockdown stringencies have been comparable with Wales, Scotland or Northern Ireland. And since the South Africans have so few vaccinated, that suggests to me that vaccinations are not a big factor in helping control omicron.

How close is the UK to herd immunity?

Herd immunity is achieved against a particular variant of the virus when the actual reproduction rate of the virus (R) drops below 1 and stays there, either until the virus is beaten, or a more transmissible variant appears. The actual R-rate, in its turn, is a function of the basic reproduction rate (R₀) of that variant and the proportion of people in the population who are still susceptible to the virus (S). (Where different groups of people have different risks, for example due to different levels of vaccination or to some having already had COVID, each can be weighted by an appropriate risk factor when calculating the effective S).

The relation I would expect between the two is R = R₀S. That is, the actual reproduction rate should be the basic reproduction rate multiplied by the proportion of susceptibles. The criterion for herd immunity is then R₀S < 1, or S < 1/R₀.

What is the R₀ for omicron? According to a Lancet article from December 17^th [[9]], the delta variant has an R₀ of just under 7. That means that, to achieve herd immunity against delta, you need(ed) to reach S < about 15% of the population. One expert says the R₀ for omicron “could be as high as 10.” That would mean S < 10% as the herd immunity criterion.

What is the value of S in the UK today? To calculate S, all (sic) you need to know is the number of people who have had COVID, the chance someone who has already had it will contract it again, and the effectiveness of different levels of vaccination against the virus.

We know the number of reported UK cases so far – about 22% of the population. But that is far less than the actual number of people who have had the virus, since many early or asymptomatic cases will have been missed. I saw a paper that suggested you should add 28% to the reported cases to allow for the unreported ones, which would lift the 22% to 28%; but I didn’t like the methodology much, because they seemed to be averaging figures from different countries and different stages of the epidemic all into one big pot. Moreover, the UK’s Office for National Statistics (ONS) are now saying that infection rates for omicron may be three times published case counts: see [8]. That means that the correction factor for undetected cases will probably need to be well bigger than 28%!

Meanwhile, we don’t know just how effective the vaccines are in preventing transmission, and it’s said they are less effective against omicron than against earlier variants. If the South African experience is anything to go by, that may well be true. But irrelevant, if herd immunity is close anyway.

One statement in the Lancet article I referenced above is interesting: “the proportion of the population who harbour antibodies against SARS-CoV-2 exceeds 90%.” These antibodies are produced when a person recovers from the virus and acquires T-cell immunity, and can also be produced as an effect of vaccination. Could a very significant fraction of the population indeed be already, at least to some extent, immune?

Then there is this quote from the USA from October 2021 [[10]]: “Fewer than 0.005% of fully vaccinated Americans have experienced a breakthrough case resulting in hospitalization or death — and people who have already had COVID-19 may be even less likely to be reinfected, according to the Cleveland Clinic.” That referred, of course, to delta, not omicron.

Yet Imperial College modellers, publishing on the same day as the Lancet article [[11]], seem to think that “the risk of reinfection with the Omicron variant is 5.4 times greater than that of the Delta variant.” But then, their study also “finds no evidence of Omicron having lower severity than Delta.” I think there is now good evidence, from hospitals and ICUs all over the UK, that omicron is less likely to cause hospitalization than delta. So, I’m inclined to take their estimates with several pinches of salt.

False dawns – and the beginning of the end?

I see from the UK wide new cases graph that we have had three “false dawns” already. On three occasions, new cases have fallen abruptly without any increase in lockdown stringency, but after a while have started rising again. The first was in the second half of July 2021, right after the “great unlock,” and cases fell to about 55% of the peak before coming back up. The second was near the beginning of September, around back-to-school time, with trough about 75% of peak. And the third was towards the end of October, around school half-term, with trough about 70% of peak.

If I look at the latest peak and descent, weekly averaged cases have dropped by 36% in the first 10 days or so of the new year. The big difference, though, is that this time round, the four constituent countries of the UK have moved in lockstep. That may imply a convergence of conditions between the countries, because omicron spreads so fast. It may also mean that the Christmas and New Year period has been a perfect opportunity for the virus to spread, and that opportunity is lessened considerably once life returns to something approaching normal.

Can I be sure this peak won’t go the same way the last three did – cases dropping to 50% or so of the peak, then turning upwards again? No, I can’t. At least, not without estimating the count of susceptibles S with a great deal more accuracy than the data I have is capable of supporting. But I actually think – feel in my bones, if you like – that omicron may well be the “beginning of the end” for COVID in the UK. Get fully over this hump, and herd immunity may prove to be a lot closer than it looks at first sight.

As to SAGE’s idea of another wave in early summer, bring it on! That should seal herd immunity for sure. And not before time.

So, I’m going to do what I usually do… Keep watching the data. If new cases keep on going down for a month or so, we’re on a winner. Until the next variant arrives, of course.

---

[[1]] https://github.com/owid/covid-19-data/tree/master/public/data/

[[2]] https://github.com/OxCGRT/covid-policy-tracker/tree/master/data

[[3]] https://coronavirus.data.gov.uk/details/cases

[[4]] https://coronavirus.data.gov.uk/details/deaths

[[5]] https://coronavirus.data.gov.uk/details/healthcare

[[6]] https://www.ukpopulation.org/

[[7]] https://coronavirus.data.gov.uk/details/testing

[[8]] https://www.theguardian.com/world/2022/jan/14/expect-another-covid-omicron-wave-in-early-summer-sage-says

[[9]] https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00559-2/fulltext

[[10]] https://www.nbcchicago.com/news/coronavirus/can-you-get-covid-twice-heres-what-one-infectious-disease-doctor-says/2654958/

[[11]] https://www.imperial.ac.uk/news/232698/omicron-largely-evades-immunity-from-past/

COVID-19: Omicron Reaches Europe

For my latest COVID rant, I thought I would return to the 14 countries, including the UK, which together form the core of Western Europe. First, because I wanted to see whether there was any evidence in the data that the “omicron” variant in the UK, and perhaps some other European countries, has indeed – as is claimed – a lowered risk of requiring hospitalization. If so, that will be good news. Second, I noticed that different European countries have often been taking completely different attitudes towards lockdowns over the last six months, and I wanted to compare and contrast both these differing attitudes and their results.

I took the data from the Our World in Data and Blavatnik School of Government feeds on December 25^th. The data runs up to December 24^th.

Omicron

But first, a few words about the Omicron variant. According to the Guardian [[1]], it became the dominant variant in the UK (more than 50% of cases) around December 14^th. (An excellent article, by the way; for once, a journalist has asked some of the right questions!) By December 18^th, it was accounting for about 70% of new UK cases. There’s a lot of uncertainty in these estimates, since only PCR tests can actually distinguish between the omicron and delta variants, and these are only a minority of the tests being done. But I’m inclined to accept these figures as “the best I have.”

Moreover, according to Al-Jazeera [[2]], the UK hospitalization rates for omicron are about 50% to 70% lower than for delta. So, I’d expect at least some decline in the rate of COVID hospitalizations, and hence in hospital occupancy, to show up in the most recent data.

Cases

Much has happened in the three months since I last reported on COVID in these 14 countries. Here are the total cases per million population:

Prominent in the graph above is the separation of the countries into two groups. There are a number of countries – the Netherlands, Belgium and the UK, also Ireland, Denmark and just recently France – which seem, relatively speaking, to have been “letting the virus rip.” It’s interesting that the acceleration of new case counts in the UK dates almost exactly to Sajid Javid’s take-over of the health ministry in June. On the other hand, countries such as Germany, Italy and Switzerland seem to be taking a far more cautious attitude.

Here are the daily cases per million:

The graph shows recent peaks for those countries which have locked down in the face of “unprecedented” levels of cases (Austria, Italy, Belgium). There’s a peak for Denmark as well, but this is not due to any lockdown. It is due to a major negative adjustment in the case counts, which appears in the figures for December 24^th.

Notably, every single country in the list is above the WHO’s “endemic” threshold of 200 cases per million per day, above which they recommend no unlocking. The cynic in me is coming to think that this figure may have been deliberately set low, perhaps in order to prolong the epidemic and damage Western economies more as a result.

Vaccinations

I’m not going to say much about vaccinations today, for two reasons. First, as the list below shows, the differences between the countries in vaccination levels are not huge, except for Portugal:

Second, the omicron variant is rumoured to be able to evade the vaccines; which, if true, could turn out to be a game-changer. Reports from Denmark already suggest this is so. But I definitely don’t have nearly enough data yet to make any call on that particular issue.

Lockdowns

The picture on lockdowns has become rather confused over the last six months or so:

It’s worth comparing this list with the “stacked average lockdowns” list, which measures over the whole epidemic the propensity of each country to impose lockdowns of various types:

It’s generally the Catholic countries and Germany which have tended to lock down hardest, though the UK’s record is not brilliant either. And Sweden, Denmark and Luxembourg have been consistently near the bottom of the stringency list.

Hospital Occupancy

Here are the hospital occupancies by COVID patients per million population (the Germans are not reporting this figure, as they only supply data on hospital admissions):

Here are the same numbers expressed as a percentage of available hospital bed capacity. I also added, for comparison, the list of peak hospital bed occupancy by COVID patients over the whole epidemic:

You can see which countries are under-provided with hospital beds! The UK, Italy and Spain.

Another metric I follow is hospital occupancy per new case, with an offset of 7 days, to allow for the gap between infection and hospitalization. Although this is expressed as a percentage, it would need to be divided by the average “dwell time” in days of COVID patients in the hospital, to give an idea of what fraction of cases require hospitalization. As I have no idea how long this “dwell time” is, or how it varies by country, I’ll simply show the metric as it is:

The French seem both to have more hospital beds available than others, and to use them for longer in each case. The UK’s very different positions in the lists of percentages full and occupancy per case suggest that despite the high number of new cases, the virus is not, right now, causing problems as serious as in some other countries.

ICU Occupancy

Here are the corresponding graphs and lists for Intensive Care Unit occupancy (Denmark does not report this). The offset between new cases and ICU occupancy is 14 days:

The numbers of ICU beds I have for Portugal, the Netherlands and Spain, at least, must be understated compared to the reality! But the downward trend in ICU occupancy per case virtually everywhere since mid-October is comforting.

Deaths

Here are the total deaths per million:

That blue line that suddenly accelerates upwards, starting in about October, is Austria. Germany, too, has had a strong rise in deaths recently. As I’ve said before, early success against the virus does not guarantee that success will continue!

Here are the daily deaths per million:

Here are the cumulative deaths per case:

Notice the UK’s constant slide down this unenviable ranking since June.

As I’ve said before, high cumulative deaths per case should provide a good indicator of poor performance of a health system as a whole. Though when the epidemic is over, I’d expect that the main metric on which politicians ought to be judged should be minimizing deaths per million; if not also minimizing loss of GDP.

Here is the excess mortality graph (from all causes, relative to the average of years 2015-2019). I won’t bother to show the latest values list, as different countries seem to report with very different lag times, and Italy in particular hasn’t reported any excess mortality figures for three whole months:

It’s noticeable that there have been quite a few countries trending upwards in excess mortality since about October, among them Austria, Germany, the Netherlands and Belgium.

Lastly, here are the average excess mortalities for each country over the whole epidemic:

Interesting. Down at the bottom, there are both relatively low lockdown countries (Denmark, Luxembourg, Sweden) and high lockdown ones (Ireland, Germany, France). But Italy, the strictest of them all on lockdowns, is right at the top.

Lockdown Effectiveness

Which leads me to the relative effectiveness of lockdowns in the different countries. Here are scatterplots of cases per million, deaths per million, cumulative deaths per case and average excess mortality against average lockdown stringency over the whole epidemic. As there are only 14 countries in the group, the “trend lines” I draw can have only qualitative value. Nevertheless, the results are interesting!

The negative correlation between cases per million and average lockdown stringency is not unexpected. Although not necessarily so in other parts of the world, it does seem that, within the core of Europe, lockdowns have had at least some effect of lowering new cases. However, the correlation between all three of the mortality metrics and average lockdown stringency is positive. In the past, I have been eager – perhaps too eager – to explain this by saying, “bad deaths figures cause politicians to lock down harder.” But, as I’m now starting to think, might there not be some feedback the other way, too? For example, might controlling early cases too hard lead to increased vulnerability to the virus later? Either because a more severe variant arrives – as arguably with the alpha and the delta – or because the virus then has more time in which to seek out the “low hanging fruit,” the people it was always most likely to get anyway? Could it be that “lockdowns cost lives” might be more than just a slogan?

Individual Country Case Studies

Now, I’ll look at the individual countries in more detail. For most, I’ll show just the weekly case growth and reproduction rate against lockdown stringency, and the hospitalizations and ICU data. I’ll also show the lockdown measures since July 1^st 2021. Where necessary, I’ll add cases and deaths for the country, and/or hospitalizations per case.

Austria

Date	Stringency	Measures
20210701	49.07	Schools: Some closed (Regional), Workplaces: Some closed, Events: Recommended cancelled, Gatherings: Up to 101-1000, Public transport: Recommended closed, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210811	56.02	Gatherings: Up to 101-1000 (Regional) Travel: Mandatory restrictions (Regional)
20210825	58.8	Gatherings: Up to 11-100 (Regional)
20210909	49.07	Gatherings: Up to 101-1000 Travel: No restrictions
20210915	51.85	Gatherings: Up to 11-100
20210918	60.19	Travel: Mandatory restrictions (Regional)
20210929	51.85	Travel: No restrictions
20211018	60.19	Travel: Mandatory restrictions (Regional)
20211101	57.41	International: Quarantine high-risk
20211108	49.07	Travel: No restrictions
20211115	59.26	Events: Mandatory cancelled (Regional) Stay at home: Required with exceptions
20211122	64.81	Events: Mandatory cancelled Gatherings: Up to <=10
20211127	67.59	International: Ban some arrivals
20211212	64.81	Gatherings: Up to 11-100

It seems obvious why the Austrians locked down hard in the middle of November; they were approaching the practical limits of their ICU capacity. And why they banned some arrivals on November 27^th; this was an attempt to keep omicron out. They seem to have done better at keeping omicron down than many of the countries around them. But the pundits are saying it’s only a matter of time before that changes.

Belgium

Date	Stringency	Measures
20210730	47.22	Schools: Recommended closed, Workplaces: Some closed, Events: Recommended cancelled, Gatherings: Up to <=10, Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required when with others
20210901	43.06	Events: Recommended cancelled (Regional) Gatherings: Up to <=10 (Regional)
20211001	40.28	Events: Recommended cancelled Gatherings: Up to 101-1000 (Regional) Face covering: Required in some places (Regional)
20211015	45.83	Events: Mandatory cancelled (Regional) Gatherings: Up to 11-100 (Regional)
20211117	48.61	Events: Mandatory cancelled Face covering: Required when with others
20211127	53.7	Workplaces: Mandatory closed Gatherings: Up to 11-100
20211130	48.15	Events: Recommended cancelled

Like Austria, Belgian ICU capacity was somewhat threatened in mid to late November. They decided to use the big stick, mandatory closure of workplaces. It has done the job – sort of – but at what cost to the people? And there are more curbs on the way: [[3]].

Denmark

Date	Stringency	Measures
20210702	47.22	Schools: Recommended closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to 101-1000, Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210731	38.89	Events: Recommended cancelled International: Quarantine high-risk Contact tracing: Comprehensive Face covering: Required when with others
20210901	29.63	Workplaces: Recommended closed Gatherings: No restrictions
20210910	24.07	Events: Allowed
20210928	24.07	Face covering: Required in some places
20211102	24.07	Testing: If symptoms
20211112	44.44	Workplaces: Some closed Events: Mandatory cancelled Gatherings: Up to 101-1000
20211130	38.89	Events: Recommended cancelled Testing: Open

The Danes aren’t providing ICU occupancy figures, so I can’t tell whether it was ICU capacity that triggered the November 12^th lockdown. But selective closure of workplaces was their weapon of choice.

Danish hospital occupancy per case has declined from a local peak of 29% in late September to under 7% by December 20^th. That looks very good. But given the recent adjustment to cases, I wonder whether this will continue?

The latest news from Denmark, though, seems optimistic: [[4]]. And according to the Rio Times [[5]]: “The unvaccinated, about one-fifth of the Danish population, accounted for only 8.5 percent of Omicron infections.” This should be a big slap in the face for all those that have been pushing to make vaccinations compulsory against all ideas of human rights. In fact, there’s even a plausible suggestion that vaccinated people may be more vulnerable to omicron than the unvaccinated.

France

Date	Stringency	Measures
20210709	43.98	Schools: Recommended closed, Workplaces: Some closed (Regional), Events: Mandatory cancelled (Regional), Gatherings: Up to 11-100 (Regional), Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places (Regional)
20210712	43.98	Face covering: Required when with others (Regional)
20210809	60.65	Public transport: Recommended closed Travel: Mandatory restrictions
20210813	66.67	Workplaces: Some closed Events: Mandatory cancelled Gatherings: Up to 11-100
20210926	66.67	Face covering: Required in some places
20211204	72.22	Public transport: Mandatory closed Face covering: Required when with others

Since August, the French have been trying out more and more stringent lockdowns. But ooh la là! none of it seems to have done them any good, as the cases graph shows:

Despite ever more stringent lockdowns, new cases are still heading north at an unprecedented rate. Do I detect, perhaps, the signature of l’omicron?

It isn’t worth showing the graph of hospital occupancy per case, as the detail of interest is so close to the axis that it’s all but invisible. However, this value has declined from 154% in the middle of October to 31% as of December 20^th. Not immediately conclusive; but it’s even possible that the French have actually had l’omicron spreading among them longer than anyone, even themselves, had thought. When I look at the French raw case numbers, I think I see an explosive growth beginning around November 10^th – more than two weeks ahead of the South African reports. Is omicron, perhaps, becoming omacron?

Post-script: Given reports that the Dutch had omicron earlier than the South Africans did – see later – I think it’s quite conceivable that the French may have had it back in November, too. That would suggest that the decline in hospital occupancy per case in France may be genuine evidence that omicron is less serious than delta.

Germany

Date	Stringency	Measures
20210801	64.81	Schools: Recommended closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to <=10, Public transport: Recommended closed, Stay at home: Recommended, Travel: Recommended not to travel, International: Quarantine high-risk, Face covering: Required in some places
20210803	59.26	Travel: No restrictions
20210820	56.48	Gatherings: Up to 11-100
20210824	62.04	Schools: Mandatory closed (Regional)
20210828	60.19	Workplaces: Some closed (Regional)
20210911	54.63	Schools: Recommended closed
20211001	46.3	Events: Recommended cancelled (Regional)
20211010	37.04	Public transport: Open Stay at home: No measures
20211019	42.59	Events: Mandatory cancelled (Regional)
20211028	43.98	Gatherings: Up to <=10 (Regional)
20211110	45.83	Schools: Some closed (Regional)
20211119	55.09	Stay at home: Recommended Travel: Recommended not to travel
20211124	73.61	Workplaces: Some closed Public transport: Mandatory closed Travel: Mandatory restrictions
20211126	76.39	International: Ban some arrivals
20211202	84.26	Workplaces: Mandatory closed Events: Mandatory cancelled Gatherings: Up to <=10

The Germans were slow to unlock, and very eager indeed to lock down again – hard. The ICU graph shows one good reason why; from late October, ICU occupancy was rising inexorably. The rises in cases and ICU occupancy have been staunched since then, but only at the cost of subjecting Germans to their second highest lockdowns of the entire epidemic.

Again I say, early success against the virus does not necessarily lead to success later. In this case, it looks as if the Germans may have shot themselves in the feet, by controlling the earlier waves too well. So now, with the lowest total cases per million among the 14 countries, they are further from herd immunity than anyone else.

Ireland

Date	Stringency	Measures
20210704	44.44	Schools: Recommended closed, Workplaces: Some closed, Events: Recommended cancelled, Gatherings: Up to 11-100, Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required when with others
20210920	40.74	Workplaces: Recommended closed
20211022	37.96	Gatherings: Up to 101-1000
20211028	44.44	Workplaces: Some closed Events: Mandatory cancelled Gatherings: Up to >1000
20211207	50	Gatherings: Up to 11-100

In the first year or so of the epidemic, the Irish suffered some of the harshest lockdowns in Europe. Their initial strategy was, like the Germans, to control cases as hard as possible. Since then, though, there seems to have been a change of approach to a more liberal one.

Ireland has climbed fast up the cases per million ladder; and yet, their deaths per million have remained low, second from bottom among the 14 countries, and below even Germany’s. New delta cases seem under control, and hospital and ICU occupancy are middling compared with the other countries, though ICU occupancy still needs watching.

For the last six months, I’d say the Irish have done a good job. And the BBC say omicron is already dominant in Ireland: [[6]]. But there are still new curbs coming in on hospitality venues, cinemas and theatres. It’s wait-and-see time.

Italy

Date	Stringency	Measures
20210701	47.22	Schools: Recommended closed, Workplaces: Some closed, Events: Recommended cancelled, Gatherings: Up to 101-1000, Public transport: Recommended closed, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210714	75.46	Schools: Mandatory closed (Regional) Workplaces: Mandatory closed (Regional) Events: Mandatory cancelled (Regional) Gatherings: Up to <=10 (Regional) Stay at home: Required with exceptions (Regional) Travel: Mandatory restrictions (Regional)
20210720	75.46	Face covering: Required when with others (Regional)
20210723	67.13	Face covering: Required in some places
20210730	50	Schools: Recommended closed Workplaces: Some closed Events: Recommended cancelled Gatherings: Up to >1000
20210806	55.56	Events: Mandatory cancelled
20210830	56.94	Gatherings: Up to 101-1000 (Regional) Face covering: Required when with others (Regional)
20210901	60.65	Schools: Some closed
20211001	68.98	Travel: Mandatory restrictions (Regional)
20211009	67.59	Gatherings: Up to >1000
20211015	71.3	Workplaces: Mandatory closed
20211019	66.67	Stay at home: Recommended Travel: Recommended not to travel Face covering: Required in some places
20211023	66.67	Face covering: Required when with others (Regional)
20211025	71.3	Stay at home: Required with exceptions (Regional) Travel: Mandatory restrictions (Regional)
20211206	76.85	Public transport: Mandatory closed

The Italian COVID experience has been the worst among all 14 countries. Second in deaths per million, first by a mile in cumulative deaths per case, heaviest locked down of all. And yet, second from bottom in cases per million, so very probably second furthest from herd immunity. Moreover, new cases are currently going through the roof:

That looks like omicron to me; as in France. And the lockdowns seem to be having no effect whatsoever.

Here’s the hospital occupancy per case:

Hospital occupancy per case has gone down since mid-October, but not by as much as in France. The Italians, I fear, are up the proverbial shit creek. So much for their high-lockdown strategy.

Luxembourg

The alphabet takes us to a more optimistic, if less sunny, clime.

Date	Stringency	Measures
20210720	37.96	Schools: Recommended closed, Workplaces: Recommended closed, Events: Recommended cancelled, Gatherings: Up to 101-1000, Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210921	37.96	Testing: Restricted
20210924	34.26	Schools: Open
20210927	37.96	Schools: Recommended closed Testing: Open
20211012	46.3	Gatherings: Up to 11-100 Public transport: Recommended closed
20211214	46.3	Face covering: Required when with others

As their current daily cases per million is unexceptional, I surmise that omicron hasn’t reached Luxembourg yet, at least not to a significant extent. Though they have already announced some fresh curbs: [[7]]. Otherwise, this looks to have been a mostly sane and proportionate response to the virus; so far.

But the “Christian Democrat” party is agitating for compulsory vaccination! We’ll see what they do when omicron really hits.

Netherlands

Date	Stringency	Measures
20210710	36.11	Schools: Recommended closed, Workplaces: Some closed, Events: Recommended cancelled, Gatherings: No restrictions, Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210720	41.67	Public transport: Recommended closed
20210731	41.67	Contact tracing: Comprehensive
20210814	41.67	Testing: Open
20210925	47.22	Events: Mandatory cancelled
20211008	41.67	Public transport: Open
20211113	52.78	Gatherings: Up to <=10 Face covering: Required when with others
20211127	56.48	Stay at home: Recommended
20211219	63.89	Schools: Mandatory closed

It looks as if the lockdown on December 19^th was far more severe than just closing schools, see here: [[8]]. But that doesn’t show up yet in the Blavatnik data I took on the 25^th.

I’ll need to show some more graphs here, because I found a very interesting report from last November about COVID in the Netherlands: [[9]]. It seems they had omicron at least as early as the South Africans did! So, here are the graphs of cases and of hospitalizations per case for the Netherlands:

Now, look at that last but one peak in the cases – the one in July. That very steep rise to the peak happened in many other European countries too, and was the “signature” of the delta variant. Given that the Dutch appeared to have the virus under control through August and September, it is not hard to hypothesize that the latest peak of cases was not delta, but something else.

Could it have been omicron, as the Reuters report suggested was possible? Could omicron have been in the Netherlands already, as early as October? In that case, if omicron genuinely is less severe than delta, we might expect to see a significant drop in hospitalizations per case since September. Hospital occupancy per case has indeed dropped over that period, but only from 20.5% to 11.5%. Possible, but not conclusive.

But there’s something else odd going on in the Netherlands, too. The reported daily COVID cases per million went down by almost half during the period from November 27^th to December 21^st. The raw data still shows cases dropping, right through to December 24^th. COVID deaths per million, too, were dropping from December 12^th onwards. So why has there even been talk of COVID cases “exploding,” whether omicron or otherwise? That may have been a fair comment a month ago, but certainly not now.

And where is the rationale for imposing any lockdown at all on December 19^th? The only possible rationale I can see is that they aren’t sure they have enough ICUs to cope with another wave. But shutting the whole country down right before Christmas seems, to me at least, to be way beyond reasonable.

Portugal

Date	Stringency	Measures
20210702	74.07	Schools: Some closed (Regional), Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to <=10, Public transport: Recommended closed, Stay at home: Required with exceptions (Regional), Travel: Mandatory restrictions (Regional), International: Ban some arrivals, Face covering: Required when with others
20210705	65.74	Travel: No restrictions
20210709	63.89	Schools: Recommended closed
20210801	58.33	Stay at home: No measures
20210823	52.78	Public transport: Open
20210903	52.78	Contact tracing: Comprehensive
20210913	52.78	Face covering: Required in some places
20211001	44.44	Gatherings: Up to 101-1000 International: Quarantine high-risk
20211026	40.74	Schools: Open
20211201	43.52	International: Ban some arrivals Face covering: Required when with others

On the face of it, not much to see here, except that case growth is starting to pick up. But the Portuguese have already announced “post-Christmas curbs”: [[10]]. The reason becomes obvious when you look at the cases graph:

Omicron, welcome to Portugal!

Spain

Date	Stringency	Measures
20210717	50.46	Schools: Recommended closed, Workplaces: Recommended closed, Events: Mandatory cancelled (Regional), Gatherings: Up to <=10 (Regional), Public transport: Open, Stay at home: Required with exceptions (Regional), Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210720	47.69	International: Quarantine high-risk
20210722	47.69	Testing: Open
20210915	42.13	Stay at home: No measures
20211001	43.98	Workplaces: Some closed (Regional) Face covering: Required when with others
20211009	41.2	Gatherings: Up to 11-100 (Regional)
20211129	43.98	International: Ban some arrivals

This looks more than slightly similar to neighbour Portugal. And the recent government response is similar, too: [[11]]. The reason is plain:

Sweden

Date	Stringency	Measures
20210701	51.85	Schools: Open, Workplaces: Recommended closed, Events: Recommended cancelled, Gatherings: Up to 11-100, Public transport: Recommended closed, Stay at home: Recommended, Travel: Recommended not to travel, International: Ban some arrivals, Face covering: No measures
20210715	37.04	Workplaces: Open Public transport: Open Travel: No restrictions
20210811	37.04	Contact tracing: None
20210929	19.44	Events: Allowed Gatherings: No restrictions Stay at home: No measures

There have been more restrictions brought in recently: [[12]]. Even the Swedes are in wait-and-see land now. But it’s absolutely clear that their laid-back, low-lockdown strategy has worked well compared with most of the other countries. If they hadn’t lost a lot of people at the very beginning of the epidemic, they would (and should) be laughing at the rest of us by now.

Switzerland

Date	Stringency	Measures
20210721	40.74	Schools: Recommended closed, Workplaces: Recommended closed, Events: Recommended cancelled, Gatherings: Up to 11-100, Public transport: Open, Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required in some places
20210913	50	Workplaces: Some closed Events: Mandatory cancelled
20211205	46.3	Workplaces: Recommended closed
20211220	53.7	Workplaces: Mandatory closed Face covering: Required when with others

Like the Austrians, their ICU situation made it inevitable that the Swiss would lock down. Otherwise, they seem to be using a similar strategy to the Belgians, with closing workplaces and cancelling events as their punishments of choice.

UK

Date	Stringency	Measures
20210719	43.98	Schools: Recommended closed, Workplaces: Some closed (Regional), Events: Recommended cancelled (Regional), Gatherings: Up to <=10 (Regional), Public transport: Recommended closed (Regional), Stay at home: No measures, Travel: No restrictions, International: Ban some arrivals, Face covering: Required when with others (Regional)
20210910	41.2	Gatherings: Up to 11-100 (Regional)
20211018	46.76	Events: Mandatory cancelled (Regional)
20211215	48.61	Workplaces: Some closed Events: Mandatory cancelled International: Quarantine high-risk

Sajid Javid’s efforts as health secretary so far have, under the circumstances, been exemplary. And it is exceedingly rare for me ever to say anything nice about any politician! He has made his predecessor look like <insert swear word of your choice>. He even seems to have persuaded his boss to carry on with his strategy, at least in England and for now: [[13]].

Despite record new cases, my reading of the data is that he has steered the UK into a better position to deal with omicron than anyone else among the 14 except Sweden and Denmark. And as I write these words, the new UK cases for 25^th, 26^th and 27^th December have come in on Worldometers. 113.2K, 107.5K and 98.5K, respectively. The apparent decline over the three days, I think, is probably spurious and due to late reporting over the holiday period. But at least, the situation isn’t getting exponentially worse, as the alarmists would have us believe. And even the Guardian has caught a mood of optimism: [[14]].

Meanwhile, here’s the graph of hospital occupancy per case:

Is that a slight “knee-bend” I see in the middle of November? Maybe; maybe not. What I can say is that hospitalizations per case were around 25% on November 10^th, and have dropped to 12% as at December 20^th. A drop comparable to that in the Netherlands, and certainly not inconsistent with omicron having a significantly lower risk of hospitalization than delta.

Turn of the COVID tide?

I won’t even try to write a “To sum up” section, because the data (not to mention the stories in the media) are all over the place. But I do share the Guardian’s optimism, about COVID in the UK at least. Turn of the tide? We shall see.

---

[[1]] https://www.theguardian.com/world/2021/dec/23/if-omicron-is-the-dominant-variant-in-uk-why-is-the-number-of-confirmed-cases-so-low

[[2]] https://www.aljazeera.com/news/2021/12/23/omicron-cases-at-much-lower-risk-of-hospital-admission-uk-says

[[3]]  https://www.ndtv.com/world-news/belgium-coronavirus-belgium-omicron-cases-belgium-omicron-variant-belgiums-new-curbs-as-omicron-cases-rise-to-30-of-new-infections-2666413

[[4]] https://www.washingtonpost.com/world/2021/12/24/denmark-coronavirus-omicron-variant/

[[5]] https://www.riotimesonline.com/brazil-news/modern-day-censorship/more-than-90-of-omicron-cases-in-denmark-are-vaccinated-individuals-government-data-show/

[[6]] https://www.bbc.co.uk/news/world-europe-59718822

[[7]] https://www.luxtimes.lu/en/luxembourg/lawmakers-set-to-approve-tighter-measures-as-omicron-spreads-61c58fd8de135b923656b584

[[8]] https://www.businessinsider.com/netherlands-lockdown-christmas-as-omicron-cases-explode-2021-12?r=US&IR=T

[[9]] https://www.reuters.com/business/healthcare-pharmaceuticals/omicron-variant-was-detected-netherlands-before-s-africa-flights-2021-11-30/

[[10]] https://www.reuters.com/world/europe/portugal-imposes-post-christmas-covid-19-curbs-omicron-cases-surge-2021-12-21/

[[11]] https://english.elpais.com/society/2021-12-27/the-perfect-storm-of-spains-sixth-coronavirus-wave-omicron-is-spreading-at-christmas-with-few-restrictions-in-place-and-waning-immunity.html

[[12]] https://www.reuters.com/world/europe/sweden-tightens-covid-restrictions-cases-mount-2021-12-21/

[[13]] https://news.sky.com/story/covid-booster-drive-ramps-up-with-1-5-million-vaccine-slots-available-until-3-january-amid-new-rules-for-scotland-wales-and-northern-ireland-12504395

[[14]] https://www.theguardian.com/world/2021/dec/26/omicron-bleak-new-year-or-beginning-of-the-end-for-the-pandemic