England’s second wave of coronavirus is extending south of the worst-affected areas in the North of the country and infections are spreading out of young age groups to the at-risk older generations, official data shows.
Professor Jonathan Van-Tam, England’s deputy chief medical officer, today hosted a television briefing laying bare the data that Prime Minister Boris Johnson is using to impose tougher lockdown rules on millions of people today.
Mr Johnson, speaking in the House of Commons this afternoon, confirmed that the Government will use a traffic light system for categorising local lockdowns in which green or ‘medium’ will be national guidelines only, while red, ‘very high’, will see all socialising banned and pubs, restaurants and gyms required to close.
Data presented by Professor Van-Tam showed that hospitals in Liverpool now have the highest levels of coronavirus admissions in the country, and that there are now more patients in hospital in England than at the start of the March lockdown.
Mr Johnson warned in Parliament that cases have ‘quadrupled in the past three weeks’ as data shows positive tests surging since a lull in the summer, but Professor Van-Tam said comparing the outbreak now to that of March and April was ‘apples and pears’ because barely any testing was available then.
Hospital admissions and deaths, the deputy chief medical officer said, are rising now based on a surge in cases that happened weeks ago. The even higher numbers of people being diagnosed in the past week will later lead to even more going into hospital in the coming weeks.
Here is a breakdown of what the charts in today’s briefing showed and what the data is behind them:
‘Second peak’ of cases since the summer – but not comparable to April
Professor Jonathan Van-Tam, England’s deputy chief medical officer, held a televised briefing today to warn that hospital admissions and deaths from Covid-19 will rise in the next few weeks
The first graph presented by the deputy chief medical officer Professor Jonathan Van-Tam was the familiar day-by-day count of positive coronavirus tests over time.
It shows a dramatic spike in cases in September and October after a lull in the summer, which illustrates that the virus is rebounding in the UK.
Department of Health testing data shows that in the last week of July, when the virus appeared to have been driven into submission over the summer, there were an average of 753 people diagnosed with Covid-19 each day.
The daily cases hit a low point of 352 on July 6, when there were fewer cases than at any time since the public testing system was set up.
By the September 24, however, the average number of daily infections had surged to 4,964 per day and, now in the second week of October, there have been more than 12,000 cases every day for the last nine days straight.
However the Government graph, Dr Van-Tam admitted, is an ‘apples and pears comparison’ and it could be misleading if looked at over the entire year.
It makes the spike in cases now appear larger than the one that sent the country into lockdown in the spring, which is inaccurate.
The first hump of cases, seen in March, April and May, happened at a time when there was no public testing system for many weeks and, when one was set up, it managed fewer than 30,000 tests per day until the end of April.
This meant criteria for tests had to be stricter and they picked up on the most seriously ill patients, not people who only had mild illnesses.
By comparison, there are now around 230,000 tests done per day, the vast majority of which are negative.
Dr Van-Tam said: ‘Comparing [the first peak] with the second peak, please bear in mind that this is an apples and pears comparison based on case numbers, because our testing capacity in the spring was very much lower than it is now.
‘But the key point is that having had a rather flat summer with very low amounts of Covid-positive patients in the UK, you can see that from early September there has been a marked peak.’
This slide shows how the number of positive coronavirus tests has spiked in the UK since a lull in the summer. The second spike is not comparable to the first because so many more tests are being done now than they were then
Outbreak focused in the North of England but ‘extending south’
Dr Van-Tam presented a series of maps which show how the second wave of coronavirus is focused in the North of England.
This backs up what official data has been showing for weeks and makes clear that the worst-affected parts of the country are in the region around Manchester and Liverpool, as well as Newcastle and Sunderland.
Darker patches on the map illustrate higher numbers of Covid-19 cases per person (purple map) and outbreaks that are growing more quickly week by week (brown map).
Dr Van-Tam said: ‘There are now very dark areas in the North West of England, in the North East of England and, really, a confluent dark purple colour across the northern part of the UK, extending down into the West Midlands and the East Midlands.’
He added: ‘Of rather more concern [statistics on the brown map] indicate the latest data on where things are heating up…
‘You can see that the reach of the dark brown colours is further south into a greater land mass across England and, in fact, I received these slides this morning – I showed very similar data to MPs in the House of Lords on Friday and the brown chart had not extended that far south.
‘So it has changed in a matter of just a few days and that is clearly a matter of concern to me.’
Weekly Public Health England data showed on Friday that 18 out of the 19 areas with a coronavirus infection rate of more than 250 cases per 100,000 people (0.25 per cent) are in the North of the country, with the exception only of Nottingham.
The vast majority of areas with local lockdown rules are in the North and there are no regional restrictions further south than the Midlands.
Knowsley in Merseyside was the worst-affected area by Friday, October 9, with 557 cases of Covid-19 for every 100,000 people – meaning one in every 180 people is infected.
This was followed by Manchester (532 per 100,000), Liverpool (517) and Newcastle (475).
The fastest rate of growth in the first week of October was seen in Nottingham, where cases surged almost seven-fold from 62 per 100,000 to 424 in a week, making it the fifth worst hit place in the country.
There were also fast rises of more than triple in areas outside of the Northern hot spot, including Devon, Suffolk, Torbay, Brighton and Richmond upon Thames.
Mapped coronavirus infection rates show that cases are concentrated in the North of England but the outbreak is ‘extending’ south, Professor Van-Tam said. (Pictured: Areas with the darkest patches are the worst-affected. Purple map, left, shows the number of coronavirus cases per 100,000. Brown map, right, shows the change in the infection rate between the last week of September and first week of October)
Cases highest among teens and 20s but leaking into older at-risk groups
Separate maps and heat charts presented by Dr Van-Tam showed how cases are rising in elderly people in areas that have bad outbreaks.
Throughout the second wave the resurging cases have been pinned on young people, with infection rates highest in people in their 20s, followed by teenagers.
Much of the rise in cases has come after students returned to school and university, and student areas are seeing up to seven times as many people getting infected as other parts of the country.
To begin with rising infections among young people were not a huge concern because they are significantly less likely to die from Covid-19, and young schoolchildren did not seem to be experiencing more cases.
But in the worst-hit areas – as chief medical officer Professor Chris Whitty warned would happen in the last TV briefing – infections have now crept into older groups.
Dr Van-Tam said today: Our resurgence of cases this autumn has been mainly in adults aged 20 to 29 years of age and that is absolutely true.’
Showing maps plotting cases of specifically people aged 60 and over, the deputy chief medical officer explained: ‘You can see that there is the spread from those younger age groups into the 60-plus age group in the North West and the North East and there are rates of change in the same place, but also extending a little futher south.
‘This is again of significant concern… because, of course, the elderly suffer a much worse course with Covid-19. They are admitted to hospital for longer periods and they are more difficult to save.’
Last week’s PHE report showed that infection rates are highest in 10 to 19-year-olds – at 237 cases per 100,000 people – followed by 20 to 29-year-olds (200).
They are markedly lower in the older age groups, with rates of 62 for those in their 60s, 39 per 100,000 for people in their 70s and 53 for the 80+ group.
Cases are rising among the at-risk over-60s in areas that have bad outbreaks, top medics warned, meaning hospital admissions will rise in those areas. The same trend is likely to continue across the whole country, they said (Pictured: Areas with the darkest patches are the worst-affected. Purple map, left, shows the number of coronavirus cases per 100,000. Brown map, right, shows the change in the infection rate between the last week of September and first week of October)
However, although these age groups have lower rates they have risen at approximately the same pace as younger people.
Rates may be lower because elderly people are more aware about the personal risks they face and more likely to keep social distancing and shield themselves at home.
In the month up to October 4, the infection rate in people in their 60s more than tripled from 21 cases per 100,000 to 62.
This 199 per cent increase was close to the 221 per cent rise seen in the 20 to 29 age group, where the infection rate rose from 62 to 199.5 during the same time frame.
While rising cases in the under-30s may not directly increase the death toll, it is dragging up case rates in the elderly, data shows, which will inevitably lead to fatalities.
In a series of heat charts, Dr Van-Tam explained that although in the North West cases appeared to be growing only among 16 to 29-year-olds in early September, they quickly spread to older, more at-risk age groups.
This heat map illustrates how infection rates have changed in different age groups since the start of September. Age groups are listed horizontally with the oldest at the top for each region, while the dates run across the bottom. The darkening of a box shows infections are increasing. As the dark boxes move higher towards the top of the graph, it means cases are increasing among at-risk older age groups
The trend was most obvious in the North West, Professor Van-Tam pointed out, where most of the infections (dark orange boxes) were concentrated in younger groups (lower rows) in early September, but have since moved higher up meaning older people are getting infected
The diagonal line broadly shows that the infection rates seen in younger people at the start of September are now happening in older groups, meaning hospital admissions and deaths are likely to increase
More patients in hospital than before first lockdown, and admissions rising
Professor Stephen Powis, the medical director for NHS England, flanked Dr Van-Tam this morning to warn the public that hospital admissions are rising.
There are more people in hospital now, Professor Powis said, than there were before Britain went into lockdown in the spring.
Statistics show there were 3,097 patients in hospitals in England with coronavirus on March 23, the day Boris Johnson made his landmark address to the nation.
This number was surpassed on Saturday, when the number of people on wards hit 3,225, and it is now at least 3,451.
The rate of increase in March was immense, however – the number of patients tripled in just one week to 10,767 on March 30.
At the current rate of rise, according to Government figures, it took three weeks for the number of patients in hospital to treble, from 1,141 on September 20.
Daily admissions are significantly lower now than they were then, but are rising as case numbers continue to go up around the UK.
There are an average of 487 admissions per day in England at the moment, compared to around 1,049 daily in the first week of lockdown and more than 2,700 at the peak.
Professor Powis said: ‘You will see, since the beginning of September, paralleling that rise in infection in the community… we are starting to see an increased rise in hospital cases.
‘It is clear that hospital admissions are rising fastest in those areas of the country where infection rates are highest… particularly the North West, where you can see that hospital cases are accelerating the fastest and are at the highest.’
The hospitalisation graphs show that, although cases are high in young people and low among the elderly, the opposite is true of hospital cases.
In the week to October 4 there were nearly 40 over-85s admitted to hospital every day with Covid-19, compared to an average of fewer than five under-65s.
As well as a clear age divide, there is a regional divide in hospitalisations that is not seen in the graphs.
Of the 3,451 hospital patients recorded yesterday, 2,132 are in the North West and North East & Yorkshire regions alone (62 per cent).
In the week to October 4 there were nearly 40 over-85s admitted to hospital every day with Covid-19, compared to an average of fewer than five under-65s
NHS England’s medical director Professor Stephen Powis said: ‘It is clear that hospital admissions are rising fastest in those areas of the country where infection rates are highest… particularly the North West, where you can see that hospital cases are accelerating the fastest and are at the highest’
Hospital cases are currently concentrated in the North of England where daily admissions are higher than the national average, this graph shows. Separate Government data shows that of the 3,451 hospital patients recorded yesterday, 2,132 are in the North West and North East & Yorkshire regions alone (62 per cent)
Liverpool University Hospitals NHS Trust currently has the highest number of coronavirus patients of any hospital in England, data shows
Time lags mean hospital cases and deaths now relate to a time with fewer cases; both will rise in coming weeks
While warning about rising numbers of people being admitted to hospital with Covid-19, the chief medics stressed the point that there is a lag in the records.
On average it takes a severely ill coronavirus patient around seven to 10 days to become sick enough with coronavirus to need hospital care.
Once they are in hospital, they usually spend between five and 23 days on wards until they recover enough to go home or die. Some patients stay for longer, while others recover or die faster than the average period.
Around one in three people admitted to hospital with Covid-19 have died with the disease so far in England.
The time delays mean it can take a month or more between someone catching the virus and then dying, so the surging number of cases now (an average 14,000 diagnosed per day, plus others that do not get tested) may not lead to an obvious increase in deaths until mid-November.
‘I want to be very clear with you that, as patients become ill with Covid-19, they don’t immediately go into hospital,’ said Professor Van-Tam.
‘And they don’t die in hospital the moment they arrive. Some, unfortunately, do die – but not instantly.
‘The point I’m trying to make here is that there is a lag between cases and when we see hospital admissions rise and when we see deaths rise.’
He added: ‘Hospital admissions we have now actually relate to a time when there were fewer cases of Covid-19, and what I’m trying to say here is that already, with the cases that we know about, we have baked in additional hospital admissions and, sadly, we also have baked in additional deaths that are now consequent upon infections that have already happened.’
Risk of coronavirus death in hospital is FALLING: Treatment helps intensive care fatalities drop to 20%, new figures reveal
The chances of surviving coronavirus after falling critically ill have increased significantly since the pandemic began, data shows.
Scientists say improved treatment has seen death rates in the most seriously ill patients fall by almost a third since the peak.
The figures have also been helped by more widespread testing picking up a greater number of less serious cases.
The proportion of patients dying in hospital intensive care units has fallen from around 30 per cent to below 20 per cent since April.
The fall in the death rate as a proportion of all patients admitted to hospital is even more striking – plummeting from 6 per cent at the peak to around 2 per cent now.
The proportion of patients dying in hospital intensive care units has fallen from around 30 per cent to below 20 per cent since April. The fall in the death rate as a proportion of all patients admitted to hospital is even more striking – plummeting from 6 per cent at the peak to around 2 per cent now
Professor Peter Horby has welcomed the ‘good news,’ that the proportion of Covid-19 patients dying in hospital has fallen dramatically since April
Professor Peter Horby, a member of the Government’s Scientific Advisory Group for Emergencies, welcomed the ‘good news’ amid rising case numbers.
He said increased testing and tracing capabilities combined with a ‘much better understanding of the disease’ has led to death rates among the sickest dropping to a less than a fifth.
‘What’s great to see is that it is the risk of death in hospitalised patients is coming down,’ he told the BBC’s Andrew Marr Show.
Government data shows that the North West and North East and Yorkshire are the only regions to have seen a sustained and sharp increase in people being admitted to hospital (line graphs show daily hospital admissions between April and October)
‘It was pretty high at about 25 to 30 per cent in the last wave. And although the data are preliminary, it looks like it’s coming down and may be below 20 per cent so that’s something that is good news.’
Experts agree that treatment breakthroughs have had the most significant effect on the rate of people dying from coronavirus.
Dexamethasone, a common steroid which costs around 50p a day, has been found to cut deaths among the sickest patients by a third.
The antiviral drug remdesivir, originally developed to tackle Ebola, has also been found to improve recovery time in the sickest patients.