^{The Friday Report – Issue 22                                                                                                                                        COVID-ARG.COM}

By Matthew Fletcher, Dan Ryan and John Roberts

COVID-19 Actuaries Response Group – Learn. Share. Educate. Influence.

COVID-19 is still one of the hottest topics for scientific papers and articles. The COVID‑19 Actuaries Response Group will provide you with a regular Friday update with a curated list of the key papers and articles that we’ve looked at recently.

Modelling

ECDC – Baseline projections of COVID-19 in the EU/EEA and the UK: Update (September 2020) (link)

The European Centre for Disease Prevention and Control’s latest report contains a projection of COVID‑19 cases for EU / EEA countries and the UK up to 14 October. It also presents a comparison of previous projections (published 12 May) with the observed epidemiological data up to 9 June.

The projections suggest that the number of cases are likely to increase in many countries (including the UK) but at this stage they do not show a material increase in the number of deaths in most countries – amongst larger countries, France and Italy are projected to see increased deaths by 14 October.

Impact of baseline cases of cough and fever on UK COVID-19 diagnostic testing rates: estimates from the Bug Watch community cohort study (link)

This pre-print paper estimates the prevalence of coughs and fever in England in 2018-2019, noting that COVID-19 tests are typically offered to people with these symptoms. From this, it extrapolates the diagnostic testing rates required between July 2020 and June 2021, under four second wave scenarios.

Assuming that 80% of baseline cough or fever cases require testing, the authors conclude that testing demand in the UK would exceed current capacity for all of October 2020 to February 2021, peaking in December 2020. The authors suggest that testing capacity will need to be immediately scaled up to meet demand.

Imperial College Report 32 – Age groups that sustain resurging COVID-19 epidemics in the United States (link)

This paper, from the Imperial College COVID-19 Response Team, investigates areas in the United States that have seen increased transmission of COVID-19 following initial declines. The study uses age-specific mobility data and links it to mortality data. The paper concludes that almost 2/3rds of all infections originated with adults aged 20-49. It predicts that, whilst the re-opening of schools in August and September is essential, it could increase the spread of the disease. It notes that when schools do re-open in areas with resurgent epidemics, it will be necessary to offset any resulting increase in the spread with other measures to avoid the epidemic accelerating even faster. These interventions will be most effective if targeted at 20-49 year olds given this group has driven the re-emergence of the virus in recent weeks.

Clinical and Medical News

Surge in demand for COVID-19 tests

In the last few days we have seen increasing reports and concerns expressed over the availability of PCR tests and the distances that individuals are expected to travel to get a test. In response to questions from the Health and Social Care Committee on 15 September, Matt Hancock conceded that demand was outstripping supply and that future tests would be focused on acute clinical care and social care. Data from Our World in Data illustrates the growth in processed tests and how the UK compares against other countries (after removing published data in respect of serology and surveillance testing).

NHS service recovery and winter preparation at risk from current testing shortages

Further to the above, NHS Providers expressed serious concerns in a briefing on 15 September in a briefing that current testing shortages are beginning to impact NHS service recovery and preparations for winter, and in particular in Bristol, Leeds and London. A survey referenced in the briefing indicated that 54% of members thought they should be testing patient facing staff (estimated to be 600,000-800,000) at least once a week.

Primary care and COVID 19

Following the A(H1N1) influenza pandemic, there was a renewed focus on whether countries were adequately prepared for future pandemics and in particular whether primary healthcare systems were sufficiently robust. A recent international study concluded that those countries with a prepared pandemic plan and a strong primary healthcare system did not necessarily experience lower COVID‑19 mortality rates. Instead, the study concluded that containment was better achieved if prior plans were implemented and where primary health care was effectively mobilised through physical distancing, testing, triaging and contact-tracing measures.

No association between hospital discharge and care home outbreak

One of the putative failings of the first wave in the UK was that many nursing home residents were discharged early from hospital without containment, it being thought that this led to outbreaks and avoidable deaths. A recent pre-review study of all nursing homes (1,068) in Wales concluded that the major risk factor was size of nursing home, and that discharges from hospital were not significantly associated with an increased risk of new outbreaks after controlling for nursing home size. This would instead suggest that the determining factor was the higher number of external contacts that a larger nursing home would expect, such as greater use of agency staff.

Internet search patterns reveal clinical course of COVID-19 disease progression and pandemic spread across 32 countries

Back in 2008, Google pioneered the use of internet searches to develop Google Flu Trends as an early warning system for flu outbreaks. Very recent research by the Predictive Medicine Group at Boston Children’s Hospital (Tina Lu & Ben Reis) has illustrated how internet search patterns could provide information on the clinical course of COVID-19. Their study investigated searches for COVID-19 symptoms in 32 countries in March and April in 10 languages, and concluded that initial symptoms of fever, dry cough, sore throat and chills where followed by shortness of breath after 5 days, matching current medical literature. In addition, increased COVID-19 symptom searches predicted increases in the number of COVID-19 cases 18 days later and number of deaths 22 days later.

RECOVERY Trial to Investigate a further therapy

It was announced this week (link) that the UK’s RECOVERY trial project is to evaluate the anti-viral antibody cocktail REGN_COV2.

The cocktail is the first specifically designed COVID-19 therapy to be evaluated by RECOVERY. Pre-clinical data has shown it could protect against viral escape mutations, and in investigations in non-human primates it reduced the amount of virus and associated damage in the lungs. REGN-COV2 is currently being studied in two Phase 2/3 clinical trials for the treatment of COVID-19 and in a Phase 3 trial for the prevention of COVID-19 in household contacts of infected individuals.

In the usual randomised control trials, it is expected that the therapy will be given to 2,000 patients, along with a control group of a similar size. One benefit of the unwelcome recent increase in the virus is that it should become quicker for these trials to reach a conclusion than whilst numbers have been much lower.

Data

Infection Surveillance Monitoring

The latest weekly update by the ONS (link) is now clearly showing the increase in infectivity levels. The estimate of numbers infected has risen from 1 in 1,400 to 1 in 900 and the number of new infections from 3,200 per day to 6,000. The regional variation is now becoming clearer with the North West and, maybe surprisingly, London, highest. The age variation is also clear, with the 17-34 group driving the overall increase. The data relates to 4 – 10 September, so we can expect the current position to have reflected further growth since then.

Update on “R”

We published our estimate of R earlier this week in Bulletin 63 “Are we experiencing a second wave?” and suggested that in England it was likely to have risen to around 1.6. This contrasted with SAGE’s most recent estimate of 1.0 to 1.2. SAGE has now updated its estimate for the UK to a range of 1.1 to 1.4, and for England to 1.2 to 1.4, with an upper growth rate of 7%, equivalent to a 60% growth over a week.

We note that hospital admissions in England are currently growing at 80% per week, and that this suggests a higher growth rate than SAGE is reporting. The SAGE estimate is caveated that it relates to the situation “over the past few weeks”, and thus, if the epidemic is accelerating, may understate the underlying position.

The impact of disability status on COVID-19 mortality

The ONS has also published (link) an analysis of the effects of disability on mortality from the virus. It notes that 59% of deaths up to 14th July were individuals who classified themselves as disabled in the last census, whereas they account for just 16% of the overall population. Adjusting for age and socio-economic factors still resulted in a significant variation, with even those who consider their activities to be only restricted a little experiencing COVID mortality around 60% higher than those without disability.

And finally …

Was your lockdown time well spent? For some people, it would seem so. The new edition of the Guinness Book of Records was released this week, and – thanks to all that lockdown? – we’re glad to see progress in some useful areas this year.  A new record for ‘speediest headstand on a motorbike’ has been set – Marco George at 76 mph – and confronting a different type of fear, the record for most alternating paw tricks with a rat in 30 seconds is now up to 28. Definitely a year to remember …

18 September 2020