SAGE told time to death of Covid-19 patients is shorter than in April

The SAGE files: Papers presented to Government claim Covid-19 is mutating, London ISN’T seeing a spike in cases and patients are dying quicker in the second wave than they did in the first

  • Papers discussed by scientific advisors to the Government were released today 
  • Scientists said the UK did not have the capability to research mutations in depth 
  • Another document confirms that London has so far avoided a ‘second wave’
  • SAGE also attempted to end the debate about a segregated lockdowns strategy

Scientific advisers have been warned that the coronavirus is mutating and could become more infectious, according to SAGE papers published today. 

The New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) said the UK did not have the capability to research these mutations in depth and whether they would be harmful.

It’s one of a number of papers released by the Government today that give an insight into how scientists are steering the pandemic. 

The idea was explored in a scientific report handed to the Scientific Advisory Group for Emergencies (SAGE), which then presents the findings to the Government to help inform public health policy. 

Another document shows how scientists have found that London has so far avoided a ‘second wave’ on the scale of those happening in other major cities in England, such as Liverpool and Manchester.

Experts speculate this is because more of the capital’s population has some form of immunity to the coronavirus after having it already, compared to the North West, which did not have infections as high as London in the first wave.

Meanwhile data reveals hospitalised Covid-19 patients are dying quicker than they were the first time around – take a week on average, rather than two. This may be because treatment has improved, and therefore doctors can save the lives of those who are not as sick and would usually take longer to die, pushing up the average time.

SAGE also attempted to end the debate about a segregated approach to lockdowns, whereby the most vulnerable are shielded and the young return to normality.

It said the approach, which the Health Secretary has also shutdown a ‘flawed’ option, could lead to an ‘uncontrolled epidemic’ in the young while also causing mental health problems in those forced to shield for longer. 

Cities in England are seeing a fast rise in cases – except London. Pictured: Coronavirus outbreaks continue to be mostly contained to urban areas and cities, particularly in the North of England and the Midlands, according to a heat map published by Public Health England on October 22

Data reveals hospitalised Covid-19 patients are dying quicker than they were before – in a week, rather than two. Pictured is a timescale of when men aged between 40-49 (top) 50-59 (middle) and 60-69 (bottom) die after symptoms start (bottom axis is days since symptoms started). The orange is the first wave, and the blue is the second wav

Cities in England are seeing a fast rise in cases – except London

Cities across England are seeing a surge in cases in the ‘second wave’ of coronavirus, but London is exempt, SAGE said.

In a meeting on September 10, before the rule of six or tiered lockdown was implemented to control the rapid increase in cases, scientists discussed the current state of the crisis.

IS THE UK’S OUTBREAK SLOWING? 

An array of statistics revealed cases are no longer growing as quickly as they once were, although the epidemic is still growing. 

Government scientists today claimed the crucial R rate has dropped slightly. SAGE estimates the reproduction rate for the UK has fallen for the first time in a month, from between 1.3-1.5 to 1.2-1.4. The number – the key measure at the heart of Number 10’s plan to control the virus – must stay below one, or the outbreak will continue to grow.

And the Office for National Statistics, which tracks the size of the Covid-19 outbreak through thousands of random swab tests, today revealed that the number of people catching the coronavirus in England alone every day stood at 35,200 last week.

Despite being a 26 per cent rise on its previous estimate and double that of a fortnight ago, top scientists insisted that the figure was ‘hopeful’ because the speed of growth has clearly dropped. Cases doubled between October 2 and 9, then jumped by two thirds (62 per cent) the following week to 27,900 per day, according to the ONS data, which is considered the most reliable indicator of the true size of the crisis.

And in other promising developments, MailOnline today revealed that almost half of local authorities in England saw their coronavirus infection rate drop last week. Newcastle and Nottingham, which are both battling some of the largest Covid-19 outbreaks in England, witnessed some of the biggest drops.

The data echoes comments by the UK’s chief scientific adviser, Sir Patrick Vallance, who said yesterday that there are now signs local lockdowns are starting to work and that case numbers are beginning to show ‘flattening’ in some areas.

Speaking in a TV briefing alongside Prime Minister Boris Johnson, Sir Patrick said: ‘There are some areas where we’re beginning to see real effects of what’s happening. There are some indications [that] amongst young people the rates are coming down or flattening off a bit due to the huge efforts that people have made to try to adhere to these changes in behaviours that we need to have in order to get this down.

‘And in some areas of the country we can begin to see a little bit of flattening, possibly. So the measures are having an effect but we’re going to need to do more if the aim is to get R below one and to shrink this epidemic.’  

The minutes read: ‘Major cities, excluding London, appear to be experiencing faster increases in transmission than other areas.

‘Though there remains variability between areas, it is almost certain that R is greater than 1 across large parts of England.

‘This suggests that the epidemic is moving from being concentrated in local outbreaks to more widespread transmission.’

Since the meeting, Liverpool, Manchester, Sheffield and Birmingham have been placed in the ‘very high’ Tier 3 restrictions group to try and curb the rise in cases. Nottingham is expected to be next.

Meanwhile, London is in Tier 2, and has an infection rate almost six times lower than Liverpool, with around 100 cases per 100,000 people compared with 570.

The reasons for this are yet to unfold. But scientists have speculated it is because London has fewer people susceptible to the coronavirus because a higher number were infected in the ‘first wave’. 

Government research, supported by Imperial College London, reveals that in the capital, there are twice the number of people with antibodies than the national average (13 per cent), while the South West has the lowest (three per cent). 

This has given them some form of immunity to catching the coronavirus again, or at least being protected from anything other than mild disease, it is thought.

The number of people admitted to hospital in London over the last week was 464 — roughly twice as high as at the beginning of the month. But this is well behind the peak of the first wave, when 883 people were admitted to hospital in a single day in March, analysis by the Evening Standard revealed.

Professor Anthony Brookes, from the Department of Genetics and Genome Biology at the University of Leicester, said London being battered by Covid-19 in the spring has benefited it now.

He told MailOnline: ‘Places that had a large outbreak in the spring/summer are in general now undergoing only a small or even trivial secondary wave. That is a fact – and the reasons for it need to be explored objectively and with open minds.’

He said government graphs presented at the Downing Street briefings in September, showing how the rate of infection has changed across the country since the start of the pandemic, proves this theory.

He said: ‘If herd immunity was not a significant factor in all this, then after lockdown the level of the virus would have fallen simultaneously in all regions – but London falls to next to nothing far before the rest of the country.

‘The only way I can explain this is that herd immunity has largely been established in London, and far more so than in the Northern regions.

‘Then, in this so called “wave 2” part of the animation, it is apparent that the level of virus in London barely increases whilst it does go back up in the North. Again, consistent with London having achieved herd immunity.’

PHE data shows the number of cases per 100,000 people in the worst hit regions appeared to turn and start falling in the week up to October 11 after at least five weeks of continuous increases. London has had considerably lower infection rates compared to the other regions

Coronavirus is mutating which may impact on how easily it spreads, but the UK has an ‘incapability’ to scientifically assess the risks

The coronavirus is mutating and may become more infectious. But the UK is unable to scientifically assess the risks, a paper warned.

NERVTAG explained in its paper that mutations of a virus, like SARS-CoV-2, are normal. It is how the virus would have adapted to infect humans from an animal source in the first place.

Most of these mutations will be harmless and at the moment, researchers believe that none of the genetic changes found in the virus increase or decrease severity of disease.

‘But they may affect transmission,’ NERVTAG said, relating to the coronaviruses ability to spread.

‘In the UK, researchers are currently monitoring whether mutations are occurring, but are not systematically checking whether these mutations “matter”. This is an important gap in our knowledge.

‘We currently lack the capability in the UK to rapidly and systematically assess the biological significance of detected genetic change.’

The group admitted this represents an inability ‘to respond’ to the virus.

When a virus mutates, it may impact how vaccines work. This is the case for flu, whereby a new jab is needed each winter to match the type of flu circulating that season. It may also make tests less reliable because the chemicals in the kit look for a specific variation in the DNA.

Data shows the coronavirus’s genome is definitely changing, and the strains found in the UK ‘show considerable diversity’.

This is mostly because the coronavirus is genetically different across the world, and these variations in strains were largely imported from international travellers at the start of the pandemic.

The paper said there were at least 1,200 transmission lineages from other countries between March and April 2020.

Patients are dying quicker than before, in less than one week 

Covid-19 patients who are seriously unwell are now dying quicker than they were in the first phase of the pandemic, data shows.

The COVID-19 Clinical Information Network (CO-CIN) collates information from NHS hospitals across England, Wales and Scotland to give an idea of the symptoms, characteristics and outcomes of the sickest patients.

In a paper considered by SAGE on October 8, CO-CIN reported quicker times from symptom onset to death using the data of 76,700 patients.

‘Little difference is seen in time from hospital admission to death between first and second waves,’ the data shows.

Up until August 1, patients were dying an average of 13 days after symptoms such as a cough, high temperature or loss of smell and taste started.

But since then, the period has dropped to just seven days on average – 7.5 in men and six days in women.

Experts who wrote the paper did not suggest the reasons for the finding and said the evidence was ‘not strong’, given the UK has only just emerged into the second wave.

But it may be the case that only those who are the most severely sick when they arrive are dying, compared to the start of the pandemic when treatment was not as advanced.

Doctors are getting better at treating the disease because they have a better understanding of how it works. And medics are less keen on putting patients on ventilators amid concerns they could make the illness worse.

CO-CIN reported quicker times from symptom onset to death using the data of 76,700 patients. They are plotted on graphs (L: male R: female) by age (down the right hand side)

POLAND TELLS OVER 70S TO STAY AT HOME 

Poland is telling over-70s to stay at home and drafting in military reservists to help deliver food to their homes as the country tries to avoid a full-scale coronavirus lockdown, with the second wave continuing to grow rapidly across Europe.

Polish PM Mateusz Morawiecki declared the entire country a ‘red zone’ today after total infections doubled in two weeks while deaths reached a record 168 on Thursday.

It comes as Europe’s daily coronavirus cases crossed 200,000 in a day for the first time after doubling in just 10 days, with many countries setting records and governments torn between fighting the virus and keeping the economy alive.

With seven out of 10 deaths in Poland coming among over-70s, Morawiecki urged the elderly not to go out unless necessary and promised a ‘senior support corps’ to get them through the crisis.

The ‘senior protection’ programme will include a mixture of government employees, volunteers, emergency workers and military reservists as Poland’s government tries to keep over-70s safe without shutting down the entire economy.

The government-funded support package also includes a dedicated helpline which seniors can call to request help with food or hygiene supplies.

‘Volunteers will deliver shopping to seniors, but also help with household chores or simply talk to an elderly person,’ the Polish government promises.

 

It’s hoped survival rates will improve further still after a number of cheap steroids, including dexamethasone and hydrocortisone, were proven to treat severe Covid.

Hospitals are also far less busy than they were in April and May, meaning doctors and nurses can spend more time with virus patients. Staff sickness rates are also lower.

It comes after CO-CIN revealed Covid-19 mortality rates have significantly dropped.

In a paper submitted on September 16, it said of patients admitted after August 1, 12 per cent died compared with 31 per cent over the course of the pandemic.

In both papers, CO-CIN said conclusions could not be made because the data is only from August 1. There has not been enough time to properly follow-up with all patients, who may die weeks or even months after they first become sick. 

SAGE paper insists targeted protection approach would lead to ‘uncontrolled epidemic’ in young people which will still harm the NHS

A Covid-19 lockdown strategy involving shielding the elderly while leaving the young to return to normal life would not work, SAGE was told.

The approach would lead to an ‘uncontrolled epidemic’ in the young, which would have ‘dire consequences for the NHS’, the SAGE sub-group Scientific Pandemic Influenza Group on Modelling (SPI-M-O) warned on October 15. 

It is also not clear what the impact of Long Covid will be, known to strike Covid-19 survivors young and old, who had mild or severe disease.

‘We do not know if long term immunity results from infection with SARS-nCOV-2,’ the paper said, refuting the idea that ‘herd immunity’ could be achieved and wipe the coronavirus out.

‘Even if high levels of immunity could be achieved with in the younger age group, it is almost certain that a further epidemic wave in older people would happen occur once segmentation ended,’ scientists speculated.

The paper, which drew on various pieces of evidence, shut down the prospect of a segregation strategy proposed by the Great Barrington Declaration

Thousands of scientists signed the declaration in support of ending the ‘damaging physical and mental health impacts of the prevailing COVID-19 policies’ and switching to ‘focused protection’.

Scientists from the world’s top universities have penned an open letter calling for the UK and US to build herd immunity to Covid-19 by letting it spread in young people 

But the SPI-M-O said it would not be possible to completely separate the most vulnerable of society and the rest of the population, not least because it was ethically wrong and would also involve shielding people who lived with them.

Commenting on the paper, Dr Michael Head, senior research Fellow in global health, University of Southampton, said: ‘It is good to see a consensus statement from SAGE, reiterating that this segmentation idea is a strategy that has no place in our society. 

‘This follows on from statements by the WHO, who called the idea ‘scientifically problematic and unethical’. 

‘Other major expert groups have also refuted a segmentation strategy, including Independent SAGE, the Academy for Medical Sciences, and the many signatories of the John Snow Memorandum.’

Only 1 in 10 stay at home for two weeks after being told to by NHS Test and Trace

Only 10.9 per cent of people told to self isolate by NHS Test and Trace complete their two-week period without leaving home, SAGE was warned.

Scientists at King’s College London, working alongside Public Health England, quizzed 30,000 people living in the UK about how they have acted during the Covid-19 pandemic.

Even though 65 per cent of people said they would quarantine if contacted by Test and Trace, only 10.9 per cent actually did.

The figures were slightly better for those who had not been contacted by NHS, but came down with tell-tale symptoms of coronavirus, such as a cough, fever or lost their sense of taste or smell, but still shockingly low.

Results showed intention to self isolate was high; 70 per cent of those who had not suffered Covid-19 symptoms said they would if they fell ill.

Similar results were seen for those who had been asked to self isolate by NHS workers. Some 65 per cent said they would quarantine if contacted by Test and Trace but only 10.9 per cent actually did

But of those who actually reported tell-tale signs of Covid-19 in the last seven days, only 18.2 per cent stayed at home for the duration of their symptoms.

Experts behind the study claimed younger people, men, key workers and those from deprived backgrounds were most likely to break the rules.

Their paper, which was considered by SAGE on 3 September but published in a public domain since then, suggested ministers should up the financial payments given to those asked to quarantine at home.

Matt Hancock has since promised £500 as an ‘isolation support income’ for people on benefits who are urged to self-isolate, so they don’t ‘worry about their finances while they’re doing the right thing’. Self-isolation can be costly because statutory sick pay does not always give people enough to live on.

The survey also found a quarter (23.2 per cent) of people would not give details of close contacts if asked to by the NHS, the most common reason being because they were concerned about data privacy.

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