This week Karl Friston FRS and I publish a research article projecting the COVID-19 epidemic to October 2023 and counting its potential sequelae. The results are frightening.
A threefold increase in the number of new cases in the next 12 months is predicted. This has the effect of increasing COVID-19 deaths by 150,000 in the coming year which is over half the number of deaths which have been caused by COVID-19 so far. The new wave of COVID-19 is likely to add 800,000 hospital admissions and for the number of people suffering acute-post COVID-19 syndrome to reach 4.7 million.
To put these projections into numbers, the first column counts the numbers from the start of the epidemic in February 2020 to 1st October 2022 – over 2½ years and the second column counts from the start of the epidemic to 1st October 2023 – 3½ years.
| Scenario assuming FTTIS is 25% effective | Actual | DCM projection |
| Estimated incidence | 105,678,000 | 485,604,000 |
| Confirmed cases by PCR | 22,241,000 | 53,410,000 |
| Deaths within 28 days of a positive PCR test | 178,000 | 331,000 |
| Tests (both PCR and LFD) | 514,606,000 | 821,182,000 |
| Hospital admissions | 994,000 | 1,868,000 |
| Acute-post COVID-19 Syndrome ≥ 12 weeks | 1,726,000 | 4,727,000 |
Can we be confident about the numbers? The last time we did this sort of projection a year ago we underestimated the numbers by 20% because two things happened – Omicron variants arrived and the government abandoned masks, contact tracing and free testing. Our predictions will underestimate again if a more virulent variant (such as the new XBB.1.5 surging right now into New York hospitals) appears, but will overestimate if standard public health measures are re-introduced. The research paper highlights the huge beneficial effect of adding an effective test & trace system to a re-invigorated vaccine rollout.
We need to be worried about two potential disasters. First, with flu on the rise, hospital beds already full and recorded NHS staff vacancies at an all-time high, the NHS will be overwhelmed. Second, we now know that Long-Covid causes much long-term sickness and disability. We are talking about an epidemic of sickness absence which will have a profound effect on the national economy. It has already started as shown in recent Office of National Statistics data in November.
Are we sleepwalking into a national disaster? Yes. Is there a remedy? Yes. Introduce a set of standard public health interventions, not lockdowns and not just vaccine but masks in crowded indoor spaces, good ventilation in schools and workplaces, and a Test & Trace system that works. These are relatively cheap, easy and acceptable. What are the arguments that will be used to excuse any lack of action?
- People are tired of wearing masks and will refuse to do so – mask compliance has always been surprisingly high. The usual surgical mask is not good enough. South Korean Government issued KN94 masks sized for children as well as adults to make them very effective. We should follow suit.
- Money for better ventilation in schools has already been distributed and more is on the way. A recent schools survey suggests schools can’t afford ventilation and heating. There are health and safety regulations for safe ventilation in workplaces which are being ignored. Better ventilation in buildings is a sound long-term investment when linked to energy efficient measures.
- The highly infectious Omicron variants are too quick for Test & Trace to work – just look at China. China has only abandoned lockdowns and is still using isolation of cases and contacts. Our Test & Trace system was designed to fail – national not local (except in Scotland and Wales), using private companies with no expertise in public health – not local directors of public health, GPs and local hospital labs, far too slow – test from GP to result needs to be less than 24 hours, and support – not financial support designed to encourage compliance. The incubation period which dictates the speed needed to identify contacts has shortened with from 2.05 with Wuhan to 1.95 days with Omicron (Influenza is about 1.5 days) but not so short as to make contact tracing ineffective if done properly.
- So, there are no excuses – we need to wake up to the dire situation we are in. But is there political flexibility, wisdom and statesmanship to get these things done?
This is the 4th post by Dr Cam Bowie who is a retired county medical officer of health
