SAGE 99 minutes: Coronavirus (COVID-19) response, 16 December 2021

Held through Video Teleconference.

Scenario replace

1. The variety of Omicron infections within the UK has continued to extend very quickly with the doubling time in England at present round 2 days. That is quicker than the expansion fee seen in March 2020.

2. In England it’s virtually sure that there are actually a whole lot of 1000’s of latest Omicron infections per day. Ranges of Omicron an infection are at present highest in London. Reported numbers of confirmed and suspected Omicron infections will solely be a small proportion of the particular quantity. It is because there are lags between individuals changing into contaminated, being examined, and getting take a look at outcomes (information lags matter most when development may be very quick); not all checks permit the variant to be recognized; and never everybody who’s contaminated is examined.

3. At the moment noticed numbers of Omicron infections admitted to hospital within the UK are most likely round one tenth of the true quantity as a result of the info lags of hospital reporting. The remark that there are apparently not many individuals being admitted to hospital due to an Omicron an infection is due to this fact deceptive. It’s at present very unclear what number of such individuals there are.

4. In Gauteng, which is forward of the UK within the epidemic trajectory, excessive ranges of an infection are actually resulting in important numbers of hospitalisations, regardless of the younger inhabitants and excessive ranges of previous an infection, however this can be slowing. Different components of South Africa have an epidemic trajectory behind Gauteng and extra in step with the UK.

5. It’s nonetheless too early to reliably assess the severity of illness attributable to Omicron in comparison with earlier variants. Though a preliminary evaluation from South Africa means that this wave could also be much less extreme than earlier waves, a comparability of SGTF (primarily Omicron) and SGTP (non-Omicron) instances inside this wave suggests much less distinction between variants. Some severity estimates ought to begin to grow to be obtainable in a couple of week as hospital information accumulate. Even when there have been to be a modest discount in severity in comparison with Delta, very excessive numbers of infections would nonetheless result in important stress on hospitals.

6. Because of the very excessive variety of present infections, hospitalisations in UK will attain excessive ranges in about 2 weeks even when transmission is lowered quickly, as a result of there are lags between infections, signs showing, and hospitalisation (excessive confidence). There are more likely to be between 1,000 and a pair of,000 hospital admissions per day in England by the top of the yr. Many of those might be people who find themselves already contaminated now or who grow to be contaminated within the subsequent few days. The acceleration of the booster vaccination programme is not going to have an effect on transmission and extreme and gentle illness in time to mitigate these hospitalisations for the remainder of 2021 (excessive confidence).

7. With out intervention past these measures already in place (‘Plan B’), modelling signifies a peak of a minimum of 3,000 hospital admissions per day in England. Some eventualities have considerably worse outcomes throughout the first few months of 2022 however there are numerous uncertainties. If the purpose is to scale back the degrees of an infection within the inhabitants and forestall hospitalisations reaching these ranges, extra stringent measures would have to be applied very quickly.

8. The sooner interventions occur the better the impact they’ll have (excessive confidence). This will additionally imply that they are often saved in place for a shorter period. Illustrative eventualities from SPI-M-O recommend that measures equal to these in place after Step 2 or Step 1 of the Roadmap in England, if enacted early sufficient, might considerably cut back the potential peak in hospital admissions and infections in contrast with Plan B alone (medium confidence). The timing of such measures is essential. Delaying till 2022 would tremendously cut back the effectiveness of such interventions and make it’s much less seemingly that these would stop appreciable stress on well being and care settings.

9. Slowing the wave of infections would additionally permit extra individuals to obtain boosters earlier than they’re probably uncovered to Omicron. This could stop (not simply delay) some hospitalisations and deaths.

10. Decreasing incidence of an infection would additionally cut back the morbidity burden in those that will not be hospitalised and cut back the extent of workforce and faculty absences. If incidence reaches very excessive ranges, there are more likely to be many simultaneous workforce absences. It might additionally current appreciable challenges for managing the epidemic as areas resembling testing would wrestle to satisfy the demand. An evaluation of mortality over earlier waves signifies that mortality will increase as a wave progresses and healthcare comes beneath stress.

11. There stay many uncertainties concerning the organic parameters of Omicron together with the mix of transmissibility and immune escape which give it a development benefit over Delta within the UK. Proof continues to recommend a major diploma of immune escape, and far greater ranges of reinfections are being seen with Omicron (8% to 9%) than Delta (round 1%). All believable mixtures of transmissibility and immune escape give qualitatively related outcomes when modelling the dimensions of this wave of the epidemic.

12. Exact vaccine efficacy towards extreme illness and demise from Omicron stays unsure as a result of small numbers of extreme outcomes thus far. Length of vaccine efficacy additionally stays unsure.

13. Behavioural components are more likely to considerably have an effect on the timing and scale of the height. Behaviour stays a supply of main uncertainty in modelling. Some information point out that individuals have been adopting safer behaviours in latest days together with elevated use of face coverings (as much as round 95% self-reported utilization) and reductions in contacts. These adjustments will take a while to result in any slowing of development in infections, and longer to have an effect on hospitalisations, and so while probably important, are unlikely on their very own be adequate to avert the big wave of hospitalisations.

14. Enabling individuals to make safer behavioural decisions will stay vital, significantly over the festive interval the place they could really feel obligations or pressures to take part in some higher-risk actions or occasions along with those they do wish to prioritise.

15. In addition to excessive ranges of transmission related to mixing exterior the house, information present that there’s a close to 3-fold elevated threat of transmission in households with Omicron an infection. UKHSA information present that secondary assault charges (SAR) each for family and non-household contacts seem like round twice as excessive for Omicron as for Delta.

16. Nosocomial transmission is an excellent better threat on account of Omicron. Extra measures might have to be put in place. This will embody measures to scale back the chance of transmission amongst healthcare staff, significantly as vaccine effectiveness towards an infection might be lowered. Some settings apart from hospitals (for instance care properties and prisons) may even want particular measures.

Response measures within the context of Omicron

17. Though elevated vaccination is a critically vital mitigation and can cut back illness severity, a major bundle of non-pharmaceutical interventions could be required to gradual development in infections. Crowded indoor mixing with many alternative teams stays the largest threat issue for unfold. Massive gatherings current a threat for a number of spreading occasions.

18. Any elevated transmissibility of Omicron might relate to a decrease infectious dose and or the next viral load (low confidence). This may enhance the relative threat of long-range aerosol transmission (low confidence), which might account for tremendous spreader occasions and speedy transmission in settings together with households, workplaces, well being care settings, care properties, prisons, and hospitality.

19. If aerosol transmission is greater for Omicron than earlier variants, then some actions might have an elevated threat of transmission. There may additionally be an elevated threat of transmission throughout longer distances and inside shorter durations of time round an infectious particular person. This will additionally drive a rise in within-household transmission. This will enhance the potential influence of family isolation on lowering transmission (low confidence).

20. Mitigations for Omicron are much like Delta, together with use of well-fitting and well-made face coverings, lowering occupancy ranges in indoor environments, and guaranteeing ample air flow. Nevertheless, further or strengthened measures could also be wanted in step with Omicron’s elevated transmissibility (resembling lowering group sizes, rising bodily distancing, lowering period of contacts and shutting high-risk premises).

21. Testing earlier than attending any gathering or occasion (together with at workplaces and colleges) is extremely fascinating, with isolation to observe if the take a look at is constructive. The damaging predictive worth of a damaging take a look at declines in a matter of hours, so a take a look at must be carried out as near a gathering or occasion as attainable. Testing after attending a gathering or occasion can be vital, with isolation of constructive instances and call tracing following.

22. Lateral stream units are useful at a person stage, however they will also be used at a gaggle stage. If there’s one constructive take a look at inside a gaggle (resembling a family) there’s a important probability that others are already contaminated, even when not but testing constructive. If one individual from a gaggle checks constructive previous to an occasion or gathering, then none ought to attend.

23. Guaranteeing adequate testing capability (together with sustaining quick turnaround occasions for outcomes) might be important if testing measures are to be efficient. If testing just isn’t attainable, bodily distancing, sporting of face-coverings, and environmental interventions might have to extend additional to compensate. The identical is true if, or when, contact tracing capability is exceeded.

24. Consistency of messaging might be vital to make sure that individuals perceive the significance of mitigations and are in a position to apply steerage (resembling on use of face coverings or bodily distancing) constantly in a spread of environments.

25. Policymakers might want to make tough choices to make concerning the implementation of measures and allocation of assets which incorporate components past scientific recommendation. In some circumstances it could be helpful to have frameworks developed prematurely to help decision-making. Design of such frameworks might embody enter from ethicists.

Record of actions

• UKHSA and NHS to work collectively to establish methods wherein lags in information flows could be lowered as a matter of urgency; genotyping of hospital sufferers can be vital
• Cupboard Workplace C-19 Taskforce to stipulate the necessity for any additional recommendation together with on any particular packages of interventions; the paper ‘NPIs within the context of Omicron’ gives steerage on measures

Attendees

Scientific consultants (34):

• Patrick Vallance (GCSA)
• Chris Whitty (CMO)
• Angela McLean (MOD, CSA)
• Ann John (Swansea)
• Brooke Rogers (KCL)
• Calum Semple (Liverpool)
• Charlotte Watts (FCDO, CSA)
• Fliss Bennee (Welsh Authorities)
• Gavin Screaton (Oxford)
• Graham Medley (LSHTM)
• Gregor Smith (Scottish Authorities, CMO)
• Harry Rutter (Tub)
• Ian Diamond (ONS)
• Ian Younger (Northern Eire Government, Well being CSA)
• Jeanelle de Gruchy (dCMO)
• Jenny Harries (UKHSA)
• Jim McManus (ADPH)
• John Edmunds (LSHTM)
• Julie Fitzpatrick (Scottish Authorities, CSA)
• Kamlesh Khunti (Leicester)
• Lucy Chappell (DHSC, CSA)
• Mark Wilcox (Leeds)
• Matt Keeling (Warwick)
• Meera Chand (UKHSA)
• Michael Parker (Oxford)
• Nicola Steedman (Scottish Authorities, dCMO)
• Peter Horby (Oxford)
• Sharon Peacock (Cambridge)
• Steve Powis (NHS England)
• Steven Riley (UKHSA)
• Susan Hopkins (UKHSA)
• Thom Waite (dCMO)
• Wendy Barclay (Imperial)
• Yvonne Doyle (NHS England)

Observers and authorities officers (32):

• Alan Penn (DLUHC, CSA)
• Andrew Curran (HSE, CSA)
• Charlette Holt-Taylor (DHSC)
• Christopher Williams (PHW)
• Daniel Kleinberg (Scottish Authorities)
• David Crossman (Scottish Authorities, Well being CSA)
• David Lamberti (DHSC)
• Edward Wynne-Evans (UKHSA)
• Gideon Henderson (Defra, CSA)
• Giri Shankar (PHW)
• Henry Prepare dinner (No. 10)
• Ian Corridor (Manchester)
• Jennifer Rubin (HO, CSA)
• Jim McMenamin (Well being Safety Scotland)
• Laura Bellingham (CO)
• Laura Gilbert (No. 10)
• Louise Tinsley (HMT)
• Osama Rahman (DfE, CSA)
• Paul Monks (BEIS, CSA)
• Paul Taylor (NPCC, CSA)
• Rob Harrison (CO)
• Sarah Sharples (DfT, CSA)
• Tom Rodden (DCMS, CSA)

Secretariat (all GO-Science) (15):

• Simon Whitfield
• Stuart Wainwright
• Zoe Bond

9 observers and authorities officers and 12 secretariat redacted.

Complete: 81