Coronavirus: the latest position

Further to the tier change today, here is my best understanding of the reasons and what our data looks like locally:

How are tiering decisions currently being made?

The decisions are still based on the five assessments that we’ve talked about before – (i) overall positive test rates in the community, (ii) positive test rates in those ‘at risk’ (ie over 60s), (iii) proportion of people testing positive, (iv) trend of increase / decrease in positive test rates and (v) impact on local health capacity.  As before, there are no specific thresholds on each of these – they are all looked at in the round before a decision is taken.

At the same time, it looks like the risk associated with this new strain of coronavirus means the experts are being much more cautious in general.  This new strain means that rates can get out of control really quickly (London went up from 270 to 590 in just a week, as an example). 

Context: the current situation across England

When I last wrote a note in mid December, England had an overall positive test rate of 195 and rising.  Based on 24/12 data, the overall positive test rate in England is now 408 and still rising.

In mid December, there were 18,038 people in hospital who had tested positive and 1,326 people on mechanical ventilation.  There are now 23,771 people in hospital (as of 28/12) – something which is going up by c900 people a day and is higher than during the first phase in Spring.  1,847 people are on mechanical ventilation. 

In terms of death rates, 612 people sadly passed away the day before I wrote my last note.  Yesterday, 981 deaths were reported (which is a few hundred higher than usual so we will have to see whether that is an unfortunate one off or the start of a more worrying trend).

So, whatever way you look at this, the situation has deteriorated significantly since the middle of December across the country.  There is a real risk around the overwhelming of the health service if rates continue to increase in the way they are (with this new strain being particularly dangerous for that).

What are our rates locally?

Taking Derbyshire as a whole, the overall number of positive tests has gone up from 160 to 224 in the last couple of weeks (+ 41%).  The other indicators are also trending the wrong direction.

At the Royal, things still remain difficult but haven’t yet deteriorated massively (thankfully).  The number of people on mechanical ventilation is 9 and has stubbornly stuck around that number for the last month.  The number of people testing positive in the Royal is starting to move up again – from the late 20s to the late 30s.  Whilst it is positive that hospitalisations haven’t shot up, our objective was to reduce the number of people in hospital to prevent any future surges exceeding capacity.  We haven’t managed to do that, I’m afraid.

And, on a district-by-district basis we are seeing problems across the county – including surges again in both Chesterfield and North East Derbyshire:

 24/12 ratesChange since last note 
  Number change% change
Amber Valley186+ 15+ 9%
Bolsover231+ 0No  change
Chesterfield185+ 51+ 38%
Derby267+ 75+ 39%
Derbyshire Dales166+ 93+ 127%
Erewash184+ 63+ 52%
High Peak159+ 28+ 17%
North East Derbyshire205+ 87+ 74%
South Derbyshire277+ 64+ 30%

So, why have we been put in tier 4?

I’m afraid it is due to the deterioration in our numbers shown above.  And, as the new variant gets nearer, the experts want to suppress the virus more so that we are ready for the pressure it is likely to place on the Royal and elsewhere. 

Why is Sheffield and South Yorkshire in tier 3 and we are in tier 4?

Using overall positive test rates, Derbyshire has a positive test rate of 224 currently.  South Yorkshire, which usually is taken together as a unit, is lower than this.  Sheffield, in particular, is significantly lower than Derbyshire – at 175. 

Ultimately, if we accept the principle of tiering, then we must accept that different areas will be in different tiers.  South Yorkshire is currently lower than us so it is reasonable they are in a lower tier – just like it was reasonable that Derbyshire was in a lower tier than South Yorkshire when the roles were reversed in some of October / early November.

In the last day, some residents have told me that it would be better for us to group with South Yorkshire, rather than Derbyshire.  Whilst it (very temporarily) looks as though Sheffield is doing better than us currently, I really would be careful before we make that case – Sheffield and South Yorkshire usually have higher rates than Derbyshire. 

Can I travel to a tier 3 area?

Whilst we must all stay at home as much as possible, you can still travel into tier 3 for work, education, caring, for your support bubble, for your childcare bubble, to seek medical help or to provide emergency assistance. 

We have much lower case rates than the south of England – why are we now in the same tier?

75% + of the country is now in tier 4.  This ranges from areas such as Redcar with case rates at 125 to bits of London and Essex which are over 1,000.  We’ve got to focus on trying to control the virus rather than seeing this as some kind of league where we compare one area with another.

There are 18 other areas (ranging from Gloucestershire to Manchester, Bolton to the New Forest), who have case rates lower than Derbyshire who have been placed in tier 4 – presumably for the same reasons (trends, geography, susceptibility to the new variant) as us.  Derbyshire is not being treated unfairly.

Is this new strain with us?

The assumption is yes – but that it will take a little time to show up in the figures.  It has been moving up the country over recent weeks and, eventually, displaces the other variants and becomes the dominant variant which is transmitted between people.  As a result, more people unfortunately are hospitalised – exactly what we are trying to protect against.

Why not just ask the vulnerable to shield and let everyone else live their lives?

It’s a good idea in principle but nowhere in the world has managed to make this work so far.  When rates of positivity go up in the parts of the population not at risk they inevitably end up with rates going up in the more vulnerable parts of the population, too.  It just isn’t practical.

Why not just do a full complete lockdown?

Throughout all of this, the desire is to try to avoid national restrictions.  We can’t rule out further national restrictions (although I hope they can be avoided) but we should try to avoid them where we can.  Tiering is a long way away from perfect but it’s better than the alternative.

Ultimately, however frustrating it is, there is no lever that Government can pull in terms of how this virus transmits.  Instead it can – as it is trying to do – respond to the circumstances in front of us and keep to the overall strategy of keeping this as low as possible until the vaccine gets out there.

If Andy Burnham was our MP, we wouldn’t be in tier 4

I’m afraid that’s not true: Greater Manchester went into Tier 4 yesterday, too.

Restrictions don’t work – so why are we keeping doing them?

Restrictions may be hugely frustrating (as they are) but they do work.  This virus has a natural R rate of around 2.5.  At the moment we are managing, through social distancing and the restrictions, to keep it closer to 1.  There are times over the last nine months when it has been below 1 and times (like now) when it is above 1 and further actions are necessary.  Yet, if we had done nothing, we would demonstrably be in a much worse position than we are now with many millions more people having got the virus than has done so. 

Would a different unit have meant anything else for us?

As residents know, my preference is that we are dealt with as a North Derbyshire unit, rather than a Derbyshire one.  Again, though, I’m not sure a North Derbyshire unit would have made much of a difference in this latest decision – the North Derbyshire rate is a little lower than Derbyshire (around 210 rather than 224).  Most areas at around 210 also went into tier 4, too.

So, what happens now?

Nothing has changed in the overall strategy – keep the virus as low as possible until the vaccine solves the issue.  I’ve been on calls for most of today on the proposals for ramping up vaccinations in Derbyshire and it still should allow restrictions to fall away in 2021. 

It will take some weeks but look out for vaccinations doing two things – (i) that the overall number of people getting coronavirus starts to reduce and (ii) the correlation between cases and hospitalisations breaks down and hospitals stop being under pressure.  That will take a little time but it will allow us to still get back to normal in 2021.

Coronavirus: What the latest data says

Later today, the Government will announce the latest decision on tiers for England and, in advance, I said I would set out the latest position for residents to be able to review.

Back at the end of November, Derbyshire was placed in tier 3 based on high numbers of cases and a high number of people in hospital. At the time, both of those numbers were reducing but they hadn’t reduced quickly enough to get into tier 2.

There are five tests which the experts are using to make a decision on which tier to put an area in:

• Overall positive test rates in the entire community;
• Positive test rates specifically in the more ‘at risk’ section of the community;
• Proportion of people testing positive;
• Trend of increase / decrease in positive test rates, and;
• Impact on local health capacity

Note on data
Just a quick couple of points on the data I am going to refer to –

1) There are no absolute, published thresholds for where an area has to be in order to be in tier 1, tier 2 and tier 3. Instead, the experts look at all of the indicators and come to a decision.

2) It may also be that the Government is more or less cautious at different times based on what they think is coming up or where the overall situation is in the country. Christmas, and the increase in mixing (and, therefore, likely increase in coronavirus transmission) is a big factor in the considerations for the next couple of weeks – we are expecting rises everywhere for a time in January.

3) There is always a lag in terms of data being available. This means that I need to use data from around 11th December to give you an idea of the current position. When making comparisons with what was happening at the last tier review (on 25th November), I will compare with the data which was available at the time (so again a few days earlier – 21st November or thereabouts).

4) Some of the data isn’t published regularly so I can’t include it at this stage. I have a meeting later today (Thursday) where I expect to receive more and will publish it then.

Context: the current situation across England
At the last tiering decision, England had an overall positive test rate of around 200 and it was reducing each day. By the beginning of December, rates had dropped to around 150. In recent days, however, that has started to climb again quickly. It is now at 195 as of 11th December and rising.

There were 17,084 people in hospital with coronavirus on 25th November and the numbers were reducing by around 200 – 300 a day. As of yesterday, there were 18,038 people in hospital and rising. (Note: this is the number of people who are testing positive in hospital, not necessarily the number of people who are ill – but it is a useful indicator nonetheless). The number of people on mechanical ventilation was 1,480 on 25th November (and reducing) and is now 1,326 (15th December) (and rising).

In terms of death rates in England, 479 deaths were announced on the day prior to the last tiering decision. 612 deaths were announced yesterday.

Unit of assessment: Derbyshire vs North Derbyshire – does it matter?
At the last tiering decision, the whole county of Derbyshire was used as the unit for our area. As a consequence, Derbyshire entered tier 3 (along with Nottinghamshire and South Yorkshire nearby).

As many residents may know, since the return to tiering, I have argued that using a whole county approach is very blunt and I would prefer a smaller North Derbyshire unit to be used which better reflects natural boundaries. Individual district by district approaches (such as North East Derbyshire or Chesterfield) are too small as the rules get very confusing and lots of people cross the borders daily for work, leisure and life.

As it happened, at the last decision on tiering, the unit was pretty academic as any reasonable configuration of unit for all area – Derbyshire, North Derbyshire, Greater Chesterfield or the Sheffield City Region – all had rates which would have placed us in tier 3.

I have, and will continue, to make the case that a North Derbyshire unit should be used in the future.

So, what do the comparisons look like at the moment? Well, taking overall positive test rates, there still isn’t much of a difference between Derbyshire and North Derbyshire – and, in fact, a North Derbyshire unit is actually slightly higher than the county as a whole when looking at positive tests (whole county unit is 156 vs the average of Chesterfield / Bolsover / North East Derbyshire being 161). So, again, for the purposes of making a tier decision, the unit is going to be pretty academic. For ease of comparison, therefore, I will refer to Derbyshire as a whole to give you the data below.

Derbyshire: Positive test rates
At the last decision point, overall positive test rates in Derbyshire were around 220 and falling. They are now at 156 and rising.

Derbyshire: Positive test rates for more vulnerable communities
I am awaiting up-to-date figures on this (and expect to receive more later today) but the trends tend to follow the overall population, with a lag. I will update more on this later.

Derbyshire: proportion of people testing positive
The number of people testing positive will likely be rising based on the overall positive rates given that the amount of testing for those symptomatic remains pretty static and mass population testing in the county does not start until Monday. I will update more on this later.

Derbyshire: trend rates
There is a clear rise across Derbyshire in positive tests and, over the last seven days, county rates are up by 20%.

Underneath that number is quite a lot of variation. Looking at individual district-by-district rates:

District / Borough 11th Dec rate Change from 5th Dec (number) Change from 5th Dec (percentage)
Amber Valley 171 + 13 + 8%
Bolsover 231 + 66 + 40%
Chesterfield 134 + 1 No change
Derby 192 + 45 + 31%
Derbyshire Dales 73 – 6 – 7%
Erewash 121 – 6 – 5%
High Peak 136 + 41 + 43%
North East Derbyshire 118 + 11 + 10%
South Derbyshire 253 + 101 + 66%

Impact on the local health capacity
The number of patients in critical care in Chesterfield Royal tends to follow a similar trend line to the overall positive test rates, albeit several weeks behind.

A few weeks ago, there were around 13 – 18 people in critical care in the Royal at any one time. By the beginning of last week, when I had my last catch up with the Chief Executive, that had dropped to 9. This was positive although it remained the case that a substantial number of beds in critical care were being taken up at any one time by coronavirus patients.

Based on data issued two days ago, the number of patients in the Royal is now increasing again and is back up to 12.