The effect of lockdown easing in the UK

My forecast for the UK deaths as at July 30th, including trend line for reported deaths, for 83.5% lockdown effectiveness

Introduction

As reported in my previous post, there has been a gradual reduction in the rate of decline of cases and deaths in the UK relative to my model forecasts. This decline had already been noted, as I reported in my July 6th blog article, by The Office for National Statistics and their research partners, the University of Oxford, and reported on the ONS page here.

I had adjusted the original lockdown effectiveness in my model (from 23rd March) to reflect this emerging change, but as the model had been predicting correct behaviour up until mid-late May, I will present here the original model forecasts, compared with the current reported deaths trend, which highlights the changes we have experienced for the last couple of months.

Forecast comparisons

The ONS chart which highlighted this slowing down of the decline, and even a slight increase, is here:

Figure 6: The latest exploratory modelling shows incidence appears to have decreased between mid-May and early June
Figure 6: The latest exploratory modelling shows incidence appears to have decreased between mid-May and early June

Public Health England had also reported on this tendency for deaths on 6th July:

The death rate trend can be seen in the daily and 7-day average trend charts, with data from Public Health England
The death rate trend can be seen in the daily and 7-day average trend charts

The Worldometers forecast for the UK has been refined recently, to take account of changes in mandated lockdown measures, such as possible mask wearing, and presents several forecasts on the same chart depending on what take-up would be going forward.

Worldometers forecast for the UK as at July 31st 2020
Worldometers forecast for the UK as at July 31st 2020

We see that, at worst, the Worldometers forecast could be for up to 60,000 deaths by November 1st, although, according to their modelling, if masks are “universal” then this is reduced to under 50,000.

Comparison of my forecast with reported data

My two charts that reveal most about the movement in the rate of decline of the UK death rate are here…

On the left, the red trend line for reported daily deaths shows they are not falling as fast as they were in about mid-May, when I was forecasting a long term plateau for deaths at about 44,400, assuming that lockdown effectiveness would remain at 83.5%, i.e. that the virus transmission rate was reduced to 16.5% of what it would be if there were no reductions in social distancing, self isolation or any of the other measures the UK had been taking.

The right hand chart shows the divergence between the reported deaths (in orange) and my forecast (in blue), beginning around mid to late May, up to the end of July.

The forecast, made back in March/April, was tracking the reported situation quite well (if very slightly pessimistically), but around mid-late May we see the divergence begin, and now as I write this, the number of deaths cumulatively is about 2000 more than I was forecasting back in April.

Lockdown relaxations

This period of reduction in the rate of decline of cases, and subsequently deaths, roughly coincided with the start of the UK Govenment’s relaxation of some lockdown measures; we can see the relaxation schedule in detail at the Institute for Government website.

As examples of the successive stages of lockdown relaxation, in Step 1, on May 13th, restrictions were relaxed on outdoor sport facilities, including tennis and basketball courts, golf courses and bowling greens.

In Step 2, from June 1st, outdoor markets and car showrooms opened, and people could leave the house for any reason. They were not permitted to stay overnight away from their primary residence without a ‘reasonable excuse’.

In Step 3, from 4th July, two households could meet indoors or outdoors and stay overnight away from their home, but had to maintain social distancing unless they are part of the same support bubble. By law, gatherings of up to 30 people were permitted indoors and outdoors.

These steps and other detailed measures continued (with some timing variations and detailed changes in the devolved UK administrations), and I would guess that they were anticipated and accompanied by a degree of informal public relaxation, as we saw from crowded beaches and other examples reported in the press.

Model consequences

I did make a re-forecast, reported on July 6th in my blog article, using 83% lockdown effectiveness (from March 23rd).

Two issues remained, however, while bringing the current figures for July more into line.

One was that, as I only have one place in the model that I change the lockdown effectiveness, I had to change it from March 23rd (UK lockdown date), and that made the intervening period for the forecast diverge until it converged again recently and currently.

That can be seen in the right hand chart below, where the blue model curve is well above the orange reported data curve from early May until mid-July.

The long-term plateau in deaths for this model forecast is 46,400; this is somewhat lower than the model would show if I were to reduce the % lockdown effectiveness further, to reflect what is currently happening; but in order to achieve that, the history during May and June would show an even larger gap.

The second issue is that the rate of increase in reported deaths, as we can also see (the orange curve) on the right-hand chart, at July 30th, is clearly greater than the model’s rate (the blue curve), and so I foresee that reported numbers will begin to overshoot the model again.

In the chart on the left, we see the same red trend line for the daily reported deaths, flattening to become nearly horizontal at today’s date, July 31st, reflecting that the daily reported deaths (the orange dots) are becoming more clustered above the grey line of dots, representing modelled daily deaths.

As far as the model is concerned, all this will need to be dealt with by changing the lockdown effectiveness to a time-dependent variable in the model differential equations representing the behaviour of the virus, and the population’s response to it.

This would allow changes in public behaviour, and in public policy, to be reflected by a changed lockdown effectiveness % from time to time, rather than having retrospectively to apply the same (reduced) effectiveness % since the start of lockdown.

Then the forecast could reflect current reporting, while also maintaining the close fit between March 23rd and when mitigation interventions began to ease.

Lockdown, intervention effectiveness and herd immunity

In the interest of balance, in case it might be thought that I am a fan of lockdown(!), I should say that higher % intervention effectiveness does not necessarily lead to a better longer term outlook. It is a more nuanced matter than that.

In my June 28th blog article, I covered exactly this topic as part of my regular Coronavirus update. I referred to the pivotal March 16th Imperial College paper on Non-Pharmaceutical Interventions (NPIs), which included this (usefully colour-coded) table, where green is better and red is worse,

PC=school and university closure, CI=home isolation of cases, HQ=household quarantine, SD=large-scale general population social distancing, SDOL70=social distancing of those over 70 years for 4 months (a month more than other interventions)
PC=school and university closure, CI=home isolation of cases, HQ=household quarantine, SD=large-scale general population social distancing, SDOL70=social distancing of those over 70 years for 4 months (a month more than other interventions)

which provoked me to re-confirm with the authors (and as covered in the paper) the reasons for the triple combination of CI_HQ_SD being worse than either of the double combinations of measures CI_HQ or CI_SD in terms of peak ICU bed demand.

The answer (my summary) was that lockdown can be too effective, given that it is a temporary state of affairs. When lockdown is partially eased or removed, the population can be left with less herd immunity (given that there is any herd immunity to be conferred by SARS-Cov-2 for any reasonable length of time, if at all) if the intervention effectiveness is too high.

Thus a lower level of lockdown effectiveness, below 100%, can be more effective in the long term.

I’m not seeking to speak to the ethics of sustaining more infections (and presumably deaths) in the short term in the interest of longer term benefits. Here, I am simply looking at the outputs from any postulated inputs to the modelled epidemic process.

I was as surprised as anyone when, in a UK Government briefing, in early March, before the UK lockdown on March 23rd, the Chief Scientific Adviser (CSA, Sir Patrick Vallance), supported by the Chief Medical Officer (CMO, Prof. Chris Whitty) talked about “herd immunity” for the first time, at 60% levels (stating that 80% needing to be infected to achieve it was “loose talk”). I mentioned this in my May 29th blog post.

The UK Government focus later in March (following the March 16th Imperial College paper) quickly turned to mitigating the effect of Covid-19 infections, as this chart sourced from that paper indicates, prior to the UK lockdown on March 23rd.

Projected effectiveness of Covid-19 mitigation strategies, in relation to the utilisation of critical care (ICU) bedsProjected effectiveness of Covid-19 mitigation strategies, in relation to the utilisation of critical care (ICU) beds
Projected effectiveness of Covid-19 mitigation strategies, in relation to the utilisation of critical care (ICU) beds

This is the imagery behind the “flattening the curve” phrase used to describe this phase of the UK (and others’) strategy.

Finally, that Imperial College March 16th paper presents this chart for a potentially cyclical outcome, until a Covid-19 vaccine or a significantly effective pharmaceutical treatment therapy arrives.

The potentially cyclical caseload from Covid-19, with interventions and relaxations applied as ICU bed demand changes
The potentially cyclical caseload from Covid-19, with interventions and relaxations applied as ICU bed demand changes

In this new phase of living with Covid-19, this is why I want to upgrade my model to allow periodic intervention effectiveness changes.

Conclusions

The sources I have referenced above support the conclusion in my model that there has been a reduction in the rate of decline of deaths (preceded by a reduction in the rate of decline in cases).

To make my model relevant to the new situation going forward, when lockdowns change, not only in scope and degree, but also in their targeting of localities or regions where there is perceived growth in infection rates, I will need to upgrade my model for variable lockdown effectiveness.

I wouldn’t say that the reduction of the rate of decline of cases and deaths is evidence of a “second wave”, but is rather the response of a very infective agent, which is still with us, to infect more people who are increasingly “available” to it, owing to easing of some of the lockdown measures we have been using (both informally by the public and formally by Government).

To me, it is evidence that until we have a vaccine, we will have to live with this virus among us, and take reasonable precautions within whatever envelope of freedoms the Government allow us.

We are all in each others’ hands in that respect.

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