Sage projected deaths ‘highly likely to exceed reasonable worse case scenario’

It comes amid increasing pressure for a national circuit-breaker in England as infection levels climb.

Coronavirus – Wed Oct 7, 2020
Coronavirus – Wed Oct 7, 2020

The Government’s expert advisers said coronavirus infections and hospital admissions were exceeding the worse case scenario planning levels four days before Boris Johnson announced the three-tier system of restrictions.

A document from the Scientific Advisory Group for Emergencies (Sage) summarising the Sage meeting of October 8 said incidence and prevalence across the UK continue to increase with data showing “clear increases” in hospital and ICU admissions, particularly in the North of England.

The paper said projections indicate the number of deaths is “highly likely” to exceed Reasonable Worst Case Scenario (RWCS) planning levels within the next two weeks.

“Well over 100 new deaths per day are projected to occur within 2 weeks, even if strict new interventions are put in place immediately,” the document said, adding: “In all scenarios the epidemic is still growing.”

Four days after the Sage meeting, on October 12, the Prime Minister announced England would be placed into “medium”, “high” and “very high” alert levels – or Tier 1, Tier 2 and Tier 3 – under a new tier system of restrictions aimed at tackling the virus.

At a Downing Street press conference that day alongside Mr Johnson, England’s chief medical officer Professor Chris Whitty – a member of Sage – said he was “not confident” that the “base case” for Tier 3 proposals “would be enough to get on top of it”.

The newly published Sage document comes as the effectiveness of the three-tier system is more widely being called into doubt, with the NHS Test and Trace system recording its highest ever weekly number of positive cases and a study by Imperial College London finding that almost 100,000 people are catching Covid-19 every day.

Experts are suggesting a more national approach is needed to address the soaring infection rate, with the expectation that the current trajectory is likely to result in nearly everywhere in England in at least Tier 2 before Christmas.

Since the three-tier system has been implemented, the number of deaths announced on the Government’s coronavirus dashboard has exceeded 100 on every day except two – and on a couple of days more than 300 deaths were announced.

The document from October 8 also warns of the pressures faced by the NHS due to rising infections.

“NHS data also show increases in hospital admissions, particularly in the North West, North East and Yorkshire.

“If there are no decisive interventions, continued growth would have the potential to overwhelm the NHS, including the continued delivery of non-Covid treatments,” the paper said.

The document said Sage has previously advised that a package of “non-pharmaceutical interventions (NPls) needs to be adopted to reverse the exponential rise in cases”, adding: “As previously, the earlier additional measures are introduced the more effective they will be. Longer-term sustained measures will also be essential.

“The interventions previously recommended for consideration are those which will have significant population-level impact on reducing transmission.

(PA Graphics)
(PA Graphics)

“Case control studies indicate that restaurants and bars are associated with increased transmission risk.”

A circuit-breaker was at the top of a shortlist of coronavirus interventions recommended to the Government by Sage more than a month ago.

The Sage document, dated September 21, said a package of interventions will be needed to reverse the exponential rise in cases.

Top of the list was a circuit-breaker, a short period of lockdown, “to return incidence to low levels”, followed by advice to work from home for all those that can.

Third on the list was “banning all contact within the home with members of other households (except members of a support bubble)”, and fourth was the closure of all bars, restaurants, cafes, indoor gyms, and personal services such as hairdressers.

The final measure on the list was for all university and college teaching “to be online unless face-to-face teaching is absolutely essential”.

Meanwhile, a separate Scientific Pandemic Influenza Group on Modelling, Operational sub-group (SPI-M-O) consensus statement dated October 14, said: “Combined estimates from six SPI-M-O models suggest there are between 43,000 and 74,000 new infections per day in England.

Professor Chris Whitty
Professor Chris Whitty (PA Video)

“This is significantly above the profile of the reasonable worst-case scenario, where the number of daily infections in England remained between 12,000 – 13,000 throughout October.”

A Government spokeswoman said: “As a responsible government, we continue to prepare for a wide range of scenarios, including the reasonable worst case scenario, and this is kept under constant review.

“Our approach is based on the different levels of prevalence of the virus across the UK, but we will not hesitate to put in place further measures if necessary.

“We have made significant strides in our response to the pandemic – an extra £3 billion in funding has been made available to the NHS to help it continue to provide high quality care as we head into winter, treatments like dexamethasone have been proven to save lives, and there is promising progress in finding a safe vaccine through government-backed scientific research.”

Professor Azra Ghani, chair in infectious disease epidemiology at Imperial College, said governments use RWCS for planning purposes, and they require assumptions about future transmission levels that are difficult to predict, and it is more important to focus on the current stage of the epidemic.

He said: “Whilst there has been some indication of a slowing in the rate of growth of the epidemic in parts of the country, R remains above 1 in all areas and therefore infections, hospital admissions and deaths can be expected to continue to rise in the near-term.”

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