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Two countries divided by a "common" virus

The roll-out of vaccination is accelerating apace. In the UK, the BBC reports that those aged 70 and over and those listed as clinically extremely vulnerable (priority group 4) will start receiving invitations to vaccination this week. In the US, President-Elect Biden has announced his ambition to vaccinate 100 million in the first 100 days of his Presidency at a cost of $400 billion. No one wants to go through the pain of 2020 again, with almost 600,000 extra deaths across the countries last year.

But the time course of these experiences were different and it is worth reflecting on this. Figure 1 sets out analysis of weekly excess deaths in England and Wales, using the classic definition that compares number of deaths in each week against the average over the last five years.

Figure 1

The brutality of that first wave has not been dimmed by the intervening months. The second wave has had a devastating impact on our hospitals coming as it does in the midst of the winter season, but learned behaviours, more testing and continuous improvements in the management of the disease has averted a repetition on the scale of those early dark days. The graphic makes clear what we all know and hear - that vaccinating the 4 highest priority groups will dramatically reduce both deaths and hospitalisations.

In the US, the focus is similarly on vaccinating the elderly, those at high risk and essential workers. Figure 2 shows the weekly excess deaths across 2020 for the USA, and the driving motivation for the urgency of the vaccination programme. Over 500,000 lives have been reported lost through the direct and indirect effects of COVID-19.

Figure 2

In the USA, we see three waves rather than two, and the full extent of the last wave will only become clear with further reporting. Comparing the figures, we can see how the impact on those under 75 (gold, orange and purple) is much more prominent in the USA than in England and Wales. I will share analysis in a further post on how the experience of different states have combined to generate these overall pictures.

In both countries and throughout the world, these analyses of excess deaths by age group will be intensely scrutinised as we look for the expected signs of the impacts of vaccination. This, rather than isolated reports of deaths, will be the metric of the success or otherwise of the vaccination programmes.

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