Average age of hospital admissions and vaccine priority groups

[Musicaldilemma]

Please could someone explain something to me that I have been wondering about. If the average age of hospital admissions is 58-60, but the very elderly are vaccinated first, how will this lead to less hospital admissions quickly? (if that is where the NHS being overwhelmed comes in)?
All the NHS TV clips I have watched in the last couple of days keep talking about hospital admissions being mainly 50s now so should they not be the priority then? If the aim is to stop overwhelming the NHS? Because if the NHS is less overwhelmed with Covid cases then everyone else needing treatment in hospitals will likely get it more quickly. From everything I have read a very elderly patient who catches Covid quickly usually dies quickly. It is the middle aged who are overwhelming the NHS?

@bobbiester

Also bear in mind, the low numbers of 80+ people in ITU are because doctors are avoiding sending 80+ people to ITU. As they are "not good candidates for ITU" or "unlikely to benefit from ITU".

This is true, many of them won't qualify due to being too frail. It was the case even outside of covid, it is not necessarily care rationing. Mechanical ventilation, for example, is a very brutal procedure, not a panacea - and the patient has to be otherwise robust enough to survive it.

Bear with me...

If it takes until midFeb? End Feb? endMarch I hear them all, but I think endMarch is most common to give FIRST vaccination to the top 4 priority groups.

Who need to have 2nd jab about 12 weeks later.

Then it will take until ... end June? to give the SECOND jab to the top 4 priority groups.

The other 'priority' groups will get their FIRST jabs sometime after May, or after June even, is what I think must happen.

Explain why I am wrong.

The volume of vaccinations may increase very quickly.

There are more vaccines in the pipeline. Which UK government has large orders for. At least one of these is a single jab.

I'm quite hopeful on that part of things tbh.

It's a good point OP. Although 80+ make up the majority of Covid deaths, they just die. They don't hang about. It's the slightly younger, stronger sector that take up the hospital beds - so I suppose it depends whether you prioritise lives or hospital capacity!

HCP immunisation should help hospital capacity.

I'm not statistically fantastic but would vaccinating a younger cohort with the same number of vaccines be as effective even on hospitalisations since vastly more of them would have an asymptomatic / low symptomatic infection anyway?

Good point OP. I’m hearing more awful stories from friends about deaths in the 40-50 age group. I noticed a few other countries are vaccinating in different orders to us. I’m
not sure what the answer is. It seems to be all about ‘saving the NHS’ rather than saving lives.

News article today on how up to half of those being offered the vaccine in Birmingham are not taking it. www.birminghammail.co.uk/news/midlands-news/up-half-those-offered-vaccine-19629960

It actually says in worst bits of Birmingham. So not city wide let alone nationwide.

There's a good news thread, I think I'll take myself over there!

Some people not taking up the vaccine will be waiting until they can have it closer to home. Not everyone is willing or able to spend an hour or more travelling to their nearest centre.

But the volume of people who can safely administer vaccines may not increase dramatically. To get thru all the priority groups (first jabs for groups 5-9 & second jabs for groups 1-4) by end of June... probably need at least double the number of currently trained people, maybe 3x as many.

The current vaccinations will mainly prevent deaths. Hospitalisations are still going to be high, especially with the new variant (priority list has not been changed since our new variant became widespread).

I think the hospitalisations in those currently not in the priority lists is a big cause for concern and hopefully the government is looking in this (e.g. the 24/7 operation of vaccine sites, using all pharmacies etc) but they do seem to have a supply problem as well.

@lljkk

But the volume of people who can safely administer vaccines may not increase dramatically. To get thru all the priority groups (first jabs for groups 5-9 & second jabs for groups 1-4) by end of June... probably need at least double the number of currently trained people, maybe 3x as many.

There is another thread on this section about how hard it is for vaccinators to get taken on, even staff currently working in the NHS with up-to-date training and who normally do the flu vaccines.

Hospital staff are used to working 24/7 and are used to doing overtime/bank work (hospitals in the UK rely on nurses doing overtime to even stay open). Those kind of staff are quite easy to use in the vaccination programme and not being used much currently.

The admissions and deaths would be many times worse if it wasn't for the fact that the vast majority of the very elderly and the extremely clinically vulnerable are shielding or at the very least staying at home most of the time.
They don't show up as hospital admissions because like me they haven't been out the door.

Those elderly who do contract covid are usually the ones who need careers and that's how they catch covid.

carers not careers!

This is weekly admissions by age group in Scotland, presume it’s roughly in line with the rest of the UK. Taking even the 80+ year olds out of that would make a big impact.

OP yes I think you are right. This is why people are being naive to think all restrictions will be lifted once top 4 groups have been vaccinated. However, it will include over 70s and ECV so that will probably have more of an impact on hospital admissions than over 80s. However, I suspect restrictions will remain in place until other priority groups have been vaccinated to reduce hospital admissions sufficiently to prevent NHS being overwhelmed.
I don't think we will need to wait till second dose. One dose should be enough to reduce serious infection and hospitalisation. Hopefully by Easter.

There are far fewer people in the 80+ range than there are in the 50-70 range who are filling the hospital beds. You can vaccinate all the 80+ and move on pretty quickly: first vaccines by mid Feb seems pretty plausible now.

And then you’re slashing the death toll, you’re reducing transmission to their carers (who are often in the 50-70 age group), you’re reducing the call outs to paramedics, even if the patient wouldn’t be admitted to hospital, you’re reducing the huge emotional cost to families and HCPs (everyone dies, but this is particularly brutal).

But I agree that people need to understand that the load on the NHS won’t be lifted until the over 50s are all vaccinated: this really is a race against time.

@FindHungrySamurai

There are far fewer people in the 80+ range than there are in the 50-70 range who are filling the hospital beds. You can vaccinate all the 80+ and move on pretty quickly: first vaccines by mid Feb seems pretty plausible now.

And then you’re slashing the death toll, you’re reducing transmission to their carers (who are often in the 50-70 age group), you’re reducing the call outs to paramedics, even if the patient wouldn’t be admitted to hospital, you’re reducing the huge emotional cost to families and HCPs (everyone dies, but this is particularly brutal).

But I agree that people need to understand that the load on the NHS won’t be lifted until the over 50s are all vaccinated: this really is a race against time.

The over 50 age thing bothers me. For some reason I notice that there are plenty in the 45-50 yo bracket requiring hospitalisation. I hope the government will move onto this age group after vaccinating the over 50s. I think the less-at-risk age group is not under-50 but rather under-45

@lljkk

But the volume of people who can safely administer vaccines may not increase dramatically. To get thru all the priority groups (first jabs for groups 5-9 & second jabs for groups 1-4) by end of June... probably need at least double the number of currently trained people, maybe 3x as many.

They’re only just starting to use pharmacists lljkk. That’s a large volume of trained professionals ready to ramp up the throughput. Likewise I think the Army doctors have hardly been used to date. The well-publicised red-tape problems with recruitment means that there’s still a large pool of potential vaccinators available (I know of two retired GPs ready to step into action once recruitment problems are sorted out for example), and they’ll only need training once so it’s potentially a steadily growing pool of staff.

The government have said in the last 24 hours that the plan is to vaccinate the last group (50s and over) by the end of March.

There you go op your issue sorted

As I said before a lot of the 50 to 60 group that have ended up in hospital especially ICU are also in the valuable group. Hence why they have been hit by covid worst. So actually they will get there first jab even soon than March.

Oh and we are up to 290000 vaccination capacity a day. Next week that will be expanded to 500000 a day!

3.5 million a week is pretty good I reckon

@notangelinajolie

Do we prioritise vaccines for the 50 and 60 year olds and save the NHS and the beds they occupy in intensive care or do we prioritise vaccines for the old folk and save lives. It has to be lives doesn't it?

Not necessarily. When we look at medication approval we look at quality adjusted life years.

Saving a life is a worthy arguement, and some would say a life is a life. But if this means that we save the life of a 94 year old with severe dementia and 6 months left to live, but leave an unvaccinated 55 year old with lasting physical and psychological damage from being ventilated in hospital, or cause the death of an obese but otherwise healthy 49 year old secondary school teacher, then you have to question the decision making.

At the time it seemed that maximum life years would be saved with vaccinating the eldest first, but that was before the faster-transmitting variant and huge rise in cases. Personally I now question that decision.

At the time it seemed that maximum life years would be saved with vaccinating the eldest first, but that was before the faster-transmitting variant and huge rise in cases. Personally I now question that decision

I think it has been too politically tricky to re-address the priority list now there is a new variant that does seem to have resulted in more over 45s in hospital. Drawing up the first list was a total nightmare and they won't go through it again, especially now the vaccinations have started.

A member of the JCVI was on the radio last week and said he couldn't comment on whether the priority list was still correct because they hadn't discussed it within the committee yet - I was surprised they hadn't even discussed it.

I think the lack of effect of vaccinating over 70s on the overall ability to lift lockdown and/or case numbers will raise questions in coming weeks/months.