COVID-19: Hospitalisations up 35% in weekly terms in Hungary

Although the number of new cases shows a 20% day-on-day and a 3% weekly drop which might suggest the fifth wave driven by the rapid spread of the highly-infectious Omicron variant (B.1.1.529) could have peaked, we would not read too much into data for a single day, especially if it's a Tuesday.

The rising number of hospitalised Covid patients is even more important, and the number of ventilated Covid patients also rose 11% over Monday. The above table shows weekly changes of 7-day averages, but the day-on-day and week-on-week changes also attest worsening in terms of hospitalisations.

Here's the gist of today's data release:

• new cases -19.5% d/d, -3.0% w/w;
• 7-day average of new cases 0% d/d, +16% w/w;
• Covid patients in hospital +315 (+7.5%) d/d, +1,103 (+35.4%) w/w;
• Covid patients on ventilator +11.2% d/d, -4.5% w/w;
• Covid deaths +31 (+47%) d/d, -8 (-11%) w/w;
• Positivity rates relentlessly going up.

The volatility of local testing practices has rendered the daily and even the short-term average positivity rates practically useless. Slightly more than 18,000 tests were performed yesterday, against the Friday-Sundary average of nearly 45,000. The pattern remains the same as before.

The key indicators on the graph below are the 7-d / 28-day average and its 7-day average, for two periods: starting from 1 October 2021 and starting from 1 September 2020. Both are at their mid-Nov 2021 levels and have eased some after a brief rise.

The 7-day average positivity rate edged higher (to over 40%) to yet another all-time high.

The 7-day moving average of new daily COVID-19 cases has been going up relentlessly, while the 7-day average of Covid deaths turned around after rising for about five days and has been dropping since 19 January, but it has started to rise on 27 January. The rising number of hospitalisations does not bode well for the future, and the changes in the number of ventilated Covid patients also show a decelerating improvement (see on separate chart).

The chart below shows the data depicted on the two above, so it's a kind of 4 in 1 chart. When comparing the number of Covid cases and coronavirus-related deaths, one might say: so far, so good. In other words, there are way more cases than a year ago, yet these apparently claim fewer lives. According to various studies, this has to do with immunity gained by vaccination, which means those unvaccinated (some 3.4 million people in Hungary) can still get extremely easily infected, have severe symptoms and die. And the chances of all these happening to them is far greater than for those that have received COVID-19 shots, preferably three doses.

The situation in hospitals, however, warrant caution and diminished optimism.

On the two charts below the 0% line is important. When the curves are under 0% there’s a decline, when they go over 0% it’s an increase.

More importantly, when a value is north of 0% but the curve descends, it means an increase at a slowing rate, rather than a decrease. If the curve is above 0% and ascending, it is an increase at an accelerating rate. When we are under 0% and the curve goes lower, it translates into an accelerating decrease, and when it goes up it marks a decelerating decrease. As you can see, we are witnessing the latter here, and there was a turnaround in the improvement around 27-29 December (black oval).

The number of active cases started to drop more and more slowly from end-December, and has been rising at an accelerating rate since 5 January. The ascent, however, has started to moderate. (Note that the number of active cases - not that it is an indicator we should take very seriously - has not been this high since early May 2021).

The changes in terms of hospitalisations and mechanical ventilation first showed a similar pattern from end-December, but around 10 January the accelerating decrease in the number of ventilated Covid patients continued, while the decrease in hospitalisations slackened, and we already see an accelerating rise there. The fact that ventilation data kept showing an improvement was likely linked to (i) people infected with the Delta variant were taken off the ventilator (mostly because they succumbed to the disease), and (ii) Omicron does not lead to such severe disease.

We wrote last Friday that "if this trend does not turn around by the time 'Delta patients' are all off the ventilators, we can be fairly certain that Omicron generally causes milder symptoms."

We need to see more data to say for certain what is happening, but the change in the number of ventilated Covid patients is concerning at this point. As you can see the blue line has risen further.

The left-hand chart shows what happened a year ago. The time series spans between 1 Nov 2020 and 28 Feb 2021, and the same dates in 2021 and 2022 are indicated by the red ovals. The black oval, as noted above, shows when the turnaround this year occurred.

There are fewer Covid patients in hospital and on ventilator than a year ago, but we are yet to see how drastically the sharp spike in new cases will increase hospitalisations (the process has already started) and how severe disease those Covid patients will have.

Here's a couple of facts to consider when trying to assess, how hospitalisations, ventilation figures and eventually fatalities could change.

• vaccination helps avoid infection and effectively prevents severe disease and death;
• two doses provide seriously diminished effectiveness against infection by Omicron;
• about 3.7 million Hungarians (38% of the population) are vaccinated with three doses of COVID-19 vaccines;
• 5.65 million Hungarians got their 2nd jab more than four months ago;
• on the wild assumption that all of the 3rd doses were administered to members of the above group, there are still about 1.97 million people in that group that have not received their third jab;
• 793,000 Hungarians received their 3rd dose more than four months ago and 322,000 more than five months ago;
• An advisory panel of Israel's Ministry of Health recommends that the government make available a fourth coronavirus vaccine shot to those aged 18 and above, on the condition that five months have passed since they got their third shot or recovered from the disease;
• Israel's Health Ministry said a fourth vaccine dose for those aged 60 and up offers threefold protection against serious illness and twofold protection against infection in the current wave driven by the Omicron variant;
• more than 50% of children aged 12 to 17 and about 10% of those aged 5 to 11 have been vaccinated in Hungary;
• as in the previous waves, it is younger people that get infected first (schools, pubs, training, workplace, etc.), and then spread the disease to older generations, first to parents and then to grandparents;
• on 7 January, CDC Director Rochelle Walensky previewed agency data showing that “while children still have the lowest rate of hospitalization of any group, pediatric hospitalizations are at the highest rate compared to any prior point in the pandemic.” Walensky said that unvaccinated children are more likely to be hospitalized with COVID-19 than vaccinated kids.
• there's also a geographical pattern, which is that Budapest is the first hotspot of new infections and then new cases start to pop up in less populated areas too;
• the reason why there are fewer people with Covid in hospitals may be linked primarily to the poor testing practices, and also to (i) Omicron causing less severe disease, (ii) young people have not yet infected "enough" old(er) people or those with underlying diseases that would need hospital care. The same reasons could be behind the lower number of Covid patients on ventilator (plus that those infected with Delta are gradually taken off the machines, as they pass away).

There are still about 3.37 million Hungarians that have not received a single dose of any COVID-19 vaccine, while about 38% of the population (3.7 mn) have been vaccinated with three doses. You can read more about the 'success' of the weekend vaccination campaigns in the article below.

Cover photo: Getty Images