Inferring UK COVID-19 fatal infection trajectories from daily mortality data: Were infections already in decline before the UK lockdowns?

Abstract

The number of new infections per day is a key quantity for effective epidemic management. It can be estimated relatively directly by testing of random population samples. Without such direct epidemiological measurement, other approaches are required to infer whether the number of new cases is likely to be increasing or decreasing: for example, estimating the pathogen‐effective reproduction number, R, using data gathered from the clinical response to the disease. For coronavirus disease 2019 (Covid‐19/SARS‐Cov‐2), such R estimation is heavily dependent on modelling assumptions, because the available clinical case data are opportunistic observational data subject to severe temporal confounding. Given this difficulty, it is useful to retrospectively reconstruct the time course of infections from the least compromised available data, using minimal prior assumptions. A Bayesian inverse problem approach applied to UK data on first‐wave Covid‐19 deaths and the disease duration distribution suggests that fatal infections were in decline before full UK lockdown (24 March 2020), and that fatal infections in Sweden started to decline only a day or two later. An analysis of UK data using the model of Flaxman et al. gives the same result under relaxation of its prior assumptions on R, suggesting an enhanced role for non‐pharmaceutical interventions short of full lockdown in the UK context. Similar patterns appear to have occurred in the subsequent two lockdowns.