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The UK is well into the second wave of COVID-19, with 60 051 lives lost to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to date, according to provisional data from the Office for National Statistics. Official UK Government data show that cases have been rising exponentially since late August, 2020, with increases across all regions in England in recent weeks.[[1]] As of Nov 4, 2020, the UK had 25 177 confirmed daily cases. [Extracted from the article]

Background: Predicting the future UK COVID-19 epidemic provides a baseline of a vaccine-only mitigation policy from which to judge the effects of additional public health interventions. A previous 12-month prediction of the size of the epidemic to October 2022 underestimated its sequelae by a fifth. This analysis seeks to explain the reasons for the underestimation before offering new long-term predictions., Methods: A Dynamic Causal Model was used to identify changes in COVID-19 transmissibility and the public's behavioral response in the 12-months to October 2022. The model was then used to predict the future trends in infections, long-COVID, hospital admissions and deaths over 12-months to October 2023., Findings: The model estimated that the secondary attack rate increased from 0.4 to 0.5, the latent period shortened from 2.7 to 2.6 and the incubation period shortened from 2.0 to 1.95 days between October 2021 and October 2022. During this time the model also estimated that antibody immunity waned from 177 to 160 days and T-cell immunity from 205 to 180 days. This increase in transmissibility was associated with a reduction in pathogenicity with the proportion of infections developing acute respiratory distress syndrome falling for 6-2% in the same twelve-month period. Despite the wave of infections, the public response was to increase the tendency to expose themselves to a high-risk environment (e.g., leaving home) each day from 33-58% in the same period.The predictions for October 2023 indicate a wave of infections three times larger this coming year than last year with significant health and economic consequences such as 120,000 additional COVID-19 related deaths, 800,000 additional hospital admissions and 3.5 million people suffering acute-post-COVID-19 syndrome lasting more than 12 weeks., Interpretation: The increase in transmissibility together with the public's response provide plausible explanations for why the model underestimated the 12-month predictions to October 2022. The 2023 projection could well-underestimate the predicted substantial next wave of COVID-19 infection. Vaccination alone will not control the epidemic. The UK COVID-19 epidemic is not over. The results call for investment in precautionary public health interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bowie and Friston.)

Objectives: Predicting the future UK COVID-19 epidemic allows other countries to compare their epidemic with one unfolding without public health measures except a vaccine program., Methods: A Dynamic Causal Model was used to estimate key model parameters of the UK epidemic, such as vaccine effectiveness and increased transmissibility of Alpha and Delta variants, the effectiveness of the vaccine program roll-out and changes in contact rates. The model predicts the future trends in infections, long-COVID, hospital admissions and deaths., Results: Two-dose vaccination given to 66% of the UK population prevents transmission following infection by 44%, serious illness by 86% and death by 93%. Despite this, with no other public health measures used, cases will increase from 37 million to 61 million, hospital admissions from 536,000 to 684,000 and deaths from 136,000 to 142,000 over 12 months. A retrospective analysis (conducted after the original submission of this report) allowed a comparison of these predictions of morbidity and mortality with actual outcomes., Conclusion: Vaccination alone will not control the epidemic. Relaxation of mitigating public health measures carries several risks, which include overwhelming the health services, the creation of vaccine resistant variants and the economic cost of huge numbers of acute and chronic cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bowie and Friston.)

The COVID-19 pandemic has shone a light on the complex relationship between science and policy. Policymakers have had to make decisions at speed in conditions of uncertainty, implementing policies that have had profound consequences for people's lives. Yet this process has sometimes been characterised by fragmentation, opacity and a disconnect between evidence and policy. In the United Kingdom, concerns about the secrecy that initially surrounded this process led to the creation of Independent SAGE, an unofficial group of scientists from different disciplines that came together to ask policy-relevant questions, review the evolving evidence, and make evidence-based recommendations. The group took a public health approach with a population perspective, worked in a holistic transdisciplinary way, and were committed to public engagement. In this paper, we review the lessons learned during its first year. These include the importance of learning from local expertise, the value of learning from other countries, the role of civil society as a critical friend to government, finding appropriate relationships between science and policy, and recognising the necessity of viewing issues through an equity lens., Competing Interests: Declaration of Competing Interest All authors or or have been members of Independent SAGE. MM is Research Director at the European Observatory on Health Systems and Policies, responsible for the COVID Response Monitor. JD, SM, MP, SR and RW are members of the Scientific Pandemic Insights Group on Behaviours, which advises the UK Government. SR and LNB advise the Scottish Government., (Copyright © 2022. Published by Elsevier B.V.)