Covid-19 case numbers in Scotland are being underestimated by more than half, according to a leading expert in infectious disease.

Professor Mark Woolhouse said data from SPI-M, a sub group of the Scientific Advisory Group for Emergencies (Sage), shows there is a “persistent problem in Scotland and indeed the whole of the UK with missing Covid-19 cases”, PA reports.

Prof Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh, said official figures show Scotland had around 2,000 cases per day in late December and early January.

But data from SPI-M and the Office for National Statistics shows the true figure to be 4,000-5,000 daily infections.

He told an online symposium by the Royal College of Physicians of Edinburgh:

What those numbers imply is that we’re consistently underestimating in Scotland the size of our epidemic terms of case numbers by roughly 50 or 60%. That’s quite a large disparity, and it’s a problem.

He said as these infectious people will not be having their contacts traced and may not be self-isolating, it is “handicapping our ability to control the spread of infection”.

By expanding the range of coronavirus symptoms that people should report, “you can pick up perhaps at least half of the missing cases”, he said.

There is a “need for much wider testing, mass testing, basically, in order to find these missing cases”, he added.

Japan, for the first time in nearly four months, recorded more than 4,000 new cases on Wednesday, while its Osaka Prefecture reported a record 1,130 daily coronavirus cases, as the area struggles with a surge in infections driven by a highly contagious variant of the virus amid concerns that the country has entered a fourth wave of infections.

The Japan Times reports:

Osaka logged 1,099 Covid-19 cases on Tuesday, topping 1,000 for the first time.

Also on Wednesday, the nationwide daily tally of new cases surpassed 4,000 for the first time since late January.

The same day, the head of the government’s coronavirus panel acknowledged that Japan had entered the fourth wave and urged more of a sense of crisis over the situation.

Shigeru Omi, an infectious disease expert who chairs the government’s subcommittee, said in parliament the government should expand areas subject to tougher anti-virus measures due to rising cases “in an extremely swift and nimble manner.”

Prime Minister Yoshihide Suga, however, took a cautious stance as to whether the country has entered the new phase of infections, playing down concerns at an Upper House plenary session.

“I don’t see a big wave (of infections) nationwide,” he said.

Omi’s warning came as the government is considering adding some prefectures to the list of areas requiring the quasi-state of emergency that involves shorter business hours for restaurants and bars, among other anti-virus steps.

The quasi-state of emergency is already in place in six prefectures including Tokyo and Osaka. The capital on Wednesday reported 591 new infections and Hyogo Prefecture, which neighbors Osaka Prefecture, reported a record 507 cases. Okinawa Prefecture, meanwhile, confirmed 137 cases, topping 100 for the second straight day.

The figure in the capital was the highest since the government’s second state of emergency ended on March 21 and more than the last two Wednesdays — 555 on April 7 and 414 on March 31.

Asked when the British government will announce which countries will be in which categories for foreign travel rules, aviation minister Robert Courts told MPs: “I anticipate that at the early part of May we’ll be able to give more detail.”

He insisted “we are giving as much notice as we can” and acknowledged “there is a logistics issue” in giving customers and business enough time to prepare for the potential resumption of foreign holidays from England on 17 May.

Courts added:

I accept this is a cautious unlocking of international travel. It is meant to be because it’s meant to be robust and it’s meant to be something that is sustainable and that protects public health and ensures that we don’t have to go backwards again.

So it is intended to enable people to travel, but to do so in a way that is safe, secure and not reversible.

Most popular European holiday destinations such as Spain, Italy, Greece and Portugal should be on the UK government’s “green list” for foreign travel, the boss of budget airline easyJet said on Wednesday.

PA reports:

Chief executive Johan Lundgren said he “would expect almost all major European countries” to be put in the low-risk category when overseas holidays from the UK are allowed to resume.

Under the new traffic light system, people arriving in the UK from a “green” country will not be required to self-isolate, but those entering from an “amber” destination must quarantine for 10 days.

Existing rules for arrivals from “red” locations will continue, including the mandatory stay in a quarantine hotel.

Everyone returning to or visiting the UK will be required to take at least one coronavirus test prior to departure and after they arrive.

The earliest date that foreign holidays could be permitted for people in England under Prime Minister Boris Johnson’s road map for easing restrictions is May 17.

Mr Lundgren was asked if he expects destinations such as France, Spain, Portugal, Italy, Greece, Croatia, Cyprus and Turkey to be on the “green list”.

He replied: “Yes, by the time we open up for travel on the 17th of May and if the government continues to have the plan in place on the two-test system.

“I wouldn’t see a reason why you wouldn’t have the majority of the countries of Europe in there.”

Russian president Vladimir Putin has received the second shot of a Russian Covid-19 vaccine, the Interfax news agency cited him as saying on Wednesday.

The Kremlin said last month that Putin had received the first shot without disclosing details or providing photographs, Reuters reports.

It has not said which of Russia’s three vaccines, the most well-known of which is Sputnik V, he has received.

Eleanor Morgan writes for us this morning on her experience spending four months helping administer the vaccination programme in the UK:

When I saw an advert for people willing to train as vaccinators in early January, I applied at once. The idea of being an active part of a historic vaccination rollout was thrilling. I have clinical experience as an assistant psychologist, can put people at ease and was very ready for a meaningful break from spending 10 hours a day looking at a screen alone in my flat. The training was delivered by a group of witty, absolutely zero-bullshit female clinicians wearing Crocs. The conversation was sharp; I adored them immediately. We covered infection control (including a sobering experiment with UV gel; trust me, you need to clean your thumbs), PPE, life support and, of course, learning to inject. I remember a surreal moment, looking around a room full of lawyers, medical students, psychotherapists, cycling instructors and shop managers in full PPE, all bound by the shared purpose of wanting to do something.

On my first shift, vaccinators were led to the pharmacy where an enormous fridge buzzed away. The only contents were two slim boxes on the middle shelf: the vaccine. It was the centre’s opening day and only a modest number of patients were booked in. The pharmacist joked about the anticlimax of seeing something so inconspicuous, but inwardly, I was squeaking. The pain, isolation, loss, boredom and fear people have experienced during the pandemic is complex and individual, but the hope of freedom sat in those vials, each containing a few crystalline millilitres of scientific brilliance. When I signed out my first vial, I stared at the label and grinned.

My stomach lurched when I welcomed my first patient into my vaccination “pod”. I was supervised by a nurse until she was comfortable with my technique, but the floor was mine. I felt the patient deserved to be greeted with an air of confidence and hoped that my face, flushed and clammy with emotion, didn’t give me away. In a year that has been defined by the lack of touch for so many, the moment my hand felt the warmth of this stranger’s skin felt profound. The first injection went well. So did the next 20. I was sad to leave when my shift ended, but so tired I could have fallen asleep standing up. That tiredness was delicious; the feeling of having made myself useful, after a year of feeling anything but. I kept my purple “vaccinator” lanyard on for my cycle home.

Read more here: Hope, humour and zero-hours contracts: what four months as a vaccinator has taught me

Related: Hope, humour and zero-hours contracts: what four months as a vaccinator has taught me

Ireland is considering extending the gap between injections of the Pfizer Covid-19 vaccine to more than four weeks to keep its vaccine programme on track while other vaccines are restricted, the health minister said on Wednesday.

Conor Humphries for Reuters reports that Stephen Donnelly told journalists: “We are looking for options for how we can keep the pace of the vaccine programme going given the news we’ve had. Certainly extending the interval for Pfizer beyond the four weeks is something that is being looked at,” he said.

Busaba Sivasomboon reports for Associated Press a little more detail from Thailand, which recorded more than 1,300 new Covid-19 infections on Wednesday, setting another daily record. The numbers are adding pressure on the government to speed up a nearly nonexistent vaccination drive, and to do more to control a surge that comes amid mass travel as the country celebrates its traditional New Year festival.

The 1,335 new infections brings the number of new cases to nearly 7,000 since 1 April, when a cluster linked to nightclubs and bars in central Bangkok was found. Most of the new cases reported today were yet again in Bangkok, but also seeing hefty increases were the northern province of Chiang Mai and the southern seaside province of Prachuap Khiri Khan.

Many of the new infections are a more contagious variant of the virus first found in the UK and that coupled with widespread travel for the Songkran festival, or Thai new year, is fuelling the surge, said Dr Opas Karnkavinpong, the director general of the Disease Control Department. The festival officially began Tuesday and lasts for three days, but many people travel for a week.

Large daily increases in new infections had been rare for Thailand, which has weathered the pandemic far better than many nations through measures including strict border controls that have damaged the country’s lucrative tourism industry.

With millions of Thais moving around the country – often from urban areas to rural villages – for Songkran, prime minister Prayauth Chan-ocha and his government have faced questions as to why they didn’t prevent people from traveling as they did last year, when they canceled the festival at a time when the country was reporting far fewer infections.

Opas said that Thailand’s policy of hospitalizing all infected patients whether they have symptoms or not needed to continue as the “main strategy” to control the current surge. “We cannot risk more infections caused by those who break their home quarantine and wander to other places,” he said at a daily press briefing.

The policy coupled with the pace of new infections has caused shortages of hospital beds for Covid-19 patients in major cities including Bangkok and Chiang Mai.

Rewat Wisutwet, the deputy chief of the opposition political party Sereeruamthai and a former Health Ministry official, said increasing the vaccination rate was critical to blunting the spread of the virus.

“Thailand’s rate of vaccination is very low – too low to be effective in prevention. And we might eventually see the country’s healthcare system fail if the number of infections keeps rising quickly,” he told AP by phone. “The government must find the money to spend on vaccines … and do it fast..”

So far, Thailand has been using a relatively small supply of the Sinovac and AstraZeneca vaccines, until a local plant can start producing and distributing the AstraZeneca vaccine mid-year.

Former Australian prime minister Kevin Rudd is pointing his Twitter followers to our report from Josh Nicholas this morning on how Australia’s coronavirus vaccine rollout compares with other countries.

Rudd, who was prime minister from 2007-2010 and again in 2013 said: “100th in the world … Under Morrison’s bungled Covid vaccine rollout, Australia has slipped tragically through the ranks. Sourcing vaccines is Morrison’s responsibility exclusively. Not the states’.”

You can read the report on our datablog here: How Australia’s coronavirus vaccine rollout really compares with other countries

Related: How Australia’s coronavirus vaccine rollout really compares with other countries

Some very strong words from George Monbiot on our opinion pages today –Apparently just by talking about it, I’m super-spreading long Covid:

Rejoice! A mystery has been solved. We now have an explanation for long Covid, a condition afflicting many thousands of people. A super-spreader has been identified. Important as this finding is, I’m reluctant to call for the vector to be eradicated. Why? Because it’s me.

In a presentation to the reinsurance giant Swiss Re, Michael Sharpe, a professor of psychological medicine at the University of Oxford and founder of a long Covid clinic, proposed that one of the causes of the syndrome was “social factors”. The social factor at the top of his list was an article I wrote for the Guardian, describing the suffering of patients with the condition.

I listed the symptoms of long Covid and compared some of them to myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), the debilitating condition that afflicts around a quarter of a million people in the UK. Press coverage like this, Sharpe claimed, as well as the work of support groups and sympathetic doctors, could induce people to believe they had the illness, thereby spreading it. Long Covid, he appeared to suggest, is partly a psychological condition, so “the best treatment is psychologically informed rehabilitation”. This, we can only hope, will cure people of the fearful pox of Guardian journalism.

I was bemused by the fact that none of the references he gave at the end of the presentation supported these claims. So I wrote to Sharpe asking for his sources. He told me the evidence consisted of “patient reports”, and that “we are seeing many improve with reassurance about the absence of damage and with supported rehabilitation”. But assertions like this do not meet the standard of scientific evidence. Unfortunately, he told me, “I am unable to engage in further correspondence”.

A scientific assessment of the use of cognitive behavioural therapy (CBT) – a form of “psychological rehabilitation” that Sharpe has repeatedly championed – suggests that it’s of no use in treating other post-viral syndromes, and is unlikely to “reduce disability or lead to objective improvement in long Covid”.

But what if, despite the lack of evidence, he happens to be right? What if, by discussing the problem, I’ve caused it? As I look back on my work, my heart sinks. I’ve covered many terrible issues, and the more I’ve written about them, the worse they’ve got. I might be responsible for more human suffering than the entire cast of Alvin and the Chipmunks.

Read more here: George Monbiot – Apparently just by talking about it, I’m super-spreading long Covid

Related: Apparently just by talking about it, I’m super-spreading long Covid | George Monbiot

Iman Amrani writes for us this morning on how as Britain starts to open up, Ramadan begins. For her, it feels like perfect timing:

It might be that we’ve been in lockdown for too long, but on a personal level the timing feels divine. Just as the UK nations are starting to open up, a holy month begins that centres on discipline, restraint, community and charity – a welcome antidote as the floodgates of consumerism reopen.

Religion has become incredibly unfashionable in recent decades. But lockdown has made a lot of us think a little harder about the big questions. What’s it all about and how can we be happier, better people? How do we decide what we value and then live in a way that might protect the things we hold dear?

One thing that has been consistently in my mind this year is the overarching importance of intention. An intention is different to a goal. It is like the energy that guides you in a process: the objective that continues even when the goalposts move, or that can overcome the challenges or obstacles you encounter along the way.

Several times this year I’ve deactivated my Instagram account and come off Twitter because social media feels like the antithesis of intention-setting. You scroll aimlessly and allow whatever you see to affect your mood and energy, often as a result of boredom, or trying to make sense of what is going on. Reading is the obvious answer to this. As you pick up a book, you make an intention – whether it is escapism or knowledge that you are reaching for.

Read more here: Iman Amrani – As Britain starts to open up, Ramadan begins. It feels like perfect timing

Related: As Britain starts to open up, Ramadan begins. It feels like perfect timing

PA Media has the latest figures from the ONS, which suggest an estimated 54.9% of people in private households in England were likely to have tested positive for Covid-19 antibodies in the week to 28 March – largely unchanged on the previous two weeks.

The presence of Covid-19 antibodies suggests someone has had the infection in the past or has been vaccinated.

The ONS said antibody positivity has levelled off in England, Wales and Scotland.

In Wales, the latest estimate is 49.1% and for Scotland it is 46.0%. In Northern Ireland, an estimated 54.5% of people were likely to have Covid-19 antibodies in the week to 28 March – up from 50.0% in the previous week.

Here’s more on the latest situation in India from Rafiq Maqbool and Aniruddha Ghosal at the Associated Press. They report that India’s worst-hit and richest state Maharashtra will impose stricter restrictions for 15 days from today in an effort to stem the surge of coronavirus infections that is threatening to overcome hospitals.

Top state officials stressed that the closure of most industries, businesses, public places and limits on the movement of people didn’t constitute a lockdown.

Last year, a sudden, harsh, nationwide lockdown left millions jobless overnight. Stranded in cities with no income or food, thousands of migrant workers walked on highways to get home. Since then, state leaders have repeatedly stressed that another lockdown wasn’t on the cards.

Maharashtra chief minister Uddhav Thackeray said that most public places, shops and establishments will be shut starting 8pm Wednesday, except for essential services such as grocery shops and banks.

Although the state has announced a relief package of $728m (£527m) that will include assistance for the poor, industry experts say that the new restrictions might prove fatal for businesses that were only just recovering from last year’s economic recession.

“Livelihoods are important, but life is more important,” Thackeray said, echoing a difficult choice faced by other states in India.

The scenes playing out in Maharashtra in the past week mirror those developing in other parts of the country which confirmed a national one-day record of 184,000 new coronavirus cases in 24 hours today: patients gasping for air turned away from hospitals that are running out of oxygen and weeping families waiting their turn to bid farewell to their loved ones at crematoria.

Matthew Snape, associate professor in paediatrics and vaccinology at the University of Oxford and chief investigator on a trial exploring whether different vaccines can be safely mixed for the first and second doses, has told Times Radio this morning his research was planned at the end of 2020.

Asked about the Johnson & Johnson vaccine, which has been delayed across Europe following concerns in the US about a small number of blood clots, he said: “We knew that there was a high chance of unpredictable things happening, whether it be a problem with aa manufacturer, or various supply to different countries, or things such as these safety signals.”

He added: “So it kind of emphasises the need for these kinds of studies that look at how do you bring great flexibility and resilience to the immunisation schedule by looking at all possible combinations.”

PA Media reports that he also said that research on animals gives some suggestion that combining doses of different coronavirus vaccines may provide a better immune response. He was asked why it might be the case that mixing vaccines is a good or bad thing.

He responded: “Ultimately, they are all actually generating an immune response against the spike protein and it’s being delivered by different platforms. So we think, actually, it is likely that you will see a good response with these different combinations, but we don’t know until we look at it.

Prof Snape added: “We need the evidence before we can make those decisions to whether or not it’s the right thing to do. There’s some suggestions from animal studies in mice that actually you may get a better immune response if you, for example, combine the AstraZeneca-type vaccines with an RNA-type vaccine, and that actually seems to generate in some aspects a better immune response.

“So it will be interesting to see if we see that in humans also.”

Germany is gripped by a third wave of the pandemic, which has brought an increased number of infections of the more contagious British variant and left many younger patients sick. “The third wave is clearly upon us,” 42-year-old Thomas Marx, medical director of a hospital in Freising, Bavaria, told AFP.

Of the clinic’s 14 intensive care beds, five are occupied by Covid-19 patients. The patients are also younger now, with most of them “between 40 and 60”, according to Marx. “They often have to be intubated and then face a long fight with the virus,” the doctor sighed, adding that one in four do not survive their battle with Covid-19.

In one bed at the intensive care unit, a man of about 40 looked exhausted as he struggled to breathe through an oxygen tube. “We were ready to intubate him a few days ago, but we managed to avoid it,” said Marx. Nevertheless, his recovery will still take a long time, the doctor explained at the man’s bedside.

After coming through the first wave of the pandemic relatively unscathed, Germany has been rocked by a rough third wave. The number of hospitalised patients aged 35 to 49 has “strongly increased” lately, said Lothar Wieler, the head of the RKI infections disease control agency.

Despite repeated warnings from health workers about the urgency of the situation, German authorities remain entangled in a fierce political debate over restrictions imposed to fight the pandemic.

While Chancellor Angela Merkel has been pushing for tougher measures to keep the population home and avoid contagion, some of the country’s powerful regional leaders are refusing to sign up.

Fed up with the dithering states, Merkel’s government agreed a law change which would give Berlin more centralised power to impose tougher measures such as night-time curfews in hard-hit areas.

“When I look at the news and I see that the measures are not enough, it’s difficult to take,” admitted Marx.

Marx voiced fears about the days ahead. “It’s not just a question of treating those with Covid-19, it’s also about dealing with all the other patients and making sure we don’t reduce the quality of their care,” he said.

Sir Iain Duncan Smith, MP for Chingford on the outskirts of London, who before Christmas was repeatedly in the media arguing against stricter lockdown measures – he for example described putting London into tier 3 just before Christmas as a “blunt instrument” with “a horrifying amount of collateral damage” – has been on the airwaves this morning crediting January’s lockdown with saving many lives. He said:

In the earliest stages, the lockdown before people were vaccinated in anything like the numbers they have been vaccinated, back in January, of course it was the lockdown that had probably the biggest impact at that particular stage. The reality was at the beginning, maybe, certainly the lockdown had an effect. Professor Spiegelhalter was on, I heard him earlier on today saying that it was in the early stages, definitely the lockdown.

However, his main thrust was that the prime minister was wrong to credit lockdown as the main reason for the drop in cases – it was, he said, vaccines.

Those quotes from Spiegelhalter he referenced were probably these from the Today programme earlier [see 7.40am]:

It is the lockdown that has caused the major drop, of course, because we’ve seen that happen in the huge reduction in the people who haven’t been vaccinated. We’ve estimated that the vaccination programme has maybe saved 10,000 lives – a fantastic success. But that is not what has brought the enormous reduction since earlier in the year – that is lockdown.

My colleague Sarah Marsh has a fuller report on the UK study into mixing Covid vaccines between jabs being expanded. Particularly worth noting are the words of Professor Jeremy Brown, a member of the UK’s Joint Committee on Vaccination and Immunisation.

He has told BBC Radio 4’s Today programme this morning that people will eventually “have to” mix Covid-19 jabs.

It’s practically going to have to be that way because, once you’ve completed a course of, say, the Moderna or Pfizer or the AstraZeneca with two doses, in the future it’s going to be quite difficult to guarantee you get the same type of vaccine again.

You can read more here: UK study on mixing Covid vaccines between jabs to be expanded

Related: UK study on mixing Covid vaccines between jabs to be expanded

Prof Anthony Harnden, deputy chairman of the Joint Committee on Vaccination and Immunisation (JCVI), has been out doing the morning media round in the UK. He urged people “not to go wild” after restrictions were eased, warning that it could lead to the variant first identified in South Africa becoming “more prevalent”.

“From a vaccine point of view the South African variant is of concern”, he told ITV’s Good Morning Britain.

“We know from studies that none of the vaccines are as effective against the South African variant – though the vaccines still prevent against severe disease and death even with the South African variant.

“The problem is, they may not protect against infection which allows infection to transmit, and if we allow transmission through the community in large numbers with high infection rates then we could see other variants emerging.”

PA Media reports she added: “We’ve all been desperate for our freedoms – and it has been great this week when we can get out to the pub gardens and enjoy the outside space – but we must not go wild.

“If we s