Early summer Update – clouds and silver linings

Summary

• To date, the vaccination programme has prevented 11,700 deaths and 33,000 hospital admissions in the UK.
• Due to the huge number of viruses replicating globally, the virus continues to spread and mutate.
• The average loss of years for those dying with COVID is 16 years.
• New combinations of mutations lead to new variants and much uncertainly, but vaccination seems to be breaking the link between infection and the need for hospitalisation.
• Globally we might be seeing the beginning of the end of the pandemic, but there remains billions of people without effective immunity.
• Nearly 2 billion does of vaccine have been administered and more vaccines and treatments are coming along.
• Rich nations are hogging the vaccines needed by the rest.

Introduction

Drought follows deluge in our mixed up world and so I try to keep up to date with the pandemic while trying to manage the increasingly tricky task of growing food and being a worthwhile grandad. Summer has arrived after a miserable wet May and some of the latest frosts I have ever seen have left the natural world seeming rather disordered and late. Swallows, who have nested here at my place for the last two decades have come, had a look around and left, agreeing with my impression that there really are very few insects around. Frosts and ice on Dartmoor in June add to the visual disturbance of seeing late bluebells flowering with foxgloves. With all this, the pandemic has settled to the back of my mind, yet is still determining the medical and political landscape as we attempt to hurry back to our species destroying ways. So whats the score right now?

The virus and us….

Globally there has been 170 million COVID19 cases recorded with 3.7 million deaths, and still running at about 10,000 a day. There is evidence too that undercounting is common. In Peru for example, they have more than doubled their toll after a closer look at the causes of death, and this is also certain to be the case in Africa. Pandemics kill many times more people in the poorer countries whose health systems are scant and ill equipped for day to day life; there is about 1 ICU bed with a ventilator per 100,000 people in many African nations so there in now a concern as the virus now spreads to Africa in particular.

This recent study hints at the personal costs. It calculates the average years lost per COVID death is running at about 16 years. Three quarters of those years lost are in under 75’s and almost a third in those below 55.

Here in the UK, our complacency has been wobbled by the spread of the B1617.2 (now to be called “Delta”) variant which is said to be 40% more transmissible than the Kent variant and now accounts for 60% of samples sequenced. However, in terms of hospitalisations, it’s so far so good despite an increase which was to be expected with more indoor mixing. The virus continues to circulate, but that the NHS boss is suggesting that vaccination has broken the link between infection and hospitalisation is really good to hear. Hospital admissions are from younger, less vaccinated age groups, who need less care and doing better.

It is also really good news that 70% of us in the UK now have antibodies against SarsCov2, either through infection, which provides 95% effectiveness at 7 months, albeit with big risks, or more commonly via the far less dangerous vaccination (See table below), but the next question is how useful this will be against the B1617.2?

It seems a single shot of AZO or Pfizer vaccine offers just 33% protection against symptomatic illness caused by the new variant, increasing to 60% (AZO) and 88% (Pfizer) two weeks after the second jab, but again with more effectiveness against severe disease. Natural immunity after infection is similarly reduced, though all this is based on lab tests rather than real world data. A more transmissible variant will also increase the proportion of the population needed to be immune in order to arrive at herd immunity as well as increasing cases, hospitalisations and the troublesome Long COVID.

Meanwhile across the planet, Vietnam is worried about another new variant which seems to be a combination of the Kent and Indian variant and they say, is far more transmissible. The hardy Vietnamese have done well with the pandemic due to early action, in particular border closure, and don’t want to lose the benefits of aggressive infection control. After an outbreak affecting just 150 people after a religious event, they are locking down and surge testing the affected areas, testing the whole of Ho Chi Minh City’s and advising social distancing for all in an effort to do what we seem unable to do – take early and decisive action.

Lost leaders

Complacency should be more than wobbled by Cummings revelations about the inner workings of the Government. It seems that we are being led by people whose ability to understand the world of science and ethics which must underpin our future is, to put it very kindly, shaded out by their desire to make money and do business. Cumming’s tirade, in its mischievous schoolboy pomp revealed much about himself as well as the day to day workings of Number 10; and none of it good.

The endless cock-ups, dithering delays and in-built structural weaknesses exposed by the pandemic offer many important and immediate lessons. Yet even those have been kicked into the long grass by the delay of a public inquiry until it may longer matter, and which will provide doors after the horses have bolted. To Johnson and Hancock, basking in the success of vaccination, it seems almost incidental that tens of thousands of lives were needlessly lost. Further, it makes the bigger picture more worrying – we have leaders whose priority seems to be to announce whatever suits the daily press briefing irrespective of the facts and this bodes badly when facing trickier challenges.

Another example – setting targets to reduce CO2 emissions – are also appealing headline grabbers. However that this is impossible to achieve without some immediate and radical changes in the way we live our day to day lives are still not being seriously addressed.

In fact, we are working hard to actually increase CO2 emissions in critical area, (HS2, Heathrow, roads, etc) new trade deals will ensure steak and lamb will have travelled across the globe from Australia to arrive on British plates. All to be facilitated by a luxury £200 million yacht supplied by the taxpayer. You could not make this up! Once again reassuring announcements followed by worrying action. Though Cummings told me nothing I didn’t know in the bigger picture, the bumbling incompetence and pettiness of day to day life in No10 is expectedly disappointing. Politics seems to have moved back to the world of flags, photos and self preservation which has implications beyond the idiocy, egos and Cummings nasty revenge for what are going to be decisive years for us all all future generations.

Vaccine update

Astonishingly, there has been 2 billion doses of vaccine given which must make it the worlds most comprehensive vaccine programme ever, even though only 50 million doses have been found their way to poorer nations though COVAX, so once again headline promises of togetherness are not being honoured. Joe Biden is providing 500 million doses of the Pfizer jab, which will help things along, but we have been tardy to say the least.

Rates of significant side effects from the vaccines are low, 0.03% in Canada for example, and reporting of immediate side effects is about that expected from the trials, both in the USA and here. The systems seem to be identifying rare side effects the trials couldn’t, such as clotting disorders and now inflammation of the heart (USA).

Our vaccination programme ploughs and has done very well with 87% of people here trusting the vaccine. We are vaccinating lower risk groups and encouraged by US vaccine trials on 12-18 year olds which showed 100% effectiveness and few side effects. So, vaccinating children is now on the agenda. It makes sense for those children at risk of COVID19, but vaccinating children en masse for me raises tricky questions about ethics and efficacy, given the low risk to that age group which may be exceeded by the incidence of rare side effects. It may be a hard sell.

As far as vaccine effectiveness goes, this table from Canada just about sums up how the vaccines are doing. Ignore the highlighting, I couldn’t get rid of it, but it gives a pretty good summary of how well the vaccines work.

In other words, vaccines work well. They have already saved, it is estimated by PHE, over 11,700 lives and 33,000 hospital admissions so far in the UK. They will also have prevented much suffering in terms of complications such as fatigue, lung damage and neurological complications even in those not needing hospital and will provide economic and social benefits in terms of life re-emerging from the restrictions.

Sadly, rare side effects will continue to emerge. The latest one being inflammation of the heart muscle called myocarditis. Israel reports that out of more than 5 million people vaccinated in Israel, there were 62 recorded cases of myocarditis in the days after the Pfizer vaccine. It found that 56 of those cases came after the second shot and most of the affected were men under 30. Two have died. This might indicate problems in vaccinating the very young, but of course, SARS2 infection also causes heart problems with one study showing 60% of people recovered from COVID19, who were previously healthy and with an average age 49, had myocarditis two months after diagnosis. Nothing comes for free.

Not so silver linings

Putting it another way, returning to our normal driving and freight habits as lockdowns ease will return us to ‘normal’ levels of excess deaths caused by vehicle exhausts with child deaths being accepted as a price to pay for mobility.

So it seems the old abnormal is set to return, though with hopes that home working might make a difference to peak traffic levels. Might we have glimpsed that life is possible without the hyper-mobility behind the pandemics spread or the daily death toll from poisoned air? Those living in polluted areas will have to, pardon the pun, hold their breath. In 2018, it is estimated that 8.7 million people died due to the burning of fossil fuels and this is a stark warning for the future. Perhaps Birmingham’s clean air zone hints at what can be done now, electric cars will help and corners can be turned, but it remains in the UK, a low political priority. On a personal note, I’m pretty sure that one of the reasons my MS is under control is breathing fresher rural air.

Perhaps too, governments stung by the costs of COVID29 and falling incomes have simply had to do something about the parasitic accumulation of wealth by the tech companies. The G7 meeting in Cornwall have agreed to move towards a global rate of corporation tax levied where sales are made will be a huge step forward. It is not without its problems and loopholes, and has hurdles to overcome, but with good news in such short supply, this is welcome.

Treatments

A simple steroid inhaler used for asthma seems to be helpful for COVID, with implications for anyone with asthma and perhaps for early treatment for COVID symptoms. There are antivirals in the trial pipeline which could potentially have a big impact. Protease inhibitors prevent viral replication and have already been used with success for HIV and Hepatitis C. One candidate, called PF-07321332 is being trialled as we speak with some promises of availability next year. Fingers crossed for its success and its affordability.

I recently posted on Ivermectin, the latest “wonder cure” for COVID19. I wondered if I would have to change my mind and wondered that there is something in it. I guess after the hydroxychloroquine debacle, with much wasted effort, and harm done, scepticism is in order for miracle drugs advertised by on-line presentations These can be very convincing, though I am always suspicious of the “world best/cleverest/most published doctors” using megaphones rather that journals to make their findings knows. Yet, the best study I can find showed no benefit of treatment and a sobering recent and decent meta-analyses concluded:

“In comparison to Standard Care or placebo, Ivermectin did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease…. IVM is not a viable option to treat COVID-19 patients.”

There is more research going on with more trials on their way, particularly in terms of using Ivermectin for prevention of illness in contacts of those with infection – at tricky thing to prove. Some of the analyses on line are convincing but when looked at in detail are not of the quality needed to enable regulators to approve the drug for mass use. The US national Institute for Health was unconvinced in February, as were the WHO in March, both recommending its use in the research setting only, so we have to await the results of more studies in the pipeline.

While the WHO have much to learn from the pandemic, Modi’s government should be hiding their heads in shame and perhaps Indian legal experts could more usefully look a little nearer home for incompetence..

Interestingly another very old drug used to treat and prevent gout, Colchicine, seems to be more promising and in a good quality trial showed some modest benefits in terms of preventing hospitalisation or deaths in at risk patients. This was a randomised, prospective, blinded, placebo controlled trial with 4,800 patients and has all the qualities so lacking in so many of the Ivermectin studies.

Shenanigans

Scandals and horrors are much in the alt-news. Terrible vaccination side effects, mounting vaccine related deaths (easily debunked), COVID19 outbreaks actually caused by vaccination, the conspiratorial denial of the “wonder drug” ivermectin and other imagination grabbing nonsensical headlines.

Despite the evidence, the small but vocal anti-vaxx community continue to dominate vaccine related posts online. Incredibly, 65% of online anti-vaccination posts come from just 12 individuals, a vivid description of the power of the internet to distort reality. This matters. Belgiums equivalent of our own Chris Whitty has been targeted by a gunman made angry towards experts advocating lockdowns. This is made worse by the fact the gunman is an ex-military sharpshooter and shows how online conspiracies can drive you to madness.

Origin of the species.

It seems this all hinges on whether or not three lab workers who are rumoured to have needed hospitalisation with a mystery illness last December were in fact COVID19 patients.

The source of this is a Wall Street Journal article on an unsubstantiated “intelligence leak” authored by the same reporter who has previously written howlers on weapons of mass destruction in Saddam’s Iraq and an article on Russian activity in the Crimea which had to be retracted. Perhaps too its a legacy of Trumps Sino-bashing time at the helm. I wonder?

For me the lab created virus idea has at its heart, a good deal of politics and escapism. It is tempting to avoid the more horrifying reality which is the biology of habitat destruction in the hope that the whole thing has been a simple hideous mistake. The solution is therefore simple – alter lab processes, change priorities for research and putting an end to fiddling around with the structure of viruses and hey presto! No more pandemics!! If only! It is of course true the Chinese will cover up any misdemeanours which make them look bad, yet it’s also true that proponent of the lab theory we are all busily evading the simple truth that destroying nature will eventually destroy us, with COVID19 one hint of how that might happen.

The labs, we should remember, are about preparing for future pandemics and perhaps next time, having vaccines ready to go. This involves working with some dangerous viruses, and yes indeed, accidents do happen. Yet, we simply can’t have it both ways at least until we have taken more notice of the underlying causes of pandemics we have to try to keep one step ahead, particularly when it comes to influenza.

The other strand to the lab leak hypothesis is that the actual virus has not been isolated from an animal. Yet, this does not surprise me as it takes some imagination, time, effort, and courage to find the natural reservoirs, as it did to find the horseshoe bats infected with SARS1 as well as the bat origin of Ebola, Hendra, and Nipah viruses and the simian origin of HIV.

It makes perfect biological sense and also would lead to the best reaction to the whole pandemic experience, rather than a politically driven blame game or conspiracy fodder.Like so many facets of the pandemic, it seems you can pick your conclusion, depending on how you want to feel.

As I said over a year ago now, there is a colony of bats, we know not where, possibly carrying the virus-zero and unknown variants thereof, and a pangolin or some other vector scurrying around somewhere carrying these close to humans. It might be sensible to give them the space they need, and to keep away from handing or eating them, unless you want another pandemic. That, Im afraid, is aside from the influenza viruses replicating in intensively reared pigs and birds – that is where the Real Leak is most likely to come from.