COVID19 – So is that it?

Summary

• Freedom day is going to be on the 19th July with just about all restrictions removed.
• In the upstroke of our fourth wave, this involves a risk which falls largely on the less well off.
• There are lots of infections out there and health experts call for less recklessness.
• Data shows once again how badly England has done when compared to Europe.
• Vitamin D is playing a role right now.
• Schools, testing and the Liberty Myth explored.
• How amazing new levels of misinformation continue to play out.

Introduction

Well there we are. After the 5 million UK cases of COVID19, the 128,000 deaths, the testing, the restrictions, the isolation, the shielding, the economic damage and the barrage of daily news regarding the pandemic, Boris Johnson has declared peace, the restrictions and lockdowns can entirely be lifted and we can all go about our business pretty much as before. While I’m surprised he did’t put on a bowler hat and give us all the V sign, is that really it?

Viral reality

Well not quite. For one thing, we are on the upslope of the fourth wave as I described before, with gloomy predictions of 70,000 cases a day from the Chief Medical Officer being trumped by the new shiny Health Secretary’s predictions of 100,000 daily cases at its peak. Savid Javid is clearly aiming low not to disappoint and acknowledges that the new variant, being more transmissible, will spread widely among those not fully vaccinated. I am not alone in thinking there are a few issues with this, as this letter to the Lancet describes.

100,000 daily cases means that, if we are going to continue with isolation of contacts, surely still the bedrock of pandemic control, that means an awful lot of people isolating – far more due to the increased number of contacts people will be having. If every case has just two contacts that means about 1.5 million people isolating each week. The personal and economic effects of this are significant. Isolation might be waived for those fully vaccinated which will reduce this number, but there will be considerable chaos with the NHS Test and Trace App already pinging rapidly increasing numbers and talk of dumbing it down, something I used to call ‘cheating’.

While the link between cases and hospitalisations has to a considerable degree been reduced, it still exists. Adding to vaccination, (93% of the over 50’s) natural immunity will be out there too, but for the 5 million who have been infected, resultant immunity will be more variable than that obtained from vaccination. This does mean that from the 17 million currently unprotected, and for those in whom the vaccine fails, (4% Pfizer, 8% Oxford) there will be more hospital admissions at a time when there are real problems catching up with the unprecedented backlog of people waiting for treatment.

Given the prevalence of chronic problems after COVID19, there will be large numbers of people, many young, who will be hit by this policy and experience ‘long COVID’ which is a poorly understood syndrome with no well defined treatment from a struggling health sector. With schools out during the summer, might we expect another wave in September, as we did last year?

More mutations will result from more cases and this leaves the possibility of new variants emerging. So, this is a big roll of the dice. In a way, it is our own “Gain of Function” experiment, following those in the lab setting to examine how viruses can become more transmissible and deadly.

Social inequality will be widened as cases increase and as usual preferentially hit the less well off and hit those already getting the worst deal in society. Talk of levelling up is so far just that and the pandemic is making this worse. A recent report on social inequality describes its pernicious effects on health and shines a light of how things have gone backwards since 2010 after almost a century of progress in poverty reduction.

Of course, with schools out, and the sun (occasionally) shining, perhaps the thinking is “if not now, then when?‘ The Lancet doctors feel the answer to this is when more people are vaccinated, when adequate ventilation systems are put into place in public buildings, including smaller class sizes in schools. Till then, wearing masks indoors, Testing, Tracing and supporting those who need to isolate will continue to be needed, along with border controls with effective quarantine. All these look compromised by the Health Secretary undoubted instinct to consider economic matters above those relating to health; a false dichotomy is ever there was one.

Yet, the summer is a good time to relax restrictions and they can be re-introduced if needed. Interestingly I have not noticed the “I” (irreversible) word used so much this time.

England vs Europe

Just as England take on Italy in the European Cup, a more sombre comparison with Europe is described in the figure below which shows clearly how badly we have done since the beginning of the year in terms of overall mortality rates. It’s sobering to think that without vaccination, these terrible figures would have been much worse and represents a pretty dismal pandemic performance.

England vs Italy

As an interesting aside the the Euro final, how do England and Italy compare when it comes to COVID19? Three graphs describe the situation as it stand. Test numbers performed, positive results and deaths.

Let the sun shine and take Vitamin D

I continue to take 5000iu of Vitamin D daily, even with my outdoor lifestyle and more evidence rolls in that this is sensible, not only for people with MS, but for all of us whose time is predominantly spent indoors and clothed, in other words, just about everybody. Despite the evidence from trials being as mixed as their methodology I have posted before about how important Vitamin D is and it makes sense in so many ways. Put simply, we are not designed to be indoor creatures. Right up to the industrial revolution, we would spend most of our lives outdoors, most of the time. The other feature of modern life which is relevant is the amount of fish we eat. Indeed that we have eaten most of the fish out there.

Looking at those blond Danes trying their best to get to the Euro final reminded me of how biology does its best to get Vitamin D. Originally we all come from people who had dark skin to offer protection from the beating sun in tropical areas where Vitamin D lack was not an issue. After migration, white skins evolved to maximise the manufacture of Vit D. Even with this, life in Scandinavia or Scotland would have been impossible without the consumption of large amounts of fresh, oily fish, loaded with the Vitamin D now so lacking in our diet.

The biology and anthropology of skin colour highlights why racism is so offensive. Sadly it continues to play out in society where the potent lack of Vitamin D in people with dark skin living in temperate climes seems pretty much ignored, despite the recurrence of severe Vit D deficiency causing rickets. Racism never seems to be far from the surface. This might seem inflammatory, but that the maternal mortality of black women is FIVE times that of whites testifies that racism, in practical terms, is alive and well.

Liberty myth

Of course the whole concept of ‘Freedom day’ is driven by Bo-Jo’s childish libertarian instincts. I usually find myself irritated by what I call the Myth of ‘Freedom’. The concept bears little reality to those who have little choice but to take risks, that section of society so poorly understood called ‘wage earners’, or people who make a living out of work rather than those who make money out of money. The graph below describes the increased risk of those doing the tougher lower paid jobs in the UK.

For the latter the liberty to do what they please means more income, for the former, it means more work and the effects of the pandemic will continue to fall on those is the social classes whose lives are defined by stress, lower income, and the necessity to take risks. Social inequality is running at high levels in the UK and bold statements about “levelling up” ignore that to accomplish this, a certain amount of ‘levelling down’ has to take place too.

Compounding this is the reduced vaccination uptake in some of our poorest areas with a plea from Bart’s MS team pleading for increased vaccine uptake as well as some Q and A’s to dispel some of the myths driving reluctance. It seems those areas most affected by maternal mortality 150 years ago are now the areas most affected by COVID19 mortality – some things never change.

Schools

This has always been a big issue and so far, incredibly disruptive for kids with a whopping 375,000 children missing school in June. When a pandemic is at its height, people becoming ill and hospitals stretched closing schools seems reasonable, but what now? The bubble system, always a sledgehammer to crack a nut with hundreds of kids being sent home after one positive test is being done away with and replaced by more selective testing of those who are unwell and their contacts.

Yet, with high levels of vaccination among teachers and staff, (who may be more likely to spread the infection), and natural immunity, there is a case for doing away with them altogether and advising children to stay at home when they are unwell – in other words, ‘living with SarsCov2’. This would be a huge relief for school and, like in other public service sectors, allow some catching up to be done, a process likely to take years with effects stratified as ever, across the social spectrum.

While we will soon have more debate on vaccinating children over 12 and I’m sure this will be heated, ethical considerations should make this easy for now. Those vaccines should be winging their way to African nations and others whose COVID19 waves wash so easily over flimsy, privatised health systems before we start to vaccinate our low risk populations.

Testing

We have, I hate to say, bought £7 billion worth of lateral flow tests which are not much use in the school setting as they miss so many cases. In the US, The FDA has looked at the Innova tests and advised:

“The FDA has significant concerns that the performance of the test has not been adequately established, presenting a risk to health. In addition, labeling distributed with certain configurations of the test includes performance claims that did not accurately reflect the performance estimates observed during the clinical studies of the tests“

Will UK policy be driven by the need to see these things used? I got a text from my surgery just yesterday advising me to pick some up – for what? If I have symptoms I will self isolate, if I haven’t then the trials have show the test to be of little use and will miss most of those who actually have the infection, including 30% of those with a high viral load. My understanding is that they are about £8 each, and of course the cost per positive case found depends on the level of infection in the community. I’m not alone in finding it difficult to discover exactly how much the tets costs but this analysis from Wales found;

• There have been 2,655,667 “recorded tests in Wales” since January 1 according to PHW.
• If they cost £8 each then this is a cost of £21,245,336. 
• Of those tests 2,383 have come back positive.
• This means that it has cost £8,915 for every positive test

I despair to remind myself of this phenomenal mis-spending. Such elephantine sums of dosh could have kick started the process of carbon capture and sequestration which is vital if we are going to have any chance of tacking climate change, which of course is far more important to our kids then anything else we do for them. Or, it could have transformed education, or transport, or the health sector. This is called “Opportunity Cost” and it’s a huge loss.

So….

Have a good summer! Keeping healthy will continue to reap rewards whatever happens – prehabilitation is for life and not just for a pandemic. The next few weeks and months will be interesting and we are taking risks with a virus which is changing the world. I’m sadly confident the government we have will continue to make some very ropey decisions as they have done for so long. In this sense the pandemic experience is far from over and the evolution of the fourth wave with its impact of the health sector will unfold as the next few weeks go by.

Whatever decisions we make, they should be made on solid foundations of sound information and reasoned interpretation. And so I end on a description of more mischief from the anti-vaxx movement. They now are busy creating the myth that the vaccination is actually more deadly than COVID19. As I have mentioned before, I have been astonished by the level and impact of such inaccurate, misleading and potentially harmful misinformation. I find it fascinating and worrying at the same time.

Porky Pies……

More scaremongering is afoot. The latest is that the vaccinated are six, yes SIX times more likely to die after admission with COVID19 than the unvaccinated. This has been hailed as evidence that the vaccine is useless or worse but is quite a blatant misrepresentation of what is going on. Let have a closer look – of course in a superficial way they are right. Data from PHE shows that the rate of deaths is higher in those who are vaccinated, but the doomsayers miss or ignore a couple of rather significant points.

First, they ignore the age of those admitted. Most of the elderly and the vulnerable have been vaccinated but they still have some risk due to those characteristics. The vaccines are very good, but not 100% and so there will be a small number of cases in this vaccinated population. There were 12 deaths out of 1,800 admissions in fully vaccinated people, and yes, they do have a higher mortality than deaths in the far younger and less vulnerable admissions with COVID 19 who have yet to be vaccinated where there were 23 deaths out of 19,500 admissions.

The statements that vaccines increase your risk of dying from COVID19 by a factor of 6 is staggeringly dishonest – it is being old and vulnerable that takes this toll. For them and others, vaccination has been a great success.