Covid 19 – what will the winter bring?

This post looks at what is happening, to whom it is happening, the benefits of vaccination in the real world, the potential of new treatments and some predictions for the winter.

Introduction

With winter approaching the pandemic still seems to be hitting the headlines. Sadly it is just not going away – yet. With hospitals struggling once again and various health experts asking for Plan B to kick in, it looks like rather a gloomy winter might be approaching. However, there are silver linings and this post rounds up the state of play in terms of humanity versus Sars2.

What is happening?

Once again, I have take to regularly logging onto the dashboard at 4pm for the latest daily data update. It does seems things are going in the wrong direction.

In some ways this is not unexpected. Life, out and about, is pretty much back to pre-pandemic levels with mass gatherings in full swing and a gung-ho government determined, as before to wait until they are forced into later and less effective action.

So it is different this time with schools and Universities back in full flow, mask wearing dropped considerably and not much social distancing in evidence. Added to this, we have the new variant, and immunity, both natural and from vaccination, tending to fall off with time particularly in the old and infirm.

The driver of policy once again will be strain on the already creaking health and social care sector, and with lots of vulnerable people around, there is lots of scope for ITU’s filling up once again. Oh dear!

Who is it happening to?

So who is the virus hitting hardest? These graphs show the ages of new cases over the last week. The bulk of cases are are in the unvaccinated young who will acquire natural immunity at a price, with hospital admissions and deaths predominantly in the older age groups. This too is expected.

The big question is how are the vaccines making a difference?

How are the vaccines doing?

For the first half of the year the vaccine made a massive difference – the ONS reports that:

“From Jan 2 to July 2 2021, there were 51,281 deaths involving coronavirus (COVID-19); 640 occurred in people who were fully vaccinated, which includes people who had been infected before they were vaccinated.”

Of course the vaccination campaign only got started in January so there were lots of these deaths in people who were waiting for the jab, but the figures are impressive nonetheless, with only 1.5% of deaths being in the fully vaccinated. I await an update with interest.

This more recent surveillance report from PHE sums it all up in terms of the benefits of vaccination and shows the increased risk of admission and deaths in the smaller unvaccinated population over the weeks 37-40 of this year. I find this very encouraging in terms of vaccination, but sad in terms of the unnecessary lives lost. Anti vaccination misinformation is deadly.

Also how about new Delta vaccines? Pfizer has announce a new Delta variant vaccine which will start testing in August, though will take some time to assess its effectiveness and is perhaps the next pandemic challenge – to see how quickly this can be done. First results might be available in early winter. In short, the vaccination campaign will make a big difference to the winter, as it has to our experience of the Delta wave.

New treatments to the rescue?

A recent post from your truly lamented the lack of really effective treatments, but are things changing? Giving patients monoclonal antibodies like Regen-Cov can be effective, but hampered by the need for in-patient infusions and cost which limits its widespread use, more so in poorer nations.

The race for new treatments which in essence interfere with what viruses do – replicate – is most definitively on. Oral treatment with an antiviral which could be mass produced and given outside the hospital setting could be transformative and reduce pressure on hospitals which would signal an end to this phase of the pandemic.

How do they work? You can think of viral replication due to RNA as rather like zips unzipping and zipping up, using raw materials in the cell to add more and more teeth to the zips, which, when completed, contain the instructions for viral protein manufacture. Anything that interferes with this process could stop the virus in its tracks. You can insert the wrong teeth – like putting a spike in the zipping process akin to that annoying bad tooth in a stuck zip. Remdesivir does this. Or you can prevent the zip zipping by interfering with the enzymes which pull the whole process along.

The new kid on the block is molnupiravir. This inserts a false building block into viral RNA which while allowing unzipping, wreaks havoc thereafter, rather like mixing up the vowels in a short story. Merck, its manufacturer, reports a 50% decrease in risk of hospitalisation if given early to at risk people. In other words, not as much as the 70% from monoclonals targeted at the same high risk group, but with far more practicality. This is hopeful.

It also costs a bit less – even with excess profiteering – its $700 a treatment clearly overshadows the estimated $17 is costs to make. It is a pill, which is a big advantage on Remdesivir, which cuts hospital admission by 87%, but has to be given in three in patient infusions, so remains impractical for most of the world.

Astra Zenicas new monoclonal called AZD7442 consists of two antibodies derived from COVID survivors and is lies somewhere in between. It needs to be given intramuscularly, so it can be simply given in out patients. In a small phase 3 trial the risk of death or hospitalisation was reduced by over half. Larger trials are awaited, as is peer review as so many of these newer medications are announced to the world by drug company press release.

Vitamin D is being taken by more people and this continues to look a sensible thing to supplement with. This study shows its benefit is those with a dark skin.

In short, vaccination continues to be the safest and quickest way to prevent infection, and anti virals will be having an increasingly important role for those most likely to suffer. It is really useful to be vitamin D replete. All this might add up to a very different winter. Wouldn’t it be helpful to have a previous global coronavirus to compare to our situation (other than the Sars1 and Mers). It seem that perhaps we have….

Lessons from history

Perhaps history might give us a clue as to how this pandemic will end. The Russian Flu of 1889, long thought to be a influenza outbreak might, may after all have been caused by a coronavirus. It is estimate this killed 1 million people, – a considerable 1% of the global population at that time and swept the world in five waves lasting five years. The virus, now called OC34 ultimately became one cause of the common cold.

Eventually immunity reduced the virus to a little more that an inconvenience. It seems this it will ultimately be the case with Sars2. The Delta variant is out-competing the other variants and has become the universal global player and may, despite the emergence of a Delta plus version, be the pinnacle of how bad it can get.

In other words, vaccination and possibly treatments will hopefully truncate the Russian Flu experience into a shorter experience. Sars2 of course, went global for more rapidly, indeed almost instantly; unlike in 1889, vaccines and effective public health measures became a part of the norm. So is there any chance we might be heading towards the end of the pandemic?

What now?

It’s clear we are facing the winter with some uncertainty. As ever this particularly applies to those whose health is already compromised by poverty, inequality, racism, poor vaccine choices, pernicious politics and bad luck. Crises in the housing and energy sector, as well as hiccups with fuel delivery also more than hint at troubled times to come.

One thing is certain however – if public health policy decisions are being made to ensure the NHS continues to function in terms of treating COVID patients, provide a winter service for all as well as attempting to manage the growing waiting lists, then right now we are not doing very well.

Increased cases seem to be coming from schools and young people. Indeed, most of the population are mixing, and the political decision making right now deems the resultant spillover into the vulnerable is worth the cost. Will a time soon be reached when the young are also largely immune due to vaccination and infection? If, so then it would follow that cases in that group will fall and hope against hope, cases in the vulnerable and elderly fall too.

So there are reasons for optimism? Will this winter be different from the last? The answer to that must be yes. There are over 90% of us with some form of immunity to COVID19 which is encouraging. The vaccine campaign rolls on with more unvaccinated coming forward, as well as those with previous infections, which is good. Also boosters will be offered to the at risk population which should at least take them through the winter. Anti virals should also be reducing the critical impact on health services. This shouldn’t mean we do nothing.

Plan B – why not?

The UK Health and Social Care Committee have reported, vaccines apart, how badly we have done till now with our pandemic decision making. It is hard to have confidence in a government whose decisions are all so politically motivated.

It makes common sense to wear masks, to take reasonable precautions with social distancing, to plug on with testing and isolation and to work at home when possible. The latter is frequently the case as is highlighted by the increasing demand for and cost of houses in Devon from those who used to work in offices in London.

The vaccination only mandate for large social gatherings is more controversial, and perhaps the bit that Tories rail against. Add to vaccination, a positive PCR in the last year, and a recent negative lateral flow test, then perhaps this could make all but the most recalcitrant happy with the measure and reduce risk significantly if not totally – the latter is simply not possible.

Plan A plus

It makes sense to stay as healthy as you can, though this varies according to where we are with our health. I penned my prehabilitation posts which offers further information about how do manage that.

It is important not to be taken in by misinformation which remains rife. This example of discrimination against vaccinated youngsters the latest nonsense for the US, that cradle of the best and the worst. Thanks to the excellent Sethoscope in Rome blog for that, and much else.

So thanks for reading this post today and getting this far. If you have any comments of questions then please use the boxes below and I will get back to you as soon as I can.

Good health!