Omi-Christmas cheer?

As we approach Xmas 2021, rather like last year the news is less than festive. Yet for a number of reasons this year will be very different, and there is some optimism worth celebrating.

So whats new with Omicron?

It seems clear that it is highly transmissible with a R0 number up to 5, so it will spread rapidly and is likely to be responsible for the rapid increase in the number of positive tests, now exceeding 100,000 in the UK, where, once again we are world leaders.

In the lab, it has been shown to reproduce 40 times faster than Delta in the cells of the nose and throat, but less rapidly in the lungs, which gave early hope that it is more infective though a less potent cause of illness.

Further encouraging news regarding this came from South Africa where reports about the resultant illness being milder must be tempered by the younger age of cases there, that they are in summer, and that a few European visitors had mild to moderate symptoms from their Omicron infections despite double vaccination and boosted. Worrying too is an increase in admission of children, though so far the cases are reported as mild.

Like Delta, Omicron will escape the vaccines to a degree, but they do seem to be holding up against severe illness. Boosters seem to return vaccine effectiveness to high levels, but one has to wonder if this means they will be needed to be repeated again as time goes. Israel seem to be contemplating a fourth vaccine rather that waiting for new variant specific vaccines which are in the pipeline, or indeed more definitive information about Omicron. If I was an Israeli, I would wait and see before a fourth Pfizer jab.

Reports from SA and Scotland suggest that the infection may be between 40-70% less likely to end in a hospital admission than Delta which is great news, though counterbalanced by the increased overall number of infections, the small numbers so far, and that the virus has yet to filter out to the elderly.

So all this is very good news for us as individuals, but the collective issue of a struggling health sector so vital to a relatively small percentage of the population at any one time remains the driving issue for policy. From this point of view, a variant twice as infective, but half as severe might leave us back where we were – so what of our immune defences?

How is our immunity doing?

Vaccines seem to continue to do well at their main task; preventing illness severe enough to require admission.

This report offers some clarity. Discovery, a health insurer in South Africa, looked at 211,000 positive tests, of which 78,000 were Omicron. What did they find……

Omicron risk after vaccination:

Two doses of the Pfizer vaccine provided only 33% protection against infection in this Omicron wave, (down from 80% in South Africa’s last, delta wave. Protection against severe symptoms has stood up better, at 70% in the current wave down from 93% in the last.

Omicron risk after previous infections:

Omicron appears more capable than Delta of penetrating the immune defences of the previously infected. They report that in the second (beta variant) wave, new infections were 60% as likely among the previously infected as they were among the never infected. In the third (delta) wave, the previously infected ran only 40% of the risk of those never infected. But in the current wave, new cases are 73% as common among the previously infected as among the never infected.

That implies that the vaccinated seem to have better protection than those with previous infections, and as vaccination is far less risky than infection, this is good news, though this will have to be checked again as more information come in.

Risk after a booster:

Over here, modelling from Imperial shows the benefit of boosters are considerable – somewhere in between 80-85% prevention of severe illness after 2 months, depending on how the booster levels of antibody drop with time. So getting boosted really does make sense. Ive had mine.

What about the effectiveness of masks, social distancing and hand washing?

The evidence is not of great quality – public health measures, even now are the Cinderella at the ball of research grant funding – but the results suggest relative reductions in incidence of 25% for physical distancing, 53% for mask wearing, and 53% for hand washing. So, what we do know should encourage adoption of these measures to reduce personal and communal risk. In other words, back to plan B……

Plan B for Belated!

In England, Plan B has been dusted off. For most of us it means very little. Plan B is simply the measures above plus use of the NHS pass for certain events. In Scotland and Wales they are being more cautious, but England as ever, prefers to cross the road of a new wave with our eyes shut. Despite ‘libertarians’ complaining about the human rights infringement of having to keep antigen testing up to date before going to a nightclub it is a reasonable measure till we know more.

The pronouncement of Lord Frost (amongst many others) that he is opposed to any restrictions at all after his resignation as chief Brexit negotiator makes the mind boggle at scientific illiteracy of so many of our politicians. I’m frankly embarrassed by his representing the UK in European negotiations. Boris Johnson himself is increasingly looking like a fraud, the only caveat being his total lack of any significant experience of anything other than Euro-bashing, making money and having fun. What else could we have expected?

Plan C for Crossed fingers

Once Delta has been displaced, perhaps later in December (what timing!) then the picture may well change and like Chris Whitty says, the number of cases might start to fall quickly as Omicron variant finds too few people without any immunity to infect. Fingers seriously crossed! Encouragingly, this seems to be happening in South Africa.

Thus what we are trying to achieve, once again, is the preservation of the ability of the health sector to cope, That is getting tougher as healthcare workers get ill themselves, isolate or quit out of exhaustion. The pandemic has starkly revealed we need a better, smarter and probably bigger health sector to counter the ills of our market capitalism, whose externalised costs are coming home to roost in ways that the pandemic is but a gentle hint.

Plan D for Drug treatment

As someone with MS, I have been put on a priority list for treatment with Molnupiravir, and Ronapreve in the case of becoming unwell. Right now, I would not be keen on either with the much better Ritonavir waiting in the wings.

Once again, Pfizer look to be taking the lead and are set to rake in yet more unsustainable profits. At what point, I wonder, will governments demand their investments be returned to public coffers, get better price deals and look at taxes?

Of course, Big Pharma comes in for a lot of stick, some if it fair, and some of it blanked bias. I have always considered them corporations which behave in their own interests like any other, it is the task of governments to regulate them, negotiate drug prices and tax their profits.

Development of Omicron specific vaccines may well be an option in a few months and at that time, perhaps the virus will be fading from our day to day life.

Meanwhile out there in orbit…..

I continue to be astonished by the anti-vaccination movement in the US. Mercola, for example, continues to claim we are the edge of a vaccine induced armageddon (no wonder he deletes his posts after 48 hours!). .

Dishonesty lurks under the shiny surface – A paper his website frequently quotes to highlight the supposed ‘toxicity’ of the vaccine induced spike protein concludes with a sentence he never never alludes to: “.. that vaccination-generated antibody … not only protects the host from SARS-CoV-2 infectivity but also inhibits S protein-imposed endothelial injury.” His list of references gives the impression of scientific validity, but frequently if they are read, it shows how twisted are Mercolas daily missives.

Peddling supplements, most of which hurt the pocket without improving health, he generates huge profits. Some of which support the considerable US antivaccine industry. He insultingly accuses the worlds healthcare staff from suffering from a mass psychosis. I feel compelled to visit his site to read the latest insane offering, but increasingly feel it is like a badly written, implausible sci-fi novel. In the UK, he would be in big trouble for doing harm, in the USA little action seems to be taken.

Its Python like presentation is compromised by the fact that they seriously believe what they are saying and worse still, that they expect listeners too believe it too. That there are willing ears shows, once again the dark side of American anti-science. Worse still, is that those willing ears are Republican law makers in Ohio. The notion that millions of Americans are now magnetised is offered by those who think working doctors have been brainwashed!

And on a truly fantastic note, HPV vaccine, highly politicised in the US and opposed by religious extremists there, looks like making cervical cancer a rare event. I feel so pleased that a simple vaccine will be saving thousands of lives and much suffering around the world every year, despite fear mongering from the idiotic Tenpenny about non existent side effects.

Anyway, back in my real world…..

Bacteria visit my bladder….

I recently developed fatigue, chills and a feeling of being unwell. In tune with the times I suspected COVID and was thankful the LFT was negative. The next day along came a significant fever with peeing conforming to the widespread description of passing broken glass. Ouch! That night I broke all my personal records in getting up 40 times to pass tiny amounts of infected urine. Pain made it impossible not to. I allowed the feeling of being an old man, with old mans problems to settle and pass. Illness demands getting things right, so:

In other words, my immune system in action against bacteria which managed to get into the rich pasture of my bladder, probably an effect of my otherwise merciful MS.

Leaving aside philosophical questions that arise from looking at these cells, wonderful called polymorphonuclear neutrophils, which are in every sense of the word “Me”, I sensed without their frantic efforts and huge numbers life for me would not be possible. Well done and many thanks to my bone marrow where they are assembled and released when needed!

The immune system does such wonderful things! Usually.

As with all illness, it’s important to get the diagnosis and treatment right – ideally first time. With urinary tract infections this is not too complex. Urine sample off to the lab and antibiotics from the GP who wished everyone had access to a microscope. So do I, not just to help diagnose infection, but also for the ability to safari the micro world with all its astonishing inspiring wonders. My GP’s rapid verbal delivery speech reminded me of how pressures of time change who we are.

Tolerating the side effects of the treatment, I re-examined my urine the next day. It made me think of visiting a battlefield when the fighting is over. Less though still plenty of white cells, lots of fragments of broken and unidentifiable bits of stuff. Battle it seems, being hopefully, slowly won. Indeed, my immune system has won every battle it has ever fought, otherwise I would not be penning this post. Though very noticeable, this is simply the latest and I will soon be on the mend to consider in more depth why this has happened and how to prevent it happening again.

A Yuletide message

Optimistically, perhaps that offers a metaphor for the pandemic. I hope after the New year, after a milder Omicron wave a clearing up operation will start, with the glaring need for better pandemic preparedness, better population health and a reality based drive to level down social inequality. This will give us a chance for a better 2022. The tough nature of life for too many people has been laid bare. Like climate change, and unlike austerity, we are all in this together.

Still for now, it’s time for the love of family and friends to displace the worry and angst of the times. I know that the festive season if not fun for everybody, for public sector worker it looks, once again, likely to be tough, but for most at least it’s a break in he midwinter gloom. So, I wish anyone with the persistence required to get this far a very Merry Christmas indeed!

As usual if you have any comments or questions, please leave them in the box below and I will get back to you as soon as I can.