Well here we are at the end of a long year of infection with all its problems, vaccination campaigns, anti vaccination scandals, the steady arrival of new variants, unrest at public health measures and much uncertainty – to arrive back where we were a year ago; facing a big wave of a another new variant. Yesterday there were an astonishing 183,000 new cases and that is likely to be an underestimate. Evolution has suddenly become very immediate and visible.
Add to that are the increasing hospital admissions – up 13% in the last week, and likely to rise further as the variant spreads into the more vulnerable populations. Although about 20% of those hospital cases might be those who may have become infected in hospital, it is a real concern that were heading for more big problems.
Right now there remains optimism that this wave will crash, albeit after spreading far faster than any of the old variants .
Happy and hopeful New Year!!
In a sentence, the best hope is that rapid spread of this milder virus will displace Delta, will lead to wider immunity and the end of the pandemic, the worst that it is pathogenic enough to overload hospitals and their staff and lead us back to restrictions.
There is plenty of reasons for optimism and so this is my last round up of the year – and attempt to sum up where we stand with Omicron, vaccination and generally, our ability to get by.
Omicron spreads about 7 times faster than Delta and 500 times faster than the Wuhan strain. It may not respond to therapeutic antibodies, the effectiveness of Molnupiravir has dropped from 50 to 30% in terms of keeping you out of hospital and vaccines has lost some of their edge. Oh dear.
Indeed, it has become the worlds second most infections virus. (After measles which is 18 times more infective than COVID19 and explains why measles outbreaks are so explosive)
This variant too is explosive with responses to increasing infections varying from total lockdowns in China, specific restrictions for the unvaccinated in Germany, (seems effective – see left!)
Here in England just about everything is slapdash and voluntary and once again we are leading the way in the number of infections, which is undoubtedly to some degree an effect of our huge use of tests.
Here in the UK, we use 5 times more tests (per 1000 people) than the next heaviest user, the USA.
This does not seem to translate into better pandemic performance and is costing the many times more than the sum needed, for instance, to prevent 18,000,000 Afghanis from starving.
Back to Omicron – How is it so infective? Newer methods of working with viral particles have shown that a mutation on the nucleocapsid, the casing of the virus, allowed the Delta strain to be supercharged with 10 times more mRNA than the original Wuhan strain. This explains why it is better at making our cells manufacture more viral particles after infection and why, even with vaccination, viral load can be very high – as high as in the unvaccinated, though levels drop more rapidly when pre-armed by the vaccine. I wonder if a similar thing is going on with Omicron?
Thankfully, it seems infection results in a milder illness for the individual. In South Africa they have a younger population enjoying the sun and far less older people (life expectancy 65). That admissions have been reduced by 70% compared to Delta is encouraging but may not be he case here (life expectancy 81). We shall find out over the next few weeks as it spreads out into the wider population including the elderly and vulnerable. I’m back viewing the daily stats with trepidation and crossed fingers and the strain on hospitals is sadly increasing.
A less harmful virus is good news for each of us, but the collective issue remains of how to protect public services on which many depend, and this defines policy. (Albeit rather less than many public health experts feel it should). The double whammy of more admissions coupled with more sick leave is a real problem for us all. The hope is that the wave will come and go fairly quickly, but this could leave chaos in its wake.
Its not just services, airlines and railways are shutting down too as Omicron spreads, and worryingly, this winter more children are being admitted to hospitals with COVID19 – 500 in the UK the week prior to Xmas. Increasing numbers of problems for kids might well change the arguments on how extensively we vaccinate children.
There is a risk that Bo-Jo is getting it wrong yet again! So what to do?
Oxford Street last week!
By the look of less crowded streets and shopping malls, even without formal restrictions, behaviour has changed.
Thankfully more people are getting vaccinated, not just boosted, but also their first jabs. Perhaps this is due to the need for a pass to get into certain events, but perhaps also an appreciation that it is just a good idea for personal and collective health. Why?
What about vaccination…….
Vaccination continues to disappoint those who expected, or imagined, a magic bullet. Effectiveness against infection continues to decline with time, partly explaining why case numbers, even before the arrival of Omicron were climbing all over Europe. However, data shows claims that vaccination has been a failure are way off the mark.
For instance, this pre-Omicron analysis from Northern Ireland is reassuring:
- Hospital Admissions
- Vaccinated individuals aged 50 and over are more than 4 times less likely to be admitted to hospital with COVID-19 as unvaccinated individuals.
- For adults under 50 a vaccinated individual is more than 8 times less likely to need hospitalisation from COVID-19.
- Vaccinated individuals aged 50 and over are almost 4 times less likely to die than unvaccinated individuals
There is similar UK wide information here which shows that the vaccinated are again nearly four times less likely to be admitted and 3.2 times less likely to die within 28 days of a positive COVID19 test. That is really good news.
Protein based vaccines are now available and may help those worried about the newer technologies. Essentially these give a dose of the spike protein without involving mRNA or viral vectors and importantly, don’t need cold storage.
Vaccinated vs unvaccinated on ITU
This is getting a hot topic with some commentators questioning official statements that the hospitals are filling up with those unvaccinated.
Figures do vary according to place and time. I read this morning that 70% of those on a Gloucestershire ITU are unvaccinated, and increasingly those beds are occupied with younger people; in London with its low rates of vaccination, it has been put at 90%. Some of the best data comes from the Intensive care research community and shows that the proportion of unvaccinated people on ITU is declining as the number of unvaccinated people decline, but the unvaccinated are clearly heavily over-represented on ITU and again shows the ongoing benefits from vaccination.
Admissions are not the whole story as the length of stay determines bed occupancy – it may be that the unvaccinated have a more severe illness, a longer stay and thus might occupy more beds than this data suggests.
Risks of ‘natural’ infection…..
Another reason why avoiding illness severe enough to require admission is such a good thing is that those hospitalised have a tough time, not only during their illness, but at least for the year after.
Those who have recovered from admission with severe COVID19 have significantly higher mortality than those with mild disease in the year after discharge, and only 20% of those deaths are due to the respiratory or heart problems. The increased risk was times 3 for the under 65’s and interestingly tailed off in the over 65’s. The risk when compared to those Covid free was even more pronounced.
The benefits of boosting are coming through. This paper relates to the benefits of boosting against Delta, so those bets are off, but prevention of serious illness is holding up and likely to keep at least 80% of vaccinated people out of hospital. Given that the illness from Omicron is milder, that has to be good news.
Anti Vaccine Xmas
Joe Mercola is one of the worlds most prominent anti vaccine professionals with a wide reach. I wondered if he would have a day off on Xmas day but indeed he didn’t. His festive post featured a description of the death, early in December of the aged partner of one of Mercolas biggest contributors, prominent antivaccine publicist, Judy Mikovits. She is aggressively blaming the hospital for his death and the whole thing is a scandal in the making. Perhaps not the most jolly Christmas fare, but more on that strange story later.
Antiviral drugs will make a difference
Pfizer Paxlovid is rolling out of the factories and likely to make a big difference. Ritonavir (its proper name)is a protease inhibitor – protease being the enzyme which is essential for the production of viral protein and not something we vertebrates have. In their trial, side effects were present in about 20% of trial volunteers, with slightly more in the placebo group. (Always interesting!)
In a press release, they found three days of treatment with Ritonavir, 3 out of 389 in the treatment arm were hospitalised with no deaths, compared to 27 out of 385 hospitalised with 7 subsequent deaths in the placebo arm. The study has yet to be published or reviewed, but if made available cheaply enough, could make a real difference to how the pandemic plays out.
As someone with MS (and therefore deemed vulnerable), I have been offered a fast track to Molnipiravir and Ronapreve, neither of which seem particularly effective for Omicron. So for me, that will be a dilemma if the moment arrives, but a recent booster and a quiet New Year may avoid the issue till the better antivirals come along.
Moves are afoot to make Plaxlovid available globally, but production is not as straightforward as vaccines; care has to be taken if on other medicines and of course, with the virus on an evolutionary fast track, resistance could soo be a problem. Perhaps too, the issue of excess drug company profits could come more to the fore.
As I said last time, Molnuparivir has run into problems with side effects related to mutagenesis – making it impossible to give to anyone of reproductive age, and animal evidence of a benign cancer risk, which makes it a risk for just about anyone.
It seems clear that the most potent form of immunity comes with infection followed by vaccination, according to the paper in Nature, which looked at antibody levels after infection or vaccination and came up with the following interesting graphic:
The new variant is less susceptible to vaccination, or previous infection, so the combination of both may be no bad thing, indeed, with 180,000 cases yesterday, it can be safely assumed that hybrid immunity is becoming more common and may also contribute to the potential end of the pandemic.
Asthma and COVID19
One of the worries earlier in the pandemic was that the vast numbers of people with asthma might be more vulnerable to infection with COVID19, but that seems not to be the case. This review offers reassurance to anyone with asthma. It seems the reductions in social gatherings, less viral infections, and perhaps lockdown induced reductions in vehicle emissions have given people with asthma a break. Those who use inhaled steroids may also, in effect, be pre-treating themselves.
Care will still be needed for people with asthma as without social restrictions, it may be that the viral illnesses which lie behind so many asthma attacks will be back as mass movement gathers pace. Care too in terms of getting the medication right and keeping as fit as possible.
Vitamin D shuts down T cell-mediated inflammation
To add to its many immunological roles it seems vitamin D is also needed to reduce T cell enhanced inflammation, a part of the cytokine storm that creates big problems for those with COVID19. Also the beneficial effects of sunny weather have been shown to reduce the risk of COVID19. All this adds up to Vit D being a useful thing to take – I don’t consider it a supplement – it is there to replace the Vitamin we should have made in the summer, or by eating traditional amounts of fish. We are now mainly an indoor species and the fish have just about all gone.
It seems important to get Vitamin D levels high before any infection; as ever treating established infection is a far bigger ask.
Xmas midriff warning
Two things are certain. One is that weight goes up over Xmas. Mine did this year having drifted from my Zero added sugar approach. The other is that overweight is not good for health and this is particularly so for COVID19. Why?
It seems that SARS COV -2 attaches itself to fat cells in the abdomen and activates immune cells called macrophages. These are very common in abdominal fat and cause inappropriate and risky inflammation.
Ho Ho Ho dear – I’ve overdone it!!
Perhaps this adds to the many reasons why obesity is such a risk factor for severe infection and hints to us all that those extra kilos typically added to our bulk might be best removed. Sugar, as always, is the big culprit and contributes to making edible the 60% of calories we eat in fast foods which otherwise would taste more like the wrappers in which they are packaged.
The New Year resolution most likely to add years to you life and life to you years would be to give up added sugar and sugary foods. Go on!!
Happy New Year and Thanks
Thanks to all for reading this blog through this difficult and horribly interesting year. I hope for a better year and in the next few weeks we will know so much more about how things will pan out. I’m hoping for an end to the pandemic next year, though some say the year after. Till then we may all have to adapt to this new virus becoming part of our lives.
I shall do my best to keep up to date and share with you what I see as helpful news.
If you have any comments, feedback or questions then do leave them in the box below and I will get back to you as soon as I can.
Have a great New Year whatever you plan to do!!!