Is this the beginning of the end-emic?

The New year celebrations have come and gone and its seems 2022 is going to be an interesting and difficult year with lots of crises emerging together. We have passed the grim milestones of 150,000 deaths, and 650,000 hospital admissions, the first European nation to do so.

Where will we be in a year? It’s anyones guess, but I do believe there is room to hope that an end of the pandemic is in sight.

Introduction

This new variant is simply phenomenal! From its beginning in just one individual human (or animal) somewhere, perhaps in southern Africa only a month ago, it’s now well on its way towards spreading within just about every community in the world. It is truly a landmark event in the history of infections disease.

That Omicron is milder disease is a lifesaver, but how much milder? Estimates vary from 70 to 20% reduction in severe illness though there remains much uncertainty. Any benefits are countered by the increased cases caused by its transmissibility. By the look of hospital admissions, the variant still packs a punch for the unvaccinated and vulnerable, and there are enough of them to fill our limited number of hospital beds.

However immunity, the lesser impact of Omicron on the lung and better availability of treatments will also shift us away from pandemic mode as we can protect the vulnerable more effectively.

There continues hope that the wave will steeply rise and then fall over a shorter period of time than with Delta with which we were struggling before the new variant made its appearance. Ultimately, as Omicron displaces Delta and generates immunity then there is a hope the end is in sight this spring, though viral evolution will continue and can still surprise many more people are getting significant immunity after infection, vaccination courses and boosters. In that sense, things are looking good.

What is happening?

The good news is that we may, just may, have passed the peak of this wave as todays UK numbers show……

We will also have to wait and see how this translates into hospital admissions, which at 2,400 today, are climbing with a peak not as yet in sight, apart from perhaps in London, where the variant first hit. Some, perhaps a third of these are incidental with positive tests during admission for other reasons, but they all add to the workload. In the last week alone 2,670,000 people tested positive in the UK; I wish them all well and expect the vast majority to do well and hopefully avoid too much acute misery and any chronic problems. How do other pandemics end?

Without restrictions or public health measures, the attack rate of the Russian Flu was about 60%. So far in the UK 14 million people have tested positive giving our attack rate of 22% – so without the public health measures the hit rate could have been very much higher.

The case fatality rate of Russian flu was 0.1%, ours far less, maybe by a factor of 10. The difference is that we now count better, have vaccines, treatments and hospitals. The coronavirus proposed to be the cause of the Russian Flu has become one of endemic colds. I hope that is where we are now heading, even though Omicron is more like a dose of flu that a common cold.

So how will it end?

While in Israel they are offering the fourth vaccine to vulnerable groups, I do not see the need for one over here, or indeed, anywhere. The vaccines do seem to offer long term protection against severe illness for enough of us to enable most of us to leave it at that. (Barring a significant new variant) People with specific vulnerabilities may well need the protection of extra boosters, and how we deal with next winter will be another matter.

Vaccine technology has leapt forward in the last two years and I suspect any vaccination campaign for next winter will be more like flu, where polyvalent vaccines cover a number of variants, and Sars-Cov may be better targeted at stimulating T and B cells to provide protection.

In the meantime – back to the NHS

Till then the issue is how will the NHS cope over the next few difficult weeks? What indeed, does coping mean. If it means bringing in the army to fill gaps, or postponing elective appointments, or generating an almost insurmountable waiting list, the NHS is not coping as we we speak, so what to do??

This ignores the fact that this has become commonplace only over the last decade or so and is not inevitable – it is political decisions in action.

While better placed than before due to preparedness and immunity, increased admissions plus staff isolating for their own after positive tests does leave the NHS in trouble. This concern not only applies to anyone with COVID, but anyone with a health issue, or caring for or related to a patient, or at risk of illness or injury – in other words, the vast majority of us.

Even before the pandemic over 100,000 staff vacancies remained unfilled, in other words after a decade of austerity politics we are now paying the price of an NHS with no reserves. When I reflect on this, and the destruction of primary care, the mess which is social care and inadequate provision of mental health services, I lament how long the Conservatives have been in power – it would make a huge difference if we spent the EU average on health, but we have some way to go achieve that and so and struggle on.

The English response to this we continue with Plan B(elated) in all its modesty, keep our fingers crossed that it all works out well. If it doesn’t then hope that everyone forgets the promises previously made. In true populist style, Im sure Boris will just carry on saying what seems to suit the moment. Other nations, including Wales are being more aggressive with public health measures – in other words, our approach is costing lives and creating suffering in order to help the economy cope.

Mandates – good or evil?

Another big issue is how those choosing not to get vaccinated are doing. Not so well it seems. This recent review in the BMJ makes for sad reading:

“..the proportion of patients admitted to critical care in December 2021 with confirmed covid-19 who were unvaccinated was 61%. This proportion had previously fallen from 75% in May 2021 to 47% in October 2021—consistent with the decreasing proportion of the general population who were unvaccinated—before rising again in December 2021”

In Plymouth, the local headlines look like this (below) with ICU consultants stretched and asking for those hestitant regarding vaccination to think again. There are significant number of people for whom such encouragement makes a difference, and a smaller number of people who will not budge.

Yet, mandates are being discussed in many nations, with the US and Italy, as usual issuing mandates like confetti. Here, we have never followed that course apart from selected groups like health care workers and Hepatitis B. Whatever one thinks, practical and ethical issues seem difficult to overcome.

The mandate for car home workers has caused problems and cancelled contracts, but hasn’t been a total disaster. The NHS mandate coming soon has been estimated to put 126,000 jobs at risk. Savid Javid reckons there were 94,000 unvaccinated staff in early December, and 55,000 of these have now had a first dose. This suggests a considerable amount of hesitancy rather than total anti-vaccination. Im sure some have waited long enough to ‘see how it goes’ and the new variant and mandate pressure has made a difference.

Accepting the government numbers, it does leave a thorny issue of people leaving a NHS that simply cannot afford to lose them, and this particularly applies to the most important job on earth there is – midwifery. If significant number of midwives, lost their jobs – 1%, (even 1 is too many) it will cause terrible problems. It might be helpful for any midwife in this position to be interviewed sympathetically by an infections diseases expert so questions and worries can be addressed and specific measures put into place to reduce risk.

I agree with him that current vaccines are less effective at preventing transmission for any length of time, and while I would certainly get the vaccine in his position, sacking him seems insane.

Masking problems

With the new variant so transmissible, questions have also been asked about the effectiveness of masks. Omicron seems to be 3-4 times more transmissible than Delta. As I recently reported, masks could reduce transmission of the Delta strain by about half, but with Omicron, who knows. It has been conjectured that enhanced transmission is due to immune evasion rather than more than heavier aerosol shedding, in which case the 50% reduction in onward transmission may make continue, which means that mask wearing continues to make sense.

Having said that, making 11-18 year olds in crowded schools wear masks all day is to say the least problematical – they are the sector whose day to day life has been hit hardest. Reports on how difficult this will be are already seeping into the news. .

Until Jan 26th, when the rules will be reviewed, this puts the teachers, another hard pressed group, in a really tough position. It places the parents of children with risk factors in a more difficult place still. Most parents too will have a struggle convincing their teenagers to wear a mask all day. While claims of danger and risks of masks are overblown, it is big ask. While it is not made easier by the lack of evidence of schools being a focus for wider transmission in any case.

Again, classroom discussions would be useful, including sharing experiences of the illness and how infection might impact vulnerable classroom members.

It’s another case of muddling along. Hopefully, this wave will soon crash and the guidance can be changed. Availability of treatments for COVID for those vulnerable children will also hasten a return to normal. Masks in corridors is one thing, mask in classes quite another.

Profits of Doom

Then to testing. I have the feeling of another huge scandal in the pipeline. Many people, many with Conservative Party connections have made millions out of testing, including many companies which have done little more than buy them from China and sell them to the NHS after what can only be called insider dealing.

Private Eye’s “Profits of Doom” makes a compelling and frankly sickening analysis of where so much taxpayers cash has gone. It’s fair to say colossal amounts have gone into the pockets of the already rich and, along with increasing values of investments have widened the already impractical gap between rich and poor. For me this gigantic tax evading cash cow has been partially responsible for the chaos of Test and Trace which no double will be pulled apart in the forthcoming enquiry. This is likely to publish its findings when the current batch of politicians and their cronies responsible for the mess have moved onto even grassier sides.

Summary

The huge surge in infections is what might be expected from a more transmissible variant hitting a population which is largely though not totally immune. I’m keeping my fingers crossed that this is the beginning of the end and the virus will be put in it endemic place by our immune systems.

Globally, this situation if not so clear; in areas with lower immunity this variant can still have a big impact, linger and importantly, create the next variant. Pfizer has to allow its technology to be replicated around the world and keep the new antiviral affordable.

If not, then this may not be the end of the story and we will need more vaccines with more profits for them. I do think that pandemic profits would, in a sane world, be more regulated, in an ideal world. Some lessons of the pandemic are far from being learned, but I remain hopeful that the clouds will part and allow us to concentrate on the far bigger threats that face us.

Thanks for reading the blog. If there is anything you would to say or ask, the please do leave your thoughts in the box below.

Until next time…. Good Health!