August COVID update – our crashing wave

Summary

• The UK Fourth wave crashes – good news but why?
• The Global situation continues to be devastating.
• Viral variants and what they mean.
• Treatment update and Vaccinations to the rescue.
• More reasons why COVID is not just a little flu.
• More on origin, how much all this has cost, levelling up nonsense and building back better.

Fourth wave crashes.

Thanks to an unpredictable mixture of the fading Euro footie effect, school holidays, a reduction in our high levels of testing, community immunity and ongoing behavioural changes our fourth wave is on the decline. There are still nearly 1.000 admissions a day to add to the 6,000 people still in UK hospitals with COVID19, so we’re not out of the woods entirely, but it is good news. The ZOE symptom tracker calculates there are 800,000 people with the infection right now, about double the number of positive tests. In the health sector it seems winter pressures are now all year long. I feel for NHS staff and won’t feel totally reassured until admissions falling.

This wave, of course has faded due to all these things, and of course, without lockdown, but really not that much happened on the “Freedom Day”. The very name irritates as the government simultaneously are bringing in a raft of acts and measures to restrict and reduce freedoms. Plenty of people continue to wear masks and behaviour didn’t suddenly change on July 19th, indeed case numbers began to fall on the 16th. The one certain thing about the pandemic is uncertainty itself and I have my fingers crossed for when the autumnal academic year starts with that migration of youngsters to school and universities. That will be interesting.

Globally

Globally the virus seems to be one step ahead. We are relying on building up community immunity which relies on good health, luck with the infection, and vaccination. As a community, our health is far from good in particular with respect to the ongoing high levels of smoking in the world, obesity, metabolic disease and diabetes, meaning cases continue to fill some ITU’s, particularly in areas of low vaccination and high poverty. This graph shows the global score and trends…..

Going Viral

The Delta variant continues to make the news here and around the world. First detected in India, it has 13 mutations, four of which are on the dreaded spike protein and importantly, on the receptor binding domain, the viral ‘key’ which fits into the human ‘lock’ called the ACE receptor. This diagram shows (A) the virus, (B) its entire genome and what it codes for, (C) the spike protein and (D) the genes responsible for its structure – its a little complex, but it really is the entire virus in a nutshell:

These changes in the bases of the viral genome result in switches of amino acid building blocks they code for and thus a change in the configuration of that part of the virus that binds to our ACE2 receptors. This allows increased entry into our cells, and the cell next door and so on and a degree of immune escape. The average viral load of those infected with this most recent upgrade is up by a factor of 1000, and thus transmissibility is up by at 50-60%. So it’s all up in the air again with increasing cases around the world with lots of variability across and within nations.

Meanwhile, watch out for the Beta (South African) variant which has now spread to Spain and France, so beloved by Brits on holiday. There are concerns with the effectiveness of the AZO vaccine against this variant, though, there is likely to be significant reductions in severe illness from vaccination.

Vaccinations

Even with the Delta variant, vaccine effectiveness remains high as shown by this up to date study. For the Pfizer vaccine effectiveness of two doses was 93.7% against the alpha variant and 88.0% against the delta variant. With the AZO vaccine, effectiveness of two doses was 74.5% against the alpha variant and 67.0% against the delta variant. Effectiveness against Delta was significantly reduced after one dose, compared to Alpha. So the disease remains very preventable.

Confusing headlines questioning vaccine effectiveness followed the USA’s CDC new advice on masks. They now ask vaccinated people to wear masks indoors in public places in high prevalence rates. To some, this suggested that vaccines were perhaps not so good after all at preventing transmission. The advice was changed on the basis of a single outbreak in Massachusetts where viral loads in vaccinated people were found to be similar to those who were not vaccinated. This followed large public gatherings, mainly attended by men. They conclude:

However, when the CDC released their data it showed how good the vaccines are. Vaccinated people are 3-4 times less likely to get infected, 8 times less likely to get symptomatic infections, and 25 times less likely to be hospitalised with or die from COVID19. They are not 100% however, and it makes sense to wear masks in areas where vaccination rates are low, where there are high rates of infection and where lots of people gather indoors in poorly ventilated locations, even if you are vaccinated.

Despite the benefits of vaccination only 28% of the worlds population has has one dose and 14% are fully vaccinated, dropping to just 1% in the low income nations.

In America, 95% of COVID deaths are now in the unvaccinated, and are worse in those states who are, or have been, vaccine resistant. That some prominent Republicans are coming around means this might slowly change. Even Trump has (too quietly) had his vaccination. Meanwhile, in heavily vaccinated Israel, most deaths are in the vaccinated. Anti vaccine groups are making much of this, but a look at the stats reveals that this makes perfect sense. The vast majority of vulnerable people are vaccinated, so there will be a small number of deaths in that group. In Australia, the elimination policy is wobbling with the arrival of Delta and they may have to put rocket boosters under their dreadful vaccination campaign as the world seeps in.

In summary, its rather like saying most deaths from car crashes are in those wearing seat belts. In other words, vaccination works!

Without vaccination we would be relying on risky natural infection to edge us towards herd immunity, which, with every mutation gets that little further away.

Away from our cosy Western world of functional health and social support systems, there continues to be much misery in the poorer nations with South America, Africa and some parts of Asia continuing to suffer in a way we can hardly imagine. I feel for anyone short of breath who finds that oxygen unavailable due to short supply. Without that, there is little is available to interfere with fate.

Hideous inequalities in wealth continues to bite. In the UK, those disadvantaged sectors of the population are four times more likely to die from COVID19 than the better off . This is the latest demonstration of how social inequalities kill.

Treatments

Anti viral treatment has been a disappointment with trial after trial showing that most fall foul of the randomised controlled trials needed to release them to the general public. While waiting for the Recover trial of Ivermectin, this review (yet again) concludes that IVM is “not a viable option to treat Covid19”.

Still the internet seems to be dominated by how wonderful it is, with claims that it has reduced mortality by half in some US hospitals not standing up to the least analysis. In actual fact, mortality rate in the hospital who regularly uses IVM seems little different from the rest at about 7%, falling from last year as clever ITU staff have learnt how to manage a complex disease. One of the bigger papers supporting Ivermectin has been retracted due to potential fraud. All in all, it seems to make little difference – I hope the RECOVERY trial proved me wrong, but whatever happens I’m certain the conspiratorial fringe will forever continue to cry foul.

Monoclonal anti bodies wax and wane, and seem susceptible to new variants knocking them down, though this one, Sotrovimab, seems a good candidate for early treatment for patients at high risk. Wider use is likely to be limited due to its high cost. Prevention is better than cure!

Still not a ‘little flu’.

For anyone who still thinks COVID19 is like flu, this paper is sobering. Although only 0.3% of athletes who had previously had COVID had symptoms of myocarditis, when examined by MRI, this went up times 7 to 2.3%, a significant number in those who are super-fit. This also provides good information for those who are worried about vaccination and myocarditis reported after the mRNA vaccines, which though a problem, is far less so than after the infection.

This paper also shows a faster heart rate persisting with time and being a part of the Long COVID syndrome. The authors conclude: ” We found a prolonged physiological impact of COVID-19 infection, lasting approximately 2 to 3 months, on average, but with substantial intraindividual variability, which may reflect various levels of autonomic nervous system dysfunction or potentially ongoing inflammation”

Here in the UK we have decided not to vaccinate those children not at risk right now. This makes sense as long as the vaccines not used wing their way to where they are more needed. We live in a world which seems to have marginalised children, forever prioritising the short term to the long, but we should not forget the indirect impact on kids, as nearly two million have lost a parent of grandparent caregiver to COVID and that represents a huge covid impact.

Back to the Origin

It seems that a potential Italian patient Zero had Sars-Cov2 antigens detected in a skin biopsy taken in November 2019 – this make the lab leak theory less likely. Why? Because one of the corner stones of the lab-leak theory is the rumour of Wuhan Viral Institute workers suffering a ‘mystery’ illness, also in November 2019. I should say there is no actual evidence for this having taken place, but it is very hard to prove something didn’t happen – rather like having to prove innocence of a crime.

There are strong trade links between the two areas, but it seems less likely that it could have spread from the lab workers to the lady in Milan at the same time. Meanwhile, claim and counter claim will continue until, like so many other zoonotic infections, the animal reservoir is found, if it ever found. Genuinely it is like looking for a needle in a haystack. Till then, it will be ping-pong and meanwhile we continue to fail to address the critical environmental issues behind the whole pandemic experience.

Levelling up – reality

Meanwhile, governments around the world have done little as they watch the worlds wealth cascade up to the ultra rich. Conservative leaning slogans like “Trickle up” or “Levelling up” are being shown to be vote winning fibs. Perhaps Biden’s global corporate business rate is a start, but the nearly 5 trillion of wealth squirrelled into the hands of a tiny few is a recipe for disaster. This resource is urgently needed to be spent on investment on the future – and fast.

This is the most inappropriate use of resources I can think of at a time when all our resources are needed to transform our day to day lives into something very different from that we live right now and something that stands a chance of lasting.

Scraping the barrel….

Of all the crap on-line right now – and there is lots of it – comparisons of the pandemic response to Nazism continues to scrape the bottom of the barrel. Mercola has compared plans to vaccinate children to the Nazis eugenic programme and US public heath measures to the dictatorship in North Korea. It sometimes seem to me that he may be trying to provoke some sort of censorship. I wonder if it is victimhood he craves?

Perhaps he has seen the lifestyle the anti vaccine darling Wakefield lives and would like to become a hero of the anti vaccine lobby too. The worst image comes to me from the equally disgusted and skilfully thorough “Stethoscope from Rome” blog which posts this image from a Trump adoring “patriot” website whose authors clearly know about as much about history as I know about the contents of Donalds sock drawer.

Perhaps this is the epitome of freedom of speech without any obligation or responsibility for content which makes the online world so dangerous and make is so easy to insult and denigrate public health workers.

As a public health expert he has spent his life trying to prevent illness and suffering. Even is you have criticisms of him, this shows the divergence of propaganda from any sense of reality and seeks to create fear where little should exist.

Such claims are common in the anti vaccine world and paradoxically seek to hijack the pandemic to create a greater sense of er…fear and paranoia

How much has this all cost?

This is the equivalent of £21,000 per UK family, or about £6,000 for every person in the country.

The superb Good Law Project has taken risks to take the government to court when this spending has been wasteful or corrupt. They are entirely funded by donations and need support.

If the government has their way, they would examine such startling misuse of public money in a public enquiry process itself bound to cost billions and take decades. Its findings would become public long after Boris has gone back (according to his former Brexit Guru) to his inherited destiny of “making money and having fun”.

Build Back Totally Different….

With the furlough scheme being tailed off there is hope that our economy will get back to something that resembles normal. For me this is rather like someone have been successfully treated for lung cancer being able to start smoking again.

Given that we face a number of threats with the climate emergency at it apex, is seems inevitable that we will continue to need big government and big government spending, with high levels of borrowing and inevitably higher corporate and personal taxation. In other words, this is the end of free market thinking which has played such a big part in getting us into this epoch defining mess.

Are there any lessons from history? Well, its often said that this has been the biggest challenge since the war, so how did we get over that? Well in some ways we never did – residual conflicts seems to be forever lighting up as in the Ukraine, and relations between former belligerents seems as cold as ever. However, with the post war Labour Government in the UK and the Marshall Plan for Europe, we spent our way into a very different post war deal which included the establishment of the NHS, massive building of affordable homes, a welfare system to end poverty, and high levels of taxation which have become a distant memory since Thatchers time.

We also spent our way into encouraging the technology which will destroy us, and we will have to fall out love with consumerism, travel, cheap food and every aspect of our carbon hungry lives, indeed, we need to go beyond a zero carbon economy to one that sucks CO2 out of the atmosphere in addition to widespread afforestation and restorative farming. Given the scale of our Carbon Debt, that will take some doing.

If there is one thing that the pandemic has taught us, that is that we are living beings and are subject to the laws of nature, and the laws of nature are not cruel, they are simply indifferent. Like any other species, our survival is not a given. Perhaps the alternative is an eternity in space with Jeff Bezos and his crew – on second thoughts, perhaps some things are worse than death.