What does it mean that a Covid vaccine is, say, 70% effective?

Let’s start by talking about what it doesn’t mean. If a vaccine is 70% effective against a virus it doesn’t mean that 30% of the people who’ve been vaccinated will get infected. That’s an assumption that only people whose math is as bad as mine would make. The kind of people who juggle the numbers 70, 30, and 100 and come up with an answer that’s as likely looking as it is meaningless.

It turns out that the number doesn’t compare the vaccinated people who stay well to the  vaccinated people who get sick. Nay, verily, it compares the vaccinated people who get sick (or who stay well) to the unvaccinated people who get sick (or who stay well). To put that a different way (because I don’t know about you, but I’m struggling with this), it compares the risk vaccinated people run in the presence of Covid to the risk unvaccinated people run.

This matters because it leaves us with a much smaller pool of people who are vulnerable.

If you’d care to read about that with actual numbers and sensible writers, follow the link. I have a severe allergy to math and I know better than to attempt a full explanation. 

Irrelevant photo: Red clover. I’ll come back with more kitten photos soon.

 

Who gets sick with the Delta variant and can the vaccinated spread it?

In the US, 95% to 98% of the people hospitalized with Covid are unvaccinated, and 99.5% of the deaths are of the unvaccinated. Even with the Delta variant circulating, that seems to be holding true.

But some numbers have changed since the initial vaccine studies, and they have to do with what Dr. Robert Schooley, from the Department of Medicine at UC San Diego’s School of Medicine, calls “the asymptomatic shedding rate among vaccinated individuals,” which in human speech means how much of the virus is spread by vaccinated people who get infected but don’t get sick.

Or to push that one step further, how dangerous they are to the unvaccinated.

When the vaccines were tested, the Delta variant wasn’t around yet. They were dealing with a less infectious beast. On top of which, no one thought to investigate the odd sniffles and colds that people in the study cooked up. They were allergies. They were colds. They were flu. 

Remember the old days, when people caught colds? 

So the study didn’t track them.

Now, though, they’re realizing that those mild symptoms could be nearly asymptomatic Covid, and what’s known so far is that some fully vaccinated people who get infected carry enough of the virus to spread it, even though it’s not making them sick.

How do they compare with unvaccinated people as far as spreading the thing goes? The numbers aren’t in yet. I mean, they’re out there. Numbers always are. But nobody’s assembled them yet. On average, though, Schooley says the infected vaccinated person will shed less virus for a shorter time. And the odds that they’ll become infected are lower, so whatever the eventual picture turns out to be, vaccinating people does slow the spread of the disease.

 

Are the vaccines losing their effectiveness? 

As has become usual since the pandemic started, we’re not likely to find a definitive answer yet, but it does look like the number of breakthrough cases in vaccinated people is growing.

What’s a breakthrough case? A Covid case in someone who’s vaccinated. Getting one doesn’t mean you’re dead, hospitalized, or even necessarily sick. It just means you’re carrying the infection, when if the vaccines were 100% effective (very few are and no one expected these to be), you wouldn’t be. 

So if you’re fully vaccinated, it’s not time to panic yet. You can always do that later. 

Why’s this happening? The experts are still debating that, but it doesn’t look like the Delta variant is evading either the vaccines or immunity from earlier infections. 

That’s another reason to wait before you panic.

If Delta hasn’t broken through the vaccines’ protective lines, that leaves us with two possibilities. One, the vaccines’ effectiveness is fading, or two, Delta’s high transmissibility is responsible.

Several studies show what could be a waning in vaccine effectiveness, but it’s hard to know if the numbers really mean that. They could also mean that vaccinated people are taking more risks–going to bars or gyms or other Covid exchange sites–and giving themselves more chances to meet the virus.

And protection against getting so sick that you need to be hospitalized, though, is holding steady, which may mean effectiveness isn’t waning. All this will be perfectly clear in hindsight, but for now we have to make do with what we can see from where we are.

So do booster shots make sense? 

On the side of saying no are the many countries that the vaccines have barely reached. How can rich countries be talking about booster shots when initial doses are desperately needed elsewhere?

On the side of saying yes is that in people with weakened immune systems, because of either age or disease, they can make a difference, although the evidence on that is still preliminary.

 

Testing news

A new study shows that testing saliva for Covid is as reliable as testing nasal swabs. So at some point we may be able to stop puncturing our brain pans with sticks that are allegedly softened with cotton wool–or something that looks vaguely like cotton wool.

If Covid tests shift to using saliva, they won’t have to rely on patents’ willingness to make themselves uncomfortable, which will make them more reliable. And we won’t have to worry about a shortage of swabs.

If, in fact, worrying about that is one of the things that’s keeping you up at night.

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Several times now, I’ve sworn off writing about newer, faster, cheaper Covid tests because although I keep reading about them, they never seem to be adopted–at least not anywhere I read about, and certainly not where I live. But you know how it is when you swear off something multiple times: It’s a sign that you keep breaking your word. So here we go again:

A newer, faster, cheaper Covid test has been developed. And it uses the same stuff that pencil lead is made from, which isn’t lead at all, it’s graphite. It cuts the cost to $1.50 per test, takes six and a half minutes, and is 100% accurate using a saliva sample and 88% using one of those evil nasal thingies.

The system can be adapted to test for other transmissible diseases. Now all we have to do is wait and see whether we hear of it again.

Younger, sicker, quicker: does the Delta variant target young people?

An article in the New York Times considers why the Covid Delta variant is hospitalizing more young people than the beginning-of-the-alphabet variants did. The answers are still a bit iffy, since the numbers involved haven’t had the time or money to hold a convention yet, but the phrase front-line doctors are whispering to each other, at least in the US, is younger, sicker, quicker: The patients are younger and sicker and they’re deteriorating faster. Or quicker. Or more quickly. Or possibly in a greater hurry.

The article’s talking about patients in their twenties and thirties. And these aren’t people with risk factors like diabetes or obesity. What they are is unvaccinated.

Some doctors think the Delta variant is what’s making the difference. It’s suspected of causing more severe disease, although that’s still educated guesswork. See above about the numbers. It may also be hitting an age group that was thought to have a Get out of Covid Free card. But as the Times puts it, “There is no definitive data showing that the new variant is somehow worse for young adults.”

I don’t often get to correct the Times, but technically that should be “definitive data…are.” It sounds awful, but it’s right.

Irrelevant photo: a begonia

So we don’t have solid data. It could be that the high percentage of younger patients is a result of older people being vaccinated in higher numbers than younger people. Take, say, 90% of old people out of your hospital emergency rooms and your patients’ average age falls dramatically. 

It’s also possible that the numbers are a result of people mixing more just when a more contagious variant is circulating, a significant pool of people remain unvaccinated, and many people aren’t wearing masks.

However.

According to an internal Centers for Disease Control document that somehow wandered into the Times newsroom with a sign saying, “Read me,” the Delta variant is as contagious as chicken pox and “may cause more severe disease than Alpha or ancestral strains.” If that turns out to be true, it would account for those hospitalized patients who are sicker and deteriorating more quickly.

According to  Dr. Catherine O’Neal, of Our Lady of the Lake Regional Medical Center in Baton Rouge, “Something about this virus is different in this age group. We always saw some people who we just said, ‘Why the heck did this get them?’ But that was rare. Now we’re seeing it more commonly.

“I think it is a new Covid.”

Dr. Cam Patterson, chancellor of the University of Arkansas for Medical Sciences, said, “Our sense is that younger, healthier people are more susceptible to the Delta variant than those that were circulating earlier. . . .

“The transition we saw toward younger patients and toward people getting sick more quickly coincided almost precisely with the emergence of Delta here in Arkansas. This to us feels like an entirely different disease.”

 

Meanwhile back in Downing Street 

Boris Johnson, Britain’s alleged prime minister, was exposed to Covid last week. Or else he wasn’t exposed. Either way, he’s not going to go into isolation because, basically, he doesn’t want to. He went into isolation before (under protest) and he’s bored with it.

Besides, what’s the point of being the prime minister if you have to follow the same rules as everyone else?

The exposure happened when one of his aides tested positive on a political visit to Scotland. The aide dutifully went into isolation. A Downing Street spokesperson informed us, with a straight face, that he and Johnson weren’t in close contact. Yes, they were in a plane together, but Johnson didn’t inhale. And neither did anyone else on the plane.

The rules on isolation are set to change on August 16. After that, vaccinated people will be exempt. Before Johnson was exposed himself, he’d resisted calls to move the date forward, saying it was important that everyone follow the rules.

Unless they happen to be him. 

 

Vaccine news

Of the 100 Covid vaccines now in development, 7 of them are nasal sprays, and nasal sprays have advantages and disadvantages.

On the plus side, they act more quickly and if you’re twitchy about needles they won’t make you twitch. Since Covid tends to enter the body through the nose, nasal sprays deliver the vaccine to the site of the infection. They act faster than injected vaccines. And “ they can elicit mucosal immunity in the lungs.”

You might want to notice that, for fear of screwing it up, I’m not rewording that. I think I understand it but I don’t want to find out I’m wrong. You’re on your own.

On the down side, the immunity created by nasal spray vaccines doesn’t last as long. And they use live viruses that have had the hell kicked out of them so that they won’t make most people sick, but with a very, very few they will.

Using both forms of vaccine isn’t out of the question–one for its fast action, the other for its long life.

One trial gave infected animals the AstraZeneca vaccine as a nasal spray, and it decreased their viral load, which doesn’t prove–but does suggest–that it decreases the amount of virus they shed.

To translate that, they might be less likely to infect anyone else. 

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Let’s end on a hopeful note. Scientists are working on a vaccine that targets a huge category of coronaviruses known for jumping from animals to humans. They’re called sarbecoviruses, and Covid’s one of them. The idea is that this would work not just against whatever variant Covid can cook up but against whatever coronavirus the world might throw at us next. 

So far, the vaccine’s been effective in mice. The hope is that after more animal testing it’ll be tried in humans next year.

By the numbers: how to help Covid outrun the vaccines

In Europe, a group of experts who model disease spread plugged as assortment of variables into their computers–things like vaccination, transmission, and mutation rates–and asked about the odds, under various conditions, of the virus mutating into something that would escape the vaccines.

It turns out that that highest risk comes when a large proportion of the population has been vaccinated but when it’s still not a high enough proportion to create herd immunity. In other words, exactly the situation in Europe right now. And in the US. 

Britain has a higher percentage of vaccinated adults, but I think I could safely add “and Britain” to that paragraph.

This sounds counter-intuitive, but when a large proportion of the population’s been vaccinated, a vaccine-resistant strain of the virus will have an advantage. So what countries need to do at that stage is control the spread.

Irrelevant photo: The north Cornish coast

“Of course we hope that vaccine-resistance does not evolve over the course of this pandemic, but we urge caution,” one of the study’s co-authors said. “Evolution is a very powerful force and maintaining some reasonable precautions throughout the whole vaccination period may actually be a good tool to control this evolution.”

I mention that just in case anybody’s listening. In Britain, they’re  not. Masks are now optional in most situations, although many people are still wearing them. (Thanks, folks. You’re wonderful.) Nightclubs are reopening. (Thanks, Boris. You’re a fool.) Vaccinated people wearing blue, who say please and thank you, and who come into the country from Covid-safe countries or from countries that might or might not be Covid-safe no longer have to go into isolation, never mind quarantine. 

Why? Because the government’s thrown up its hands and said, “This is making us confused and we’re not going to bother anymore.”

So yes, we’re being perfectly sensible here. Wish us luck.

Thank you.

 

Breakthrough infections and the Delta variant

When vaccinated people get infected with the Delta variant, as some small percentage of them will inevitably, they’re very likely to get mild or asymptomatic cases of Covid, but that doesn’t tell us whether they’ll be as infectious as an unvaccinated person who gets infected. 

Stop the presses, though. For the first time, we have a gesture toward a move in the direction of an answer: They will have as high a viral load as an unvaccinated person. That seems to mean that they’re every bit as likely to transmit the virus, although no one seems willing to say that without a plugging in some sort of word that creates wiggle room in the sentence.. 

As the US Centers for Disease Control director put it, they “have the potential to spread the virus to others.”

That’s a large part of the reason that the CDC reversed its throw-away-your-mask-if-you’re-vaccinated policy and now recommends masks for all students, teachers, visitors, and school staff when they’re indoors. And all includes people who’ve been vaccinated. 

The CDC also recommends masks in indoor public places in parts of the country that have had at least 50 new cases per 100,000 people in the last week. That’s something like 60% of the counties in the US. 

And it says that vaccinated people should be tested for Covid after they come into contact with an infected person. Even if they don’t develop symptoms. 

In a couple of months, we may get definitive news on just how infectious fully vaccinated people who have mild or symptomless Covid are. In the meantime, we’ll have to go with seems and as high a viral load. Common sense might indicate caution.

 

Covid and public policy

A paper from the Commission for Pandemic Research of the Deutsche Forschungsgemeinschaft–a group whose name is almost as long as the paper itself–makes a heroic effort to talk sense to people (and more to the point, governments) who are still recommending hand washing to combat the spread of Covid. 

Okay, that interpretation is strictly my own. What the article I stole this information from says is that they “aim to contribute to establishing a reliable information base that is broadly coordinated among specialists as well as offering concrete advice on how to guard against infection.” 

So to be objective and reliable and not at all snarky about this, they’re aiming to contribute to establishing a coordinated effort to offer the world an extended string of verbs with the intervention of a few nouns. And they’re damn good at it. 

The article’s headline is an even better source of fun: “Prevention of coronavirus infection spread through aerosols.” I spent an unconscionable amount of time wondering how to spread the prevention of infection before I worked out that prevention isn’t being spread; spread has taken a part-time job as a noun.

To be fair, the committee with the long name probably didn’t write the headline.

Are you following any of this? I’ll get to the information any minute now.

For all its oddity, the headline doesn’t approach the genius of a newspaper headline published during the Falklands War that said, “British left waffles on Falkland Islands.” I had a carton of maple syrup all packed up and ready to send to the Falklands before I realized that left was the noun (political leftists, presumably in Parliament) and waffles the verb. 

Maybe this is only funny if you’ve worked as an editor.

But to go back to our article: It breaks infections into two categories, direct and indirect. 

Direct infection happens when one generous soul is close to someone else and passes the virus on to them. That usually happens indoors. 

Indirect infection happens when infectious aerosols accumulate indoors. The first person–the one with the virus–doesn’t have to stay in the room to make sure the second person breathes the germs in. If they’ve spent time in the room, exhaling, when they leave, unless the room’s well ventilated, their germs will not follow them out.They’ll stay there, available for the second person to inhale and take home.

And all of this is free. Just imagine! No one has to pay a red cent for it.

Indirect infections are what make it pretty much pointless when people put on their masks only when another person comes into the room, the shop, the wherever. They’ve been in there breathing. They can’t unbreathe those aerosols. 

Indirect infection is somewhere between hard and impossible to accomplish outdoors, although direct infection is possible if the people are in close enough contact for a longish time. So if you’re spending time in a bus shelter, at a demonstration, at a football game, or in a brawl, you might want to wear a mask, even though you’re outdoors. And you might want to ask the people you’re brawling with to also wear masks. 

In closed rooms, though, they (that’s the experts, not the people in the brawl) suggest using–well, pretty much every breath-related protective measure you can think of: avoiding contact, keeping a distance, wearing masks, using protective panels, and ventilating the hell out of the room.

Yes, “ventilating the hell out of” is a thoroughly scientific term. It means opening windows and using permanent ventilation systems as well as mobile air purifiers.  

“Only regulations that are as consistent and uniform as possible guarantee a high level of safety with as few restrictions as possible,” the article says, paraphrasing the experts, something that becomes necessary when the nouns and verbs grow exhausted from holding down two jobs. 

I’d love to think that the world’s governments will get their heads around the idea that consistent regulation is the way to live (relatively) safely with Covid, and that ventilation and masks are essential parts of that. But then I’d love to think all kinds of things, including that our problematic species will still be around in, oh, say seven generations, and that it will have gained some wisdom. Those aren’t impossible, but I’m unable at this time to issue the money-back guarantee that we inadvertently advertised. 

Can fermented soybeans destroy Covid?

It’s too early to celebrate this, but from Japan comes the news that an extract made from natto–a sticky food involving fermented soybeans–inactivates Covid’s spike protein by digesting the receptor binding domain.

What’s a receptor binding domain? No idea, but Covid’s spike protein needs it, so anything that digests it has got to be good–at least from our point of view.

The extract of natto works on all the existing variants.

The reason it’s not time to celebrate is that so far it’s only worked in a lab. No one’s gotten the natto and the virus together inside the body. Eating natto won’t help. Neither will sending the virus invitations to a party and serving natto hor d’oeuvres. No matter how much it mutates, the virus will continue to be illiterate, so it won’t show up.

Irrelevant photo: a wild orchid.

The next stage is to isolate the molecular mechanism that’s destroying the–what was that called?–the receptor binding domain. Figure that out and you could well have a treatment for Covid. 

Possibly. At some time in the indistinct future. But c’mon, we need all the hope we can find.

 

England’s world-beating experiment in irresponsible government

On July 19, England took what little common sense it had forgotten in the drawers of 10 Downing Street’s desks and set it on fire. It’s been dry lately, but there wasn’t enough common sense to burn for long, so we didn’t get the second Great Fire of London, just another round of Covid stupidity.

To be clearer about this, nightclubs are now open. So are bars, restaurants, and pretty much everything else you can think of. It’s up to you whether to throw your mask away and sit nose to nose, indoors, and sing loudly with six of your favorite strangers and no ventilation. Or with thirty of them if you can get your noses close enough. Crowd limits are out of fashion, along with distancing. 

The first day of that was called Freedom Day. Those of us currently cowering under the covers are free to cower under the covers. Unless of course we have to go to work or in other ways mix with the rest of humanity.

The official justification for this is that vaccination has severed the link between infection and hospitalization. Or weakened it, depending on when you listen to the explanations and who gives it. We have to return to normal life. We have to live with Covid. The economy needs us. And if not now, when? 

Maybe when it’s safe, that’s when. Because the link between infection and hospitalization hasn’t been severed, it’s only been weakened, and that’s not enough. The number of infections is going up, and so is the number of deaths. Not as sharply as it once would have, but more than it would if we kept to a marginally sensible policy.

And the thing about deaths is that once people are dead, they’re gone. It’s kind of irreversible.

The government’s Scientific Advisory Group warns that the combination of a large number of vaccinated people and a high number of infections creates the perfect conditions to create a variant that will escape the vaccines. No one can know whether that will happen–vaccines mutate randomly–but the likelihood increases as the number of infections increases.

And while all this is shoving us in one direction, Boris Johnson says vaccine passports will be required for nightclubs etc.–but not until the end of September. Between now and then, let Covid rip.

What are they thinking? One of the government’s scientific advisors, Robert West, says it’s “a decision by the government to get as many people infected as possible as quickly as possible, while using rhetoric about caution as a way of putting the blame on the public for the consequences.” 

That wave of infections would combine with the number of vaccinated people to push the country toward herd immunity and the virus would no longer spread.

What are the problems with the strategy? Well, in addition to opening the doors to a variant that evades the vaccines, no one knows what level of immunity is needed for herd immunity to Covid. The best guess is 85%. And then there’s long Covid–the long-term damage that some people live with for no one knows how long, after even asymptomatic infections. 

The government says that’s not its strategy. You’re welcome to believe it if you like. 

And a unicorn just pranced down the street outside my window. You’re welcome to believe that as well. It was wearing a tutu and singing a Mozart aria.

Not long ago, the Netherlands opened everything up and Covid infections rose sevenfold. They’ve since closed bars, restaurants, and nightclubs.

England’s reopening has caused the Covid tracing app to warn an annoying number of people that they’ve been exposed to Covid and should self-isolate–more than 600,000 last week–and that in turn has led to a lot of people being off work.

So what’s a responsible government to do about that? 

We don’t have one of those, so who cares? Instead of deciding that too many people are being exposed to Covid because we took all our restrictions out and burned them, the government’s decided that too many people are being notified, so it’s created a list of crucial occupations whose employees can ignore the app if they’re double vaccinated–although they will at least have to test themselves. 

Can people who are doubly vaccinated spread Covid? Why look! It must be time to talk about breakthrough infections! Because buried in that segment somewhere is the news that we don’t have a clear answer to that question yet.

 

Breakthrough infections

First we need a definition of a breakthrough infection, even if you already know it: A breakthrough infection happens when a vaccinated person gets Covid–or (it can happen with any matched pair of disease and vaccination) whatever else they were vaccinated against. When that happens, it doesn’t mean the vaccine isn’t effective. It means the vaccine isn’t 100% effective, much as we wish the Covid ones were. 

That leaves us–or me anyway–wondering why one person will get a breakthrough infection and another won’t. The definitive answer is that it’s hard to say.

Thanks, Ellen. That was really helpful.

Sorry, but I can only pass on what I find. The direct quote is, “It’s difficult to determine why any particular breakthrough case happens.” 

How large a dose of the virus you’re exposed to might make a difference–with the emphasis on might. Our individual immune systems will make a difference. They can be affected by health problems and by medications that make an immune system respond to the vaccine less enthusiastically.

And new variants can make a difference. The vaccines were developed for the Covid 1.0, or 2.0. We’re now onto–

Hang on a minute. I have to go look up the Greek alphabet and figure out where Delta comes. 

We’re now at Covid 4.0.

It’s also possible for a person to have gotten a vaccine dose that wasn’t administered correctly, although that’s a lot less likely. And no, I’m not sure how you administer a vaccine the wrong way either. Maybe you let the stuff get too warm. Maybe you let it expire. Maybe you miss the arm entirely and inject it into the hat. That last one is the reason they don’t let me do vaccinations anymore.

People who are (fortunately) better than I am at figuring this stuff out are tracking the number of breakthrough infections, looking for evidence that the vaccines’ are wearing thin and booster shots are needed. So far, they haven’t seen it. 

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We can break breakthrough infections into a few categories, and in order of decreasing likelihood they are: 1, testing positive, 2, having a mild infection, 3, having a serious infection, and 4, dying.

Patients are strongly advised to keep themselves out of category 4. 

If you’ve absorbed that advice–and it is important–we’ll move on to the question of whether fully vaccinated people who’ve been exposed to the virus should have to go into isolation. In the US, the Centers for Disease Control (citing “limited evidence” according to the article I found) says they not only don’t need to go into isolation, they don’t need to get tested unless they develop symptoms. The theory is that they’re less likely to infect other people than unvaccinated people with asymptomatic infections.

Other countries are making different rules.The evidence is limited, the lights are off, and we’re all bumping into the furniture. 

What percentage of fully vaccinated people test positive after being exposed to Covid? If anyone has numbers on that, I haven’t found them.

What does seem to be well established is that breakthrough infections are rare, and we do have statistics (sort of) for categories 3 and 4–the one you want to stay out of and the other one you want to stay out of. In the US, 5,492 vaccinated people were either hospitalized or died and also tested positive for coronavirus. That doesn’t exactly say they were hospitalized for or died of Covid, but it’s as close as we’re going to get. That’s 5,492 out of the 159 million people who’ve been fully vaccinated. I’ll leave someone else to figure out what percent that is and just say it’s small.

Most breakthrough infections are mild, and the number of mild or asymptomatic infections will be larger, but again if numbers are available for that I haven’t found them.

 

A different way to live with Covid

Is it possible to return to normal life in some sane and safe way? A study from Barcelona points us toward a possibility. It followed the 5,000 people who attended a carefully controlled indoor concert. 

People were screened on the way into the concert, using an antigen-detecting rapid diagnostic test (it’s called an Ag-RDT if you want to sound like you know what you’re talking about), and the test was done by nurses. At least with other rapid Covid tests, that makes it more reliable than when people do it themselves, probably because they maneuver those nasty swabs into the right spots.

Everyone wore masks–specifically, filtering facepiece 2 masks–the whole time. Presumably over their noses and mouths, not their chins or back pockets. They look like this.  (I’m conducting a one-person boycott of Amazon, but I’m not above using them as a link if I don’t have to give them money.) They’re a kind of mask that offers more protection than your average cloth mask, but they’re disposable, which if everyone used them everywhere would create its own set of problems. Especially since a few of us out there hate throwing things away when they still look usable. 

But enough of that. Let’s move on.

The event’s described as a concert but people danced. People sang (presumably along with the music but it shouldn’t really matter from a medical point of view.) No one was asked to keep 6 feet away from anyone, at least by the organizers, although some predictable number of individuals will have told some predictable other number of individuals to back off. 

I don’t have details on the ventilation except for a passing mention of improved ventilation. Ventilation’s probably the most overlooked way to make work and public spaces safe. 

The event was held in an area that at the time had a moderate rate of Covid and a low number of vaccinated people. 

What happened? The followup found 6 cases of Covid two weeks after the event. Three of those were traced to sources other than the concert. Another person may have been in the incubation stage when she attended the event and could’ve been missed by the test. No one’s figured out where the other two cases came from. 

Which isn’t bad for 5,000 people. So it can be done if we have the will to do it.

 

. . . and in the schools

In the US, the American Academy of Pediatrics is calling for all students, teachers, and staff to wear masks in school, whether they’ve been vaccinated or not. That runs counter to Centers for Disease Control advice, which exempts the vaccinated and says the unvaccinated should wear masks in school to protect themselves.

Even though–apologies, CDC–your average mask is better at protecting people around the wearer than at protecting the person sporting one.

The article I got this from has the first statistics I’ve seen on how many kids get multi-system inflammatory condition (called MIS-C, in case you have any need to address it directly): It’s 1 out of every 600 infected children and teenagers. That’s not the same as 1 out of every 600 kids, only out of the ones who get infected.

MIS-C is seriously serious and more often than not will land a kid in intensive care. It comes several weeks after the primary infection.

Has anything like long Covid happened before?

Well, yes or I wouldn’t ask the question. Let’s start with the Russian flu, which ran from 1889 to 1892, and its after effects.

 

The Russian flu

Geographical names for pandemics have gone out of fashion, since they’re generally wrong and lead people to blame entire countries for things they suffered from themselves, but the Russian flu was at least first spotted in Russia and to date no one seems to have gotten around to renaming it. So, Russian flu it is. 

Извините, Россия.

That doesn’t make the name correct, though. The Russian flu might not have been a flu at all but a coronavirus. And just to confuse the issue a bit more, the flu was also called the grippe at the time. That becomes relevant in a few paragraphs.

Whatever we call it, the Russian flu seems to have been highly infectious. Half the population of St. Petersburg got it, and it (that’s the disease, not half the population of St. Petersburg) moved across Europe, arriving eventually in Britain. Not because it had been watching Downton Abby and wanted to tour the great houses. Diseases don’t have destinations or intentions or TV sets, and Britain wasn’t its final destination anyway, just a stopover. I give Britain special mention because it’s what I allegedly write about here, although the pandemic’s led me off in other, less predictable directions. 

The Russian flu is now considered the first modern pandemic (no, we’re not going to stop and define that), spreading worldwide along the paths so helpfully laid out by train lines, roads, navigable rivers, and steamships, and demonstrating that it was spread by human contact and by the wonderful ways that humans could now travel.

The Black Death was green with envy. 

Irrelevant photo: roses

In a nifty preview of what would happen with Covid, public health officials in the US watched the virus cross Europe and played it down. It was a particularly mild strain of flu, they said. And when it inevitably disembarked, without passport or visa, on American soil, they swore the first cases were either common colds or just a seasonal flu. 

Nothing to worry about, folks. It’s all under control.

The New York Evening World wrote, “It is not deadly, not even necessarily dangerous. . . . But it will afford a grand opportunity for the dealers to work off their surplus of bandanas.” 

Yeah, I’m having flashbacks to the beginning of the Covid pandemic myself.

This wasn’t a mild disease. Worldwide, an estimated 1 million people died. A survivor said, “I felt as if I had been beaten with clubs for about an hour and then plunged into a bath of ice. My teeth chattered like castanets, and I consider myself lucky now to have gotten off with a whole tongue.”

It also had serious after effects and some uncounted but substantial number of people had them. More than three months after having been ill, the English women’s rights campaigner Josephine Butler wrote, “I am so weak that if I read or write for half an hour I become so tired and faint that I have to lie down.” 

If exhaustion wasn’t bad enough, some people had the added insult of insomnia. 

A Victorian doctor, Morell Mackenzie, said the flu seemed to, “run up and down the nervous keyboard stirring up disorder and pain in different parts of the body with what almost seems malicious caprice.” 

That sounds like he’s describing the flu itself, not the after effects, but the Lancet, which is a medical journal and can be assumed to know what it’s talking about, put that quote and the next one inside a discussion of the after effects. 

Another doctor, Julius Althaus, wrote, “There are few disorders or diseases of the nervous system which are not liable to occur as consequences of grip”.

The collection of symptoms went by an assortment of names: neuralgia, neurasthenia, neuritis, nerve exhaustion, grippe catalepsy, post-grippal numbness, psychoses, prostration, inertia, anxiety, and paranoia. The range on offer backs up my theory that when you can’t cure a disease it helps to change its name from time to time. 

We’d be on shaky ground if we tried to sort the after effects of the Russian flu from–well, everything else that might’ve been available, including psychosomatic problems, tight corsets, and zombies, but observers in the mid-1890s blamed it for everything from a high suicide rate to general malaise. According to the Lancet article, the image of England at the time was “of a nation of convalescents, too debilitated to work or return to daily routines.” 

I would have assumed that the description applied only to the upper class, who could afford not to return to work or daily routines, but what happened in Tanzania (called Tanganyika at the time) shows that I’d be underestimating what post-viral syndromes can do to a person.

 

The 1918 flu

Let’s back up briefly. 

The 1918 flu epidemic used to be called the Spanish flu and sometimes still is. It didn’t originate in Spain, it’s just that Spain put up the first Instagram post. But it was at least genuinely influenza.

How serious was it? Worldwide, at least 50 million people died. About half a billion people—that was a third of the world’s population–were infected. So no, this is not the pandemic you’d want to challenge to a wrestling match. 

Like the Russian flu, its after effects were fierce. They included apathy, depression, tremors, restlessness, and sleeplessness. 

A New Zealand book collecting people’s experiences includes references to “loss of muscular energy” and “nervous complications.” Along similar lines, a South African collection includes this: “We were leaden-footed for weeks, to the point where each step meant a determined effort. . . . It also was very difficult to remember any simple thing, even for five minutes.”

But they got off lightly compared to people in Tanzania, where the flu was followed by a wave of exhaustion so severe that in some parts of the country people couldn’t plant when the rains came and in others couldn’t harvest when the crops were ripe. The result was a two-year famine, called the famine of corms, named after a part of the banana plant that people ate in desperation. 

One strand of post-epidemic symptoms was called encephalitis lethargica–EL for short–or sleepy sickness. It left people not fully asleep but not what you’d call awake either. They were aware of their surroundings but not functioning in anything like a normal way. 

Worldwide, an estimated 500,000 people had EL. A third died, a third recovered, and in the final third the symptoms went on.

Unborn children were also affected. A 2009 study looked at people who, based on when they were born, could have been exposed to in the womb to the 1918 flu. Compared to people born either slightly before or slightly after them, they were 25% more likely to have heart disease after the age of 60. They were more likely to have diabetes. They were, on average, shorter. They had less education and their “economic productivity” was lower. I think that means they made less money. I can’t think how else anyone would measure it. 

 

What does that mean for the Covid pandemic?

No one knows yet how many people have long Covid, which is of several names for Covid’s after effects. No one knows how many people will recover and how many will carry at least some of the effects with them through life. 

No one has a clue what the effects will be on children born during or just after the pandemic, or if there’ll be any, and I’d be surprised if many people are worrying about that yet. They’re kind of busy with more immediate problems.

No one’s even agreed on a definition of long Covid.

It is known that people who have mild or even asymptomatic cases can get long Covid, and that children can. 

It is, as one researcher put it, “One of the reasons I worry so much for people with long-Covid is the . . . uncharted aspect of it. . . . It’s one of the reasons why I do worry when I see people being laissez faire, saying ‘Well, if we’ve got [to] the stage where people aren’t dying, and aren’t filling up the intensive care units, do we need to care?’ And the answer is, I think, until we’ve got more data, we don’t know how much we need to care.

 

A recent study identified 203 symptoms in 10 organ systems. After seven months, many people in the study still hadn’t gotten back to their earlier levels of functioning. When the study was conducted, 45% had to work a reduced schedule and 22% weren’t able to work at all. 

And in a peripherally related seam of worries, a study has called attention to the estimated 1.5 million children around the world who’ve lost a parent or a grandparent who was either raising them or lived with them. It’s an overlooked side effect of the pandemic.

We don’t need zombies, folks. This is scary enough.

Are the fully vaccinated likely to get long Covid?

A bit of scientific brooding over Covid’s statistical tea leaves tells us that the chances of getting long Covid if you’re fully vaccinated are probably small. 

But with the emphasis on probably.

Was anyone other than me worried? After all, the statistics tell us that a vaccinated person who does catch Covid will probably have a mild case. Unfortunately, though, mild cases fairly often leave people with long Covid. 

So far, the information that’s coming in is anecdotal, and the experts say that it’s too early to be certain. In six months, it’s possible that a significant number of vaccinated people will start showing up with long Covid. It’s also possible that they won’t. 

So stay tuned. That’s not the reassurance I was hoping for but it’s the best we’ve got. 

Irrelevant photo: traveler’s joy

 

Do young people have Get out of Covid Free cards?

By now, we all know that young people are unlikely to get seriously frightening cases of Covid, at least when compared with old coots. 

But that doesn’t mean they’re immune. Like anyone else, they’re liable to come down with long Covid even after a mild case of the virus, and the small number who are sick enough to be hospitalized are almost as likely to have organ damage as the old coots are–almost 4 out of 10 of them. 

The message here is that Covid is not the flu. And that young people don’t have a free pass on this.

Young, by the way, is defined as anywhere between 19 and 50. Which from where I stand looks younger all the time. 

 

Taking quarantine seriously

Australia and China have decided that the new Covid variants are too contagious for hotel quarantine to be safe. They’re planning special quarantine centers

Compare that with the way Britain’s treated quarantine, which ranges on the strict end from hotel quarantine after sharing air with passengers who won’t be quarantining to, on the loose end, go home and look in the other direction when you pass other people on your way there.

 

The Covid news from Britain

Over twelve hundred scientists from around the world have signed a letter objecting to Boris Johnson’s policy of lifting all Covid restrictions on July 19. It will, they say, help spread the Delta variant around the world.

As professor Christina Pagel put it, “Because of our position as a global travel hub, any variant that becomes dominant in the UK will likely spread to the rest of the world. . . . UK policy doesn’t just affect us–it affects everybody. . . .

“What I’m most worried about is the potential for a new variant to emerge this summer. When you have incredibly high levels of Covid, which we have now in England–and it’s not going to go away any time soon–and a partially vaccinated population, any mutation that can infect vaccinated people better has a big selection advantage and can spread.”

Some of the experts described the policy as “murderous” and “herd immunity by mass infection.” The words unscientific and unethical also came up. If you pay careful attention, you’ll come away with the impression that they’re pretty pissed off. Not to mention scared. 

In the meantime, the number of people hospitalized with Covid in Britain is doubling about every three weeks and could reach what England’s chief medical officer, Chris Whitty, called “quite scary numbers.” Soon.

The government’s been telling us that vaccination has uncoupled the train car of hospitalizations from the accelerating engine of Covid cases. The problem is that they watched too many westerns when they were young, and uncoupling the cars from a runaway engine solved any problem involving railroads. 

Unfortunately, this is a pandemic, not a train. Or a western.

More cautious voices say they’ve weakened the link between Covid cases and hospitalization, but not uncoupled it. 

On Friday of last week, we had 50,000 cases, which is the highest  number since January. And 49 Covid deaths. 

Office for National Statistics data suggests that 1 in 95 people in England had Covid last week. I’m not sure why it only suggests that, but I’ve learned not to mess with the wording of things I don’t understand. 

The health secretary, Sajid Javid, is one of those new cases. He just came down with Covid. After having visited a care home earlier in the week–a visit that I’d guess was more pr and photo op than anything necessary. 

He’s fully vaccinated and says his symptoms are mild. He’s now self-isolating. No word on how things are going at the care home.

 

So what about Britain’s world-beating Covid tracing app?

Well, it’s been pinging a lot of people and telling them they’ve been exposed to Covid. That means they should self-isolate. Which means they should miss work. Which means the places they work, a lot fo which are already short on staff, are shorter on staff.

Which means no one’s in a good mood.

There was talk–quite definite-sounding talk–about dialing down the app’s sensitivity. People were uninstallling it, the government said, so as not to be bothered by its nagging. It was too sensitive, they said. The number of people pinged had grown by almost 50% in a week, to over 500,000. Transportation, trash collection, and health care were being affected, along with meat processing and car manufacturing. 

Then there was talk about not dialing down its sensitivity. It wasn’t too sensitive. The number of cases had grown, so of course the number of people exposed to Covid had grown right along with it.

So, the government mumbled to itself, what if we say that people who’ve had both their vaccinations are exempt from having to isolate themselves? They’ll get pinged, but they’ll be able to work? 

Last I heard, it hadn’t answered the question and was still mumbling. In other words, it’s taken the worst elements of both choices: It’s changed nothing but called the usefulness of the app into question and by saying lots of people are uninstalling it, it’s encouraged people to uninstall it. 

Why England’s ditching the face mask

England’s preparing to declare a half-assed victory over Covid (“We have to live with it”) and celebrate with a nationwide germfest. Starting on July 19–or yesterday, if you want to be the first kid on the block–masks will be voluntary. Social distancing will be a memory. Getting drunk and hugging strangers will be an Olympic sport.

No, sorry. England doesn’t get to decide on Olympic sports. I got carried away.

If you want to gather a few thousand of your closest friends in a closet for snacks and drinkies, you’re free to. Sporting events will be back. If you’ve been working from home, you can go back to the office. 

Cases, our alleged prime minister Boris Johnson predicted, will rise to 50,000 a day and “we must reconcile ourselves, sadly, to more deaths from Covid.” But as long as we slip the word sadly in there, who gives a damn? I mean, these are people who’d die sooner or later, wouldn’t they? Of something.

Irrelevant photo: The Cornish coast

What they’re counting on is that vaccination has–in the phrase that’s being used so often that it’s started sticking to the walls–weakened the link between infection and hospitalization. Or sometimes the phrase is broken the link.

Broken it ain’t, and although the link’s weaker, the number of Covid hospitalizations has risen.

The main regulation that’s left is that you have to self-isolate if you’ve been exposed to the virus. Unless you’re fully vaccinated, in which case you get to collect £200 pounds in Monopoly money and start the game again.

A lot of this is about the economy, although how face masks damage the economy is beyond me and in the long run I expect all this will do more damage than good. The rhetoric on it is particularly brainless. You’re welcome to keep wearing masks, but it’s now a personal choice. Johnson said that we need to “move away from legal restrictions and allow people to make their own informed decisions about how to manage the virus.”

The next logical step is to let people make their own informed decisions on drunk driving. They’re in charge of a heavy chunk of machinery that can kill or maim someone. Other people’s lives are in their inebriated hands. But hey, it’s not for the government to tell them what to do.

Long live the extreme edge of libertarian logic.

 

Do masks actually make a difference?

Well, a study compared counties in Kansas that had face mask mandates with those that didn’t. Mask mandates reduced Covid cases, hospitalizations, and fatalities by 60%.

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And since we’re talking about masks, a new Covid test has been developed that takes the form of a facemask. You wear it for 90 minutes and it either detects Covid or doesn’t, with the same accuracy as the PCR test–those slow, lab-based tests that are the gold standard for Covid testing. 

The team that invented it is looking for a manufacturing partner to mass produce it.

I see articles about new, fast, accurate Covid tests fairly regularly, and for a while I was mentioning them here. But after that, I’d hear nothing more about them and I kind of gave up on the topic. This one, however, has the potential to be tweaked so it detects all sorts of pathogens and toxins. I thought it might be worth a mention.

 

What about wind instruments and Covid?

It turns out that blowing through wind instrument generates fewer aerosols than either singing or talking. In fact, it’s no more than a person generates by breathing.

The amount of aerosols that singers and speakers generate rises with their volume. That holds true for both amateur and professional singers, regardless of their vocal training, their lack of vocal training, and how good or bad they sound. You run as much risk listening to a terrible singer as a good one, and get less back for it.

 

And what did you do with your time in lockdown?

A civil engineer set a new Guinness world record for the tallest stack of M&Ms. It took him hours, but it was raining, he was in lockdown, and he eventually managed to balance five on top of each other.

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On the other hand, a six-year-old, Apollo Premadasa, wrote a string quartet, “Pandemia,”  and at the height of the pandemic emailed a London hospital to tell them about it. 

“I wrote this piece to say thank you to all the doctors, nurses and scientists around in the UK and around the world for all their hard work during the pandemic,” he said. “It’s been a really hard time for them and they have all been heroes.”

He plays the trombone, cello, and timpani, and he composes music. And in case you’ve forgotten, he’s six years old. 

To celebrate the National Health Service’s 73rd birthday, it was performed at the hospital

How kids learned to fake positive Covid tests–and why

TikTok videos have taught kids that they can get out of school by faking positive Covid tests. All they have to do is pour lemon juice or Coke on them. Or apple sauce, or vinegar, or hand sanitiser, or assorted other acidic liquids. Or they can rub a kiwi across them.

And here I thought TikTok was about dancing.

In Britain, at least, if they do that it means other kids in their imaginary school bubbles get sent home for ten days along with them. And their families have to stay home. But hey, if you’ve got a math test coming up–

It’s a short-term strategy, because in Britain a positive lateral flow test has to be followed up with a PCR test, which you can’t take home and use as a stir-stick for your Coke. Still, it’s a strange enough story to earn its word count here.

Irrelevant photo: Another wildflower I can’t identify. [It’s an elderflower. Thanks to DinahMow for identifying it. Somewhere in this strange thing I call my brain, I knew that.]

A spokesperson for the National Education Union suggested that Covid tests be taken in school. But that wasn’t about lemon juice and Coke. Many kids have simply stopped using the ones they’re sent home with. 

A determined spoilsport, it turns out, can override a faked positive. You can pursue that one on your own if you’re interested. The link is here.

But the story doesn’t end there. A claim’s making the rounds that lateral flow tests are useless because if you test a glass or Coke and a kiwi it will register as having Covid. And since any reasonable person knows Coke and kiwis are immune, there must be something wrong with the tests.

Shout, “Conspiracy,” here if you would.

Thank you.

A fact-checking site called, factually enough, Fact Check points to the directions from one test, which say, “This kit has been evaluated for use with human specimen material only.” This goes to the root of the problem, which is that neither the kiwi nor the Coke is human.

You can shout, “Conspiracy,” again if you want, but I won’t orchestrate it this time. I don’t think it takes a conspiracy to prove that claim. 

Alexander Edwards, associate professor in Biomedical Technology and professional spoilsport, puts it another way: “If you completely ignore the manufacturer’s instructions or in fact use the test for something completely different, then you shouldn’t really be surprised if you get a silly result.” 

 

At last: a way that Covid doesn’t spread

A study of Covid samples from hospital surfaces found that they weren’t likely to infect anyone. That lends support to the belief that contaminated surfaces aren’t a major way to spread Covid. I’d love to explain that to you in more depth but the explanation went over my head. You’ll have to follow the link and see where your head is in relation to the information.

Even without understanding the explanation, though, it reassured  me to know that the damn virus has found a way not to spread. 

 

High fashion in the Covid era

With British kids back in school (when they can’t talk their parents into parting with a lemon) and Covid restrictions easing (in spite of a more aggressive form of the virus), colds are coming back into fashion. 

I’m not basing this on personal experience. I haven’t seen anyone with a cold in a year and a half, but then I’ve never been in the front ranks of fashion. When a style starts making sense to me, that’s a signal that it’s on its way out. But I read this in multiple publications, and those of you who care about trends need to go out and get yourselves a cold. 

Parents haven’t quite caught onto this, so they’re dragging their kids into Britain’s A&E departments. (A&E stands for accident and emergency and it’s the equivalent of US emergency room.) They–that’s the panicky parents–have forgotten what it is to have a kid with a fever, a cough, and a runny nose. 

In fairness to everyone, those are also Covid symptoms and I might panic myself.

Britain’s hospitals are already overwhelmed and have been for the past year and a half. Or for the past decade or so–ever since the government started cutting funds and saying, cheerily, “We’ve never given the NHS so much money.” So they’re not in shape to add kids with minor problems to the major-problem mix. Last month, fewer than 1% of children under 15 who went to A&E needed immediate attention and more than 72% weren’t seriously ill.

And 4.36% asked their parents if they couldn’t get a Coke from the vending machine, please.

The US is also seeing a rise in the number of colds as face masks come off. 

 

A petri dish for the world

The British government’s gone sports mad lately. We’re in the midst of the Euro tournament where they play–oh, I don’t know. Some damn thing involving a ball. The game’s not the point; the crowds are, because fans travel here and there to watch the games. They eat out. They drink. For all I know, they get happy and hug.

Then they go home, and so does Covid.

In Scotland, nearly 2,000 cases have now been linked to people gathering in public fanzones, pubs, and house parties to watch the games–not to mention stadiums. Some two-thirds of those are among the 1,300 people who went to London to watch the Scottish team play there. 

For a semifinal game in Wembley, the British government plans to allow the stadium to reach 75% of its capacity–the largest crowd at a sports event in over a year. 

The World Health Organization has warned that tournament crowds (in general, not specifically this one) can act as Covid amplifiers. And the European parliament’s committee on public health warned that such a large crowd at Wembley would be “a recipe for disaster.” But Britain’s left the European Union, so we don’t have to listen to them. The reason we left the EU was so we’d be free to spread our own germs in any way we want.

If the EU passes the law of gravity, we don’t have to follow that either.

The government’s making noises about lifting most of the remaining Covid restrictions in mid-July. When it isn’t saying that we may have to take some precautions. It’s hard to know which Boris Johnson to believe, but my money’s on him lifting most restrictions. I’m basing that on how many decibels are devoted to each side.

It’s not a prospect that makes me happy. As Mark Woolhouse, a professor of infectious disease epidemiology, said, “The UK is in a unique position. We’ve the biggest Delta outbreak in a well-vaccinated country. We are a petri dish for the world.”

The question is whether vaccination breaks the link between infection on the one hand and hospitalization and death on the other. The government seems to be betting that it will. My best guess is that vaccination will weaken the link but that without other controls–masks; an effective contact tracing system; reasonable sick pay for people who are supposed to stay off work–it won’t be enough.

 

Updating the list of Covid symptoms

Assorted experts are calling for the UK to expand its list of Covid symptoms. It currently lists only the Big Three: cough, loss of the senses of smell and taste, and a high fever. 

Europe’s list includes headache, weakness, tiredness, muscle aches, runny nose, loss of appetite, and sore throat–symptoms that often begin before the Big Three and are more common in young, unvaccinated people. 

But hey, we left Europe. We get to enact our own symptoms.

 

Your small dose of hopeful news

A small study showed the Johnson & Johnson single-shot vaccine to be effective against the Delta variant.

It’s the sex, not the money: a small political scandal hits Britain

Nothing’s as delicious as a scandal unless it’s a scandal involving a government you dislike. So forgive me, but I’m enjoying the resignation of Britain’s former secretary of state for health. 

What brought Matt Hancock down was sharing a kiss with an aide. Or more accurately, sharing a kiss with an aide within range of the office CCTV, which an anonymous someone released to the press. Or even more accurately than that, sharing a kiss with an aide within range of the office CCTV during LockdownLite, when people weren’t supposed to even be hugging people outside their household (or “bubble,” in pandemic-speak), nevermind trading long and apparently passionate (CCTV can only tell us so much) kisses with them.

It was the pandemic hypocrisy that gave it resonance. Lots of people wouldn’t have minded making physical contact with a wider range of humans, but they were sticking to government guidance and here was the person allegedly responsible for that guidance conducting an extensive germ exchange with someone he was supposed to stay two meters away from. Because the health of the nation was at stake. 

Irrelevant photo: a rose.

Both Hancock and the aide are both married. To other people. So it’s a safe bet that their bubbles burst at the point where they wedged each other inside.

And just to give the story a bit more resonance, in the early stages of the pandemic Hancock criticized a scientist on the government’s scientific advisory board for breaking lockdown by getting together with someone he was in a long-term relationship with. Hancock said at the time that it left him speechless. 

The scientist resigned, taking his expertise with him. 

The real scandal, though, is that Hancock had appointed his aide to a (well paid) position as a non-executive director of the Department of Health and Social Care, which ever so incidentally oversaw his performance as secretary of state for et cetera. Without either of them mentioning their relationship. But that’s less fun than two people playing grab-ass in the office, so although it gets mentioned I doubt it’s what brought him down. 

How well paid is well paid? For 15 hours of work a year, the position pays £15,000 pounds. Unless I’m hallucinating, that’s £1,000 an hour. The aide has now resigned too. 

The role of the non-executive directors is to challenge the government as well as provide oversight, and fifteen other people with tight connections to the Conservative Party hold the positions in various departments. They include donors, former Members of Parliament, and peers. Let’s say it all gives the appearance that it wasn’t their expertise that got them their jobs.

But that’s nowhere near as much fun. 

 

A report from the Not out of the Woods Yet Department

One of the world’s most highly vaccinated countries, Israel, has reimposed indoor mask rules as the Delta variant becomes Covid’s dominant strain. The number of Covid cases was doubling every few days. Admittedly, it was starting from a low number, but so does any spike. 

And the same thing’s happening in other highly vaccinated countries–and even more so in largely unvaccinated countries. Delta has raised the stakes in the herd immunity poker game. People who’ve recovered from earlier Covid infections–the kind caused by other variants–seem to be vulnerable to Delta. 

A good news/bad news study shows that while two doses of the vaccines that Britain’s using are 96% effective against hospitalization and 79% effective against symptomatic infection, one dose is only 35% effective against Delta. 

Delta is so contagious that over 80% of a population would need to be fully vaccinated in order to contain it. So far, only 1% of Africa’s population has been vaccinated, and the Delta variant has been identified in 14 African countries. 

In spite of all the promises to get vaccines to poorer countries, contributions to the Covax vaccine program have dried up. “The world is failing,” a spokesperson for the World Health Organization said. “Just give us the vaccines.”

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Six cases of the Lambda variant have been identified in Britain. That’s a variant that the World Health Organization has labeled a variant of interest, which translates to Don’t panic yet, but we’re watching it. It was first identified in Peru and has now been found in 26 countries. 

Don’t panic yet. At this point, it’s just something to know.

 

And a counter-report from the On the Other Hand Department

In the US, according to a study, almost all Covid deaths are of unvaccinated people. Breakthrough infections–the ones that happen to people who’ve been vaccinated–are 0.1% of the total hospitalizations. Of the Covid deaths recorded in May, 0.8% were among people who’d been vaccinated.

If I’m not mistaken (and I can’t be trusted with numbers), the second percentage is larger than the first, which does seem odd. I’m guessing here, but it could be because breakthrough infections happen in people whose immune systems are in one way or another out of order, so they’re not only vulnerable to infections in spite of vaccination, but having once gotten infected, are more vulnerable to the disease–again, in spite of being vaccinated. But that comes with a wild-ass guesswork alert. If anyone has some solid information on that, I’d love to hear it.

A short history of the 1918 flu pandemic

Now that we know at first hand what a pandemic is, this might be a sensible time to learn more about the 1918 flu–that thing most of us know as the Spanish flu. 

Spain’s connection was minimal. The disease first got public recognition there and that’s about it. World War I was still being fought, and newspapers were still censored in Germany, Britain, France, and the US–and possibly in assorted other countries that don’t get a mention. They weren’t allowed to mention the flu. You couldn’t publish anything that might lower morale.

Epidemics, you might have noticed, do lower morale.

Spain, though, sat on the sidelines in World War I. It didn’t censor its papers–at least not for any mention of morale-lowering diseases, although I wouldn’t rule out the possibility of censorship on other issues. So Spain broke the story and its reward was that the world blamed it for the disease it had mentioned. 

Irrelevant photo: a peony

Recent epidemiological research hints that the virus might have been circulating for two years before reaching pandemic levels, and US troops could have been–well, I don’t know if calling them the source of the epidemic would be correct, but the first known cases were in Fort Riley, Kansas, and they didn’t stop the US from shipping soldiers to fight in Europe. So you could make an argument that the US was the source. 

Alternative theories, on the other hand, point to China, Britain, and France. 

 

Numbers

Although a lot of us learned to call the 1918 flu an epidemic, it was a full-blown international pandemic. (Hands up: How many of us even knew the word before last year?) The only part of the world that didn’t report an outbreak was Marajo, which I never heard of until I started researching this post. It’s an island in Brazil’s Amazon Delta. 

The pandemic ran from 1918 to 1919 and killed over 50 million people worldwide. Or possibly 100 million. No one was keeping count, so we’ll have to settle for guesswork. And to confuse the picture further, even if folks had been counting, the symptoms were easy to confuse with other diseases. 

An estimated 500 million people were infected–a third of the world’s population.

In Britain, 228,000 people died of the flu; 1918 was the first year on record in which deaths outnumbered births. And Britain got off more lightly than many countries.

By way of comparison, worldwide Covid deaths are currently just under 4 million, although that’s generally agreed to be an underestimate. Britain’s had 128,000 Covid deaths.. 

The flu pandemic killed between 10% and 20% of the people who became infected, and more people died of it in a single year than died of the Black Death between 1347 and 1351. I believe that’s in Britain. Or in England. Or somewhere. Who cares? It’s a sobering comparison.

It hit young adults particularly hard–people between 20 and 40, who you’d expect to have the most resistance–but it also hit children under 5 and people over 65. Most of us, though, will have heard about  the 20-to-40 age group because it’s unusual for a disease to zero in on them.

 

Spreading the flu

The flu spread both through the air on droplets–those things that people breathe, sneeze, coughe, or talk into the air. It also spread on surfaces. You’d touch a surface that had germs on it, give them a ride to your face, and have yourself a nice little bout of the flu. 

Soldiers returning home from northern France get a special mention in any discussion of how the virus spread. In France, they’d been coming down with la grippe, which consisted of sore throats, headaches, loss of appetite, and the cramped trenches it circulated merrily. But they tended to recover quickly. Doctors called it a three-day fever. 

From that, though, the disease evolved into something deadly. We’ll come back to that. In the meantime, let’s go back to those British soldiers returning home on cramped troop transports and trains. Following their path, the flu spread from railroad stations to city centers, from city centers to suburbs, and from suburbs to the countryside. 

 

The pandemic’s waves

The first wave of the pandemic hit in the spring of 1918 and was relatively mild. The second came in the winter and was the most deadly. In the past, when I’ve read that the second wave was worse than the first, I assumed that meant only that more people got sick. No such luck. The disease itself had changed. In the second wave, you could be fine at breakfast and dead by nighttime. 

Let’s go to Historic UK for the gory details: “Within hours of feeling the first symptoms of fatigue, fever and headache, some victims would rapidly develop pneumonia and start turning blue, signalling a shortage of oxygen. They would then struggle for air until they suffocated to death.”  

The third wave hit in the early spring of 1919, and was somewhere between the first and third in its virulence. Smaller, localized outbreaks went on into the mid ‘20s. But in August 1918, an observer could reasonably have thought that the disease had ended, and since the government still had a war to fight it kept its attention on that. 

For the most part, pubs stayed open. The Football League and FA Cup had been canceled because of the war, but men’s regional tennis competitions went ahead and so did women’s football, which in the absence of men’s games attracted big crowds.  

Hospitals were overwhelmed, and it didn’t help that medical personnel had been vacuumed up by the war. Medical students were brought in to help fill the gaps. Doctors and nurses worked themselves to the point of exhaustion. 

Graveyards were also overwhelmed. Think of them as the kind of high-end restaurants where you need advance bookings. The draft meant the country had a shortage of grave diggers, of funeral workers, of coffin builders. Horses had been drafted as well, so even getting the dead picked up was a problem. In Sunderland at one point, 200 bodies were left unburied for over a week. 

When the war ended (November 11, 1918, in case anyone asks, at 11 a.m.), crowds turned out to celebrate, helping to spread the disease. There just might be a lesson hidden in there for us.

 

The expert advice

Sir Arthur Newsholme, the chief medical officer of the Local Government Board, wrote a memorandum in July 1918 advising people to stay home if they were sick and to avoid large gatherings. It wasn’t bad advice, and he promptly buried it. Britain had that war to fight.

Looking back on it in 1919, he said it could have saved many lives, but “there are national circumstances in which the major duty is to ‘carry on’, even when risk to health and life is involved.”

Keep smiling. Keep morale up. If you have to die, do it off stage.

The cabinet never discussed the epidemic. No lockdown was imposed, and I’m not sure the concept was available to be discussed. In 1917, it talked about forming a ministry of health to prevent disease and coordinate health care, but it did nothing about it until 1919, leaving localities to respond to the pandemic as well or badly as they could. 

In places, theaters, dance halls, movie theaters, and churches were closed for varying lengths of time, and in some places streets were sprayed with disinfectant. Some people wore masks. Some didn’t. Whatever happened, happened locally.

Public health messages ranged from the vaguely useful to the batty. Some factories relaxed no-smoking rules because cigarettes were known to prevent infection–or at least some people knew about it and probably thought the ones who didn’t were idiots or deliberately suppressing information.

But that’s just a guess.

In a Commons debate, M.P. Claude Lowther asked, “Is it a fact that a sure preventative against influenza is cocoa taken three times a day?”

The News of the World told people to “wash inside nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply. Do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge.”

Cleaning your teeth was also recommended. It might not keep you alive, but at least you’d die with clean teeth. Brandy and whisky were popular preventatives. So was ventilation, which would have actually helped, along with warm clothes. Worrying about your health, on the other hand, would make you more vulnerable. Besides, it could interfere with the war effort.

Predictably, in the absence of solid information, individuals were often blamed–for catching the disease; for spreading it; for taking risks that no sensible person would take, like passing up that third cup of cocoa.

People rushed to chemists to buy quinine, which was useful against malaria but roughly as helpful against the flu as turkey feathers. 

We can–and we might as well–laugh, but remember that there weren’t any antibiotics yet, which could have been useful against flu’s secondary infections. And there were no antivirals. The first vaccine for the flu wasn’t licensed until 1940. 

Many doctors prescribed what they had available: aspirin. Its patent had expired in 1917, so new companies moved in to produce it–I’d assume cheaply. Patients were told to take up to 30 grams a day, which is now considered a toxic dose. If you take anything above four grams these days, red lights start flashing and sirens go off. 

The symptoms of aspirin poisoning include hyperventilation and pulmonary edema, which is a buildup of fluid in the lungs. Some flu deaths may have been either caused or speeded up by aspirin poisoning.

To be fair, some of the recommended public health measures were useful, including ventilation, disinfection, limiting or banning large gatherings, quarantine, and isolation of patients, but they were applied unevenly. 

 

The pandemic’s legacy

Industrialized countries went into the pandemic with atomized health systems. Doctors worked for themselves or for charities or religious institutions. Public health policies–and this isn’t particularly about Britain–were colored by eugenics, a theory that, to simplify wildly and irresponsibly, managed to show that the people at the top of society were there because they were better genetic specimens and the people at the bottom were degenerate and a mess. So public health policy–or so the Smithsonian tells me–tended to be about protecting the elites from the diseases of the poor. 

When the pandemic died down and they had some space to think, the lesson many countries took from it was that healthcare had to be available to all, and free, although the moves in that direction weren’t universal or, at first, complete. Public health embraced the idea of not just treating disease but preventing it. Epidemiology–the study of diseases’ patterns, causes, and effects–came into its own, and epidemiology demands data, which governments, or some of them anyway, began to gather. One of the problems that article after article mentions about the flu pandemic is that it wasn’t a reportable disease, so doctors weren’t required to report cases to the government and wouldn’t have had a bureau to report them to if they’d been inclined that way. That meant no one knew the size or shape of the crisis.

In 1919, the forerunner of the World Health Organization was founded–an international bureau to fight pandemics.