The herd immunity debates

Professors at University College London grabbed some headlines with the news that Britain’s almost achieved herd immunity.

Should we celebrate? 

Nope. The small print said we can’t ease restrictions yet. “If we let up, that threshold will go up again and we will find ourselves below the threshold and it will explode again,” Karl Friston said.

This makes it sound like we’ve probably misunderstood what herd immunity means. Or else that the people who wrote the study have. I thought it marked the point where we could all wander back to whatever we can reconstruct of our normal lives, trusting that the virus will stay in retreat. Apparently not, though–at least not by this definition. 

Irrelevant photo: a rose. Indoors. It’s too early in the year for them outdoors yet.

In a rare moment when the health secretary, Matt Hancock, and I agree (I’m sure that upsets him as much as it does me; sorry Matt; it won’t happen often), he’s dismissed the suggestion of herd immunity, although his comments are oblique enough to be unquotable. They’re not incoherent but they’re not exactly to the point either. Never mind, though. I have agreed with him. It’s a rare moment. We need to mark the occasion.

Cup of tea, anyone?

Another estimate of herd immunity, this one from Airfinity (it “provides real time life science intelligence as a subscription service” and as part of that tracks vaccination programs around the world), sets it at the point where 75% of the population is vaccinated. The U.K.’s expected to reach that point in August, shortly after the U.S. and a few weeks before Europe.

Sorry about the rest of the world. It seems to have dropped off the map the article I found was using. 

There will, of course, still be a need to booster vaccines to keep up with the variants, at least until those countries that fell off the map get access to vaccines so are species can stop producing variants so prolifically. 

 

Creeping out of lockdown

As Covid deaths go down, Britain’s taken another step toward ending its lockdown, opening gyms, shops, pubs and cafes with outdoor seating, assorted other businesses. Internal tourism is causing traffic jams in all the usual places. 

About half the population has at least one dose of a vaccine. Will that be enough to keep the virus from rebounding? I wish I knew. Chile has an impressive vaccination program and unlocked too early, giving the virus the gift of a trampoline. Cases there have spiked. 

Optimist that I am, my mind snags on Britain’s remaining virus hotspots and on the two London boroughs where the government’s chasing cases of the South African variant. I expect they’ll do better with the variant than with the hotspots, because one of the things the government resolutely refuses to do is pay people a workable amount of money to self-isolate, and if you’re broke you’ll go to work, regardless of what the test says. Because you have to. 

On the other hand–and before I go on I should issue an Unimportant Personal Story Warning–I’m grateful to have stores open. I have a battery-operated watch whose battery stopped operating a while ago. (Whose idea was it to run watches on batteries, anyway? I seem to remember winding my watch every day without feeling unduly burdened. I didn’t even break a sweat.) 

How long ago did the battery run out? No idea. We were in lockdown. Who needs a watch? But eventually I did need a watch and I noticed that mine was no longer in touch with consensual reality. So I got a battery (thanks, Tony). I opened up the back (thanks, Ellen), took out the old battery, put in the new one, put the innards back together, and was just starting to congratulate myself when I found that I couldn’t fit the back on, making the whole project pointless. I put a rubber band around the thing and left it alone.

I still didn’t have a watch.

On Monday, the first day that unimportant stores were open, I took it to a jeweler. Jewelers have a little gizmo to hold the back in place while they thump it shut. I now have a working watch.

I don’t need it more than once a week. We’re still halfway locked down. 

So yes, it’s nice to be able to do that sort of small thing. It also makes me nervous–and it should.

 

Lockdown and the economy

Britain’s economy’s now in the worst recession it’s had in 300 years. Worse than the Great Depression of the 1930s? Apparently. To find one that was worse, you have to go back to the great frost of 1709, when Britain was an agricultural country.

On the other hand, having shrunk 9.9%, the economy then grew by 1% in the last quarter of (I believe) 2020. Household savings during the pandemic reached £140 billion–16.3% of people’s disposable income. That’s compared to 6.8% in 2019. Predictably, that’s unevenly distributed, with some people building up savings while others struggle to hold onto their homes and food banks struggle to keep up with need. 

It’s a lovely way to organize a world. 

 

The Covid risk indoors and out

Want to figure out the Covid risk people face indoors? Measure the carbon dioxide level

This works because–well, the thing about infectious people is that they exhale. Admittedly, uninfected people do too. You probably do it yourself. And all that exhaled carbon dioxide joins together and either stays in the room or doesn’t. The Covid virus does exactly the same thing: It either stays in the room or if the room has enough ventilation it wanders out into the world, where it poses next to no danger.

The thing is that carbon dioxide levels can be monitored cheaply. If you see them rise, you still won’t know if anyone infectious is breathing into the mix, but you will know that the ventilation isn’t what it needs to be and it’s a risky place to stand around inhaling. At that point you can (a) limit yourself to exhaling, (b) leave, or (c) improve the ventilation. Preferably (b), since that will help everyone.

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An Irish study reports that roughly one Covid case out of a thousand is caught out of doors. 

Professor Orla Hegarty said, “During Spanish flu people were advised to talk side by side, rather than face to face, and this is borne out by how viral particles have been measured moving in the air when people breath and speak.

“The risk of infection is low outdoors because unless you are up close to someone infected, most of the virus will likely be blown away and diluted in the breeze, like cigarette smoke.”

Do vaccines keep us from transmitting Covid?

One of the endless unanswered Covid questions has been whether people who’ve been vaccinated will still spread the disease, and evidence is piling up that they’ll spread it less. 

During their early trials, Pfizer didn’t test for asymptomatic cases, but AstraZeneca did and they fell by 50%. That matters, because asymptomatic people can still spread the disease, so fewer cases means less spread. Not to be outdone, Pfizer did its own study and reported that one dose of vaccine cut the risk of transmission by 70% and two doses by 85%. 

Don’t put too much weight on the differences in those numbers. They were measuring different things.

In Scotland, people living with vaccinated NHS staff were considerably less likely to catch the virus than people living with unvaccinated NHS staff. 

How much less likely? Considerably. Will you stop asking awkward questions?

Irrelevant photo: More daffodils.

Hospital workers in Cambridge showed a 75% decrease in asymptomatic infections, and an Israeli study showed that when vaccinated people did have infections they had lower viral loads, which would make them less infectious than people with higher viral loads. 

So if we’ve been vaccinated, can we throw a party for a few hundred of our closest friends as long as they’ve also been vaccinated? ‘Fraid not. The British government’s advice is that “the full impact on infection rates will not become clear until a large number of people have been vaccinated” and we should please keep our heads on straight and be cautious. 

Why? Well, consider what’s happened in Chile. 

 

Okay, what has happened in Chile?

It’s vaccinated about a third of its population with at least one dose–it’s vaccination program has been impressive–and even so it’s going into another wave of the pandemic. Both deaths and case numbers are rising and they’re threatening to overwhelm the health system. Some 20% to 30% of the country’s medical professionals have gone on leave because they’re exhausted, wrestling with health problems of their own and with thoughts of suicide.

“When transmission rates are high, the vaccine does not rein in new infections right away,” said Dr. Denise Garrett, an epidemiologist at the Sabin Vaccine Institute in Washington. “And with the new variants, which are more contagious, we’re not likely to see a big impact until the vast majority of the population is vaccinated.”

According to Dr. Francisca Crispi of the Chilean medical association, the government unlocked the country too quickly. It reopened its borders and loosened restrictions on businesses. It introduced a permit system that let people go on summer vacations–or holidays, if you speak British. So people came into the country. People went out of the country. People traveled around the country. Gyms, churches, malls, restaurants, and casinos reopened. Experts fretted, but the government stuck with it, reopening the schools at the beginning of March. 

Nobody traced anybody.

And it all felt so good.

So no. No parties for the time being. Sorry.

 

The mass testing report

A study of mass Covid testing in British universities and colleges reports that it was haphazard, expensive, and a lost opportunity.

The BMJ–a medical journal–sent freedom of information requests to 216 schools and got full information from only 16, leading me to think that information may be free but it’s still elusive. But never mind that. They got partial information from others and it was enough to draw some tentative conclusions.

The testing was part of the government’s Operation Moonshot, which was going to make the country Covid safe and avoid a second lockdown by testing people–lots of people–whether they had symptoms or not. Since it started, we’ve had not just a second lockdown but also a third.

Never mind, though. It’s been a good use of £100 billion. 

The university and college testing was just a small part of Op Moonshot, and the study estimates that every positive test result cost £3,000. It also says that’s likely to be a massive underestimate because it doesn’t include the staffing of test sites and whatever other costs are hidden under the rug. 

You’d noticed that the rug was lumpy? I tripped on it just this morning.

Angela Raffle, consultant in Public Health and honorary senior lecturer at Bristol University, said the testing program was “a desperate exercise in trying to get favourable publicity for number 10, trying to get rid of the Innova test mountain, and trying to change the culture in this country so that we start to think that regular tests for everybody is a worthwhile use of public resources, which it isn’t.”

Number 10? That’s the center of the British government.

And the Innova test mountain? It’s made up of £1 billion (as far as I could figure out) worth of quick-result Covid tests that the government bought and which turn out to work best on people who have a high viral load. In other words, they’re exactly what you don’t want to use on asymptomatic people–the program’s target audience. 

And they’re even less accurate in the hands of non-experts. 

So who’s using them? Non-experts. 

We’ll skip the most confusing of the numbers involved in this and settle for these: Let’s say you use them to test 100,000 people and get 630 positives. Of those, 400 of those will be false positives, and you will have missed half the positive cases (that should, I think, be 230) in your sample. If that isn’t worth £1 billion, I don’t know what is. Or even £100 billion. Because what’s £99 billion between friends? 

Regular testing of secondary school students was rolled out this spring, although it’s too early for anyone to have statistics on how effective or expensive that will be. The program was sold to us as a way to reopen the schools safely. 

Stephen Reicher, a member of Sage, the government’s science advisory group, said, “The government keeps on seeking quick fixes based on one intervention. What they consistently fail to do is build a system in which all the parts work together to contain the virus.” 

 

Vaccine passports vs. mass testing 

All of this is particularly relevant because Boris Johnson–our prime minister when he’s working, which he does sometimes do–just backed off his plan to introduce vaccine passports and announced that we’ll use mass testing instead. But only in England. Scotland, Wales, and Northern Ireland are doing whatever the hell they want because that’s how it works around here. 

Are you confused? Then you understand the situation.

The vaccine passports were supposed to allow people into crowded events, but MPs from across the political spectrum opposed them, including a good number from his own party, and they were joined by an assortment of civil liberties groups he wouldn’t normally listen to but what the hell, let’s mention them anyway. They’re particularly problematic because not everyone’s eligible for the vaccine yet. 

So instead of vaccination passports, everyone in Britain is going to be offered two rapid Covid tests a week. 

How many of us will use them? My best guess is not many, given the odds of coming up with a false positive and having to self-isolate. For someone who’s retired, that’s a minor inconvenience. For someone who’s working and can’t afford to miss a paycheck, that’s a disaster. 

The usual suspects are saying this would work better if people were paid enough to live on when they can’t work. And if the contacts of anyone who tests positive were traced effectively.

The usual suspects will be ignored. 

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Last weekend, the government announced a pilot program of nine events to try out Covid passports. Presumably that was before it abandoned the idea, who your guess is as good as mine, which is roughly as good as theirs. Five of the nine venues said they had nothing to do with the program. 

You have to love this government. It’s a gift to satirists everywhere. If only it wasn’t supposed to run the country as well.

 

Other vaccine news

Russia has announced a Covid vaccine for animals, Carnivak-Cov. The idea is to prevent the virus circulating in dense animal populations, where it can mutate and spread back to humans. 

And Pfizer reports that its vaccine is effective in kids between 12 and 15. It’s still testing kids between 5 and 11 and any minute now will begin tests with kids between 2 and 5. All of that’s important because although kids are less susceptible to Covid, they can sometimes get very sick indeed and can less rarely get long Covid after a mild bout of the disease. 

They can also form a nice reservoir where the disease can sit and breed before returning to the more susceptible adult population.

 

And your light relief for the day is…

An art director, David Marriott, was stuck in Australian quarantine after flying back from his father’s funeral and was going ever so slightly nuts with boredom, so he made himself a cowboy outfit out of the brown bags that his meals came in when they were left at his door.

Then–as anyone would do–he realized that any serious cowboy needs a horse, so he made one, also from brown paper, but plus the ironing board and a lamp. Its–or, I guess, his–name is Russell, and Marriott’s asked for a pet walking service.

The photos are worth clicking through for–not just Marriott brushing Russell’s teeth, but Russell lined up to use the toilet since the management turned down the pet walking request. Russell’s in quarantine too.

Marriott’s thinking about adding a cat and a dog next. 

How do we unlock a lockdown?

Britain’s poking its nose out of lockdown and looking around to see if it’s safe for the rest of the body politic to follow. A lot of people have been vaccinated–or half vaccinated, which will, we hope, hold us for the time being. The number of new Covid infections is dropping. The number of deaths is dropping. The daffodils are blooming.

Daffodils have no antiviral properties, but they do make people feel good.

So what are the prospects of getting out of this mess without setting off a new spike?

 

Daffodils. Take three and call me in the morning–or is that joke so dated that you have to be over 70 to get it?

Peeking out of lockdown

Britain’s four component nations will chart their own routes out of lockdown and each will look contemptuously at the choices the other three made, but we’ll only follow England’s here, because that’s complicated enough, thanks. 

Stage one is reopening the schools, which will open on March 8, and initially all students from secondary level on up were supposed to return at once, bright-eyed and with a negative Covid test in hand.

How were they supposed to get that negative test result? We’ll skip the details, but headteachers said there wouldn’t be time–it would take a good three weeks to get everyone tested. Teachers unions and school governors had been calling for a phased return for a good long while, although the government was ignoring them.

Hell, what do they know?

Then two days after announcing the plan, the government did a U-turn. Of course secondary schools can bring the kids back in stages. 

You’d think a government would be embarrassed to be this visibly disorganized, but if it bothers them they hide it well. And the outrage machine that makes up a large segment of the British media doesn’t seem to be bothered by it.

Once they’re back in school, older kids will take a continuing series of tests–the quick kind called lateral flow tests, which are problematic. They miss a lot of cases in the best of circumstances and miss more when done by non-experts. The kids will have a few tests at school and after that they’ll take them home to do themselves. 

These are school kids, remember. They’re the definition of non-experts. So don’t expect too much from the results here.

The government’s Scientific Pandemic Influenza Group on Modelling says the scientific consensus is that opening the schools this way will drive up the R number–the number of people that each infected person goes on to infect–by anywhere between 10% and 50%. 

Have I mentioned that teachers haven’t been a priority category in the drive to vaccinate the country? So they’re being asked to take a deep breath, walk into class, and roll the Covid dice. Masks are at least recommended for older kids in class, not just in the hallways, but that’s recommended, not required. 

Elementary school kids? Nope, they haven’t even gone that far. 

And in case the message on masks sounds too coherent, though, the school standards minister (who knew we had one?) went on TV to say that masks and testing weren’t compulsory. Parents could decide whether their kids would use either. 

I despair,” the head of one school was quoted as saying.

Let’s not go through the unlocking stage by stage. What matters is that before the country moves from one stage to the next, the situation will be evaluated. If it looks good, we move on. If not, we wait. So far so good, but what they’ll be measuring isn’t the number of cases but the number of deaths, the number of hospital admissions, the number of people vaccinated, the variant situation. So if a gazillion twelve-year-olds all test positive, it’s okay as long as deaths and hospitalizations don’t get out of control.

Are you getting a sense of why this makes my skin itch? People who test positive are the early warnings of a new spike, but the assumption seems to be that cases can be contained as long as they’re not hospitalized or dying. That kids won’t pass it to families. That teachers won’t be hospitalized and won’t pass it to partners and parents. That kids themselves won’t get seriously ill. That somehow you can get through this thing without having to worry about new cases. That as long as the hospitals aren’t overwhelmed and people aren’t dying in the streets, it’s okay. 

What the government’s doing is betting heavily here on vaccines and tests, hoping to keep the number of cases down to a manageable level until those save our hash. And it may work. In the meantime, forgive me if I scratch where it itches. I like our hash. I don’t want to see us lose it.

The Royal College of Paediatrics and Child Health says that vaccinating children and teenagers could be the way out of this mess,  but the vaccine trials involving kids have only just begun. We should hear the results in six months or so. That’s not a quick hash-saver.

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Another detail that makes me itch as we poke our collective nose into the open air is that healthcare workers still don’t have proper protective equipment. Twenty healthcare bodies have written  to the prime minister about this. In response, the prime minister rumpled his hair and asked if he didn’t look cute. 

Okay, what the government actually said was that it was monitoring the evidence and would update advice “where necessary.” And by the way, didn’t the prime minister look cute?

Healthcare workers are four times more likely to become infected than the rest of us, and within hospitals people working in intensive care have gotten the highest grade protective equipment, but it turns out that people working on the general wards have double their rate of infection–and less effective protective gear.

But, what the hell, the country’s only had a year to get this right. And we do have a prime minister who knows how to rumple his hair.

Meanwhile, the government is paying consultants to locate the protective equipment that it owns and that it stored someplace, although no one person knows exactly where. Billions of pounds worth of the stuff is stashed here and there.

“We have amounts in containers, in storage around the country; there are some on the docks and there are some en route from China,” the auditor general said. 

I wonder if that’s what’s on the floor by my computer. If so, I’d really like it out of there when the prime minister’s done with his hair. It was only supposed to be there for a couple of days. 

Some of the equipment will go out of date if it’s not used. Some of it is needed in hospitals and (yup, see above) isn’t available. Some of it–possibly all of it–was bought by external consultants at inflated prices and I should have known better than to let them store it on my floor but they were being so damn nice

Anyway, they don’t seem to have a central system to track all this, so they’re paying consultants to figure out what they own and where they can find it. 

You’d laugh if it weren’t so expensive. 

 

The sciency stuff

Lab studies have confirmed that the mutation common to the British, South African, and Brazillian variants really does make Covid more contagious than the original form. The initial argument was based on modeling, and I was holding out for confirmation, thinking that maybe the variants had just gotten lucky. Now, damn them, the scientists have given me what I asked for. So yup, it’s more contagious.

New York and California–not to be left out–have developed (or found, since we don’t really know where any of the variants first emerged) variants of their own. Let’s not panic about them until more is known. There’s always time for that later.

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A new quick Covid test has been developed in France. It gives you a result in ten minutes–a third the time of the lateral flow tests–and it’s more accurate, although still not perfect. It’s 90% accurate, with the remaining 10% taking the form of both false negatives and false positives.

That’s good news, but it’s going into a three-month trial, so don’t rush out and try to buy a few thousand of them for your local school. 

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The US Food and Drug Administration has said that Johnson & Johnson’s one-dose vaccine is both safe and effective. That’s not yet approval, but it’s a move in the right direction. If you don’t read past the headlines, you may not fall in love with it: It’s only 66% effective, which is lower than the be-sequined two-dose vaccines that crossed the finish line first and got all the cheering.

Read past the headlines, though.

The vaccine was tested in the US, several Latin American countries (sorry–I don’t know which ones), and South Africa, and 66% is the number that comes out of the jar once you pour all those results together and shake them. In the US, it was “much closer” to the be-sequined numbers. The effectiveness depended on which variants were prevalent in which countries. 

How much closer is “much closer”? In the US, it’s 72% effective. In South Africa, 57%. After that, I run out of numbers. Sorry. 

That’s still not in the 90% zones of the star vaccines, but all the vaccines (“all” here means the ones that have been approved in the US, but may well include others that are in use around the world) are 100% effective at preventing hospitalization and death. That’s no small thing. 

 

Creativity and lockdown
In a recent blog post, Emma Cownie asked, Can the boredom of lockdown push us to be more creative? For her, the answer has been yes, and it’s also worked that way for Peter Quinn, who creates special effects for a living. You know special effects–those things we see in movies that kids think are real and adults–um, yeah, we sometimes think they are as well. I won’t try to describe what he’s done, but he’s created a few sequences just to make himself laugh, and he’s strung them together in a video clip. 

They made me laugh too. Go on. Watch it. It’s good for your immune system.