Herd immunity, sterilizing immunity, and the current best guesses

Britain is now the proud operator of several mass vaccination centers, with more promised shortly, and general practitioners are scheduling their oldest patients for vaccination. But that doesn’t mean we’re out of trouble. The number of hospital cases is still rising and there’s talk of the current lockdown not being tight enough.

And we just approved a third vaccine, Moderna’s. Not long ago, Boris Johnson was crowing at Scotland (which on average isn’t happy about having left the European Union) that if they’d stayed in the EU they wouldn’t have gotten vaccines so quickly. So it’s a nice little piece of irony to read that, approved or not, we won’t get or hands on this third vaccine until April because we’ve left the European Union.

I know I shouldn’t think that’s funny, but I can’t help myself.

 

Irrelevant photo: heather

Are we close to herd immunity?

The latest statistical modeling says one in five people in England may have already had Covid. How did they come up with that number? Since the official statistics inevitably underestimate the number of infections (a big chunk of people don’t get sick but carry the disease without knowing it or showing up in the statistics) and since the track and trace system is widely recognized as being roughly as useless as it is expensive, they get their statistics by comparing the number of deaths in an area to the estimated infection rate, putting them in a blender with a few other number and a dash of cinnamon, then baking at 160 C. for fifty minutes. 

In some areas, they estimate that one person in two has had the disease. The number of infected people may be up to five times higher than the number on the test and trace books.

Is that herd immunity? 

Nope. Exactly how many people would have to have had the bug to create herd immunity is still unknown, but a computational biologist estimates that 70% of the population will need to be vaccinated to stop the pandemic in the US. But that only applies to the US; it’s not a fixed number. People behave differently in different places, which upsets the numbers–they’re touchy little beasts–so they arrange themselves into different patterns. 

The number also depends on how long immunity lasts–no one knows yet–and on whether the vaccine turns out to keep people from passing on the infection. 

Most of our commonly used vaccines prevent severe illness but don’t give us what’s called sterilizing immunity. In other words, they keep us from getting sick–or at least from getting very sick–but they don’t kill off every bit of the disease that’s running around inside us. 

On the positive side, having less of the disease circulating inside our complicated little innards may (notice how much wiggle room I’ve left myself there) mean we pass on a milder form of the disease if we do give it to someone else.

An experiment with a chicken virus and a flock that was half vaccinated found that the unvaccinated birds came down with a milder disease than if the whole flock had been left unvaccinated. So even if the current vaccines don’t give us sterilizing immunity, Covid may yet follow that pattern and become milder once a significant portion of our flock has been vaccinated.

May. No one’s offering us a guarantee.

And no, none of the vaccines currently in use will cause us to grow feathers.

 

Transmission and hospitalization

In Britain, the current crop of hospitalized Covid patients are younger than they were during the first peak of the virus. People under 65 now make up 39% of hospital admissions. In March that was 36%. It’s not a huge change, but it is a change, and it’s worth noticing. 

The best guess is that the over 65s are more likely to be out of circulation. We left the party early and are tucked up in our little beds just now. That makes us less likely to become infected and less likely to show up in either the hospital or the statistics. But so much emphasis has been put on the elderly being vulnerable that we tend to think the non-elderly are made of steel.

They’re not. They can get very sick from this thing. In particular, pregnant women seem to be more vulnerable than non-pregnant women (or non-pregnant men, for that matter) in their age groups. 

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Half of all Covid transmissions come from people with no symptoms, including from people who never do develop symptoms. 

What does that mean in practice? That every one of us needs to act as if we could be carrying it. And that we need to look at our friends and family and neighbors as if they could be carrying it. That we need to look at other human beings and think, Oooh, yuck, germs! 

That’s not, I admit, a policy recommendation. It’s not even a real recommendation. It’s just an observation on how much it goes against the grain to live this way.

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A study reports that Covid can still be transmitted after seven days. Or after ten days. After ten days, 76% of the people tested still had detectable levels and 86% did after seven. 

So recommending a shorter period of isolation is a gamble. On the one hand, the theory goes that people are more likely to actually isolate themselves if you demand a shorter time. On the other hand, they can still be shedding the virus at the end of it.

The problem is not only that some people are jerks and don’t put the safety of others first. The larger problem is that a lot of people can’t afford to miss a day’s work–they’re living on the edge as it is. So when mass testing’s offered, they don’t show up because they can’t afford to be told to stay home. If they do end up getting tested and are positive, they stagger to work for as long as they can anyway. Because the hounds of hell are nipping at their heels. 

Already 70,000 households have become homeless during the pandemic and some 200,000 are teetering on the edge. There’s money available to people who have to self-isolate, but not to everyone and it’s not enough to cover the bills anyway. 

And if that doesn’t hold your attention, some people are still being told they’ll be fired if they don’t come to work.

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On a happier note, my partner’s been scheduled for her first vaccination. If all goes well (stop laughing–it could) I should be in line in mid-February. 

Moles, pizza, and remdesivir: It’s the pandemic news from Britain

A local spike in coronavirus cases in Leicester has been handled with all the grace and efficiency we expect of our government. It announced a local lockdown. The health secretary said the police would enforce it as needed. The message was, we’re tough. We’re efficient. We’re gonna win this thing.

The local police and crime commissioner still didn’t know where he was supposed to enforce the lockdown, though, because he hadn’t been sent a map. Then he got a map but still didn’t know the details of what they were supposed to enforce. 

But it’s okay, because we have a prime minister who can do at least one pushup while keeping two yards away from a photographer.

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Irrelevant photo: St. Nectan’s Kieve

Chaand Nagpaul, from the British Medical Association, said Prime Minister Boris Johnson’s strategy of dealing with local outbreaks will be no use if the local people who are expected to contain them aren’t given the data they need. 

I could have said that, but it sounds better coming from someone with a medical degree. Leicester could’ve responded earlier if they’d been told they had a problem, and where and how and why.

When Johnson introduced his strategy of containing local outbreaks, he described it as whack-a-mole–a game where you whack a plastic mole with a plastic hammer and even if you’re fast enough to hit it, it pops up out of another hole. 

It was a rare moment of honesty in political discourse.

While we wait to see where the mole’s going to pop up next, Johnson tells us that local authorities have been sent the data they need. 

And the check is in the mail.

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You’ve probably heard by now that the U.S. bought up almost the entire stock of remdesivir–500,000 doses: 100% of the manufacturer’s July production, 90% of August’s and 90% of September’s.

Remdesivir cuts Covid-19 recovery times, although it’s not clear whether it improves survival rates. Other counties have pointed out that buying up almost the entire stock might, um, undercut international cooperation in the face of the pandemic. 

“International what?” Donald Trump replied. 

Okay, he didn’t actually say that. I can’t remember ever seeing a quote in which he asks a question. 

The sale makes it sound like other countries are thoroughly screwed, but in fact they should be able to get the drug via compulsory license, which allows countries to override patents and buy generic versions from countries where the patent isn’t registered. This one is widely registered, but there will, it seems, be gaps.

The drug is made by Gilead, which sounds like it escaped from The Handmaid’s Tale. I’d love to tell you that it didn’t, but I don’t really know that. Lots of things have escaped from fiction lately, and nothing is more bizarre than reality. 

The UK’s Department of Health and Social Care tells us it’ll be fine and it has enough remdesivir “to treat every patient who needs the drug.” 

For how long?

They didn’t say.

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The New Scientist says, “There is no longer any serious doubt that our bodies can form an immune memory to the SARS-CoV-2 virus.” 

The bad news is that we still don’t know how effective that memory will be. In other words, we don’t know if an immune memory’s the same thing as immunity.

Don’t you just love to hear from me? Don’t I just lift your spirits?

And from the Department of Confusing Information comes this snippet: For every person testing positive for Covid-19 antibodies, two more turn out to have specific T-cells that identify and destroy Covid-infected cells. That’s true even in people who had asymptomatic cases or mild ones.

What does that mean in everyday English? It means that for every person who registers positive on an antibody test, two more have some sort of immune response that doesn’t register. 

Those T-cells the two people have might give them some immunity to the disease. They might keep them from passing the disease on to other people.

They also might not.

The reason T-cells don’t register on an antibody test is antibodies are a whole ‘nother part of the immune system. Expecting to notice T-cells on an antibody test is like making yourself a pizza and wondering why it doesn’t come out of the oven with a side salad.

Basically, antibodies–that’s the pizza–attack the virus before it enters the body’s cells. T-cells–they’re  the salad, and it’s important to remember which is which–go into action once cells have been infected, attacking  them so they won’t infect  new ones. A balanced immune system meal needs both pizza and that salad.

You’re welcome. I’m here to clarify every baffling bit of our world, just for you.

What does all that mean for herd immunity? Not much, because for all anyone knows at this point, those T-cells could protect the bearer without keeping him or her from passing the virus on. 

If you worked this many twists into a pandemic movie, I’d throw my popcorn at the screen and stomp out, muttering, “Enough already.” 

Then I’d go out for pizza and a salad.

I’m just about old enough to remember a world where it was safe to go to movies and pizza joints.