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.

What does “we have to live with Covid” mean?

Periodically, someone announces, as if it ends the discussion, that we’ll just have to live with Covid. But that doesn’t end the discussion, it only begins it. What does living with Covid mean?

To some people, it means, end the lockdowns, burn the masks, and get together in an unventilated space with a few thousand of our closest friends so we can all get shitfaced and dance. Because that’s what normal looked like, at least in retrospect, and we need to get back to normal.

To others, it means that we keep wearing our masks and hoping to hell other people do the same, because someone out there is contagious and someone else is vulnerable. It means staying out of closed, crowded spaces. It means admitting that we only liked six of those few thousand closest friends anyway and haven’t missed them this past year and a half.

But forget what we think. I’m making it up anyway. Let’s turn to the experts. 

An article in the Medical Xpress says that we may never reach full herd immunity–that point where so many people are immune to a disease that those who aren’t immune are protected by not being exposed to it, ever. 

Irrelevant photo: poppies

Why aren’t we likely to reach that point? Because Covid immunity seems to wane over time. Because the disease continues to evolve, especially where unvaccinated groups of people create pools that the virus can spread through and evolve in. And because animals can harbor the virus and pass it back to humans. 

There may be conflicting arguments that say we will reach herd immunity, but I haven’t found them. Let’s go with what we’ve got. 

The article’s authors say that even if we don’t reach full herd immunity, we could still reach practical herd immunity, allowing us to go back to near-normal levels of activity. Their measure of near normality seems to be how far a country can open up without overwhelming the health-care system. It depresses the hell out of me that we measure safety not by the deaths and disabilities the disease would cause but by how many cases of it a health system can sustain, but–well, there it is, written in black and white. That’s what happens, I guess, when you enter the land of policy making.

How many people need to be immune to reach practical herd immunity? It depends on the level of restrictions–or adaptations, if you want a more user-friendly word–we’re willing to live with. Masks? Contact tracing? Mass testing of asymptomatic people? Measures to stamp out outbreaks? 

It’s interesting that although this is a consideration, how many deaths and disabilities we’re willing to live with isn’t. 

Practical herd immunity also depends on vaccination levels: “Some estimates,” the article says, “suggest that we may need two-thirds of the population to be protected either by successful vaccination or natural infection. If 90 percent of the population is eligible for vaccination, and vaccines are 85 percent effective against infection, we can obtain this two thirds with about 90 percent of the eligible population being vaccinated or infected naturally.”

Don’t let those numbers scare you. They’re safely contained within quotation marks.

There’s still a possibility that new variants will escape our immunity, but the fewer outbreaks we have, the fewer chances we’ll give the disease to reach escape velocity.

And we’ll all live happily–if cautiously–ever after.

I hope.

 

The cost of herd immunity in cold, hard cash

But if you’re in love with the idea of restricting nothing and either pursuing herd immunity or in letting Covid circulate freely because it’s no worse than the flu–or if you want to argue with someone who is–academics have calculated the cost to Western Australia if it had pursued a herd immunity strategy: They say the state saved $4.9 billion and avoided 1,700 deaths in a year by locking down hard. It also prevented 4,500 hospitalizations.

In Britain, it was the cost of a hard lockdown that made the government hesitate, repeatedly, to either stamp out or contain the virus. It sounds like it was an expensive savings.

 

Vaccination news

In Britain 52% of the people who said they’d never get vaccinated have now gotten vaccinated, along with 84% of the people who said they weren’t likely to. The percentages shift when you break the population down into religious and ethnic subgroups, but in all of them the trend is in the direction of vaccination.

Part of the change, I’m sure, comes from work that’s being done with community leaders and work to counter misinformation campaigns, but I can’t help wondering if a kind of herd immunity isn’t at work here too: People around us have been vaccinated. We see that keys don’t stick to their faces and that axe heads don’t pursue them down the street, so we figure they probably haven’t been magnetized after all–or at least not heavily. There probably hasn’t been enough time for them to demonstrate that they can still get pregnant–at least those of them who could’ve gotten pregnant in the first place. That–allow me to remind you–excludes all males of the species and enough categories of females that I won’t list them. Even the real but very rare serious side effects of some vaccines–well, they’re very rare. Have they happened to anyone we know? Um, no.

It’s an odd thing, but a 1 in 100,000 chance looks more likely to happen if it happens to someone you know and less likely to if it doesn’t. Even if the numbers don’t care who your friends and acquaintances are.

Humans do seem to be herd animals. We see people around us getting vaccinated and going on with their lives, not visibly marked by the vaccine, and it starts to look like a safe thing to do. Even a smart one. 

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The Netherlands is offering pickled herring to people who get vaccinated. Traditionally, the year’s first barrel of Hollandse nieuwe is auctioned off to raise money for a good cause, but since that couldn’t happen this year it was given, “on behalf of the Dutch people” to the head of the health services. Other barrels were sent to vaccination sites and people are being offered herring when they show up.

 

Counterfeit and Covid

Counterfeit Covid vaccines, tests, and vaccination passports are becoming big businesses. Vaccines and test kits are sold through online pharmacies. Amazon, Etsy, and I’m sure other places sell vaccine passports, with no proof of vaccination required. 

Why not? Everything’s available online. This Christmas, I bought my partner a certificate making her a minister in the Church of the 400 Rabbits. All I had to do was make a donation (it went to a food bank) and print it myself.

Although the article I found talked about the danger of counterfeits infiltrating the supply chain that countries use for genuine vaccines and tests, it didn’t say it had happened. So we’re talking about individuals–people made desperate enough by the world’s uneven rollout that they’re willing to roll the dice and hope that luck will lead them to the real thing.

 

Odd ways to fight Covid

Okay, just one odd way, but the plural made a better subhead. Scientists have developed a sticky wall surface that uses ingredients in hair conditioners to trap the aerosolized droplets that contribute so heavily to the spread of Covid. 

The theory works like this: Droplets bounce off indoor surfaces all the time. Add sticky stuff to your plexiglass divider, though, and their bouncing days are done. 

The developers coated a barrier and it captured almost all the aerosolized microdroplets and 80% of plain old droplet-size droplets. (The comparison point for those numbers is an uncoated barrier. I have no idea how you compare them.) The coated barrier didn’t need cleaning any more often than the uncoated one did, and once it was wiped down with water the coating could be reapplied.

It also works on fabric, concrete, and metal, turning low-touch surfaces into Covid fighters.

This won’t eliminate the need for ventilation, though. We’ll still need air filtration systems and open windows. But it does give us another tool. 

The bad news? A lot more work needs to be done to confirm its usefulness and get it authorized. 

“We understood that the current pandemic may end before this concept is implemented,” said engineering professor Jiaxing Huang. “It may or may not be used now. But next time, when an outbreak like this happens, I think we will be better equipped.”