Tag Archives: lateral flow tests

Covid, Cornwall, and the G7 meeting

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Cornwall’s had a low Covid rate throughout most of the pandemic, but it now has the fourth highest Covid growth rate in England. That’s not the highest number of overall cases–that’s still relatively low. It’s the rate of growth, which went from 12.2 cases per 100,000 people to 99.5 per 100,000. 

Did that happen because the G7 met here? Or is it because the county’s a tourist center and we’re visitors have flooded in–more than usual, since going abroad’s a gamble just now? County councilors (which I initially misspelled as counselors, as noted in a comment; councilors is British for politicians, not for mental health professionals) are arguing both sides, but heavy Covid concentrations have shown up in Falmouth, St. Ives, and Newquay, where assorted people associated with the summit stayed, and in Carbis Bay, where the meetings were held 

Most other parts of the county haven’t seen spikes. That argues for the G7 as a superspreader event. 

Irrelevant photo: honeysuckle

On the other hand, the spikes started three weeks after what we’ve learned to call hospitality venues–those place we might once have called cafes and pubs and things like that–opened back up. Staffed heavily by young (by which you can understand largely unvaccinated) people, and customered at least in part by people visiting from parts of the country with higher Covid rates, many of them accompanied by children (by which you can understand smallish unvaccinated people). 

Also on that second hand, some spikes point toward a local university campus at Penryn.

Those points argue for reopening hospitality venues as a superspreader idea.

The national government’s announced that the spikes have nothing to do with the G7. It’s also announced that it’s not about to publish its summit risk assessment and anyone getting themselves into a state about reading it should go have an ice cream cone and settle down.  

Someone may manage to untangle the threads in the next week or three, but until then you can take your pick of the causes.

My small patch of the county is still fairly Covid free, but we’re full of visitors and the cafes, pubs, and restaurants are open. We’ll see what happens next. 

 

Covid transmissibility

A study of two Covid variants–the one first found in South Africa and the one first found in Britain–looked at why they’re more transmissible and found that the people they infect don’t have increased viral loads, which a person might logically think would be linked to high transmissibility. But nope, that doesn’t seem to be it.

People with the variants are less likely to have asymptomatic cases, though. And although they’re not more likely to die of Covid, they are more likely to be hospitalized. 

I can’t draw any conclusions from that. All I can do is toss it on your doorstep and hope you find something useful to do with it. 

 

Covid test effectiveness

Not long ago, the US FDA–that’s the Food and Drug Administration–urged the public to stop using the quick Covid tests that Britain relies on to test asymptomatic people. To which Britain said, “What do you know anyway?” and extended its emergency use approval. 

One of the problems with the tests is that when the number of Covid cases drops below a certain point, they produce more false positives than genuine positives, turning them from a not terribly accurate but possibly useful tool to an outright pain in the neck. Other tests are available and better supported by test data. But we like our lateral flow tests and we’re not about to abandon them. I have no idea why. 

 

Stay safe: avoid birthdays

A study in the US found a link between the spread of Covid and–guess what–birthdays. Yes indeed, gathering data from 45 weeks in 2020, a study found that in areas where Covid was circulating heavily, a birthday was 30% more likely to be followed by a Covid diagnosis in the household than a non-birthday. If it was a kid’s birthday, the rate was higher. 

The study was designed to look at the impact of small gatherings in spreading the disease. It didn’t specifically look at whether the household had a party–it drew its information from insurance records–but it is suggestive.

But don’t worry. If you don’t have a birthday in any given year, you should be safe enough.

The Covid testing dilemma

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England’s pushing mass testing as a way to contain Covid. It’s free, it’s government approved, it’s somewhere between uncomfortable and painful, and it may or may not be a good idea. Let’s tear the numbers apart and see what we can figure out.

Since the schools reopened, secondary students–those are the older kids–have had to do quick Covid tests twice a week, and that’s been a bulwark of the program to keep the schools open while not letting the virus get out of control. 

The tests, unfortunately, have a reputation for being unreliable, especially when done by non-experts. Since the kids are doing their own tests, or asking their parents or three-year-old sisters to stick the swabs up their noses and down their throats, these are in the hands of the distilled essence of non-expert. One fear about relying on the quick tests has been that false positives will send a lot of people into isolation unnecessarily. So half of the positive tests were sent to a lab to be confirmed by the slower, more reliable tests, and only 18% of them were false positives. 

Irrelevant photo: Rhododendrons. Photo by Ida Swearingen

But wait, because we’re not done yet. Those numbers are from March, and Covid rates have fallen, at least in parts of the country. (Some hot spots remain, and I don’t know if numbers are falling there as well. Just put that possibility off to one side. The recipe may call for it later. If it doesn’t, we’ll stick it in the freezer.) The point is that where the number of cases is lower, everything changes. 

Why? Because the tests will crank out the same number of false positives, no matter how many people are infected. Find yourself a population of people who’ve never been exposed to Covid and the test will swear on any religious book you like that some of them are infected. 

I’m about to throw some numbers at you, so if your allergies are bad today just skip a few paragraphs.

Ready? In London, the southwest, the northeast, and the southeast of England, the prevalence of Covid ranged from 0. 08 to 0.02. In England as a whole, it was 0.12%. Using those figures (I’d assume that means the England-wide ones), it would take 16,000 tests to find one infected person. If the tests cost £10 each, that means spending £160,000 to find that one person.

Is that worth it? If we were trying to stamp the disease out and keep it stamped, as New Zealand is, it would be. Given that we treat stamping it out as the silly thought of irresponsible day dreamers, probably not. 

Meanwhile, in leaked emails (I do l love a good leak) “senior government officials” are talking about scaling back mass testing, although the Department of Health and Social Care says it has no plans to end the program. One in three infected people, they remind us, show no symptoms but is still contagious. 

That brings us neatly to the question of whether the rapid tests will spot that one person. In other words, it’s time to talk about false negatives. Administered by an expert, the tests pick up 79% of infections. Or to put that the other way around, they miss 21%, and those are mostly people with a low viral load. Or to put that another way, they’re most likely to miss people who don’t have symptoms, who are just the people the testing program is looking for.

Administered by secondary school students or their three-year-old sisters, they’re more likely to pick up 58% of infections, or to miss–umm– I think that’s 42%. Although estimates of the number of cases the test misses vary. It might be as high as 50%. 

The government denies that it has any plans to scale back anything ever and Boris Johnson is urging everyone to get tested twice a week. Even though his advisors say that in areas with low infection rates, only 2% to 10% of the positive results may be accurate. 

But what the hell, guys, we’ve got these tests. Someone’s cousin has the contract for them. Use them, will you, please? For the good of the nation.

 

News of an accurate rapid test that’s in development

A new test is being developed that’s both fast and accurate. It also tracks variants and tests for other viruses that might be mistaken for Covid. It can screen 96 samples at a time and within 15 minutes it starts to report the samples as negative or positive. In 3 hours, it will have sequenced all its samples. 

It’s also small and portable. It doesn’t make coffee, but it just might be able to make you a cup of tea.

Juan Carlos Izpisua Belmonte, a professor in Salk’s Gene Expression Laboratory where it’s being developed, said, “We can accomplish with one portable test the same thing that others are using two or three different tests, with different machines, to do.”

That’s the good news. But will it go from development to being manufactured and used?

“Market analysis would be required to determine whether the initial cost of commercialization—and the constant tweaks to the test needed to make sure it detected new variants or new viruses of interest—are worth it.”

I believe that translates to “maybe.”

It’s called NIRVANA, which doesn’t seem to stand for anything, so I don’t know why it’s in all caps. 

 

High- and low-tech approaches to Covid

In New Zealand, they’re trying out an app that connects to smart watches and fitness trackers, monitoring people’s heart rate and temperature. It’s called an Elarm and the developer claims it can spot 90% of Covid cases up to three days before symptoms appear.

Does that include people who don’t go on to develop symptoms? I’m have to give you a definite maybe on that, because the article I found doesn’t address it. The company’s own website doesn’t answer the question either but says it will also let you know about stress and anxiety, although you might notice those without needing an app. Basically, it figures out your normal levels and lets you know when you’ve wandered off them, so you could end up going into isolation over the flu as easily as over Covid. That would scare the pants off you but would, at least, take a lot of the punch out of flu season.

So how do you use this? New Zealand wants its border force to try it out, since almost the only cases of Covid there are in incoming travelers, who have to go into quarantine, meaning the people who work for the border force are in the front lines.

When New Zealand says quarantine, by the way, they actually mean quarantine. It’s one reason they’ve been able to contain the virus.

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On the other end of the scale comes the recommendation that we open windows in public places to minimize Covid transmission. It’s cheap, it’s simple, and–

Oh, hell, how many public places these days have windows that open? Okay, ventilation. The air in public indoor spaces needs to be replaced or cleaned. 

We’ve heard a lot about keeping two meters (or yards) away from people to avoid contagion, but in addition to the heavier droplets people breathe out, which can carry Covid, the tiniest particles that we breathe out can also carry it, and they can stay suspended in the air for hours. The goal is to run them outside and get some fresh air in. 

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If you’re looking for a low-tech way to decide how far from people you should be standing, you can think of it this way: If you can smell that they’ve had garlic or peanut butter for lunch, you’re too close. 

 

Drug news

An asthma drug, budesonide, has been shown to shorten people’s Covid recovery time –and it can be used at home without anyone involved needing welding gloves, a deep-sea diver’s helmet, or a set of allen wrenches. It’s relatively inexpensive and comes in an inhaler. It shortened people’s recovery time by three days and at the end of two weeks the people who used it were in better shape than the control group.

It’s not clear yet whether it made hospitalization less likely. In the budesonide group, 8.5% were hospitalized. In the control group, that was 10.3%. That sounds like a result, but the problem with interpreting the numbers is that hospitalization rates are dropping in Britain. If you want to understand why that makes the numbers hard to interpret, you need to talk to someone who actually knows something.

Everyone in the test was over 50 and had underlying health problems. The drug can be used in the early stages of infection. 

Do vaccines keep us from transmitting Covid?

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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. 

Can you catch Covid outdoors? 

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If you work at it, yes, you can catch Covid out of door, but fresh air dilutes the virus, moves it off in directions that aren’t toward you, and it dries up the little liquid space suits it travels in. And sunlight kills it. 

Zap. Take that, virus.

So far, somewhere between one case and very few cases of outdoor transmission have been documented. But not documented isn’t the same as impossible, so let’s look at the risks.

At the riskier end of outdoor contact are extended face-to-face conversations where people get too close to each other. We still need to keep our distance, especially during the colder weather, because the virus likes the cold. 

Also risky are what in Britain are called market stalls–outdoor markets that are often under three-sided tents–don’t have the advantage of being fully ventilated. They’re safer than the indoors, but the air doesn’t circulate freely through them. Ditto bus shelters. 

And crowds. 

In those situations, the experts recommend masks, even outdoors.

Irrelevant photo: A wallflower. Yes, it’s a plant, not just someone who clings to the wall at a dance.

But Professor Cath Noakes said she doesn’t “want people to be terrified of passing each other in the street.” To transmit the virus that way, someone would have to cough right at you and you’d have to inhale at just the wrong moment. On the other hand, running with someone so that you’re following in their slipstream for an extended period of time might be a problem.

“The sad fact is that your greatest risk is from the people you know.”

It’s not impossible to pick the virus up from a contaminated surface, but it’s a lot less likely than breathing it in. 

 

Lockdown: the effect and the politics

On Saturday, Covid cases in parts of England were starting to level off. Or by a different set of calculations, the number of infections  is declining in the country as a whole, although it’s still going up in a few regions (including mine, thanks). Either way, the lockdown seems to be having an impact. But I’m going to have to leave you linkless on that, because every link I can find is behind a paywall. I got it from an actual piece of newspaper that I spilled tea on yesterday.

Quite a lot of tea. 

You can’t do that to your computer and expect it to survive.

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A former Supreme Court judge, Jonathan Sumption–known to his friends and family and all the kids who were in kindergarten with him as Lord Sumption–has made a name for himself as an anti-lockdown advocate. Let the old and vulnerable isolate themselves, he argues, while the rest of the world carries on as usual. 

And so it came to be, children, that he was on a TV show telling a woman with stage four bowel cancer that he hadn’t said her life wasn’t valuable, he’d only said it was less valuable than other lives.

Not just telling her, interrupting her to tell her. Because what some people have to say is more important than what other people have to say.

Don’t feel bad for her. She held her own.

“Who are you to put a value on life?” she said. “In my view, and I think in many others, life is sacred and I don’t think we should make those judgment calls. All life is worth saving regardless of what life it is people are living.”

Lord S. has since said that his comments were taken out of context.

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A group of Conservative Members of Parliament, though, is getting twitchy about lockdown. Some 70 of them have formed the Covid Recovery Group, which worries about “draconian restrictions” and wants to know when “our full freedoms will be restored.” They can be assumed to be after Boris Johnson’s job–but that’s an assumption. And they can’t all have it.

 

Covid testing and the schools

Somewhere back there, Boris Johnson presented us with a plan to reopen the schools safely by testing the kids every week. Or every day. Or every minute of every day. It was going to be miraculous and world beating and headline grabbing. What’s more, it was going to work, which would make a nice change. 

Or maybe it wasn’t going to work, because the Medicines and Healthcare products Regulatory Agency (known to its friends as MHRA) wouldn’t authorize the tests. It’ll give people a false sense of safety if they test negative, it said. 

This is a £78 million plan and part of the government’s £100 billion Operation Moonshot, which involves not putting a shot glass on the moon but mass Covid testing of various and miraculous sorts. 

The testing started in secondary schools and was scheduled to expand into primary schools (vulnerable kids and the kids of key workers are still in school), and move from there to universities and workplaces. 

The government’s already spent £1.5 billion on lateral flow tests made by Innova, which are fast and, unfortunately, not accurate. They miss a lot of people who are carrying the disease, and miss even more when nonprofessionals use them. 

In response to the MHRA not approving the plan, the government said, “So what? We don’t need regulatory approval because this is assisted testing.” (You understand that I made up that quote, right? But it’s true to the spirit of what they said.) 

Assisted testing is when someone sticks the swab down their own throat and up their own nose. Under supervision–that’s the assisted part, I believe. So it’ll be a seven-year-old supervised by a teacher with no medical background. Using a test that works its imperfect best when done by a professional.

I don’t have a problem with that. Do you?

The plan is that the close contacts of confirmed cases will be tested every day for seven days. If they’re negative, they can stay in school.

The MHRA, on the other hand, said it “continues to advise that close contacts of positive cases identified using the self test device continue to self-isolate in line with current guidelines.”

 

Tipping right over the edge

A super-Orthodox rabbi in Israel has warned people not to get vaccinated because the vaccine can turn people gay. 

He should be so lucky.

The logic is as follows: “Any vaccine made using an embryonic substrate, and we have evidence of this, causes opposite tendencies. Vaccines are taken from an embryonic substrate, and they did that here, too, so … it can cause opposite tendencies.” 

Are you following this? 

I’m not doing so well with it either. I did ask Lord Google about embryonic substrates and he was resolutely unhelpful, so I’ll nod vaguely, say, “Uh huh,” and sidle quietly out of the room while the good rebbe’s attention is distracted. Being ultra-Orthodox, he (and I admit I’m guessing here, and probably being influenced by stereotypes as well) probably doesn’t have a lot of time to talk with women anyway. 

In response, an Israeli GLBT etc. organization (that stands for gay, lesbian, bacon, and tomato, with whatever else you can fit between two slices of bread without disaster ensuing)–

I’ve lost the thread there, haven’t I? An Israeli GLBT etc, organization has announced that it’s gearing up for a massive influx of new members. 

Israel has managed to vaccinate a large swath of its population–2 million people in a population of 9 million have had at least the first shot. So far, no noticeable change in their sexuality has registered on the Richter Scale. 

What Israel isn’t doing is vaccinating the Palestinians who live in territories under its control. 

A public service announcement

For the record: I am not related to Senator Josh Hawley–much to his relief. 

How the pandemic tempts us into insults and sports metaphors

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Britain has approved the first Covid vaccine, thereby starting a robust exchange of insults with a random sampling of other countries, and in case that didn’t bring enough joy to the world, setting off another round of the sort of chaos that allows us to recognize Boris Johnson’s government even when we’re blindfolded in the woods on a moonless night. 

I look at each day’s news with a mixture of dread and glee.

The insult exchange

It started with Gavin Williamson, the education secretary, who you might think (being the education secretary and all) would know better but, hey, silly you.

Williamson went on the radio and said Britain was the first country to approve the vaccine because “we’ve got the very best people in this country and we’ve obviously got the best medical regulator, much better than the French have, much better than the Belgians have, much better than the Americans have.

“That doesn’t surprise me at all, because we’re a much better country than every single one of them.”

Several winces later, Conservative peer Michael Forsyth (his friends and family call him Lord Forsyth; you can call him Mikey) tweeted, “Frankly, [that’s]  just unseemly.” 

European Commission spokesperson Eric Mamer pointed vaguely in the direction of the high road and said, “This is not a football competition.”

 

Irrelevant photo: erigeron

Anthony Fauci, on the other hand,  ignored all of that, but he was critical of how quick Britain was to approve the vaccine, saying the UK hadn’t reviewed it “as carefully” as US health regulators.

The next day he backtracked, saying, “I have a great deal of confidence in what the UK does both scientifically and from a regulator standpoint” and on top of that, “I did not mean to imply any sloppiness.”

The difference in speed is because the US regulator often goes back to the raw test data while both UK and European Union regulators work from the reports the companies assemble. 

A few people have commented not that the slower approval process would be any safer but that people might have more confidence that it was safe. It could be a valid point, but where’s the fun in that?

 

The Brexit connection

Unable to see a flap going on and not jump into the middle of it, prominent Brexiteers in the government waded in and claimed that Brexit was the reason Britain had been able to approve the vaccine so quickly. 

“Prominent Brexiteers” describes pretty much the whole government, but this was only a couple of them, Matt Hancock and Jacob Rees-Mogg. Their quotes, sadly, are as boring as they’ve turned out to be inaccurate, so we’ll skip them, but you can follow the link if you want all the Ts dotted and the Is crossed.

The inaccuracy, though? EU law allows individual countries to distribute a vaccine in an emergency. They don’t have to wait for the European Medicines Agency to approve it. In fact, since Britain’s in a transition period until the end of the year, we’re still running on EU law and yes, that’s what we’ve done.

 

The chaos

Having approved the vaccine so quickly, we’re kind of like the kid who snatched the first potato out of the oven. Yes, he made sure he got the big one, and yes he gets to boast to everyone else about that, but he might’ve been smart to grab a potholder first. It would only have taken a few seconds.

In other words, as far as I can tell, from my vantage point on the couch, we’re having trouble figuring out what to do with the vaccine now that we have it. Because it all happened so fast and we haven’t exactly been (I know this’ll surprise you) planning for it. 

I seem to remember some loose talk, oh, maybe last week sometime, about frontline staff being a top priority for the vaccine, although I don’t remember hearing a definition of frontline staff. There was equally loose talk about NHS staff being at the top of the list. Whether those two were the same thing or not is anyone’s guess. 

During the first lockdown, we were all governmentally cranked up to respect the underpaid people who kept the buses and trains running, the stores stocked, the cash registers registering, the packages delivered, the food produced, and the cabs zipping around our towns. They put their lives on the line, we were reminded, and if they didn’t get the pay they deserve and need, they did at least get a bit of recognition.

Now that a vaccine’s imminent, are they still frontline staff? 

Well, um, it doesn’t look like it.

The government’s circulated (and the newspapers have duly published) a priority list with nine categories, starting with care home residents and the people who take care of them and working its way down to people over fifty. The list has some oddities, including putting frontline medical (and only medical) staff in the second category instead of the first and not bringing in the clinically vulnerable until the fourth category, where they keep company with the over-seventies. The Black and minority ethnic people (it’s a category in Britain, however vague it may seem to me as a foreigner) who are statistically at higher risk are mentioned nowhere. It also leaves out teachers and people who work in public transportation and food processing and retail the many other jobs that put people at risk. You know, all those people we appreciated so much the first time around and have now forgotten.

Then, after the list had been circulated, it somehow looked like care home residents and their carers might have to wait, because the vaccine has to be stored at the temperature of dry ice and you can’t just toss it in your back seat and drive it to the nearest care home. But hospital inpatients and outpatients who are over eighty might just skip to the top of the list because they’re easy to find. 

I have a picture of NHS staff running down hospital corridors vaccinating any random person who looks old enough. Whether they’ll find them again when it’s time for their booster shot is a whole different problem. But we have weeks  before we have to solve that one.

What we do know is that the first batch of the vaccine has arrived in the UK and that it will be distributed to hubs–places selected because they have the equipment to keep it cold enough. 

How many doses do we have? 

Um. Dunno. The business secretary, Alok Sharma, said that by next week, when vaccinations are supposed to start, the government’s “absolutely confident” that it will have 800,000 of them. 

I wasn’t worried until I saw that “absolutely confident.” 

Are they going to divide those 800,000 doses so they cover 400,000 people at two doses each? Or is the plan is to give one each to 800,000 people and trust that the second dose will be available when it’s needed? More doses are expected before the end of the year, but Sharma couldn’t say how many and NHS Providers said the UK would have to assume that more doses might not arrive “for some time.”

Sober-sounding voices on the radio advise us not to try to book a vaccination. The NHS will contact people to let them know their vaccination category is open and tell them how to register. But the NHS generally communicates with patients by letter. You know letters? Those paper things that appear in your mailbox or fall through a slot in your door? They take time to write, to print, to seal into envelopes, to move from wherever they started to wherever they’re going.

In theory, the vaccination program begins on Tuesday.

Independent of all this, I’ve read that it may be April before everyone in the nine at-risk categories is vaccinated. 

 

Mass testing

In the meantime, we have lots of twenty-minute Covid tests, which are also called lateral flow tests, in case it makes your life better to know that. They were supposed to be game changing, but the government’s announced so many game changers since the start of the pandemic that I’m not sure if I’m supposed to be running around with a tennis racket or a pool cue. 

The tests were rolled out on a mass scale in Liverpool, which has a high infection rate, and Dr. Angela Raffle, a consultant in public health and an honorary senior lecturer at the University of Bristol, said, “The infection rate in Liverpool has come down no quicker than in many other places that haven’t got mass testing and we haven’t yet seen a proper evaluation report from Liverpool.”

I read elsewhere else that mass testing alone isn’t a solution. You have to do something useful with the results if testing’s going to bring down the infection rate, and we seem to have missed that part of the plan. Possibly because it involves different sports equipment, which is stuck in the government’s Warehouse of Sports Metaphors. We filed forms that will let us get our hands on it long ago, but they’re still waiting for approval.

The NHS test and trace program, which is the key to doing something useful with the test results, usually hits the headlines because it misses some absurd percentage of people (4 out of 10 a month ago, which is–holy shit–almost half), but recently it improved its contact rate. 

How’d it do it? 

It changed the way it reports its data. I’d love to give you a link on that, but I heard that on the radio and I can’t find the right combination of words to coax the information out of Lord Google. But it was the BBC, and whatever complaints everyone from all sides has about, it isn’t known for making up its facts.

The rapid tests are also being used to allow relatives to visit people in care homes and do what I’m old enough to remember once seemed natural: hug them. But because the rapid tests miss some problematic percentage of infections, the BBC writes that “there has . . . been concern in some parts of the care home sector over the use of the tests, with homes in Greater Manchester reportedly urged not to use them to allow visits.” 

Some homes report not having received tests, in spite of a government announcement that everything was in place and reunions were possible. Others say they have the tests but not the training to use them

And there I have to leave you. A masked delivery driver is at the door and I hope he’s brought my sports metaphor delivery. 

He’s not on the list of priorities for a vaccination and he’s working on a zero-hours contract.

The problems with mass Covid testing

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Britain started a £100 billion Covid testing program, Operation Moonshot, which is supposed to catch asymptomatic cases so people can quarantine themselves instead of transmitting the disease and life can return to normal. The plan is to screen millions of asymptomatic people every week, and it’s being tried out in Liverpool as I type. 

Which sounds great, but Dr. Angela Raffle, a consultant to the UK national screening programmes, said, “It worries me that ministers . . . can wake up one morning saying let’s spend £100 billioin on this and not have it scrutinised–it would be like building a Channel tunnel without asking civil engineers to look at the plans. . . . This seemed to me to be the most unethical proposal for use of public funds or for screening that I’d ever seen.”

Other than that, though, it’s a good plan.

Irrelevant photo: apple blossoms–a photo I stole from last spring. 

The program relies on the Innova lateral flow test, which when it’s used by research nurses catches 76.8% of positive cases. When it’s used in the real world by what the article I read called “self-trained staff,” though, it picks up only 57% of positive cases. And Jon Deeks, professor of biostatistics, said people aren’t being told that they still might be carrying the disease, so if they test negative they feel safe to do–well, whatever they haven’t felt safe to do. Visit granny in the nursing home or tear off their masks and run through twelve supermarkets breathing heavily on staff and fellow shoppers. 

Nursing homes in three counties, including mine, are trying out rapid tests to allow visitors in. The publicity I’ve seen doesn’t mention the possibility of false negatives. It’s all how great it is that granny got a visitor. And up to a point it is great. I’m sure granny was pleased. I also hope it doesn’t end up killing her.

The good news is that the test doesn’t generate a lot of false positives. 

Italy was the first country to use mass testing–they used antigen tests–to control the virus, and it seemed to be working, which encouraged other countries to try it, including Britain. Italy’s now in its second wave of Covid. It went from  500 cases a day in August to more than 35,000.

So what went wrong?

Andrea Crisanti of the University of Padua says the tests were used the wrong way and that using them to protect vulnerable people in care homes was “absolutely criminal,” because of the infected people they miss–the false negatives.

The tests they used are 80% to 90% accurate and give both false negatives and false positives, but they’re quick and they’re cheap. If they’re used, say, before people catch a train, they could reduce travelers’ exposure. But they wouldn’t eliminate it because, again, they don’t catch every case.

Crisanti said, “If your objective is to screen a community to know if transmission is there, fine.” But the quick tests, he said, need to be backed up with the more accurate but slower PCR tests, along with stay-at-home orders.

There doesn’t seem to have been–or to be–any strategy for what to do with the information beyond simply boosting the number of tests.

In an article about how antigen tests were used in the US, the website ProPublica writes that “When health care workers in Nevada and Vermont reported false positives [from the tests], HHS [that’s Health and Human Services, a federal agency] defended the tests and threatened Nevada with unspecified sanctions until state officials agreed to continue using them in nursing homes. It took several more weeks for the U.S. Food and Drug Administration to issue an alert . . . that confirmed what Nevada had experienced: Antigen tests were prone to giving false positives.”

In nursing homes, false positives are as dangerous as false negatives. A person who tests positive will be moved in with other people who test positive. If the test gives out some false positives, healthy people will be exposed to Covid, making the test a self-fulfilling prophecy.

The tests HHS recommended are meant for people with Covid symptoms, and when they’re used that way they produce virtually no false positives and catch 84% to 97%  of positive samples in a lab test. But a study–like many Covid studies, it hasn’t been peer reviewed yet–found them catching only 32% of positives in people without symptoms.

Still, HHS is recommending them for use on nursing home residents without symptoms and suggesting repeated tests to reduce false negatives. An October survey found that a third of nursing homes hadn’t touched the antigen tests they’d been given. They didn’t trust them, they didn’t have the staff time, and the paperwork and reporting requirements were more than they wanted to deal with.

Dr. Rebecca Lee Smith, an epidemiology at the University of Illinois, said, “It’s how you use the tests, not just how many tests you have.” If you have a million tests, is it better to test a million people once, or test half a million people who are at high risk twice, or test essential workers five or 10 times? 

If anyone has an answer to that question, I haven’t seen it in print yet.

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Earlier this week I introduced the game Where’d the Money Go? and missed some of the more outrageous examples of where the money’s gone. I plead extenuating circumstances, because a National Audit Office report hadn’t hit the news yet. So let’s make up for my lapse. 

Sorry. I do try to sneak some good news into these posts. Some weeks, it’s like fighting gravity.

Early in the pandemic, in an effort to get protective gear for the health and social care systems, the government set up a high priority contracting channel for businesses that were recommended by ministers’ offices, lords, politicians, or officials. Oddly enough, those lords and politicians seem to all have ties to the ruling party, the Conservatives.

The rule of the playground is that we don’t share.

Their bids that went through that channel were ten times more likely to be successful than the bids that went through ordinary channels. One source said their pitches were automatically treated as credible. The documentation is–

Quick, someone, what’s a shoddier word than shoddy? Paperwork documenting why a particular supplier was chosen is sometimes missing. Contracts were sometimes drawn up after the work had been started. 

The person who recommended the company to the priority channel is documented less than half the time. No rules for how the priority channel should operate seem to have been written.

This was in the first six months of the pandemic, when £18 billion was spent on Covid-related contracts.

Liz David-Barrett, a professor of governance and integrity (that’s what she studies–I’m not commenting on her personal qualities), said that firms recommended in this way are usually treated as higher risk rather than lower.  

In a related story, although I can’t say what channel this contract went through, Gabriel Gonzales Andersson made £21 million for wandering through a deal between the UK government and an American jewellery designer, Michael Saiger, to procure protective gloves and gowns from China. 

According to the BBC, Gonzales Andersson was paid to find a manufacturer for deals that had already been arranged.

If you can figure out what happened between the two, you’re doing better than I am, but they’re both in court in Florida–suing each other, I think, although I can’t swear to that. Saiger had several follow-up contracts, and the gear he was supposed to supply was delayed, possibly because the relationship between the two men fell apart.

One more example before I stop: Lord Feldman, a former chair of the Conservative Party, and a managing director of the lobbying firm Tulchan Communications, acted as an unpaid advisor on Covid. 

Tulchan is also called a public relations firm; flip a coin if you care.

After the firm Oxford Nanopore signed a £28 million contract with the Department of Health, and also after Feldman stepped down as an unpaid advisor, Nanopore hired Tulchan. The health secretary, Matt Hancock, happens to have met with both Feldman and Oxford Nanopore before the contract was signed. I have no idea what they talked about. Movies, probably. Pornography. Gummi bears. Surely not whose money would end up in whose pockets. I wasn’t there. That’s how the gummi bears came into it. 

Tulchan says Oxford Nanopore was already in discussions with the Department of Health before the meetings, so everything’s fine.

Nanopore later picked up another £100 million in contracts.

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The British Medical Association has gone public with advice on how to lift the current lockdown. The approach last time was, “Wheeee, that’s over. Go out, have fun, spend money. Don’t work from home. The economy needs you.”

That was followed by a faint, “And, oh, do be careful, okay? Wash your hands or something.” 

Which is one of several reasons that we’re now in a second lockdown. 

What the BMA advises includes giving local public health teams more of the test and trace budget, along with more oversight of the program; limiting socializing to two households instead of six people; keeping the local tiered lockdown system that imposes varying restrictions depending on an area’s level of infection but banning travel between areas in different tiers; encouraging people to work from home if they can; and replacing guidance about how to keep workplaces and public areas safe with rules about how to keep workplaces etc. safe. The theory goes that rules are enforceable and might be taken more seriously.

Dr. Chaand Nagpaul, the BMA’s chair of council, said, “The big question in practical terms is can we reopen hospitality venues–pubs and restaurants–in the run-up to Christmas and still avoid infection levels increasing?

“I suspect we can’t, but the decision may be made to do so anyhow on the basis that any increase will be slow and may be able to be counteracted later.”

Because what the hell, it’s Christmas. What do a few extra deaths matter?

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If I haven’t managed to be funny this time–and I’m pretty sure I haven’t–I’ll try to do better next time. It’s not that this stuff isn’t funny, in a demented sort of way. But it takes time to find the humor and I want to get this posted before the next wave on insanity breaks over us. 

Stay well. It’s dangerous out there.