How to eliminate Covid, and other pandemic news

 

Academics at the University of Otago studied New Zealand’s experience with Covid and say that the virus can be eliminated, not just contained. 

The emergence of an apparently more infectious virus variant is just another reason to eliminate this infection,” they said

Actually only one of them said it, but let’s pretend, for the sake of simplicity, that they spoke in unison. They do stuff like that in New Zealand. 

What you need if you’re going to eliminate the virus, they said, is informed input from scientists, political commitment, sufficient public health infrastructure, public engagement and trust, and a safety net to support vulnerable populations. 

Those will be easier to cobble together in some countries than in others. That’s me speaking in unison and not mentioning any countries by name. To protect the guilty. 

Irrelevant photo: Crocuses. They’ll be coming up soon, and they’re not afraid of the corona virus.

One of the barriers to eliminating the virus is the belief that hard measures will hurt the economy more than half measures, causing greater hardship, which (as advocates of half-measures reminded us at the start of this mess) has its own health impacts.

“Our preliminary analysis suggests that the opposite is true,” the academics said. “Countries following an elimination strategy—notably China, Taiwan, Australia and New Zealand—have suffered less economically than countries with suppression goals.”

The introduction of vaccines should make elimination easier.

 

Antibody therapy

Scientists are testing an antibody therapy that could prevent someone who’s been exposed to Covid from going on to develop it. It could, at least initially, contain outbreaks–in nursing homes, hospitals, or universities, say–or protect people in households where one person is known to be infected. They’re also investigating the possibility that it could protect people with compromised immune systems. 

If all goes well–please notice the if in that sentence–it could be available in March or April.

The Pfizer and Oxford vaccines don’t confer immunity for about a month after injection. With this, the immunity would be immediate.

It goes by the snappy name of AZD7442. 

 

Mass testing evaluated

Britain tried a mass testing program in Liverpool, using rapid-result Covid tests, and managed to miss over half the cases. 

So was it worth doing?

A study went through the data and came back with a definitive maybe. In this corner, wearing the electric pink tee shirt that says No, is the danger presented by false negatives. People who test negative but in reality carry the virus may be prone to riskier behavior than people who haven’t been given any reassurance. They think they present no threat, so they may spread the disease more.

And in this other corner, wearing the soothing green tee shirt that says Yes, is the benefit that comes with spotting Covid cases that would have been missed and taking those people out of circulation. Assuming, of course, that they actually do take themselves out of circulation, which most of them will. 

I think.

The Liverpool data hint that the test may spot people with the highest viral load–in other words, people who may be the most infectious–while missing those least likely to be infectious. But you might want to notice how many tentative words wiggled their way into that sentence. It hasn’t been established that a light viral load means you’re less infectious. 

People who are asymptomatic, by the way, can still have a high viral load, and an estimated 40% to 45% of cases are asymptomatic.

So is mass testing with rapid tests worth doing? It’s a matter of weighing the possible gain (spotting cases that would otherwise have been invisible) against the possible harm (giving false reassurance to people who are in fact carriers). And it depends on that unknown: how contagious people with low viral loads turn out to be.

Whatever it is you come here for–and that’s still a mystery to me–it’s not rock-solid certainty, is it?

 

The compassion report

With a show of compassion worthy of the current American and British governments, Colombia’s president announced that the country will refuse Covid vaccines to hundreds of thousands of Venezuelan refugees. The only refugees who’ll have access to the vaccine are those with dual citizenship or official status. That’s less than half of them, and more are crossing the border daily.

The idea that no one will be safe until we all are is a hard one to get across. As will that business the academics from Otago mentioned–political commitment. 

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A bookstore in Trieste asked for volunteers to call people trapped at home by the virus and spend twenty minutes at a time reading to them over the phone and just generally chatting. They figured they’d be doing well if they found a few people to help out the three staff members who were already doing making calls during their breaks and on their days off.

They got 150 responses. Some were from Italians living abroad. Some came from a theater company that had itself been trapped by the pandemic–not at home but offstage. Some were I have no idea who–people who don’t fall into such neat categories. The plan was to have the calling run during Christmas, but with the response it’s gotten it now has no end date.

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An Amsterdam museum that sold a Banksy work for £1.5 million so that it wouldn’t have to lay off staff had a bit of compassion and goodwill returned to it. The anonymous buyer emailed a few months later and offered to lend it to the museum for at least a year.

How the pandemic tempts us into insults and sports metaphors

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.