UKH

The continued worry about the future of covid from a specialist Prof in immunology. 

https://www.theguardian.com/commentisfree/2022/jul/01/herd-immunity-covid-v...

An interesting, if slightly worrying read.

I’ve got Covid. Just been out to fill a bird feeder and just sat down slightly breathless. Surprised how bad it is, and my brother says the similar. He’s had it ten days, me five. And the brain fog is very evident. I even have to concentrate posting on here, whereas  normally I can spout drivel with total ease. 

But: I believe in Portugal where BA4 etc kicked in earlier, cases are dropping quickly. 

Believe me it's all relative, I got Covid in the middle of a particularly agressive chemotherapy and one doesn't notice!

I think this line is probably a massive underestimate: "619,000 new long Covid cases"

Based on a sample of one, the most accurate kind, my wife has had long Covid since February this year (we both got Covid for the first time then and suffered pretty bad with it). She's been ill ever since. Continuous colds and coughs and a general feeling of not being well.

We're really keen to get it formally recognised as long covid, as it would stop her employer recording all he absences against her. But after multiple GP visits, they just send her away, try some antibiotics and nothing else. If this is typical, the true long covid numbers are likely much much higher.

I had it in April, thankfully pretty mild and no lasting effects. I was speaking to a friend recently who had Covid in March 2020 and has got it again now, worse than the Wuhan strain which was pretty mild for her.

It was never going to be a cakewalk normalising this virus in to circulation, and I don't think there was much expectation this would magically happen in the first year after mass vaccination and then wider vaccine-moderated spread.  Hence the significant concern over the coming winter, for example.  

The article title - "Where’s the herd immunity?" - there isn't any, and I thought it was pretty clear to the experts that from Delta onwards that there never would be any...  Yet parts of the article are written as if the author still things we should be gunning for it...  Herd immunity / elimination aren't even a pipe dream now.  

A lot of the article seems to be written with the expectation that after live infection, one should not expect to get Covid again.  That's not the case for any of the circulating "colds" including the coronavirus OC-43 - we catch them again, and again, and again.    We just don't get so ill from them that we go to hospital and die, at least not until we reach our twilight years... 

I found this line a bit ambiguous - "We considered many facets of immunity, including the antibodies most implicated in protection (“neutralising antibodies”),".  Those antibodies prevent (re)catching the virus for a strictly time limited period, then the antibodies degrade.  In fact, the body seems to encourage their degradation, presumably to stop the blood becoming physically thick with antibodies over time.  In terms of protection, enduring protection comes from other areas such as the T-cells.  

No vaccine is going to protect an individual for more than a strictly limited period through neutralising antibodies.  As I see it, they're not a general protection mechanism - they help shut down an infection once it's underway, and they protect most people from re-catching the same variant for around half a year.

"The results tell us it is unsurprising that breakthrough infections were so common. Most people – even when triple-vaccinated – had 20 times less neutralising antibody response against Omicron than against the initial “Wuhan” strain."

Again, this doesn't seem surprising.  The Wuhan strain was caught by people totally immune-naive, and it would multiply under the immune radar until the soft tissue damage was so bad the body threw everything at it including antibodies.  Exposure to Omicron is almost entirely in people who are not immune-naive, and their T-cell response should kicks in much sooner, which in turn activates the B-cell and memory B-cell responses (including making the neutralising antibodies) far sooner; the immune system is then likely to achieve their objectives well before the virus reaches the level of infection it would in an immuno-naive person.  As presented in the Guardian article it feels strongly like an apples-and-oranges comparison that's got a totally misleading number - compare "London only sent 1/20th of the firefighters as Paris" with "London only needed 1/20th of the firefighters because only one building was on fire instead of a whole city block".   

Perhaps I'm missing something but the whole article feels like it's leaning in to the most negative takes possible...

As I said in my wrap up post on the plotting threads, I think that a lot of people are going to be at increased risk for many years from Covid, and there's a bunch of stuff they and others can do to manage that risk.  With long Covid there's a lottery element to it.  (After my first detected infection in winter 21/22, my energy levels crashed and it took months to recover, and every illness since then crashes them down again although recovery is now faster.  It sucks.)

His conclusion "From where I stand, “living with the virus” is proving hard for many. This fight is far from over, and learning how to pull this off is an active process requiring considerable effort, intervention and ingenuity." - I totally agree.  Adding another virus to circulation was always going to make things worse, but it remains the least-worst option (how many people reading would be happy living in Shanghai under their recent elimination attempts?) and it's important that research into mitigating the effects is supported, as well as ongoing work in to improving workplace and public space ventilation.

Maybe the negativity is in the context that the government are not being very helpful and most in the population act as if everything is over with (at least until they end up with resulting problems), when facing an NHS struggling in the summer months and with plenty of problems lining up for the rest of the year....including people with long covid and many immuno-suppressed fearing to go out.  ... Still, all fair points from you though.

When I saw mountainbagger's thread "I don't think this law is for people like me!" and watched the video, I couldn't help but relate it to our current attitudes towards covid. We're still rather like that nationally, always thinking in terms of "getting away with it", and we have a government that reflects the worst of those tendencies. It doesn't help much when you know the people in charge aren't adults.

What's most remarkable about Altmann's article, in my view, is what's missing. There's no mention of the existing CEV. His argument isn't at all about us failing to protect the CEV, but seems to nudge us gently towards thinking about the sheer numbers of people who are swelling the ranks of the CEV. The vaguest of his paragraphs is the one in which mentions "immune imprinting" but I find it brave of him to mention it at all, given the furore it's provoked. Nonetheless it needs addressing: we can't keep on increasing the proportion of the population who are unable to work indefinitely.

...and little-to-no thought for them in the post-control-measures plan.  

Which is maddening when - as I know you know incredibly well - there is so much low hanging fruit to both protect people, and to help them protect themselves, that is not well communicated and not well supported by policy or healthcare.  

• E.g. Air quality ratings on indoor public spaces, legal requirement to have a minimum level of air replacement or filtration on schools, certain workplaces, healthcare facilities etc, prescription fitting and supply of FFP2/FFP3 masks, a clearly accessible regional "Covid Risk Forecast".  Many of these things would have benefits far beyond Covid.

Whilst he talks about the risks of long covid, a point he doesn't explicitly make - and it's an important point - is that there are still unknown risk factors for getting  long covid.  There's no way we're making the virus go away now, but until everyone has had it a few times, those unknown risk factors won't be fully explored and we'll continue to see a lot of cases of long covid generated.   (I'm implicitly assuming that the risk factors are longitudinal here...)

It's been discussed on here under the less scientific name of "original sin".  The problem now is that there are so many different possible sequencing of immunogenic events and timings that trying to understand how an immune compliment comes about must be nearly impossible.  

Seems to me like being able to characterise an individual's T-cell and memory T-cell compliment and then identify the most potent vaccine to build their immunity is a big step forwards, but T-cell assays remain a lot more expensive than antibody ones.  Also - it's not too late for the UK to retract the counter-factual comments given under parliamentary privilege (by the Health Secretary) on Valneva and use that for a booster round.

I agree with all those as concerning points.  

Chuck in the goings on in the wider world and I'm very pessimistic about the coming winter.  If Covid was plucked out of existence with a magic wand tonight, I'd be worried about this winter from both healthcare and wider perspectives.

But none of that changes my sense that the article is leaning in to a concept of herd immunity that has simply been impossible for almost two years now.

Think it's about the 6 months mark for recognition 

I see it more as putting another nail in the coffin of an increasingly daft idea; but we would need to ask him. Funding for the vaccination  service also seems to be a bit on the ropes but not very public yet, despite added workload from a scary likely  increase in flu and the monkey pox work.

I'm as fraud I can't take seriously anyone using "twenty times less" as a mathematical expression, and would seriously question the validity of any peer reviewer accepting this. 

It would be puzzling if he were, given that elsewhere Altmann very much isn't an adherent of herd immunity. I suspect that he's doing that thing that academics often have to do when writing in a public space: he's addressing several different conversations taking place elsewhere without naming their participants.

In the Science paper mentioned he's more explicit (but not much...): "At this stage in the pandemic there is a view that the global spread of B.1.1.529 (Omicron), through its association with a relatively milder disease phenotype and, possibly, a potential to boost vaccine immunity, may herald the transition into a new, endemic relationship". It's this view that the paper criticizes; he says elsewhere that he's attacking the idea that Omicron infection tops up immunity.

I'm reading the way the Guardian article leans into the conversation about herd immunity as an implicit public criticism of, among others, a number of scientists, journalists, and GBD-adjacent pressure groups who, owing to having channels into parliament, have managed to sway UK Gov policy to the point that it's a herd immunity policy in all but name.

I have been taking antibody therapy every 6 months since the start of Covid. With all but no immune system its been a terrifying few years. When I finally did catch it I assumed it was just hay fever due to work related tasks.
All the best with your chemo, I only had a short course of it in 2020 and it wasn't too much fun.

Keeps one on tenderhooks waiting for the blood tests, see if the little thingies have recovered enough to have the next course! I'd guess about a third of my fellow patients were on immunotherapy, a third on blood and the rest on chemo. Luckily I'm pretty robust and took it all pretty well but it sure wears you down after a while, I coped with the hard-core stuff okay but there kept being delays from Covid and my blood values which sorta dragged it out a few months longer than expected. From all the crap-inducing side effects Covid wasn't noticeable, only found in a routine test (and all my family were positive).

Psychologically interesting though, chatting to other patients and how they and oneself reacts to the whole thing, for me it was a technical problem how the body reacted and coming to terms with a "different" me.

All done and dusted though, hair growing back and muscles stopped acheing so it's all good, just got to get rid of 10kg and turn the rest back into muscles! Never got friendly with alcohol-free beer though.

It caught up with me yesterday and it’s really knocked me out, I ache oh god do I ache. Toe joints, every joint, my bum cheeks, roaring headache and hacking cough. All came out of nowhere overnight and I’m bloody exhausted. The small teen in the house also has it but she’s obviously made of stronger stuff and is ploughing on like a trooper.

a good friend works for the NHS via Serco and is programme manager for the test  and vaccine drop-in centres across the midlands. He’s rapidly tearing down these sites, yet is also waiting a rapid about face to get them all up and running again pdq end of July tume. Both for testing and booster jabs.

Hope you're starting to feel a bit better. It's finally caught up with me after avoiding it for the last few years - woke up freezing and shivering in the middle of the night then this morning I had a fever and body aches like I'd been hit by a truck. Neck and lower back are the worst but I've also got a banging headache, sore throat, cough etc. 

Very faint positive on the LFT but that might be my ineffective swabbing as my other half, who is totally asymptomatic at the moment, had a much more pronounced line. 

I seem to have been incredibly lucky so far in the Omicron waves: close contact indoors with a number of people with covid (symptoms and +ve LFT) but have escaped (no symptoms and -ve LFT tests afterwards). I have had a number of colds in the last year so might have had it (despite -ve LFT tests) but they correlate with meeting people with colds who tested -ve.

It feels surreal that we have infection levels so high with consequences as bad as typical  flu waves but almost no significant public health information from ministers. Even Jenny Harris, who does give a more appropriate message admitted not always following her organisational  advice on the Sunday Morning show on the beeb. Yet in addition to those suffering with the infection, hundreds of thousands of the still vulnerable self isolating are really struggling with mental health impacts... hundreds of thousands with long covid ( who regularly complain about poor NHS support)... and hospitals will really struggle with increased admissions (already locked in).

Simple cheapish actions like mask use in enclosed poorly ventilated indoor spaces (preferably FFP2), improved ventilation in public spaces, consistency in messaging, and financial protection of those self isolating required to work or will lose pay (no access to sick pay), could really help for covid and other respiratory infections. Looking to Australia flu is high this year and early...a high risk for a wave in autumn.

Ah, pants, commiserations.
I hope you'll be feeling much better v soon and it's not too disruptive for you both.

I finally caught it a couple of weeks back and I was actually rather shocked with how badly it hit me. On Sunday I went for a ride around the Matlock hills and I got unusually destroyed by it, then on Monday I started feeling very iffy and developed a cold. Once I went to bed for the night I had a fever and felt awful. Had a test in the morning and it lit up instantly, as the fluid went over the test line it just changed colour.

I had 5 days of fever up to 39.5C, then a couple of 37.5C, then a headache for a couple of days. I finally tested negative and felt alright at day 10.

Cough was never particularly persistent and was throaty at all times, it pretty much felt like the infection was exclusively in my throat without any lung involvement. Considering it felt like a particularly bad case of strepthroat, I am quite glad about that fact because if it can turn my throat to mince I dread to think what it would have done to my lungs. The worst part was the constant brain fog and fever.

Being the idiot that I am I went climbing pretty much as soon as I was negative and feeling alright. Recovery from that session involved sleeping through the entirety of Saturday, so I'm taking it easier now and moderating my activities.

I do wonder whether I would have been hit as badly had I not done that ride, I can't imagine reducing your body to a quivering mess does great things to your immune response.

On the flip side, it killed at lot of my wife's patients (she's an oncologist, lung cancer).

Sunday before last I started shivering for no reason and felt shattered. Went to bed exhausted. And then the aches started - well achy - all my old injuries sore as hell. After three days I was left with breathlessness, cold symptoms and brain fog. Now testing negative, feel OK-ish but ‘ropey’ - head cold and tinnitus. I’ve tried very hard to simply rest. 

Totally agree, a friend works at a supermarket and the management were quite happy for her to be in work whilst testing positive if she felt will enough. ​​​​​​I get the need to return to normally, but quarantining whilst positive is plain common sense and the lack of financial support makes this difficult, especially for low paid workers.

My friend stayed home on SSP and two weeks on still isn't well enough to go back to work. Financially she is struggling, but sounds like her workplace is now a super spreader as lots of co workers have gone down with it over the last 2.5 weeks.

(And don't get me started on the impact of long covid)

In retrospect, going to my first gig in 2 and a half years last week and spending 2+ hours, unmasked, in a crowded venue full of people singing along seems like a suboptimal strategy. The annoying thing is that I'm usually so careful!! I still wear my (FFP3) mask on the train and in the shops and I opt to eat outdoors if that's available. But the thought of going to the gig masked up, not being able to sing, getting a really sweaty face etc felt like it would really impair my enjoyment of it. Ah well, after avoiding it for this long (well, apart from a suspected bout of OG covid back in Feb 2020) it was bound to happen.

Cheers. I'm feeling a bit perkier now than I did this morning and my fever has subsided a bit but we'll see how things go over the next few days. It's a good opportunity to catch up on my knitting anyway.

I was going to offer you my commiserations and then, before I could do so, Alkis, and Bottom Clinger, and climbingpixie all chimed in with news of their infections too... Commiserations and fingers crossed for a full & rapid recovery to all of you.

Offwidth: it does feel surreal. Harries' admission that she does have a mask but that she "routinely keeps it in her handbag" struck me as one of the most Alice-in-Wonderland bits of public health messaging ever.

Covid + a bad flu season + high energy costs meaning millions of OAPs unable to heat their homes properly…. This Winter could see the NHS well and truly screwed.

Latest

https://www.theguardian.com/world/2022/jul/05/covid-surge-jcvi-chief-andrew...

Thanks for the kind words all! 
 

im over the worst of it but it’s knocking the rest of the house down bit by bit, only the dog left. I’ve taken the full week off work to rest-up and to look after those that pandered to my needs at the weekend. Overall though I still have a thick head, and my lower back still aches. I shouldn’t be surprised at all at how much of a toll the virus has taken on me but is has still been a shock. What’s equally shocking is how hard it has hit my super-fit teen. He’s slept on and off for about 72 hours now waking only to have showers and a bite to eat (I know this is almost normal for teens) and he looks terrible, he’s coming through and getting up and about now which is excellent, but I was rather worried for a time.

Commiserations to all who are suffering, silver lining is that I guess as individuals we’re done for the summer, the next jab should protect us for the winter, and we should be a bit more robust come the next wave.