Friday night Covid Plotting #41

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 wintertree 28 Aug 2021

A slightly different order to posts this week to go through England first, then Scotland.

We’ve had about a month of very gradually rising cases, hospitalisations and deaths in England since the big post-football drop.  Lots of thumb twiddling and head scratching about what it means - very hard to say without having all this data broken down into vaccinated and unvaccinated numbers, but my best guess is still that we’re close to the point where there’s enough immunity about to send symptomatic infections (as opposed to all infections) in to decay. With the threshold for that being a very high level of immunity and with the daily infection rate relatively low compared to the number of people without antibodies, it’s a slow process.  English cases are doing a good impression of going in to decay over the last few days - the demographics (a later post) are illuminating here and don’t contract the idea we might be reaching a tipping point for symptomatic infection going in to decay as immunity rises…. But the navel gazing at plots is getting harder without data split by vaccination status. The absence of that on the dashboard is more glaring each week, and another nations are starting to categorise their data like that.

Link to previous thread: https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_40-...


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OP wintertree 28 Aug 2021
In reply to wintertree:

I’ve added an annotated version of the usual D1.c with a couple of regions encircled on the right side plot.  In the first region, we see a big spike in the exponential rate constant for adults around 20-25 in particular.  The happened around the time of a few big university outbreaks and decreasing restrictions.  This rapid exponential growth is followed by a large number of cases on the left side plot.  Then there’s a sudden vertical blue band in all ages which corresponds to the end of the football and the gender ratio returning from male-skewed to the usual level.  Then, everything turns faintly orange as we go in to the very mild growth of the last month.   Now, in the second encircled region we’re seeing cases turn to decay in the same ages that had the most growth and the highest absolute number of cases over the last couple of months.  The very far right is now looking like it’s turning to decay for all ages, but as ever the far right is highly provisional.  If naturally acquired antibodies are “filling in the gaps” and tipping us over from growth to decay, it kind of fits that we’re seeing the tipping over first in the ages with a lot of recent cases - as the spread of cases now is likely concentrated in the unvaccinated.

The relative distribution of cases in P1.e has been broadening out a bit from the high concentration in young adults.  This can be seen in the "sections" plot with the red line above the orange from age 40+.  I come back to this in the bit on the Lissajous figure.


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OP wintertree 28 Aug 2021
In reply to wintertree:

Plot 18 suggests all regions are turning to decay - most strongly so in the South West which a couple of posters have suggested is related to a recent festival there.   This turn to decay is on the far right of the plots which as ever is the highly provisional zone so I’d want to see another few days of data before really believing it.  Still, the hospitalisation data is starting to tip over in some regions too, almost too soon to be corroborating a turn to decay in cases - but this data is not subject to the day-of-week noise or the variable reporting lag that can confuse the leading edge of cases.

I’ve put a Lissajous figure in for England this week - it shows how we’ve gone in to much of a “holding pattern” - the relative stagnation of the last few weeks shows as all the data markers clustering in a small area of the plot.  I’ve encircled these for hospital admissions and deaths.  Such a long, near-level period means the lag drops out of the relationship between the variables, so we can get a pretty good read out of the case hospitalisation rate (~3%)  and the case fatality rate (about 0.35%) from just eyeballing the plot.  Deaths are less static than hospital admissions and are still gradually rising, I think this might be to do with the broadening out of the distribution of cases I mentioned about re: plot P1.e - whilst the daily number of cases isn’t changing much, slightly more of them are in older people now.

I was reflecting on the ~0.35% CFR now vs around 2% in the pre-vaccine winter of 20/21.  Whilst this is much less than the improvement to outcomes the vaccines make, that’s not the mechanic in play here I think - rather that because the vaccines are so effective, both cases and especially deaths are stacked towards the unvaccinated, and because vaccine uptake is almost complete in older adults, we’re seeing a younger unvaccinated demographic getting infected and dying compared to previous waves and that's what's defining the CFR.  It’s all a bit interpretive of me however as there isn’t public data for all the measures categorised by vaccination status.


1
OP wintertree 28 Aug 2021
In reply to wintertree:

The rise in hospitalisations and hospital occupancy makes it clear the recent rise in cases reflects a true rise in infections (and not a consequence of the switch-on of asymptomatic testing with schools returning).   Plot 9s shows cases then hospitalisation turning to growth with a typical ~2-week lag between them.

The cases plot looks like it’s wants to peak; this corresponds to changes in the 7-day rate constant (next post).  The next post will look at the demographics behind this; spoiler alert - don’t get your hopes up for the cases to go in to decay.


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OP wintertree 28 Aug 2021
In reply to wintertree:

A look at the demographic rate constants for Scotland to try and unpick what's going on...

The key thing here to unpicking the causality of it all is that the rate constants (D1.c, right side) reflect changes in how much or little things are stacked in favour of viral growth, and then this operates on the current number of cases (left side), making more or less cases.  So, when it comes to looking for cause and effect, the right plot is often more informative as it decouples how much the virus wants to spread from how much virus there is about and puts the focus on the mechanic of the spread (reflecting the point in time on the x-axis) not the absolute numbers (reflecting everything that happened before that point in time).

I’ve put in a line-plot of the last month of the rate constants vs time from D1.c.  From this we can see that ages 20-24 turned to growth before 15-19, and that growth 20-24 peaked both higher and sooner than in 15-19.  We now see the rate constants in these two early-risers dropping back towards 0, whilst growth slowly comes to the other bands.  0-14 in particular is rising more than the others new.  To me this feels compatible with a burst of transmission in adults aged 18-25 with the dropping of nightclub restrictions which is now decaying, and now school based transmission starting to show through, with both of these effects occulting against a generally rising trend.  The 15-19 age band will include school aged children and adults so the two different forms of curve (20-24 and 0-14) could be masking each other for a bit.

Trying to unpick the un-unpickable here is a bit of a distraction perhaps, the absolute number of cases in older people is currently much lower, but as the line plot in particular makes clear, that’s now where the greatest exponential growth is.

As some comments from SAGE said that I pasted on the last thread:

Sage (Scientific Advisory Group for Emergencies) says it is still difficult to work out whether schools are drivers of transmission, or simply reflecting the spread of the virus in the communities where they are located. - https://www.bbc.co.uk/news/health-58357021 

I’ve put a Lissajous plot in for Scotland.  If we just look at growth phases (not the loops formed during decay phases) then some trendiness (light pink, light blue) drawn by eye to the data markers are diverging.  On these log/log plots, for a fixed conversion ratio and lag from cases to the y-axis measure the gradient should always be 1:1 - that’s pretty much the case for the last wave.  The way this wave is diverging with a gradient less than 1:1 means that the product of the conversion ratio and the lag is constantly decreasing; it seems reasonable to interpret this as the conversion ratio constantly decreasing - fewer people catching the virus are going to hospital.  One way or another that’s a good thing.


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OP wintertree 28 Aug 2021
In reply to wintertree:

The general shape of the last two months in cases are similar everywhere - lots of rising, then a turn to decay around the end of the Euros, then some growth.   Ranked in terms of low to high growth it goes England < NI < Wales < Scotland.   Excepting Scotland, all now look to be back in to decay.


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OP wintertree 28 Aug 2021
In reply to wintertree:

The rate constant plots based on week-on-week changes show a turn to decay for England and hopeful signs that the rate constant is heading for decay in Scotland.  The picture in Scotland is demographically complicated though so I’m not counting on it continuing to decay.

For reasons I can't put my finger on, I'm looking at the English rate constant plot with a suspicious eye.  I want to see any residual reporting lag play out and a few more days of data before I'm really buying it.


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 Misha 29 Aug 2021
In reply to wintertree:

Thanks as always. I’ll copy my comment from #40 so that thread can retire to wherever old threads spend their retirement (Cornwall?).

I think in England it’s Paugust - you said weeks ago that rates were going to pogo around and that’s what’s been happening. It’s good to see that case numbers have levelled off and are falling a bit but in the scheme of things they are just moving around with a range of 25-40k a day (official cases, that is). Which is still a lot but if that continues to translate to a tad under 1,000 admissions a day, I guess it’s manageable.

The big question is when will it burn out to low thousands of cases a day, if ever. Depends on level of vaccine escape / reinfection. 

Seems reasonable to expect cases to go up in September due to schools and then unis. Wouldn’t be surprised to see 50-60k a day.

Your explanation for Scotland makes sense. Also the absolute numbers are much lower, so the impact of a few superspreader events will be greater. Similar thing in the SW after that festival.

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 Offwidth 29 Aug 2021
In reply to wintertree:

Thanks again. Indie SAGE had a look at Scotland numbers on Friday and said much the same as you.

Indie SAGE have also produced a handy pandemic timeline showing the recommendation of SAGE compared to their own advice and the government actions.

https://www.independentsage.org/following-the-science-a-timeline/

Plus I can't remember if I linked their document form last week on herd immunity and if and how we can reach it.

https://www.independentsage.org/how-can-we-reach-herd-immunity/

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 Si dH 29 Aug 2021
In reply to wintertree:

Thanks as ever. It's particularly good to see the exponential constant falling in England if that now covers all/most regions, which I hadn't picked up. Albeit school return this/next week will probably cause some reversal. Also particularly good to see clear demographic data for Scotland rather than having to manually interpret the PJs dashboard data, which requires a lot of effort. I agree with everything you say on that.

Good thinking on new use of the Lissajous plot. I think you are wide of the mark here though:

> I was reflecting on the ~0.35% CFR now vs around 2% in the pre-vaccine winter of 20/21.  Whilst this is much less than the improvement to outcomes the vaccines make, that’s not the mechanic in play here I think - rather that because the vaccines are so effective, both cases and especially deaths are stacked towards the unvaccinated, and because vaccine uptake is almost complete in older adults, we’re seeing a younger unvaccinated demographic getting infected and dying compared to previous waves and that's what's defining the CFR.  It’s all a bit interpretive of me however as there isn’t public data for all the measures categorised by vaccination status.

The deaths data by vaccination status for all sequenced delta cases can be seen in the same bits of the variant technical briefings as I summarised the hospitalisation data from last week. In summary:

- over half of delta deaths have been in people who were fully vaccinated plus 14 days

- about a third have been unvaccinated people

- almost exactly 90% have been people over 50

- in the 10% who have died from delta under age 50, two thirds were unvaccinated and just under a quarter were double vaccinated plus 14 days - but these are small numbers of people (27 of the latter)

The death risk is still weighted very much towards older ages and they are at higher percentage vaccination status so these %s are not that surprising. It doesn't support your theory above about the CFR though.

I haven't thought through an alternative interpretation very well. I was about to write that I suspect it may be down to many more infections now being asymptomatic...but actually I think much of that should be picked up in the vaccine efficacy against symptomatic disease, which isn't so high any more. So I'm not sure.

Post edited at 10:39

 elsewhere 29 Aug 2021
In reply to Offwidth:

Herd immunity may be illusory in current circumstances of R, vaccination uptake and vaccine efficacy against infection.

The rate at which immunity decays* in vaccinated people may exceed the rate vaccination boosters** and infections inducing immunity***.

*individual and gradual decay, not a binary on/off of immunity. Vaccinated population 45M divided by 6 months as first very approximate estimate for rate of loss of vaccination immunity of 250,000 people per day.

**It looks like booster 3rd jab may be appropriate after about 6 months based on Israeli policy.

***infections - uncertain, several times the headline number??????

​​​​​​Supposing we achieve herd immunity. We might then lose it at 250,000 people per day unless 250,000 per day are jabbed or infected per day.

Obviously vaccination has had a massive impact on hospitalisations and deaths.

Post edited at 11:22
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In reply to Si dH:

If you weight those death figures by the population of vaccinated/unvaccinated, it's still clear that deaths are much less frequent in the vaccinated.

Assuming 78% double vaccinated, and 12% unvaccinated (100-88 single jabbed), we get

(0.333/0.12)/(0.5/0.78) = 4.3 times more likely to die if unvaccinated

Given that most dying were older, it is likely that the vaccinated figures are even higher than those estimates, so that would further increase the likelihood of dying if unvaccinated.

Post edited at 12:24
 Misha 29 Aug 2021
In reply to elsewhere:

I guess there will be detailed studies on immunity loss but the initial studies I’ve seen referenced suggested a reduction in antibody levels but not memory B cells. I think boosters make sense for older people who have generally weaker immune systems and are more vulnerable in the first place (I don’t know what the cut off age should be - somewhere between 50 and 70 I guess). However for younger people I’m not sure boosters are needed, at least not yet. Better to prioritise other countries or indeed children here. Being 40, I would take a booster if it was offered but I don’t think I really need it until some time next year perhaps. 

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 Misha 29 Aug 2021
In reply to wintertree:

A few statistical titbits here re ICU admissions

https://www.theguardian.com/theobserver/commentisfree/2021/aug/29/who-is-no...

 elsewhere 29 Aug 2021
In reply to Misha:

I think Israel has started third jabs for over 40s. 

2.1 billion double jabbed worldwide so potentially loads of real world data on how/if efficacies against infection, hospitalisation and death fade in months after vaccination.

Post edited at 14:09
 Si dH 29 Aug 2021
In reply to captain paranoia:

> If you weight those death figures by the population of vaccinated/unvaccinated, it's still clear that deaths are much less frequent in the vaccinated.

> Assuming 78% double vaccinated, and 12% unvaccinated (100-88 single jabbed), we get

> (0.333/0.12)/(0.5/0.78) = 4.3 times more likely to die if unvaccinated

> Given that most dying were older, it is likely that the vaccinated figures are even higher than those estimates, so that would further increase the likelihood of dying if unvaccinated.

Totally agree vaccination is reducing deaths a lot. I'm not questioning whether the vaccines help. I was pointing this out to show however that the majority of deaths are still in the older, vaccinated court, not a younger unvaccinated cohort, and therefore the root cause of the CFR still being higher than one might expect from vaccine efficacy figures is not as Wintertree described.

(Although, I do wonder if the nature of the raw data and the complexity of understanding required to reach a good interpretation of it is a reason that the data is not published on dashboard in the way Wintertree would like. It could easily generate some poor headlines and a lot of misunderstanding about the benefit (or not) of being vaccinated that would be counterproductive, at least while the government is still trying to persuade people to get vaccinated.)

Post edited at 14:03
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 Si dH 29 Aug 2021
In reply to Si dH/thread:

> I haven't thought through an alternative interpretation very well. 

Of course, two things that will undoubtedly be contributing, but hopefully only in a small way, are (1) immunity levels declining in people who were vaccinated early and (2) Delta being more deadly than Alpha (presumably the case since according to the paper that was making headlines yesterday it has twice the chance of putting someone in hospital.)

I think it's also likely that published vaccine efficacy figures are optimistic for those at highest risk. I remember in one of the papers where vaccine efficacy was reported against delta a month or two ago, they broke the data down by broad age groups and efficacy was significantly higher in younger people, lower in older. The figures that get the headlines are always population averages. So people in their 80s and 90s are not only at much higher risk to start with, there will also be more of them proportionally who don't mount a good immune response to the vaccine(s).

Post edited at 15:12
OP wintertree 29 Aug 2021
In reply to Si dH:

>  It's particularly good to see the exponential constant falling in England if that now covers all/most regions, which I hadn't picked up

Indeed, although I'm a bit skeptical o the fall for no specific reason.  A few more days of data won't hurt...

> Albeit school return this/next week will probably cause some reversal.

Yes, in past terms we've always seen some growth in classroom ages during school terms, and school is going back with things fully converted to delta.

> Also particularly good to see clear demographic data for Scotland [...] I agree with everything you say on that.

Thanks. I'm surprised at the way various discussions are going there, always good to keep them rooted in what the data does or does not support. Speaking of which...

> I think you are wide of the mark here though:

I agree with you - thanks for extracting the relevant data table. My suggestion was well wide of the mark.  For under 50s I think I'm reasonably on, but it's also clear that doesn't translate to the total data, as deaths are dominated by the > 50s and that table shows - for sequenced cases - older vaccinated people are the main component.  I get where you're coming from with regards a more categorised data release - it's very easy to give or get the wrong impression from where things are; to me it's clear that the vaccine is shown to make a dramatic difference to survival changes when infected, as well as to the chance of becoming infected.

The question then becomes - for those who are vaccinated, how do the death rates compare to a medium/bad flu season?  

In reply to captain paranoia:

> If you weight those death figures by the population of vaccinated/unvaccinated, it's still clear that deaths are much less frequent in the vaccinated.

Yup, that's what torpedoes my bad theory up-thread.  

> In reply to Misha:

The big question is when will it burn out to low thousands of cases a day, if ever. Depends on level of vaccine escape / reinfection. 

Indeed.  Admissions really need to start plummeting at some point for "living with the virus" to look like a sustainable plan.  Right now it looks like we're still having a lot of spread in people without any antibodies.  Once basically everyone has been exposed at least once via infection or immunisation there's probably going to be another period of higher spread as the pre-Delta infection induced immunity and the vaccine induced immunity gets "topped up" by a milder Delta infection.  I haven't looked to see if the modelling is looking at this yet, but I think that phase could rumble on through winter..  Depending on what happens with 3rd doses and Valneva.. 

> Seems reasonable to expect cases to go up in September due to schools and then unis. Wouldn’t be surprised to see 50-60k a day.

I'm sure we'll see some boost in cases from schools, especially with changes to isolation policies.

Universities are a massive wild card; some seem hell bent on pretending the pandemic is completely gone when they open their doors in a month or so, no signs of vaccine mandates (unlike a trend emerging at US universities) and a mixed understanding of the efficacy of control measures in senior management teams and moribund estates teams.  Perhaps there are some really switched on, proactive ones out there - I just don't have contacts in those places....??

In reply to Offwidth:

> Thanks again. Indie SAGE had a look at Scotland numbers on Friday and said much the same as you.

Good, good.  

> Just I can't remember if I linked their document form last week on herd immunity and if and how we can reach it.

Possibly shared on a different thread.  I'm not sure we're going to reach herd immunity any longer - in the sense that R for infection remains < 1 until elimination is achieved.  It's going to take some natural filling in of gaps in vaccination and topping up of vaccination to start getting there, but where we go from there is going to depend on the rate various immunities fade and the variant processes.  So long as immunity from serious illness fades more slowly than immunity from (re)infection I hope we'll head towards this being another circulating cold-like virus and contributor to the winter-season respiratory deaths.... ??  Lots of unknowns.

Post edited at 16:13
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 elsewhere 29 Aug 2021

"Israel on Sunday made booster doses of the COVID-19 vaccine available to everyone age 12 and up who received the second shot at least five months earlier, in an effort to combat spiraling coronavirus infections."

" 'Green Pass’ to expire 6 months after last dose"

https://www.timesofisrael.com/israel-offers-covid-booster-shot-to-all-eligi...

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OP wintertree 29 Aug 2021
In reply to elsewhere:

Looks like the UK and Israel are going to give the world two quite different approaches to watch and mull over. 
 

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In reply to wintertree:

> Looks like the UK and Israel are going to give the world two quite different approaches to watch and mull over. 

The other difference between the UK and Israel is the gap between doses and vaccine mix.   As far as I know Israel was doing two Pfizers with the Pfizer recommended 4 week gap but the UK had a much longer gap due to lack of vaccine supply and has got lucky because the newer research is showing the jag has more longevity if you separate the doses by a longer interval.

It could be that for Pfizer countries which used the 4 week gap are going to need boosters before countries than had an 8 or 12 week gap.

As for Covid being something we will have to live with forever I think that drawing conclusions based on the current state of play is naive.   That's not how technology works.   The people who got us these jags have not gone home and put their feet up and right now they are in a far better situation in terms of knowledge and resources than at the start of the pandemic.  They'll be working on second generation products.  People will also be looking at tweaking dosage, dose separation and looking at mixed vaccination types.   The expectation should be that in 6 months or a year the vaccinations are more effective, there is more production capacity to make them and we can respond to new variants of Covid faster.

4
OP wintertree 29 Aug 2021
In reply to tom_in_edinburgh:

> and has got lucky because the newer research is showing the jag has more longevity if you separate the doses by a longer interval.

If by "got lucky" you mean "made a judgement call in a difficult time based on expert opinion set against limited trials data that only tried short gaps (for obvious reasons of expediency)", then I agree with you under the category that we made our own luck.  Once again you seem to be trying to drag this down to politics.  (I had to double check who I was replying to, this seems more like Rom's kind of trolling comment.)

> As for Covid being something we will have to live with forever

I did not say "we will have to live with [it] forever".  However, life goes on, and we have to get through the next month, season, year and so on with Covid.  Magic future vaccines won't be here for winter.  Valneva might be, and that hopefully moves things on somewhat.

>  I think that drawing conclusions based on the current state of play is naive.   

I am not drawing conclusions based on the current state of play.  

However, it's where the next week, month and season build from.  I'm not keen to predict even a week out, let alone a year or more.  

> They'll be working on second generation products. 

Yes, that's something that has been discussed on here plenty of times.  Surprisingly little seems to have been made public on variant-adapted vaccines.   

>  That's not how technology works.

One thing I've drawn from your technology analogies over the last few months is that you've apparently made no effort to understand immunology and still think that making car metaphors can be used to effectively predict things.  IMO it doesn't work like that.  At all.

> The expectation should be that in 6 months or a year the vaccinations are more effective, there is more production capacity to make them and we can respond to new variants of Covid faster.

When it comes to "the expectation" I very much hope that those in charge plan for the reasonable worst case scenario, whilst we all hope for the best.

I would not make any policy decisions now based on your apparent expectation that we are going to have elimination-capable vaccines in the the next year or so.  Maybe we will, maybe we won't.  In the mean time, the UK and Israel continue to be at the front of the line when it comes to having very high levels of population immunity, and are following notably different strategies in terms of boosters and vaccinating adolescents.  

Now that we know vaccines work to curtail severe illness (a big unknown 18 months ago), it's far from clear to me that elimination is the preferable option for the virus.  I'm not sure the data will be there to weigh up the options on this for another 3-6 months at least.  

Post edited at 23:13
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 Wicamoi 30 Aug 2021
In reply to wintertree:

Thanks very much wintertree -especially for the Scottish focus. I'm a bit too tired to offer anything constructive. Not too tired for quibbles though! I think 'plot 9' has something wrong with the cases line - it implies cases started falling circa 13th Aug, when they definitely did not. Also, plot 'D1.c vs time (last month)' might confuse some as it has "data" as the last word on the x-axis title when it should be "date" (though this is probably irrelevant as you'll likely never revisit it).

'Plot D1.c vs time (last month)' is really interesting though and, together with your usual Cases Rate Constant plot for Scotland, emphasizes that things probably started going wrong for young adults in Scotland following the level zero changes (July 19), and seems to me rather to reduce the significance of the Aug 9 'nightclubs' reopening. That interplay between direction of travel and speed - reminds me again how insightful your rate constant idea was.

1
In reply to wintertree:

> If by "got lucky" you mean "made a judgement call in a difficult time based on expert opinion set against limited trials data that only tried short gaps (for obvious reasons of expediency)", 

By 'getting lucky' I mean they spaced out vaccine doses because they were in the sh*t and had no choice and later on it became apparent the vaccine might work better with spaced out doses.  

> I did not say "we will have to live with [it] forever".  However, life goes on, and we have to get through the next month, season, year and so on with Covid.  Magic future vaccines won't be here for winter.  Valneva might be, and that hopefully moves things on somewhat.

It isn't magic to think that people who can get this far starting from scratch in a year and a half may be able to do even better if you give them another year and they are starting from where they are now.   If anything it is stupid to believe there will be no progress.  Especially when the mRNA vaccines are a relatively new technology with plenty of potential for future developments e.g. they could target more than one part of the virus.

> However, it's where the next week, month and season build from.  I'm not keen to predict even a week out, let alone a year or more.  

Predicting cases a week or a month out is a completely different thing from predicting that at least one of the teams behind the 5 to 10 credible vaccines will be able to come up with something significantly better with another years work.   That is getting on for obvious.

> Yes, that's something that has been discussed on here plenty of times.  Surprisingly little seems to have been made public on variant-adapted vaccines.   

Who knows.  What is obvious is there are a lot of them, they have a lot of money and equipment and they were smart enough to get the vaccines they have now.   It's business, maybe they aren't that interested in disclosing what they are up to until they are forced to do so.

> One thing I've drawn from your technology analogies over the last few months is that you've apparently made no effort to understand immunology and still think that making car metaphors can be used to effectively predict things.  IMO it doesn't work like that.  At all.

My car metaphors weren't about predicting anything.  Just the very basic point that there's no such thing as 'the vaccine' there are multiple vaccines with different characteristics and choosing which vaccine is a different decision to choosing to be vaccinated.

> When it comes to "the expectation" I very much hope that those in charge plan for the reasonable worst case scenario, whilst we all hope for the best.

Where we would diverge is that assuming no technical progress is just as big an assumption as any other and it is one which is almost always wrong.   The default assumption when you have multiple well funded and previously successful teams working on something should be that they will make progress.

> I would not make any policy decisions now based on your apparent expectation that we are going to have elimination-capable vaccines in the the next year or so.  Maybe we will, maybe we won't.  In the mean time, the UK and Israel continue to be at the front of the line when it comes to having very high levels of population immunity, and are following notably different strategies in terms of boosters and vaccinating adolescents.  

The UK isn't front of the line in terms of vaccination any more but probably is in terms of vaccination + infection acquired antibodies.

I think Israel and a few other countries that went with Pfizer at four week spacing are thinking they may need boosters but countries that had a longer spacing have less of a drop off in antibodies.

> Now that we know vaccines work to curtail severe illness (a big unknown 18 months ago), it's far from clear to me that elimination is the preferable option for the virus.  I'm not sure the data will be there to weigh up the options on this for another 3-6 months at least.  

Isn't it axiomatic that elimination is the preferable option for any disease that kills large numbers of people.   If we get the technology to eliminate it then why on earth wouldn't we eliminate it.

9
 Dr.S at work 30 Aug 2021
In reply to tom_in_edinburgh:

Re making Vaccines better - whilst I agree that thinks like tweaking the vaccines for new variants will be an advantage, it’s worth recalling that the vaccine is not directly attacking the virus, it’s priming the immune system to attack the virus, and the immune system itself will never be 100% effective.

the vaccines we currently have are very effective - even against delta - by vaccination standards, remember the ‘pass’ mark for vaccinations being accepted for use was 50% efficacy.

Vaccination has allowed us to eliminate TWO diseases ever - Smallpox and Rinderpest - it’s not an easy ask to go down the elimination route.

In reply to wintertree:

Report on R4 this morning on the situation in Tokyo. 10k people reportedly waiting for a hospital bed, and isolating at home. Doctors travelling to homes to check on patients.

The prospects for someone falling ill at the Paralympics was discussed...

OP wintertree 30 Aug 2021
In reply to Wicamoi:

> I think 'plot 9' has something wrong with the cases line - it implies cases started falling circa 13th Aug, when they definitely did not. 

You are right - something was breaking the measurement code for Scotland.  I thought I'd fixed it, but I hadn't, sorry!    I've updated a couple of plots (below) along with the fix to plot 9 - the slowing down in cases doesn't seem to have held (it's still visible as a cluster of datapoint near each other vertically around 08-21) and cases are powering up again taking the trendline with them, but with a longer doubling time.    It looks like the growth is shifting from being driven by young adults to basically everyone else with no great distinction in timing between ages 0-14 and 25 and over.

> Plot D1.c vs time (last month)' is really interesting though and, together with your usual Cases Rate Constant plot for Scotland, emphasizes that things probably started going wrong for young adults in Scotland following the level zero changes (July 19), and seems to me rather to reduce the significance of the Aug 9 'nightclubs' reopening

Indeed; the rate constant seems to me to have inertia and momentum, it doesn't respond immediately and cleanly to a policy change but takes a while to get to its new value.  Not surprising when it encodes the effects of the policy on 50 million people.  It started changing for growth after level 0 day, and that trend was clear before the opening of nightclubs, hard to say where it would have ended up after level 0 but clearly in growth.

If the growth in young adults that happened after nightclubs opened was a flash-in-the-pan style event (i.e. won't represent a sustained contribution to the rate constants) and most of this growth is just a baseline result of level 0 day, then there's no obvious or "easy" closure to make to send things back in to decay if (when?) that becomes necessary.  

I say "when" as there's two weeks of growth in hospitalisations locked in to the data, which is perhaps one doubling, and there's less than two doublings to go before hospital admissions eclipse their all-time high. Back to playing chicken with the immunity levels?  Hopefully immune levels swerve first.   I'm very relieved that England has apparently got there, we'll see what happens when schools and then universities return...

> That interplay between direction of travel and speed

Yes, rate constant plots are great.  I wish I'd hit on the approach of using 7-day changes much earlier on, it's far simpler than the method used for most of my pltos and it raises no heckles on the analytically aware about potential pratfalls in measuring it.    

> Also, plot 'D1.c vs time (last month)' might confuse some as it has "data" as the last word on the x-axis title when it should be "date" (though this is probably irrelevant as you'll likely never revisit it).

Thanks, classing wintertree substitution. I think the plot might get one more outing, so I'll fix it.


OP wintertree 30 Aug 2021
In reply to captain paranoia:

> Report on R4 this morning on the situation in Tokyo. 10k people reportedly waiting for a hospital bed, and isolating at home. Doctors travelling to homes to check on patients.

> The prospects for someone falling ill at the Paralympics was discussed...

It's just staggering beyond belief really that the games went ahead.  

The LOX crisis in Florida quietly rumbles on - the latest development was a salmon farm preparing for a cull as it turns out they depend on LOX - until securing more non-medical grade product at the last minute.

https://www.fishfarmingexpert.com/article/atlantic-sapphire-secures-oxygen-...

It's even disrupting spaceflight activities over at Vandenberg on the west coast - Tory Bruno said their LN2 supply (purge gas I guess, perhaps also ullage?) is disrupted because the cryogenic transport people are all working Covid in Florida.

1
In reply to Dr.S at work:

> Vaccination has allowed us to eliminate TWO diseases ever - Smallpox and Rinderpest - it’s not an easy ask to go down the elimination route.

We also came pretty close to eradicating Polio, and if it wasn't for the Taliban interfering with vaccination maybe we'd already have Polio eliminated.   I don't buy the 'we've only ever managed to do X once' argument: it's misleading because trying to eliminate a virus starting with the technology that's in place today is a completely different deal from trying to eliminate a virus with the technology available twenty years ago.

Also, although only two diseases have been totally eliminated there are a large number of diseases which people living in rich countries like the UK never come across because of a combination of vaccination, effective treatment and public health measures.  For practical purposes for someone who lives in the UK and only travels to other rich countries they are eliminated.    

Maybe we can't eliminate Covid entirely from places like Afghanistan but that doesn't mean we can't push it into the  'not of concern in the developed world' category.

Post edited at 00:23
4
 Dr.S at work 31 Aug 2021
In reply to tom_in_edinburgh:

Hi Tom, I’m not saying its impossible, just that it’s hard, and that it’s unlikely to be a result of a step change in vaccine efficacy - happy to be wrong on this of course!

1
 Si dH 31 Aug 2021
In reply to tom_in_edinburgh:

> Also, although only two diseases have been totally eliminated there are a large number of diseases which people living in rich countries like the UK never come across because of a combination of vaccination, effective treatment and public health measures.  For practical purposes for someone who lives in the UK and only travels to other rich countries they are eliminated.    

I think covid might be too transmissible to allow that approach to work? Genuine question for anyone who knows - if we look at the full range of diseases that have been close-to or completely irradicated in the UK but which are still prevalent in the developing world (or indeed anywhere), are any of them similarly infectiousness (directly between people) to covid, particularly through respiratory means? 

I have the impression that most diseases that have been eradicated in the UK are spread through animals or drinking water but my knowledge is limited.

Post edited at 07:29
 Å ljiva 31 Aug 2021
In reply to wintertree:  Maybe these posts should come with a spoiler alert, this one took all the excitement out of the first minus on the UK figures for days (weeks?). 

Meanwhile, just travelled though Germany, you really can’t do anything without the vaccinated/tested pass. Free tests valid for 24 hours available everywhere - even on the campsite. Seemed to work pretty well and wasn’t particularly onerous.  Still only “proper” masks allowed. 

In reply to Si dH:

If we got Covid down to the same kind of levels as measles and TB in the UK i.e. a few hundred or low thousands of cases per year and near zero deaths that would be close enough to eradication that it didn't really impact on daily life.

5
OP wintertree 31 Aug 2021
In reply to Dr.S at work:

> Hi Tom, I’m not saying its impossible, just that it’s hard, and that it’s unlikely to be a result of a step change in vaccine efficacy - happy to be wrong on this of course!

Tom was suggesting perhaps this change could come from the “new technology” mRNA vaccines being updated in the future to target other viral proteins.

The inactivated virus vaccine from Valneva is shown to be strongly antigenic against multiple viral proteins and is in multiple different phase 3 trials at the moment.  I don’t think the old/new tech approach is a good lens for predicting vaccine efficacy, under such a lens, Valneva  is nearly century old technology (give or take their adjuvenation).  The efficacy data from these trials will soon tell us if broad spectrum vaccines are much higher efficacy.  I hope their benefit will be more in having their efficacy against serious disease degrade more slowly with variation than a spike-only vaccine, helping to bootstrap a sustainable circulation-harmlessly-updates-immunity pattern.

But, as you say, an immune system can only be primed so far; especially in the old and otherwise immunocompromised. 

Unlike most other viruses vaccinated and controlled against this doesn’t seem to have much of an intrinsic lethality mechanism, more that it kills by immune dysregulation that happens in adults because every single part of it was completely unknown to the immune system.  The vaccine is the start - not the end - of bootstrapping immunity population wide to levels corresponding to other such circulating viruses.

The pharmacological pipeline has a lot of compounds in pre clinical and clinical trials looking to fix the immune dysregulation at different stages of infection.  This has the potential to significantly reduce lethality further still than vaccination alone.

In reply to Si dH:

> I think covid might be too transmissible to allow that approach to work?

Given the estimates at R0 now and how transmissive it is I agree. Elimination would need control measures unlikely to be politically viable with post-vaccination death rates.  I really wish we’d tried for it back early 2020 as a stop gap to figure things out, but now the situation is very different.

Things can always change, but vaccine assisted elimination doesn’t feel likely right now.

Post edited at 08:08
1
In reply to wintertree:

> Given the estimates at R0 now and how transmissive it is I agree. Elimination would need control measures unlikely to be politically viable with post-vaccination death rates.  I really wish we’d tried for it back early 2020 as a stop gap to figure things out, but now the situation is very different.

> Things can always change, but vaccine assisted elimination doesn’t feel likely right now.

Measles has an even higher R0 and it is almost eliminated in the UK.

https://www.gov.uk/government/publications/measles-confirmed-cases/confirme...

5
OP wintertree 31 Aug 2021
In reply to tom_in_edinburgh:

Measles has had vaccination for over 50 years, and things are moving - rapidly - in the wrong direction for global elimination of Measles.  The rise of measles is happening within some of the most developed nations. 

 Measles kills and disables lots of children, Covid does not, regardless of vaccines.  I don't know how much of the resurgence of measles is down to vaccine refusers, how much is down to the limits of the immune system (regardless of vaccine) and how much is down to variation of the virus from the vaccines.  With Covid, we have a plant of vaccine refusers, the immune system has limits the vaccine can't surpass, and we know it's varying a lot - probably as unlike measles it's still undergoing optimisation for its new human hosts.

Elimination through vaccination just doesn't feel likely ever since Kent/Alpha and now India/Delta.  As with Dr.S at work, I would be happy to be wrong on this but it's not my working assumption, and it doesn't appear to be for anyone making policy either.

Some links:

Worldwide measles deaths climb 50% from 2016 to 2019 claiming over 207 500 lives in 2019 - https://www.who.int/news/item/12-11-2020-worldwide-measles-deaths-climb-50-...

Measles cases and deaths are increasing worldwide, warn health agencies - https://www.bmj.com/content/371/bmj.m4450

Analysis of a 3-months measles outbreak in western Liguria, Italy: Are hospital safe and healthcare workers reliable - https://www.sciencedirect.com/science/article/pii/S1876034119302965

1
In reply to wintertree:

> Analysis of a 3-months measles outbreak in western Liguria, Italy: Are hospital safe and healthcare workers reliable - https://www.sciencedirect.com/science/article/pii/S1876034119302965

Right now Covid is doing 23,000 cases a day in England but 7,000 measles cases in Italy in a year and a half is treated as a cause for concern.   

If we get to a similar point with Covid i.e. a few thousand cases per year and they are almost all vaccine refusers it is pretty much problem solved.   Not elimination or eradication but close enough as makes no difference for vaccinated people.

Getting Covid where TB and measles are in the UK at the moment would be a reasonable end to this and I don't see why we should assume it isn't feasible.

7
 Offwidth 31 Aug 2021
In reply to wintertree:

Small positive shoots in NZ.

https://www.theguardian.com/world/2021/aug/31/new-zealand-covid-update-case...

Also in the news... Australia have arranged a vaccine swap to help mitigate their Pfizer supply problems. Hopefully all the spare AZ they should have been using will go to Covax.

OP wintertree 31 Aug 2021
In reply to Offwidth:

> Small positive shoots in NZ.

Yes, my contacts out there are on the hopeful side. 

> Also in the news... Australia have arranged a vaccine swap to help mitigate their Pfizer supply problems. Hopefully all the spare AZ they should have been using will go to Covax.

It's not looking great for Australia over the next couple of months.  Staggering that they're sitting on so much AZ.  Great news if somewhere else can choose to use it.

In reply to tom_in_edinburgh:

> Right now Covid is doing 23,000 cases a day in England but 7,000 measles cases in Italy in a year and a half is treated as a cause for concern.   

It's almost as if we're in a global pandemic phase for Covid.  Where we are now is not comparable with where measles is, or where we are headed with Covid.

1
 elsewhere 31 Aug 2021
In reply to tom_in_edinburgh:

The impact of vaccine technology on our human immune systems varies from measles (near perfect protection from childhood to old age) to flu (annually updated formulations offer variable and partial protection).

I wonder if the upper limits of vaccination are set by virus, variants and the human immune system rather than by vaccine technology. Hence none of the best few* Covid vaccines stands out as exceeding 90-95% efficacy against death, none stand out as likely to reduce R below 1 and none stand out as likely to last a lifetime.  

Wintertree is keen on Valneva (joke - I reckon he has shares!) but inactivated whole virus vaccines (eg SinoPharm & CoronaVac) don't look that great so far. Valneva will have to be a fundamentally different inactivated whole virus vaccine in some way.   

Maybe harmless infection after vaccination plus a Valneva booster will make us invincible, but so far Covid is looking more like flu than measles when it comes to vaccination. 

Early days though so fingers crossed.

*eg the widely approved Pfizer/Biontech, Oxford/AZ, Moderna 

Post edited at 11:08
 elsewhere 31 Aug 2021
In reply to Offwidth:

> Small positive shoots in NZ.

That's excellent.

It's funny how what you learn about infectious disease by catching measles in childhood (eg avoiding people is enough to reduce person to person spread of some germs) turns out to be right.

OP wintertree 31 Aug 2021
In reply to elsewhere:

>  but so far Covid is looking more like flu than measles when it comes to vaccination. 

That's a nice way of looking at it IMO.

> Wintertree is keen on Valneva

Hopefull, rather than keen.  The only efficacy data I've seen is summary level in company press releases.  As ever, it's all speculation until phase 3 data is published.  

Edit: The key reason I mentioned Valneva here is that Tom was again using their "new technology" metaphor ("Especially when the mRNA vaccines are a relatively new technology with plenty of potential for future developments e.g. they could target more than one part of the virus."), yet back in the real world it's one of the oldest vaccine technologies that's in the most advanced stage (by a long way) through the trials pipeline when it comes to targeting "more than one part of the virus".

> joke - I reckon he has shares!

As jokes go, it's an insightful one.  I've wondered about financial manipulation in the case of one departed poster (banned over a bizarre interaction not involving myself) and at times others.  A declaration on conflict(s) of interest is a voluntary, helpful contribution when people start taking a polarised or detailed view IMO.  Here is mine.

  • I have no direct interest in any firm involved in vaccine production
  • I have no intent to acquire any direct interest in any such firm
  • I may have indirect interests through one more more of the pensions I've subscribed to over the years or through my index linked S&S ISA.  I have not looked at their compositions, and nor would I choose based on vaccines.
  • I have a strong interest in seeing the pandemic ended because necessary lockdowns and school disruption suck badly for my family, for my friends and wider family and for my business.  Wanting this to all go away does not IMO bias towards any one vaccine.  

> but inactivated whole virus vaccines (eg SinoPharm & CoronaVac) don't look that great so far. Valneva will have to be a fundamentally different inactivated whole virus vaccine in some way.   

This is an excellent point.  All I can do is talk through why I am hopeful about Valneva - and to be clear I am jumping to conclusions on deeply incomplete data.  The question is why has the UK government invested so heavily in Valneva despite the limitations you mention on other inactivated whole cell vaccines.  Likewise another question is why multiple phase 3 trials have been entered in to including the "3rd dose booster" one.  It seems to me that there is strong confidence behind the scenes.  My best guess as to why... 

  • A vaccine comprises two active parts - the  information on the part of the virus an immune response is to be formed against, and an adjuvant, something to stimulate the immune system in to responding to that information.  This presents stimulation to the immune system along the lines of "some foreign body is present" - not very specific to viral infection.
  • DNA and mRNA vaccines undergo de novo synthesis where viral protein is synthesised within the cell.  This process presents stimulation to the immune system that specifically says "something is replicating *within* the cell" - more specific to viral infection.
  • Inactivated virus vaccines and the new synthetic nanoparticle vaccine (Novovax) do not engage in de novo synthesis and so some of the viruas-specific stimulation of the immune system is missing.
  • Novovax is not directly comparable to inactivated virus vaccines, but like them it presents complete viral protiens and does not undergo de novo synthesis.  Yet, the data shows it elicits a strong T-cell response for example.  This says to me that there's clear magic going on with its adjuvant.  They use a saponin derived molecule to adjuvenate it - a complex immune molecule.
  • SinoPharm and CoronaVac both use Alum based adjuvants.  As I understand it, these basically work by irritating the body and causing a generic inflammatory response, a rather less gory version of scratching around the injection site with a rusty needle.
  • Valneva is using a relatively new adjuvant (CpG 1018) that is a synthetic organic molecule.  This adjuvant mimics aspects of the appearance of the DNA/RNA produced in the host during viral replication.  This adjuvant has previously been shown (pre-Covid) to stimulate CD4+ and CD8+ responses as well as stimulating strong memory B and memory T cell responses.  It's shown to be particularly effective at generating the kind of responses more potent against intracellular pathogens 

It seems to me like the key here is the adjuvant component of the "DNA/RNA free" vaccines, it's worlds apart for different inactivated virus vaccines, and Novovax shows what can be achieved.

I repeat that this is a big jumping to assumptions on my behalf taking both the commercial investment and a lay persons reading around the immunology.  

It would be foolish to make policy based on Valneva working out, as always it's a case of waiting for the phase 3 results and post-authorisation real world results if things get that far.

Post edited at 12:20
 elsewhere 31 Aug 2021
In reply to wintertree:

Many thanks for such a great detailed response with scientific reasons to be a bit more optimistic.

1
OP wintertree 31 Aug 2021
In reply to wintertree:

>  a complex immune molecule.

Should have proof read this post in a text editor after putting it down for an hour, riddled with mistakes.  Re: saponins and novovax - this should be "a complex organic molecule" - so capable of undergoing all sorts of interactions the alum stuff isn't.  I have no idea what it's doing mind you, just that it likely has more potential to do stuff than alum and has presumably not been chosen at random...  Reminds me, I’ve got a saponin extraction on my TODO list for one of my hobby projects… (not DIY vaccine home biology I hasten to add!  The people doing that and posting about it elsewhere online are properly bonkers.) 

Edit: Some more reading here with results on a neutralising antibody titre for what I assume is the Medigen candidate vaccine (spike protein subunit, DNA/RNA free).

The data here shows that using both alum and CpG 1018 as adjuvants provides the strongest response in neutralising antibodies in serum assays.  Neutralising antibodies are one specific subset of one subset of immune responses, but it's another piece of evidence that this adjuvant used also by Valneva but not the other inactivated virus vaccines is leading to a measurable and significant change in the level of immune response.

https://www.nature.com/articles/s41598-020-77077-z.pdf

Post edited at 12:52
 Misha 01 Sep 2021
In reply to tom_in_edinburgh:

I think it’s pretty clear we’ll have to live with it forever in that Covid will continue to circulate in the world, including here. The question is what does that actually mean in terms of cases, hospitalisations, deaths and which demographics / sections of society are impacted by those. That’s why it’s a fairly inane thing for the politicians and the media to say. There’s a world of difference between living with 100k cases a day and living with 3k cases a day (using UK wide numbers as an example as I’m most familiar with those).

I don’t disagree that new vaccine will come on stream in due course. It might turn into a perpetual race against variants, although there must be a natural limit to how much the virus will evolve (otherwise it will eventually evolve into flesh eating zombies… or GFBLs which LSRH keeps warning us about; I suppose never say never…).

 Misha 01 Sep 2021
In reply to wintertree:

Elimination is always preferable, just not realistic I suspect. However keeping it at bay with relatively low case numbers may be feasible.

 Misha 01 Sep 2021
In reply to tom_in_edinburgh:

> Getting Covid where TB and measles are in the UK at the moment would be a reasonable end to this and I don't see why we should assume it isn't feasible.

Agree but this could take years or even decades. 

In reply to wintertree:

> Edit: The key reason I mentioned Valneva here is that Tom was again using their "new technology" metaphor ("Especially when the mRNA vaccines are a relatively new technology with plenty of

Your post is basically making my argument for me:

1.  With Covid we started mass vaccination in Jan 2020.  One year after the virus was detected in Wuhan.   We have never managed to do anything like that for any other virus.  That tells me that the technical tools for analysing viruses and developing vaccines are way better now than they have ever been and when hundreds of billions of dollars get poured in they are going to get better still.

2.  Not only did it only take a year to get vaccines available in million-off quantities there were multiple vaccines available in million of quantities within a year.  Now, only a year and 9 months after the epidemic started China on its own has given 2 billion doses of Covid vaccine.   That is truly amazing: there's only 7.6 billion people on the planet.

3. The Pfizer vaccine was extremely effective against the first variant of Covid.  95% or so.  We could get herd immunity by vaccination against the first variant of Covid.   Delta is obviously a problem for the first generation vaccines but where is the argument they won't be able to tweak their product to be just as good at Delta as they already had it for Alpha.

4. There are several completely different vaccine technologies all of which have been successful against Covid.  Maybe 10 different groups worldwide with an effective first generation vaccine.

My view is it is incredibly pessimistic to think that one or more of those groups won't come up with something significantly more effective against the delta variant of Covid than their first generation product.

Maybe we will end up having a Covid jag every year for a while but my money is on the vaccine and medicine guys sorting this and then using the technical and manufacturing base they built from the funding that came form Covid going on to sort a few more diseases too.   When 10 different groups get something fairly workable within about a year using three or four different technical approaches it is probably a solvable problem.

Last year everyone was full of hope for vaccination despite it being something that had never been done before.  The vaccine guys went and did their stuff and delivered and now everyone is assuming they wont be able to keep going and get better.   When people just showed they can do something the sensible thing is to assume they'll be able to do it even better in a year.

2
OP wintertree 01 Sep 2021
In reply to tom_in_edinburgh:

> My view is it is incredibly pessimistic to think that one or more of those groups won't come up with something significantly more effective against the delta variant of Covid than their first generation product.

I guess that’s because you didn’t read Dr.S at work’s post.

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_41-...

> Delta is obviously a problem for the first generation vaccines but where is the argument they won't be able to tweak their product to be just as good at Delta as they already had it for Alpha.

Nobody has made that argument.  It’s not the flaw in your theory.  They probably can adjust the vaccines to be “just as good”.  But “just as good” is nowhere near good enough with the higher R0 value of delta.  It needs to be “much better” and “much better” is approaching 100% effective against transmission which is likely impossible.  Law of diminishing returns; see linked post above.

> Your post is basically making my argument for me:

No it isn’t.

Edit: Timely article discussing a paper showing about 2x difference in antibody response from Moderna and Pfizer vaccines despite their similar efficacies (pre delta).  The first comment is the suggestion that both antibody levels exceed the saturation level for cause and effect, meaning that the 95% efficacy is a more intrinsic limit than the vaccine. Only one of many interpretations mind you, but it fits.

https://arstechnica.com/science/2021/08/rna-vaccines-seem-to-produce-very-d...

Post edited at 08:12
OP wintertree 01 Sep 2021
In reply to Misha:

> Elimination is always preferable, just not realistic I suspect. However keeping it at bay with relatively low case numbers may be feasible.

In a general sense of all pathogens, is elimination always preferable?  I’m not convinced our science and medicine is ready for the consequences of that.

To me, this pandemic underlines now important it is that we are exposed to a broad range of diseases in early childhood and not for the first time as adults.  

Science is now back filling the decades old “hygiene hypothesis” - that too much cleanliness during childhood leads to problems in later life.

For our current levels of understanding - scientific and medical - a disease free childhood is not looking like a good idea.

So, if we’re not ready to eliminate all pathogens, the question is which ones should we try and eliminate?  Some sort of ranking by consequence most likely.  We don’t yet know what the consequences will be of covid once immunity is “fully bootstrapped” to the best achievable approximation of the kind of immunity we’d have had if it had been circulating in everyone’s childhood.  Once we know what that world looks like, there’s reasonable odds it’s not going to rank very highly at all in a prioritised list for elimination.  

In reply to wintertree:

> I guess that’s because you didn’t read Dr.S at work’s post.

I did and I replied to it.

I don't buy the 'we only managed to do this twice before argument'.  We could never take a brand new disease emerging into humans, develop effective vaccines within a year and fully vaccinate in excess of 1.5 billion people within 2 years before.    We should expect to be able to do things we couldn't do before: it happens all the time.

> > Delta is obviously a problem for the first generation vaccines but where is the argument they won't be able to tweak their product to be just as good at Delta as they already had it for Alpha.

> Nobody has made that argument.  It’s not the flaw in your theory.  They probably can adjust the vaccines to be “just as good”.  But “just as good” is nowhere near good enough with the higher R0 value of delta.  It needs to be “much better” and “much better” is approaching 100% effective against transmission which is likely impossible.  Law of diminishing returns; see linked post above.

Pfizer had 95% effective against alpha variant straight out the box.

> I’m sure a delta tweaked vaccine could have similar efficacies against transmission as the current vaccines had against early variants.  “Significantly more effective” however?  Hmmm.

What I said was:

"My view is it is incredibly pessimistic to think that one or more of those groups won't come up with something significantly more effective against the delta variant of Covid than their first generation product."

In other words if they can get 95% effective against the Alpha variant with a vaccine developed to go after it they can probably get 95% effective against the Delta variant with a tweaked vaccine.  And given they've had another year and a half to think about it why wouldn't they do a bit better?

It was pretty optimistic to think we could get vaccines against a new disease inside a year.  But we did it.  Thinking we can get somewhat better vaccines in another year is just common sense.

1
OP wintertree 01 Sep 2021
In reply to tom_in_edinburgh:

> In other words if they can get 95% effective against the Alpha variant with a vaccine developed to go after it they can probably get 95% effective against the Delta variant with a tweaked vaccine. 

I agreed with you on this.

> And given they've had another year and a half to think about it why wouldn't they do a bit better?

I linked to Dr.S at work’s post where they gave an informed take on this.  I gave another speculative example.  Because I think the vaccine is priming the immune system as much as it possibly can.  No human immune system is perfect and they likely don’t hold the potential to be perfect.  With current R0 values (let alone another future rise…?) we need them bordering on perfection for elimination with a normal lifestyle not a 6-month long lockdown.

I’m winding this back a post as you seem to have missed the key point.  You previously said.

> Delta is obviously a problem for the first generation vaccines but where is the argument they won't be able to tweak their product to be just as good at Delta as they already had it for Alpha.

I replied:  Nobody has made that argument.  It’s not the flaw in your theory.  They probably can adjust the vaccines to be “just as good”.  But “just as good” is nowhere near good enough with the higher R0 value of delta.  It needs to be “much better” and “much better” is approaching 100% effective against transmission which is likely impossible.  Law of diminishing returns; see linked post above.

> > I guess that’s because you didn’t read Dr.S at work’s post.

> I did and I replied to it.

Yes, but did you read it all?  Specifically the part about how the vaccine doesn’t fight the virus, the immune system does, and how there are limits there not related to the vaccine itself?  You didn’t acknowledge that part and that - taken with recent R0 values - is why a lot of people don’t think elimination is going to happen.

You can make all the generic arguments you like about new technology, investment and progress but I’m not buying it and nor do I think are many others.

I don’t see much point in continuing this argument.  I’ve made my points, you’ve made yours.  It would be great if in two years you can come back and tell me I was wrong - I’d be happy with that outcome.  Let’s park it and see…

> Thinking we can get somewhat better vaccines in another year is just common sense.

You and Rom seem to share this propensity for a call to “common sense”.  Common sense can also be used to show that achieving the last 5% of something is way harder than achieving the first 95%, there’s lots in life like that.  So I’m going to claim common sense shows you to be wrong.  

See why calls to “common sense” are bullshit?

In reply to wintertree:

> See why calls to “common sense” are bullshit?

What's bullsh*t is to estimate the value of a variable at zero like a zero estimate was in some way more likely than a positive estimate because it is 'cautious'.

People do that all the time with technology i.e. assume it won't progress because they think it is 'safer' to make that assumption.   It's a stupid assumption because the whole record says if anything technical progress is accelerating.

There are already people working on mucosal vaccines.  That technology could be game changing on transmission.   

https://www.nature.com/articles/s41577-021-00583-2

4
OP wintertree 01 Sep 2021
In reply to tom_in_edinburgh:

> What's bullsh*t is to …

… bang on endlessly about hypothetical technology improvements without considering the human side of things?  Your plan would need over 95% of people to routinely get vaccinated against something posing most of them  a risk mostly nullified by that point.  We’re not seeing that level of buy in now off the back of lockdowns and 0.15 megadeaths, I doubt we’ll see engagement rise in a year's time as the deaths and disruption hopefully fade way.  Then there’s children, elimination would need 95% of under 12s vaccinated.  Have you read the JCVI narratives on adolescents and those aged 16-17?  It might be informative for you.

That's another one of the problems with the high R0 value - low uptake of vaccines in some demographics just can't be compensated for by higher uptake in other areas, again a saturation effect occurs, this time not in immune responses but in not being able to vaccinate more than 100% of one demographic to make up for low uptake in another.  Vaccination is made according to medical ethics; mortality is decreasing - I think it would need a significant increase before a case to vaccinate under 12s could be made.  Not vaccinating under 12s takes elimination off the table for 100% uptake of 100% effective vaccines by the entire rest of the ovulation with current estimate of R0.  I get the impression you haven't really developed a feel for what the R0 value means.  It transcends technology.

> People do that all the time with technology i.e. assume it won't progress because they think it is 'safer' to make that assumption.   It's a stupid assumption because the whole record says if anything technical progress is accelerating.

No, I think policy makers shouldn’t assume an elimination capability any time soon because it would be asinine to bet lives and economic harm (via policy) on something that has both major technological and behavioural barriers to achievement.

I think you are barking up the wrong tree and I feel I and others have been clear on why.  After a point your endless banging on about “technological progress” and bullshit calls to common sense starts to fall somewhere between “noise” and “trolling” on the spectrum.

Post edited at 09:28
 Offwidth 01 Sep 2021
In reply to wintertree:

Maybe some numbers will help Tom. The vaccine herd immunity threshold  is approximately (1/Efectiveness)*(1-1/R0) as IndieSAGE discussed here at about 10 minutes in.

youtube.com/watch?v=vgBF8ube3Ws&

If R0 for delta is 6 (Indie SAGE value) for a vaccine 95% effective in avoiding transmission  that requires about 88% of the population vaccinated, assuming a new vaccine as effective as Pfizer was for alpha. If R0 is 8, as most seem to think, that value is 92%. All assuming vaccine effectiveness is uniform across the population (it isn't) and doesn't decline during the vaccination process. As such I agree its much more about the unvaccinated and precautionary restrictions than the science of new vaccines. Those percentages won't drop much with a 100% effective vaccine.

In reply to Offwidth:

> If R0 for delta is 6 (Indie SAGE value) for a vaccine 95% effective in avoiding transmission  that requires about 88% of the population vaccinated, assuming a new vaccine as effective as Pfizer was for alpha. If R0 is 8, as most seem to think, that value is 92%. 

We are already at 92.4% of the adult population in Scotland with at least one dose.  Pfizer already made jags which were 95% effective against alpha variant Covid.  Would you bet against the people who did that not being able to make a booster 95% effective against Delta?

It really doesn't seem a big step to think that in a year or two and a couple of boosters with the kind of effort that's going in we could get this to the sort of level of measles in the UK.

China has the capacity to make a couple of billion doses in a few months, India can chuck out AZ at a high rate too and Pfizer is scaling up for billion dose orders from the EU so the concept of giving most of the world a Covid jag within a few years isn't that wild.

1
OP wintertree 01 Sep 2021
In reply to Offwidth:

Yup.  

That effectiveness value you give can be considered as  the product of vaccine efficacy and fraction of people vaccinated.   For a 95% effective vaccine we can determine the fraction of all people who need to be vaccinated:

  • R0=6 needs 92% of all people (not just adults) vaccinated to hit the threshold 
  • R0=8 needs 97% of all people (not just adults) vaccinated to hit the threshold

So far, about 72% of all people (not just adults) in the UK have been vaccinated.  Vaccination is only recommended for adolescents in specific circumstances, and is not recommended for those younger at all.  In the ages 16 and 17, only one dose is recommended with the express intent of moderating health damage only, not reducing transmission.  

None of these numbers change much with a 100% effective vaccine.  Law of diminishing returns.

It's actually a false assumption that the effectiveness of a vaccine has to be bounded to an upper limit of 100%.  In the 90's Disney classic "Gargoyles", there was an episode where Demona and Dr Anton Sevarius were giving a lab tour to a prospective employee.  On the tour they explained how a particular "carrier virus" was being genetically engineered to spread rapidly and harmlessly across the globe, with a customisable payload intended to immunise the world against any given pathogen.  A plot line that was rather ahead of the science at the time, but that perhaps isn't so wide of the mark of what is technically possible - if ethically and morally reprehensible in the extreme - these days.  Really quite prescient about where the science was then going, given the ongoing divide in the intelligence communities about if this is a wild origin virus or one escaped from a vaccine research lab [1].  As it is, this virus may be spreading cross-immunity to other wild origin novel coronaviruses (known and as yet unknown) as it goes.  

(The person on the lab tour remarked about "or a weapon"...).  Edit: Spoiler alert - the carrier virus was really intended for Evil, to wipe out humans in favour of the gargoyles.  https://gargoyles.fandom.com/wiki/CV-1000

[1] https://www.aljazeera.com/news/2021/8/27/us-intel-community-remains-divided...

Post edited at 10:45
 Offwidth 01 Sep 2021
In reply to tom_in_edinburgh:

The number is of the whole population fully vaccinated, not the adult population currently with at least one jab (that took two thirds of a year to achieve in a pro public health western nation). Currently vaccines are much less than 95% effective on average with delta...so do the math yourself. The most vulnerable can have defective immune systems so a 95% vaccine, like Pfizer was for Alpha is on average, might not be anything like 95% effective for them. I actually expect 95% effective vaccines for delta but by then another variant is what we will likely need to protect against.

Post edited at 11:01
 oureed 01 Sep 2021

In other news, the latest research from Israel suggests that immunity after infection is far greater than any vaccine-induced immunity.

https://www.science.org/content/article/having-sars-cov-2-once-confers-much...

Infection followed by vaccination appears to give greater immunity still.

It will be interesting to learn whether the level of immunity is dependant upon what comes first, infection or vaccination. A few weeks ago one of the regulars on here was saying they had read a scientific article suggesting the body best 'remembers' its first exposure to the virus.

5
 Ramblin dave 01 Sep 2021
In reply to Misha:

> Elimination is always preferable, just not realistic I suspect. However keeping it at bay with relatively low case numbers may be feasible.

A question that seems relevant is how we can make an informed guess at what the steady-state actually looks like in the medium to long term, if it's not "zero covid"? I mean, in a simplistic model, if r0 and the rate of breakthrough infections are collectively high enough to prevent elimination from being feasible, you seem to end up heading towards a situation where everyone has at least mild or asymptomatic covid basically all the time. But I'm assuming that I'm oversimplifying and there's some brake on that?

OP wintertree 01 Sep 2021
In reply to Ramblin dave:

>  you seem to end up heading towards a situation where everyone has at least mild or asymptomatic covid basically all the time. But I'm assuming that I'm oversimplifying and there's some brake on that?

I think you've missed a bit of the steady state model, rather than over-simplifying.  The way I'd present it is that, if immunity against infection fades on a timescale of X months, then an individual is going to get infected no more than once every X months.

So, it's possible that some people have Covid at any one time, but it's unlikely to be all people given that the data I think can bound X to be > 12 months for many people.   

Then, in a steady-state noddy model, people get re-infected soon after they become eligible (the higher R0 is, the sooner this happens) but...  It's not beyond belief that seasonality in the weather acts as an unstoppable metronome to which seasonality in the virus gradually synchronises, and we end up with synchronised waves of winter infection, perhaps like with flu and other respiratory viruses.   So, another mild cold for most people, another grim reaper in the pathogenic pantheon stalking the hospitals and care homes in winter.

Although there is always the wildcard of a nasty variant that escapes immunity against infection/transmission, which given the R0 it could access would break out of any phase locked seasonality I think.  Hopefully the population wide immunity levels in the steady state will still provide high efficacy against serious health damage, with this expected to fade more slowly than efficacy against infection/transmission.

> A question that seems relevant is how we can make an informed guess at what the steady-state actually looks like in the medium to long term, if it's not "zero covid"?

In terms of "informed", I'd map that to estimates of what fraction of people are (a) infected, (b) symptomatic and (c) seriously ill at any one time and (d) what the excess deaths are compared to an equivalent world without Covid.  

I don't think the data is there to answer (a) through to (c) until we've had a lot more natural circulation through vaccinated individuals

(d) is almost intangible given the number of different ways of looking it.

I have a very noddy plot (below) that shows the deaths within 28 days of a positive Covid test (left plot, grey markers and black trendline) and those one would expect if Covid itself carried no lethality, estimated by applying the demographic ONS 2019 All Cause Mortality data set to the demographic Covid test results.  It's lacking for seasonality in the all cause mortality model.  This suggests about 10x as many people are dying because of Covid than we'd expect if it had no mortality.  Down from close to 100x as many people during the first wave.  We'll see where this goes as natural immunity starts to build up...  

But in terms of your question - it looks a lot worse to me than a world without Covid.  Seems to me like we should be investing heavily in healthcare staffing and resources to expand capacity significantly above levels of recent winters.

Edit: Updated the plot with a few weeks more data

Post edited at 14:17

 oureed 01 Sep 2021
In reply to Ramblin dave:

> a situation where everyone has at least mild or asymptomatic covid basically all the time.

It depends what you mean by 'having' a disease. Our immune systems are constantly fighting infections.

2
 elsewhere 01 Sep 2021
In reply to Ramblin dave:

> A question that seems relevant is how we can make an informed guess at what the steady-state actually looks like in the medium to long term, if it's not "zero covid"? I mean, in a simplistic model, if r0 and the rate of breakthrough infections are collectively high enough to prevent elimination from being feasible, you seem to end up heading towards a situation where everyone has at least mild or asymptomatic covid basically all the time. But I'm assuming that I'm oversimplifying and there's some brake on that?

My very uninformed guess...

I think the brake is that you won't have Covid all the time because you have some immunity from vaccination or previous infection. That seems to be the case with the common cold or flu as you get a cold or flu every once in a while but not all the time.

When that immunity fades or a new variant comes along you catch it with mild or no symptoms because you still have some immunity and your immunity is updated/boosted. 

Eventually you get old or otherwise vulnerable and it might kill you in the same way a cold or flu might kill you when old or otherwise vulnerable.

The serious risk from Covid appears to be infection without prior immunity. A second infection or first infection after vaccination has a much reduced risk of death or hospitalisation.

Getting prior immunity by vaccination is moderately or vastly (depending on age) safer than getting first immunity by infection.

NB it might still be too early to make an informed guess!

 Misha 01 Sep 2021
In reply to wintertree:

Given its highly infectious nature, still relatively high mortality and particularly hospitalisation rates even post vaccination, plus the risk of long Covid and this being a new virus whose long term consequences (including in children) are not yet known / fully understood, I’d rate Covid pretty high on the hypothetical elimination list. As you say, with better vaccines ans therapeutics it may become less of an issue over time but at the moment it’s still a major issue.

I don’t  disagree that some exposure to viruses, bacteria and fungi in childhood may be beneficial in the longer term but that logic doesn’t really work with new pathogens which end up killing or hospitalising a large number of adults. Plus we don’t know what long term consequences infection with Covid in childhood might have, both in terms of upsides (immunity) and downsides (potential adverse effects in later life).

This is hypothetical of course as true elimination isn’t on the cards but keeping infection levels relatively low seems feasible. Personally, I’m not subscribing to the ‘we’re all going to get it anyway’ thinking just as yet and hence in no rush to get back to the office or attend indoor social gatherings (or any social gatherings really, though the crags have been busy over the summer!). I’m cautiously optimistic (perhaps naively so) that by around next April infection rates will be bubbling away in the low 1,000s as opposed to 10,000s a day, focused on the remaining unvaccinated population. At that point it would become less of a concern, both for the NHS and for us all as individuals. I guess wait and see…

 Misha 01 Sep 2021
In reply to tom_in_edinburgh:

The issue is around uptake as well as vaccine effectiveness. Uptake in ‘adults’ (16+) has effectively plateaued towards 90% for first doses and second doses will be lower. Uptake in children is going to be lower still (once advised / authorised). Add to that the uneven spread of vaccination levels through society - those %s will be a lot lower among some socioeconomic groups and in some areas (have a look at the vaccine coverage map on the dashboard - uptake is way lower here in Birmingham for example). So it won’t be enough for true elimination.

However I don’t think you’re suggesting actual full elimination - what you’re saying is getting it down to the level of something like measles. That does seem feasible but will take many years. I think a more realistic medium term ‘goal’ is 2-3k official cases a day like we had at the end of April. That would be a fairly light load on the NHS and would mean it’s not a significant concern for most people. 

 Misha 01 Sep 2021
In reply to Ramblin dave:

I think the reality is some people will be more exposed than others due to their jobs, family circumstances, social environments, geographic location and so on. Say we get to 3k official cases a day, so in reality perhaps 6k actual cases. That’s roughly 1 in 10,000 people every day.  On average, that would mean everyone gets it once every 30 years. Yet for some people it would be more often than that, whereas for others it will be less often or never. That would also be true with 30k cases a day, as now, although ‘never’ would be a lot less likely. 

OP wintertree 01 Sep 2021
In reply to Misha:

> Given its highly infectious nature, still relatively high mortality and particularly hospitalisation rates even post vaccination, plus the risk of long Covid and this being a new virus whose long term consequences (including in children) are not yet known / fully understood, I’d rate Covid pretty high on the hypothetical elimination list. As you say, with better vaccines ans therapeutics it may become less of an issue over time but at the moment it’s still a major issue.

Post vaccination is not the end of the journey we are on though.  There's reasons to expect more drops in mortality and hospitalisation rates as we move to a "post vaccination and moderated natural infection state."  If those drops don't play out, that significantly strengths the case for elimination - not that I expect the case to be well received by those of a less cautious nature.

> I don’t  disagree that some exposure to viruses, bacteria and fungi in childhood may be beneficial in the longer term but that logic doesn’t really work with new pathogens which end up killing or hospitalising a large number of adults

I was making the point generally that elimination of pathogens is not by any means a clear cut good idea.  That does translate over to elimination of this specific virus. In the long term, if we eliminate this virus (as improbable as that is) then if/when it or another offshoot of the undiscovered reservoir of novel coronaviruses hits humanity, it will once again be "new".  If we don't eliminate it but move it to endemic status, no other offshoots from the unknown reservoir(s) will ever be fully "new" again.  

There's some very big picture stuff around both novel coronaviruses and the whole relationship between humans and pathogens behind all this, and it's riddled with unknowns.

>  I guess wait and see…

As ever!

 Misha 01 Sep 2021
In reply to wintertree:

Way beyond my competence - no idea whether immunity to Covid might help with immunity to some other coronavirus which hasn’t yet been ‘let loose’.

OP wintertree 01 Sep 2021
In reply to Misha:

> Way beyond my competence - no idea whether immunity to Covid might help with immunity to some other coronavirus which hasn’t yet been ‘let loose’.

It’s unqualified speculation - but not totally in the dark, with suggestions there’s cross immunity between the nucleocapsid protein of original SARS and this one, eg [1].  

Understanding if our current virus emerged from nature or a laboratory would be very useful to understand it there’s a common reservoir (and so if cross immunity may apply to other stuff emerging from that reservoir) or if something more artificial is behind the similarities.

It’s not an area where I’ve seen a good review article, and I would very much like to read one…

[1] https://www.nature.com/articles/s41586-020-2550-z

 elsewhere 01 Sep 2021

Some good news - long Covid in children nowhere near scale feared

https://www.bbc.co.uk/news/health-58410584

 Si dH 01 Sep 2021
In reply to wintertree:

I was reading the posts above earlier but couldn't really add anything useful to the discussion so decided to do a bit of reading. I came across this briefing submitted to SAGE at the end of July which I think you might find very interesting. All about the potential ways the virus might evolve in future, and some recommendations to mitigate or prepare for each. Needs an hour to read properly. I learnt quite a bit about the underlying mechanisms.

https://www.gov.uk/government/publications/long-term-evolution-of-sars-cov-...

Also came across this paper from the same period on the subject of waning vaccine immunity. It's basically a summary/collection of all the studies done to date.

https://www.gov.uk/government/publications/how-long-will-vaccines-continue-...

Both of these docs have lots of info relevant to the discussions above on vaccines and on the way things might pan out in the medium term.

Post edited at 21:18
 aksys 01 Sep 2021
In reply to elsewhere:

> Some good news - long Covid in children nowhere near scale feared

This online discussion on Friday 3 September on “The Delta variant, children and schools” may be of interest to people on this thread.

https://www.johnsnowmemo.com/

OP wintertree 01 Sep 2021
In reply to elsewhere:

> Some good news - long Covid in children nowhere near scale feared

As the return of schools looms I've been reading quite a bit on delta, schools and children. (Not that I as a parent have much practical choice in the matter).  I'm struggling to reach a solid view; there seems to be a big disconnect between the level of concern for adolescents and younger children in the UK vs the USA, and more and more paediatricians in the USA are calling for vaccination in the 5-12 age group, on top of the 12-15 that is open to all in the USA,  but only to individuals at high risk in the UK. (Including risk to others in their household).  

Worrying to have such different takes; although there remains a pressure in the USA to vaccinate children to raise immune levels in the far of much larger adult vaccine refusal.  But the comments from paediatricians are coming from direct observations of illness, not from concerns over immunity thresholds. 

There's some good, clear descriptions in that article of how the data was controlled given that the effects being monitored have a high occurrence also in those who have not had the disease.  Whilst a difference subject, it's highly relevant I think to two recent threads on the yellow card scheme data.

In reply to Si dH:

Thanks for the links.  They're going to need a proper reading later.  

Couple of quick thoughts:

  • Good to see them acknowledging the potential of vaccinating against other viral proteins (For example, begin to develop a universal coronavirus vaccine with strong cross protection to other CoVs potentially using other viral proteins rather than just the spike glycoprotein.) - although it's odd to see it pitched as a future possibility given that Valneva is shown to be immunogenic against multiple other proteins than the spike and is in multiple phase 3 trials...  It's also oddly pidgin holed in to one sub-part of scenario two when it seems to me to apply to all off scenarios one and two... ??
  • Points 51 and 52 go over some stuff on infection induced immunity including one I've banged on about ("T cells recognise peptide fragments from a wider range of viral proteins that may be conserved between viral variants") and some timescales for fade of immunity in terms of efficacy against re-infection.  
    • This feels like the key stuff to me - this kind of immune response should give more variant proof protection against severe illness from future (re)infections.  The question becomes "Can we get there, and if so, how brutal is it to do this through post-vaccination infection?".  Something like a Valneva booster hopefully gets us closer to this kind of place without the risks of post-vaccination infection
  • It's very clear that keeping virus levels low and limiting importation of variants would reduce the identified risks substantially.
    • It worries me with our ongoing high levels that we can't possibly be sequencing most infections, which makes it less likely we'd notice a really bad variant in time to give the best chance of curtailing its expansion.  I've said before - prioritising breakthrough infections and re-infections for sequencing seems prudent.
  • Point 50 is a third strike for one of the arguments made recently: "Infections in mink farms have been observed throughout the world. The widespread presence of the virus in an animal population will render eradication even more unlikely."
Post edited at 23:03
In reply to Offwidth:

> The number is of the whole population fully vaccinated, not the adult population currently with at least one jab (that took two thirds of a year to achieve in a pro public health western nation). 

Of course it is for the whole population and of course there are several other issues.

But this virus didn't exist in humans until about December 2019 and by August 2021 we have effective vaccines and at least 1.5 billion people fully immunised globally and 92% of adults in the UK with at least one dose.

All I am saying is if we can get from zero to where we are now in a year and a half it is more likely than not with the infrastructure we have built that we can do the rest of what is needed to make this a measles level issue in rich countries inside another couple of years.   

Post edited at 01:44
3
 Offwidth 02 Sep 2021
In reply to oureed:

I've linked the paper the article is based on earlier. It's a pre-print that's not been peer reviewed and is contradictory to the current peer reviewed work based on earlier variants. The results, if true, only apply to delta with a prior covid infection.

OP wintertree 02 Sep 2021
In reply to Šljiva:

> Maybe these posts should come with a spoiler alert, this one took all the excitement out of the first minus on the UK figures for days (weeks?). 

Well, next spoiler - the decay in rate constants in Scotland has continued, and is now very close to week-on-week decay.   Tomorrow's data might show decay...

I'll plot the Scottish demographics again on Saturday; from a quick look the big spike in 20-23 and 15-19 (18-19 in practice???) has rapidly decayed, and has been accompanied by a later, slower, broader and lower spike ages 25+ which is now in to dacay.  Ages 0-14 is showing something that rose like the slower, later spikes but now may be going in to sustained growth.

So with my rather whimsical over-interpretation hat on, it looks like a rapid burst of transmission in young adults which then (a) spread out in to older adults causing more cases there but not driving enduring growth beyond the rapid burst and (b) drove cases in children which are perhaps now being sustained towards higher growth by schools.

  • It continues to looks utterly unlike any previous start of a school term and utterly incompatible with the idea that schools returning drove all this.  The litmus test is going to be what happens in England, schools returning as of yesterday give or take inset days.... 

What happens next depends on ages 0-14 and to a degree on the 15-17 component of the 15-19 band.  If these are just the slowest to decay then the top level figures will remain in decay.  If they remain in growth, it won't be long before they dominate cases and so drive the top level figures in to growth again.

That the rate constants in all adult demographics are heading for decay again suggests that we're hovering around R=1 for symptomatic covid and expect cases and rate constants to drop as immunity levels continue rising.  The same logic doesn't apply to under 16s given the lack of general vaccination there so we may see cases becoming more concentrated in schools as they're excluded from other ages by high immunity levels.

Post edited at 16:28

 jonny taylor 02 Sep 2021
In reply to wintertree:

Fingers crossed the trajectory towards decay persists.

Anecdotally: video call #1 with a medic today, he says half his staff are off with positive tests but just mild symptoms like runny noses. Video call #2 with someone who's "picked up a cold, just a bit of a runny nose" from their school-age child. Hmm.

That sort of thing starts to feel like (hopefully?) we might not be too far from normalising it as "just another circulating virus". Not to take away from the people who *are* much more severely affected by it, though.

In reply to wintertree:

> That the rate constants in all adult demographics are heading for decay again suggests that we're hovering around R=1 ....

Where's your thermometer? Chilly here....

Also found this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899041/

Touches on that thing that I swore I heard on SU but couldn't find, that I bang on about every time someone says "tweaked vaccines".

1
In reply to wintertree:

> It continues to looks utterly unlike any previous start of a school term and utterly incompatible with the idea that schools returning drove all this.  

This is a nonsense statement.   Summer holidays are two months long and the weather is good: it is nothing like return to school after Christmas or Easter.   There is only one return to school after summer with Covid to compare against and the circumstances were completely different i.e. no vaccine, major restrictions, limited return to school. 

There are no other return to school at all with Delta variant and Covid restrictions removed.  Basically, 'unlike any previous start of a school term' means SFA.

Anyone with kids knows that the last week or so of the long summer holidays are different.

Post edited at 18:29
5
 Si dH 02 Sep 2021
In reply to tom_in_edinburgh:

.

> Anyone with kids knows that the last week or so of the long summer holidays are different.

I've never lived in Scotland but I don't think they send 20 year olds back to primary school each year after the summer holidays?

Your arguments are completely absurd!

1
OP wintertree 02 Sep 2021
In reply to Longsufferingropeholder:

> Where's your thermometer? Chilly here....

I think we're seeing a lot of movement likely relating to rising immunity levels hitting a magic point - I'm getting my hopes up again after the misleading events after the end of the football...

Then there's the return of English schools coming as well which will almost certainly have an effect landing first and strongest in school aged children that could kick in to the demographic data quite suddenly  and deceptively (in terms of relation in changes in the ratio between rate constants for cases and actual infections) if there's a "switch-on" of LFDs as seen in previous terms' data.

Both of these probably have a lot of change falling in the weather passband so Other Things Are Afoot right now.  If we are really reaching the threshold for "symptomatic R < 1" then things are going to snowball for a couple of weeks...

> Touches on that thing that I swore I heard on SU but couldn't find, that I bang on about every time someone says "tweaked vaccines".

Interesting, thanks.  Lots of reading for tomorrow.

In reply to jonny taylor:

> That sort of thing starts to feel like (hopefully?) we might not be too far from normalising it as "just another circulating virus".

That's my hope.  

> Not to take away from the people who *are* much more severely affected by it, though.

It's going to be a crap few months in terms of hospitalisations as we hopefully move to the next phase, and then we see where we are again and how that compares to a "typical" flu season.  One silver lining - the immune modulatory therapeutics in the pre-clinical and clinical trials stages of the R&D pipeline are I think going to have some applicability to managing seasonal respiratory illnesses beyond Covid.  Particularly for some of the effects of influenza.

In reply to tom_in_edinburgh:

> This is a nonsense statement.

This is a nonsense rebuttal.

If we see a massive, brief spike in cases in ages 20-24 in England after schools return followed by a slow rise in younger ages I'll think again... Probably about my sanity TBH as it's such an unsubstantiated inference for which I've seen no causal mechanisms posited let alone ones with an explanation of why they've never been in play before.   We are likely to have such a spike after universities return, but that's a few weeks later in the main.

In reply to Si DH:

> Your arguments are completely absurd!

Glad it's not just me...  

 Si dH 02 Sep 2021
In reply to wintertree:

Meant to mention, I think leading edge data right now might be slightly optimistic due to the bank holiday just gone - there has been a 'three day weekend' in cases. Not sure if you have the Monday in your data yet and if you are adjusting for it. Worth bearing in mind for the next update.

In reply to Si dH:

> I've never lived in Scotland but I don't think they send 20 year olds back to primary school each year after the summer holidays?

Primary/nursery age children have parents in their twenties.  Children in the later years of secondary school have siblings and friends.

Right now the Scottish data are fairly easy to understand - we did some stuff which is likely to lead to more infection and we got a bump in infection.   The English data on the other hand are weird: they did stuff which is likely to lead to more infection and their cases are flat.  There isn't that much difference between the countries in the antibody survey.   So what's going on? 

3
OP wintertree 02 Sep 2021
In reply to Si dH:

> Meant to mention, I think leading edge data right now might be slightly optimistic due to the bank holiday just gone - there has been a 'three day weekend' in cases. Not sure if you have the Monday in your data yet and if you are adjusting for it. Worth bearing in mind for the next update.

Thanks, good point.

 The most recent data point in today's plot is for this Monday's count vs the previous Monday's count; so it is likely depressed more negative by the bank holiday sampling lull.  

I haven't been shunting cases around recent BH dates as the effect seems smaller than around Christmas 2020, and the "week on week" rate constant plots are much "cleaner" analysis that don't do any weekend or BH adjustment, the weekend stuff naturally drops out by the like-for-like nature of a 7-day comparison and I just put the blue annotations on for the matched pair of low/high data points when the BH low forms either side of the comparison and leave correction to the viewer's mach 1 eyeball. Scanning the other bank holiday days we're probably still in "real" decay.

In reply to tom_in_edinburgh:

Those are some short straws that magically have never been in play at any point before now, including during the rise to dominance of delta towards the end of the last school term. 

> The English data on the other hand are weird:

Not really.

> they did stuff which is likely to lead to more infection and their cases are flat. 

No, cases are doing a convincing impression of solid decay now.

> There isn't that much difference between the countries in the antibody survey.   So what's going on? 

The antibody survey is far from the complete picture. Where are the antibodies? What kind of antibodies are they?  

If we did have a brief, unsustained spike following the brief intense footfall at English nightclubs on opening night it would have been more or less buried in the massive decay signal from us exiting the football, which fell at just the right (wrong) time to conflate the data.

But it seems likely to me - as I've said before - that the recent wave of infections around the football was timed and located just right to concentrate a big dollop of infection granted immunity in an unvaccinated segment of the younger population, which both nightclub attendance patterns and the Scottish demographic data rather suggest are where reopening related cases are concentrated...  If we're reaching genuine thresholds, England got the last big dose of antibodies from the football; Scotland by dint of bombing out 3 weeks sooner missed out on that and took its lumps with the nightclubs.  To be clear there's a lot of speculative interpretation going on here, but it seems to fit with what we know.  Could be lots of other things.  

Post edited at 19:54
In reply to Si dH:

> Meant to mention, I think leading edge data right now might be slightly optimistic due to the bank holiday just gone 

Is now a good time to mention it was also Reading/Leeds festival? Will be interested to see if we get the Boardmasters effect again.

 oureed 02 Sep 2021
In reply to Offwidth:

>  It is contradictory to the current peer reviewed work based on earlier variants. The results, if true, only apply to delta with a prior covid infection.

Why are you even slightly bothered about earlier variants?!

4
 mountainbagger 02 Sep 2021
In reply to Longsufferingropeholder:

> Is now a good time to mention it was also Reading/Leeds festival? Will be interested to see if we get the Boardmasters effect again.

Funny you should say that. Heard about some people I know indirectly who came back from a festival complaining of a heavy cold and saying it's not Covid, it can't be. They get pinged, they get a test and, sure enough, it's positive!

Many others have probably just shrugged it off without a test.

Why people assume it's more likely they have caught a cold at the moment I don't know. Perhaps they are surprised by the mildness of the symptoms (these people were in their 20s and double-vaxxed plus 2 weeks)?

In reply to Longsufferingropeholder:

> Touches on that thing that I swore I heard on SU but couldn't find, that I bang on about every time someone says "tweaked vaccines".

This paper is about flu and HIV which are known to mutate quickly.  Coronaviruses have a different structure from flu and do not mutate as fast.

HIV has been around for decades and there is still no vaccine.  There are about 10 vaccines for Covid within a year and a half of it emerging. 

https://asm.org/Articles/2020/July/COVID-19-and-the-Flu

2
In reply to Longsufferingropeholder:

> Touches on that thing that I swore I heard on SU but couldn't find, that I bang on about every time someone says "tweaked vaccines".

This paper is about flu and HIV which are known to mutate quickly.  Coronaviruses have a different structure from flu and do not mutate as fast.

HIV has been around for decades and there is still no vaccine.  There are about 10 vaccines for Covid within a year and a half of it emerging. 

https://asm.org/Articles/2020/July/COVID-19-and-the-Flu

2
In reply to Longsufferingropeholder:

> Touches on that thing that I swore I heard on SU but couldn't find, that I bang on about every time someone says "tweaked vaccines".

This paper is about flu and HIV which are known to mutate quickly.  Coronaviruses have a different structure from flu and do not mutate as fast.

HIV has been around for decades and there is still no vaccine.  There are about 10 vaccines for Covid within a year and a half of it emerging. 

https://asm.org/Articles/2020/July/COVID-19-and-the-Flu

2
In reply to Longsufferingropeholder:

> Touches on that thing that I swore I heard on SU but couldn't find, that I bang on about every time someone says "tweaked vaccines".

This paper is about flu and HIV which are known to mutate quickly.  Coronaviruses have a different structure from flu and do not mutate as fast.

HIV has been around for decades and there is still no vaccine.  There are about 10 vaccines for Covid within a year and a half of it emerging. 

https://asm.org/Articles/2020/July/COVID-19-and-the-Flu

2
In reply to tom_in_edinburgh:

> This paper is about flu and HIV which are known to mutate quickly.  Coronaviruses have a different structure from flu and do not mutate as fast.

Please try not to miss the point occasionally. It's about immune responses.

1
In reply to Longsufferingropeholder:

> Please try not to miss the point occasionally. It's about immune responses.

First line of the abstract:

"Vaccinations are one of the greatest success stories of modern medicine, saving millions of lives since their widespread adoption. However, several diseases continue to elude highly effective vaccination strategies. Chief among these are human immunodeficiency virus (HIV) and influenza (flu), both of which will require vaccines that can guide the creation of highly mutated, broadly neutralizing antibodies (bnAbs)."

There is no reason to believe Covid is one of the diseases like HIV and flu which will "elude highly effective vaccination strategies".   

6
In reply to tom_in_edinburgh:

Pfizer now have an antiviral pill for Covid entering clinical trials.   The amount of money that's gone in to R&D the response is just going to get better over time.

https://cdn.pfizer.com/pfizercom/2021-09/First_Participant_Dosed_in_Phase_2...

Post edited at 06:48
1
 Si dH 03 Sep 2021
In reply to tom_in_edinburgh:

> Right now the Scottish data are fairly easy to understand - we did some stuff which is likely to lead to more infection and we got a bump in infection.   The English data on the other hand are weird: they did stuff which is likely to lead to more infection and their cases are flat.  There isn't that much difference between the countries in the antibody survey.   So what's going on? 

I do agree with much of this. There are things in play that limit rises in infection rates, which we just don't understand. It may be to do with variable immunity levels around the UK as per Wintertree's post but there might be something else happening. Even throughout the pandemic, there have been many points in time and place when a rise has occurred and then self limited itself in some way, even when immunity levels were much lower. I have speculated in the past whether this could be to do my with reaching immunity thresholds in the most susceptible to infection groups (key workers, teenagers etc) but I think really that theory was probably refuted simply by how much longer high case rates have continued since then in these groups. Some of it may be down to weather changes, but it doesn't explain everything.

(The Scottish data is also weird though, in that it went up so fast and is now mostly in reverse. Why? What change has caused that? Are we to believe it's all behavioural? I'd be very surprised.)

Basically, this is why I still take an interest in these threads. I have a good idea what's happening with the pandemic on a day-to-day basis already but it's interesting to pass around theories for the behaviour we are seeing that might explain what happens next and to see if others have observed data that would support or refute them.

The biggest potential implication of the English data for me is that it begins to look like the levels of infection that we have to live with for a long time might be quite high, given the high measured antibody levels and lack of continuous drop in infection rates*. Are we in for 10,000s cases per day for months or years to come? If I thought that was true I would change my personal behaviour because I'd rather get covid now (in my late 30s, 2 months post second jab so brimming with antibodies but probably will never get a booster vaccine) than in another 6-12 months time.

* Unless the reduction beginning in England in Wintertree's data becomes a definite fall that continues to a much lower level. I'm still on the fence as to whether that is happening; it's regionally heterogeneous and so far rates are still flat in the North West, which outside of London still has the highest antibody levels.

Post edited at 07:34
In reply to tom_in_edinburgh:

Ffs. Wrong battle.

Read on a bit. I was talking about updated vaccines, founders effect, original antigenic sin. Get to that part.

1
 Si dH 03 Sep 2021
In reply to tom_in_edinburgh:

> Pfizer now have an antiviral pill for Covid entering clinical trials.   The amount of money that's gone in to R&D the response is just going to get better over time.

The first paper I linked at 21:16 on Wednesday made quite a point of recommending caution with the use of antivirals, worth a read.

 oureed 03 Sep 2021
In reply to Si dH:

> I would change my personal behaviour because I'd rather get covid now (in my late 30s, 2 months post second jab so brimming with antibodies but probably will never get a booster) than in another 6-12 months time.

Particularly as we don't actually know what the virus will look like in 12 months time. However, natural immunity does seem to provide broad protection. A case of better the devil you know...

ps. this does actually appear to be current government policy at the moment in England, although it has never been announced.

Post edited at 07:39
4
OP wintertree 03 Sep 2021
In reply to tom_in_edinburgh:

> There is no reason to believe Covid is one of the diseases like HIV and flu which will "elude highly effective vaccination strategies".   

You have completely missed the point and are arguing against things LSRH has neither said nor implied.

> First line of the abstract:

Yes. Not the point of interest/relevance.

2
OP wintertree 03 Sep 2021
In reply to tom_in_edinburgh:

> Pfizer now have an antiviral pill for Covid entering clinical trials.   The amount of money that's gone in to R&D the response is just going to get better over time.

I’m a bit les keen on antivirals than the large quantity of immune modulating therapeutics in the pipeline - some already in phase 3 trials.  

Antivirals are like antibiotics - once we use them we loose them to evolution.  The immune modulatory stuff is not really evadable as it targets the host not the virus.

It’s not clear to me that the spend on R&D for covid drugs will keep ramping up - it’s order of 10 years and $1 Bn to get a compound from target discovery to market, and a 95% or higher failure rate.  What we’re seeing now is repurposing trials of the most likely candidates from pre-existing compounds.  There’s only so many of those out there and they’re going in to trials in prioritised orders.  I’m not sure many firms will start pre clinical research in to anti-covid therapeutics with where it looks like this is going.  There may well be more investment in immune modulating therapies but immunoactive pharmacological compounds is already a growth area…

Plenty of conversations in the past about the scale of the trials pipeline and emerging therapeutics.  Funnily enough I think they’ll reduce the pressure for elimination nor the virus by blunting health consequences for the remaining vulnerable. They can also be targeted where needed instead of requiring constant redeployment - as vaccination would to maintain a near-elimination strategy locally against a global circulation.

1
 Si dH 03 Sep 2021
In reply to oureed:

> ps. this does actually appear to be current government policy at the moment in England, although it has never been announced.

I might actually agree with you for once. The govt would never state it though. Is it really policy? Policy by intent? Or by default? Or are they still trying to reduce infection but just totally incompetent?

My guess is they are gunning for a strategy of immunity being topped up by booster vaccine in vulnerable groups and by disease in everyone else, but would never go so far as to tell individuals outside vulnerable groups that it's a good time to get it because it can still make some people pretty ill. Which leaves everyone to make individual, uninformed choices (edit - or just to play the lottery).

Maybe I'll be proved wrong.

Post edited at 08:08
1
OP wintertree 03 Sep 2021
In reply to Si dH:

> The biggest potential implication of the English data for me is that it begins to look like the levels of infection that we have to live with for a long time might be quite high, given the high measured antibody levels and lack of continuous drop in infection rates*.

That’s where we really need to demographic and vaccine status breakdown data, and ideally some measure of past, confirmed infection 

What is the hospitalisation rate for people catching the virus…

  1. Without immunity
  2. With full vaccination
  3. With full vaccination and prior survived infection 

Obviously a big step change from 1>2.  What happens at 2>3?  Getting harder and harder to understand the top level figures without all the context - although I appreciate you’ve reconstructed good insight from the technical reports.

> * Unless the reduction beginning in England in Wintertree's data becomes a definite fall that continues to a much lower level. I'm still on the fence as to whether that is happening; it's regionally heterogeneous and so far rates are still flat in the North West, which outside of London still has the highest antibody levels.

Let’s give it another week…….

1
 aksys 03 Sep 2021
In reply to Si dH:

This has been my logical conclusion too. (A rather depressing outlook in our circumstances too).

A great shame that strategies/policies cannot be explained clearly to the general public. 

1
OP wintertree 03 Sep 2021
In reply to aksys:

> A great shame that strategies/policies cannot be explained clearly to the general public. 

I take more gumption still at the lack of any sort of scientifically informed parliamentary airing / debate of the "shadow policy" it's felt like we've had for the last few months.

> This has been my logical conclusion too. (A rather depressing outlook in our circumstances too).

I tend to view this as likely the "least worst option" but the problem is we don't have enough evidence to judge that ourselves, nor enough clearly stated and reasoned expert opinion.  We're basically reduced to assuming that the current cabinet are indeed navigating us towards the least worst option. 

I was going to say more, but I said it all ten weeks ago:

I’m not leading with a look at cases this week, as it all boils down to “cases are going up, lots”.  There is much debate to be had about if this is the right thing to do, and if so if this is the right time to do it - a very academic debate suggested another poster on the previous thread’s continuation given the pace at which things are developing. There's lots of room for  different opinions on this - room expanded all the more by the absence of more clear communication and policy decisions from government to address the issues this raises, and to evidence that it is the least worst option.

In reply to Si dH:

> Maybe I'll be proved wrong.

I'm not holding my breath.  Well, except when walking through unavoidable areas with lots of people.

This has long been the inferable policy I think

  • There was no prior expectation that the vaccines would reduce transmission enough to put "minimal lockdown elimination" on the table, their express intent was to reduce mass individual health damage to preserve universal healthcare through protecting individual health(*).  
  • When it became evidenced that the vaccines were cutting down transmission, there was absolutely no attempt to build on this for elimination, and we already understood at that point that the sterilising immunity this relied on was against epitopes on the RBD which we also already knew was the hotbed of mutation likely related to rapid host adaption.
  • We already knew that the vaccination was not the endgame
    • We knew vaccine effects wouldn't last indefinitely against a fixed variant
    • We knew that the virus was varying a lot over time
    • It was clear we weren't going to have hard borders in even the most obvious times of risk or the most dire times of healthcare crisis, and it was clear the virus isn't going to be eliminated globally any time soon.
    • We already knew that catching the virus symptomatically - even without prior immunisation to mitigate the health damage of this virus and immune evading aspects of coronaviruses - leads to immunity, and immunity tracking the virus' evolution at that.
    • We had good reason to think that immunity against severe illness would fade more slowly than immunity against catching the virus
  • All of this points to one and only one way forwards other than elimination - "normalisation". 

A lot of this has come up on here over the last few months, and I still wish it had been spelt out back in the early summer at latest by government and preferably given an airing in the commons.   It may be the least worst option but I've not seen that robustly tested, and it has a significant death toll that's not been acknowledged up-front.  

As you note, telling people "you have to get it after vaccination" is on sketchy ground given the health consequences for a minority (a much smaller one than pre-vaccination).  I would very much like to see if any advice has been sought from the attorney general over policy and messaging with regards to this, smells like a legal minefield to me.

(*) This is why another poster's interest in presenting immunity as being "better" when acquired naturally first is irrelevant, as that clearly is an abject failure at the primary goal of protecting healthcare by protecting health with the evidence showing live infection is many orders of magnitude more dangerous than vaccination for all adult ages...

Post edited at 10:01
1
In reply to wintertree:

I'm of a similar opinion to you both, however I can see no benefit to be gained from announcing with a great fanfare that the plan is for the virus to circulate. Vallance and Whitty have always chosen their words carefully. We all know what they mean; I don't see how spelling it out would be a net benefit. Only difference doing so could make is to raise a bunch of disquiet on the way to exactly the same outcome.

Other opinions available.

1
OP wintertree 03 Sep 2021
In reply to Longsufferingropeholder:

>  however I can see no benefit to be gained from announcing with a great fanfare that the plan is for the virus to circulate. Vallance and Whitty have always chosen their words carefully. We all know what they mean; I don't see how spelling it out would be a net benefit. Only difference doing so could make is to raise a bunch of disquiet on the way to exactly the same outcome.

I can see that there's scope for a lot of unintended consequences if it had been spelt out in plain speak, but still - it's not a very democratic way forwards and the "war-like exigency" that saw cabinet justifiably calling the shots without debate has long past us.  

The lack of clear expert evaluation that this is the "least worst option" requires us to trust that the current government are acting in a scientifically guided way towards the best interests of the people of the nation.  Perhaps that belief comes naturally to some people.

More frustratingly, in the absence of clarity, mixed messaging fills the void, and this mixed messaging is leading to some gross confusion and empowerment of the less scientifically minded (shall we say) when it comes to resisting/enacting sensible risk control measures in certain kinds of workplace.  Viral load is still a thing, and there's a difference between catching delta from a conservative level of social exposure and having an employer effectively force one to be in a small, poorly ventilated room with 25 young adults for 2 hours solid severe times a day whilst refusing to consider a raft of practicable measures that would moderate any viral load.

1
 Si dH 03 Sep 2021
In reply to wintertree:

Totally accept that the end point is normalisation; whether stated or not by government. It's been obvious for a while as you pointed out.

However I suppose I had hoped it would be normalisation at an infection rate that meant any one individual acting completely normally would be unlikely to get infected in a given year and it would be a fairly rare illness because of the level of population immunity built up in the pandemic phase. I'm now wondering whether that's the case, or whether we are instead going to have to accept that relatively frequent (eg annual) infection is pretty much a given unless we restrict ourselves indefinitely and significantly.  If that's the case, then the safest course might be to get yourself infected while you have lots of antibodies, rather than continually try to avoid infection. Ie, the case rate at which normalisation happens is important to individual decisions.

1
 jonny taylor 03 Sep 2021
In reply to Longsufferingropeholder:

> We all know what they mean; I don't see how spelling it out would be a net benefit.

You would think so. I've had some rather eye-opening conversations this week though (not work-related) where it rather feels as if people have been conditioned for so long to follow government instructions that they aren't thinking for themselves. Intelligent people basically saying "well the government isn't introducing restrictions and schoolchildren are free to mingle, so we should be fine too". It seemed to come as a surprise when I suggested that needed to be accompanied by an acknowledgement of what the consequences of that would be. (Not arguing that it should never happen, just that it comes along with a heightened likelihood of transmission, under current case levels)

1
 jonny taylor 03 Sep 2021
In reply to Si dH:

> If that's the case, then the safest course might be to get yourself infected while you have lots of antibodies, rather than continually try to avoid infection. Ie, the case rate at which normalisation happens is important to individual decisions.

I share your worries there, and frustration at lack of transparent messaging. As somebody who's fortunate enough to be able to limit my risk exposure fairly well for the post part, I'm increasingly aware that I may be digging myself into an immunological hole. But equally, deliberately dialling back my level of caution would be a bold thing to do based simply on my own semi-informed lay opinions.

Post edited at 10:30
1
OP wintertree 03 Sep 2021
In reply to Si dH:

> However I suppose I had hoped it would be normalisation at an infection rate that meant any one individual acting completely normally would be unlikely to get infected in a given year and it would be a fairly rare illness because of the level of population immunity built up in the pandemic phase. I'm now wondering whether that's the case, or whether we are instead going to have to accept that relatively frequent (eg annual) infection is pretty much a given unless we restrict ourselves indefinitely and significantly.  

If we imagine this can be "normalised" to the level of other mostly harmless endemic respiratory viruses, their mechanics are something of a strong steer.  Pre-Covid I'd get 3-4 respiratory nasties a year, with the winter season one getting worse each year.  No idea how often I got any particular one, but if Covid ends up much like those it's a steer for what to expect.  I'm not going back in to a crowded lecture theatre again...

> If that's the case, then the safest course might be to get yourself infected while you have lots of antibodies, rather than continually try to avoid infection.

It's a discussion I've had offline with some people in the field.  I won't give unqualified medical opinion on t'internet but you raise a valid question...  

The other risk is that the longer one hides away from ones first post-vaccination infection infection, the bigger the likely genetic drift between the spike protein used in the vaccine and the spike in the circulating virus (or heaven forbid after it does a recombinant spike change).  That would seem to strongly favour not waiting indefinitely.  

This is why I see the Valneva vaccine as such an important part of the puzzle; a 3rd "booster" dose from that would give one immune responses against a range of viral proteins.

> Ie, the case rate at which normalisation happens is important to individual decisions.

Yup.  We're being told to make responsible decisions, but the full scope of those decisions is nowhere near spelt out, and the information needed to inform them is scattered and partial.  

The decision basically boils down to a bit of Dirty Harry:

  • You've got to ask yourself a question: 'do I feel lucky?' Well, do ya, punk?

Edit: Sorry I missed the distinction/nuance on what you were saying first time round; thanks for spelling it out.

Post edited at 10:56
1
OP wintertree 03 Sep 2021
In reply to jonny taylor:

>  equally, deliberately dialling back my level of caution would be a bold thing to do based simply on my own semi-informed lay opinions.

Is it more or less bold when it's based on a raft of semi-informed lay opinions? 

 jonny taylor 03 Sep 2021
In reply to wintertree:

> Is it more or less bold when it's based on a raft of semi-informed lay opinions? 

I did think about saying something about the FNCP braintrust there...

1
In reply to wintertree:

> The lack of clear expert evaluation that this is the "least worst option" requires us to trust that the current government are acting in a scientifically guided way towards the best interests of the people of the nation.  Perhaps that belief comes naturally to some people.

Where I've gone looking for it this is the only expert evaluation I've found, apart from the fantastically optimistic elimination campaigners or the let it rip tin-foil hat crew. I'm don't think I'm disagreeing with anything you're saying, but I'm struggling to think of any words any of the politicians, whatever colour tie they wear, could use that would make the situation or outcome better. Also sympathise with Si and have been having similar thoughts myself (being in a near identical situation).

> The rest

100% agree. 

1
OP wintertree 03 Sep 2021
In reply to Longsufferingropeholder:

> but I'm struggling to think of any words any of the politicians, whatever colour tie they wear, could use that would make the situation or outcome better. 

I'd like to see an integrated and evidence led approach to health and safety with regards managing viral loads in "highly sub-optimal" workplace environments.

With the split demographics for example over various teaching roles and over consequences of infection - including for some with only vaccine granted antibodies vs delta - recognising and managing the consequences of extreme viral loads is a clear, proactive step that would manage the impact of this stage of the process without impeding it.

I'd actually like to see managing viral load in deeply sub optimal work places carried forwards indefinitely.  It's not exactly counter-intuitive stuff when you look at managed exposure to radiological hazards for example.

1
 AdJS 03 Sep 2021
In reply to Longsufferingropeholder:

Perhaps I’ve misinterpreted some of the last few posts but there appears to be some tacit support for the government’s Great Ongoing British Schools Herd Immunity Threshold Experiment (GOBSHITE).

Not sure how many parents are keen on their kids getting covid. And of course the kids themselves shouldn’t worry as Child Protection and Safeguarding are top priority in UK schools so what can go wrong? 

Get Covid Done! It worked well with Brexit.

4
 elsewhere 03 Sep 2021
In reply to wintertree:

Politically the government cannot overtly advocate normalisation as that implies taking some responsibility for a policy that costs 100 lives per day compared to NZ style elimination.

With fading or partial immunity and in the absence of elimination, "you have to get it after vaccination" may be as inevitable catching commonly circulating viruses such as colds & flu. 

Comparing UK with countries that might be expected to have higher levels of immunity to see how things may develop here, maybe we need a LOT (10%) more immunity to reduce cases.

UK 63% fully vaccinated, 10% confirmed cases, 500 cases per 1M now, deaths 1.6 per 1M now 

Denmark 73% fully vaccinated, 6% confirmed cases, 140 cases per 1M now, deaths 0.3 per 1M now   

Portugal 75% fully vaccinated, 10% confirmed cases, 200 cases per 1M now, deaths 1.1 per 1M now 

Our world in data figures for percentage fully vaccinated, cumulative confirmed cases per million (converted to percentage), current 7 day average confirmed cases per million, current 7 day average deaths per million. UK, Denmark & Portugal now pretty much Delta only.

 We're lagging on vaccination. 

4
OP wintertree 03 Sep 2021
In reply to AdJS:

It's a gnarly issue, and one for which there isn't enough information or expert opinion in the public domain for me to really support any policy, overt or covert.  

It's notable that JCVI are diverging in approach from other nations' policy (e.g. Germany, NZ, USA) in terms of not vaccinating most chidden aged 12-15, and in keeping to one dose for ages 16-17 for now (health protection but not much protection against infection).  I also noted up thread that increasingly concerning comments are emerging from some US based paediatricians, some of whom are starting to call for immunisation in ages 4-11.  There seems to be something of an unexplained divergence in experience here as well as of downstream policy.  Perhaps I'm too swayed by "anecdata" in the absence of more hard data.

I see the arguments for and against vaccination of children, particularly with regards pre-adolescents.  With elimination beyond any hope of getting political or public support in our current situation, there is something of a feeling of inevitability about a lot of what lies ahead. Recognising the inevitability and trying to make the best of the situation is not the same as endorsement.

The medical evidence does not currently support vaccinating younger children in the eyes of the experts (JCVI).

> Not sure how many parents are keen on their kids getting covid. 

 I'm not ecstatic about the idea Jr is likely to get Covid soon enough, but weighing up the factors I'd rather they continue to receive their education and wider school experience and at their age they're still somewhat in the "catching every virus for the first time" phase.  So for them, Covid is much more like other viruses than for adults where it's a stand out in terms of comparative prior immunity to other viruses.  Some of those other viruses put a small number of unlucky children in hospital each year, too.

Many of the other parents seem to think we're in a 100% post-Covid world and show not a single concern.  This is going to start getting awkward soon over things like indoor birthday parties in small rooms etc; I'm all for avoiding situations designed to produce a weapons grade viral load for the next few months, and it's hard to convince a small child that there are valid reasons when everyone else thinks or at least acts differently - especially as I don't want them to develop any unhealthy general aversion mindset due to Covid at such a formative time and have tried very hard to find a balanced approach.

1
In reply to AdJS:

> Perhaps I’ve misinterpreted some of the last few posts but there appears to be some tacit support for the government’s Great Ongoing British Schools Herd Immunity Threshold Experiment (GOBSHITE).

That's not what I'm saying. The best possible realistic endgame is that in some years from now this virus is another on the list of what you'd call the common cold. Might never get quite that benign but we can hope. How we get there kinda sucks, but we're in a better position than we were. There's no great way there from here. Sugar coating it seems pointless, but at the same time I don't know what you'd achieve by making a song and dance about telling it how it is. As I said other opinions are available.

Agree with wt that we should learn the lessons from all this, not least staying the f*** at home when sick.

1

In reply to JaneMitch:

O hai

1
In reply to elsewhere:

> Politically the government cannot overtly advocate normalisation as that implies taking some responsibility for a policy that costs 100 lives per day compared to NZ style elimination.

NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not a strategy.

> With fading or partial immunity and in the absence of elimination, "you have to get it after vaccination" may be as inevitable catching commonly circulating viruses such as colds & flu.

This is the only way this can go from here. Well, the only way it can go and anyone be around to see it.

> Comparing UK with countries that might be expected to have higher levels of immunity ....

Be really careful doing that. Population figures are really flaky, and it matters. A lot. Remember that being off by 2% in the population denominator when talking about groups that are 96% vaxxed is a 50% error in the number of susceptibles. And e.g. Spain has vaccinated > 100% in a number of age groups. Big pinch of salt required.

>  We're lagging on vaccination. 

Kinda but not really. If you factor in the ages of the vaccinated, were not that far from the top of the least screwed countries list. Mainwood and Angus have a few good ways of visualising of it.

2
In reply to Longsufferingropeholder:

I managed to accidentally top up my immunity last week.

Based on my personal experience, getting it for the second time (after being double jabbed) was much more pleasant than the first.

I can’t really see any scenario where we aren’t continuously exposed to Covid and reinfected. Hopefully by the time I get it again in 2022/23 I won’t have to self isolate.

1
 elsewhere 03 Sep 2021
In reply to Longsufferingropeholder:

> NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not a strategy.

And certainly not a strategy likely to be seen here.

> Be really careful doing that. Population figures are really flaky, and it matters. A lot. Remember that being off by 2% in the population denominator when talking about groups that are 96% vaxxed is a 50% error in the number of susceptibles. And e.g. Spain has vaccinated > 100% in a number of age groups. Big pinch of salt required.

I don't think 2% matters for R and cases, the difference between countries of 63% vs 73% and 63+-2% vs 73%+-2% is neither here nor there when the relationship between cases & vaccination level is so unclear. Also the impact of vaccination on transmission is far from complete so the number of susceptibles is much greater than 37+-2% vs 27%+-2% making the 2% even less significant.

I also don't think 2% in the denominator matters that much for deaths. The difference is not between 100% vaccine protection and 98% vaccine protection, the difference is between about 95% vaccine protection (even with a real 100% vaccine uptake) and about 93% vaccine protection. There is perhaps a 40% greater susceptible population (7% vs 5%) and not infinitely greater susceptible population (2% vs 0%) if the denominator is a bit wrong.

2% in denominator matters - I think that requires a pinch of salt as vaccine protection never exceeds about 95% (and much less for transmission). 

I'm saying susceptible as shorthand for population level averages but there isn't really susceptible and not susceptible. There's susceptible and twenty times less susceptible (95% protection against death when vaccinated) or susceptible to transmit and an uncertain amount less susceptible to transmit when vaccinated.

Post edited at 14:13
1
OP wintertree 03 Sep 2021
In reply to AdJS:

A good article out from the BBC half an hour after my reply.

https://www.bbc.co.uk/news/health-58423152

A couple of notable paragraphs:

But the JCVI's caution may mean it's not persuaded by the data it has seen to date. The last thing it wants is to give the go-ahead and then for a series of adverse events to dent parents' confidence in other childhood vaccines.

And the UK has gone its own way before, on the decision to extend the gap between doses, which proved to be spot-on.

It has some expert comments as well - including Paul Hunter who has often been a voice of reason.  

Post edited at 14:31
1
In reply to elsewhere:

> I also don't think 2% in the denominator matters that much for deaths. The difference is not between 100% vaccine protection and 98% vaccine protection, the difference is between about 95% vaccine protection (even with a real 100% vaccine uptake) and about 93% vaccine protection. There is perhaps a 40% greater susceptible population (7% vs 5%) and not infinitely greater susceptible population (2% vs 0%) if the denominator is a bit wrong.

Agree cases aren't the important thing. Would stress though that 40% more hospitalisations matters. That's the difference between needing another lockdown and not. And the groups where we're arguing whether it's 94 or 96 (or rather 4% Vs 6%) are the ones where the hospitalisations come from. This is where the UK starts to look not so bad. The examples you gave are 2 of a small few that are in better shape when you factor in age and take the percentages at face value.

> I'm saying susceptible as shorthand for population level averages but there isn't really susceptible and not susceptible. 

Me too. It's worth making that clear I guess.

Edit: Mainwood's take here: https://mobile.twitter.com/PaulMainwood/status/1432286926212673538 I do wish he'd move to a less obnoxious platform.

Edit again: I guess another way to say it is that pointing at a country that has a higher headline vaccination figure than the UK, but has got there by vaccinating younger people, is not telling the whole story.

Post edited at 14:30
1
 Si dH 03 Sep 2021
In reply to wintertree:

> A good article out from the BBC half an hour after my reply.

> A couple of notable paragraphs:

> But the JCVI's caution may mean it's not persuaded by the data it has seen to date. The last thing it wants is to give the go-ahead and then for a series of adverse events to dent parents' confidence in other childhood vaccines.

> And the UK has gone its own way before, on the decision to extend the gap between doses, which proved to be spot-on.

> It has some expert comments as well - including Paul Hunter who has often been a voice of reason.  

From the latest news it appears that JCVI are reiterating their view now that vaccinating healthy 12-15yos is not warranted.

BBC News - Not enough benefit to offer all teens Covid jabs

https://www.bbc.co.uk/news/health-58438669

1
 elsewhere 03 Sep 2021
In reply to Longsufferingropeholder:

I selected Denmark and Portugal for gauging potential progress by the UK if vaccination rates increase here. I ignored the city states and islands with small populations that also have higher vaccination rates than UK.

2
 AdJS 03 Sep 2021
In reply to Si dH:

While I agree that the risks and benefits of vaccinating children should be carefully weighed up, and rightly jabs should be targeted at the most vulnerable e.g. the roughly 1 in 11 children who have asthma, it’s odd that neither of the BBC articles mentions what is possibly the real reason behind the JCVI’s current stance, the limited supply of Pfizer and Moderna vaccine in the UK.

Only 40k first jabs and 120k second jabs given today, with 5 million still waiting for a second jab. Not sure about the split between the type of vaccines given but Johnson’s boasting about how the UK was leading the vaccination race is starting to look a bit hollow now.

4
In reply to AdJS:

There's no supply issue. We have shitloads.

Irt elsewhere: that's reasonable (the dislike isn't from me)

1
In reply to AdJS:

We’ve just given 4m Pfizer doses to Australia. We’re swimming in RNA vaccines at the moment.

1
 elsewhere 03 Sep 2021
In reply to VSisjustascramble:

> We’ve just given 4m Pfizer doses to Australia. We’re swimming in RNA vaccines at the moment.

Gizza jab!

Older viewers may recognise that.

1
OP wintertree 03 Sep 2021
In reply to AdJS:

> Only 40k first jabs and 120k second jabs given today,

The drop in second doses is very strange, their rate has been tampering off compared to first doses "coming due" for the last week or so.

There's some suggestions that on the order of half a million people have not gone for their second dose for AZ - https://www.independent.co.uk/news/health/covid-astrazeneca-vaccine-second-...

1
In reply to wintertree:

ISTR the return rate inferred by those doing the maths was always somewhere around 95%, which I always found a bit surprising. But now with the demographics that are due their second jab and the demographics that are getting covid there's a non-negligible number that will be having to delay until however many weeks it is after they've recovered.

1
 Å ljiva 03 Sep 2021
In reply to Longsufferingropeholder:

throw in holidays as well? 

1
 bruxist 03 Sep 2021
In reply to Si dH:

> If that's the case, then the safest course might be to get yourself infected while you have lots of antibodies, rather than continually try to avoid infection.

I'm really glad you broached this. It feels like it's a question that's been troubling most of us, and I'm grateful to see an open discussion of it, and grateful to everyone here for talking about it openly.

I can understand the principle of such a strategy, but still instinctively rail against it. Post-vax natural infection might be the safest course for me personally now, but I assume the risks of such an approach depend an awful lot on age and other vulnerabilities. It seems quite a bleak prospect, scaling with age, for all those who might not cope with natural infection.

(My dad, who's 82, today asked me about news he's been reading about waning immunity from vaccination, and then asked me if I could find him any more of the FFP2 masks he'd particularly liked. He's clearly starting to get worried. Instinct tells me he'd be better protected from getting covid in the first place than by a strategy of 'get covid to avoid getting more covid'.)

Wintertree: are your hopes for the Valneva vaccine, to put it in layman's terms, that it act much more like a bout of natural infection than the mRNA vaccines do, and hence as a controlled inoculation less hazardous than uncontrolled natural infection?

1
 AdJS 03 Sep 2021
In reply to VSisjustascramble:

Willing to admit I might be wrong about the vaccine supply situation but you might wonder why the UK is sending 4m Pfizer doses to Australia, a country with a total of just over 58k covid cases and 1k deaths to date, when there are many other developing nations in a far worse position. Nothing to do with our caring government trying to get the Australian government to help them with the UK application to join the Comprehensive and Progressive Trans-Pacific Partnership, the Pacific free trade area I suppose.

3
OP wintertree 03 Sep 2021
In reply to bruxist:

>  It seems quite a bleak prospect, scaling with age, for all those who might not cope with natural infection.

Yup.  The bottom-right of this table Si dH copied over up thread [1] makes it pretty clear.

> Instinct tells me he'd be better protected from getting covid in the first place than by a strategy of 'get covid to avoid getting more covid'

Agreed; beyond some age/frailty even with the current vaccines one does not want to be exposed to Delta - the somewhat intangible benefits of getting a round of naturally induced immunity can't possibly be worth the risk.

> Wintertree: are your hopes for the Valneva vaccine, to put it in layman's terms, that it act much more like a bout of natural infection than the mRNA vaccines do, and hence as a controlled inoculation less hazardous than uncontrolled natural infection?

That's the idea - the current mRNA, DNA and synthetic nanoparticle vaccines are all limited to the spike protein; if the adjuvant is as good as it looks then Valneva is going to have effects much closer to a controlled exposure to the virus, but without any risk of runaway infection.  

>  Post-vax natural infection might be the safest course for me personally now, but I assume the risks of such an approach depend an awful lot on age and other vulnerabilities

I agree.  If we are trying to "normalise" the virus in to low level circulation there's got to be a tapering of increased caution and increased use of vaccination with increased personal risk from age and other vulnerabilities.  I don't think that "caution" is making it through current messaging very clearly.  

[1] https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_41-...

 elsewhere 03 Sep 2021

https://www.theguardian.com/society/2021/sep/03/uk-rules-out-covid-vaccinat...

"Ministers could defy JCVI and go ahead with Covid jabs for all 12- to 15-year-olds"

"However, in a tacit invitation to overrule its own recommendation the JCVI stressed that because its remit does not include wider issues such as disruption to schools, ministers could consider seeking separate advice on this, an unprecedented suggestion by the organisation."

1
 Dr.S at work 03 Sep 2021
In reply to AdJS:

Apparently a swap rather than a gift - the U.K. currently has stock that will go out of date, Australia has insufficient stock and needs it now - they have stuff on order that they will give to us for future use.

sensible stock management, but I agree that Australia’s need may be less than others.

In reply to elsewhere:

> "Ministers could defy JCVI and go ahead with Covid jabs for all 12- to 15-year-olds"

> "However, in a tacit invitation to overrule its own recommendation the JCVI stressed that because its remit does not include wider issues such as disruption to schools, ministers could consider seeking separate advice on this, an unprecedented suggestion by the organisation."

I find it quite sad to be honest. Clearly the JCVI can’t justify recommending vaccinating 12-15 year olds, but they’re aware that the political pressure is so strong they’ve asked for a second opinion.

What happened to following the science (whatever that means these days)?

The question we should be asking with schools isn’t “should teenagers be vaccinated?” but rather it’s “should kids with Covid be in school?”. 

 Ramblin dave 03 Sep 2021
In reply to wintertree:

> Agreed; beyond some age/frailty even with the current vaccines one does not want to be exposed to Delta - the somewhat intangible benefits of getting a round of naturally induced immunity can't possibly be worth the risk.

I think this is part of the reason that it's bad that public figures aren't talking explicitly about "normalizing" covid and what that looks like in practice. I know plenty of people who are vulnerable enough in one way or another to not want to catch delta even with the vaccine, and at least some of them still seem to be in a mindset that we'll vaccinate everyone and then covid will go away and then and only then will they be able to get on with their lives. And if that's not going to happen then the people making the decisions need to be up front with them about why not and what we're actually expecting and what that means for people who are still at serious risk.

 Ramblin dave 03 Sep 2021
In reply to wintertree:

> >  you seem to end up heading towards a situation where everyone has at least mild or asymptomatic covid basically all the time. But I'm assuming that I'm oversimplifying and there's some brake on that?

> I think you've missed a bit of the steady state model, rather than over-simplifying.  The way I'd present it is that, if immunity against infection fades on a timescale of X months, then an individual is going to get infected no more than once every X months.

Right, so we're okay in this case to treat immunity for X months after having covid as being essentially "perfect" immunity?

> I don't think the data is there to answer (a) through to (c) until we've had a lot more natural circulation through vaccinated individuals

Yeah,  I agree. I guess what I'd ask is what the early signals that we should be looking out for are to start getting an idea of whether we'd expect a "bad dose of covid" to be a once-a-year thing or a once-a-decade thing. Presumably, given that we don't think that current vaccines are effective enough against transmission of the delta variant to keep r below one, the first big question is how protected against transmission you are after full vaccination and a recent infection, and then how much that protection falls off over time? And then we need to keep updating that model in the context of evolving viruses?

In reply to Longsufferingropeholder:

> I'm of a similar opinion to you both, however I can see no benefit to be gained from announcing with a great fanfare that the plan is for the virus to circulate.

1. If that is the plan they've got no right to conceal it.

2. If they say that's the plan they will get their arse kicked by voters who do not want to catch Covid.

3. If they said the plan was to let the virus circulate people who are hesitating about vaccination or against mask laws might change their mind.

It is pretty shocking that we are already at more deaths than 9/11 every month and it will very likely get worse in winter and they seem to think that is acceptable.

4
In reply to VSisjustascramble:

> I find it quite sad to be honest. Clearly the JCVI can’t justify recommending vaccinating 12-15 year olds, but they’re aware that the political pressure is so strong they’ve asked for a second opinion.

The English JCVI is clearly dithering and useless.  About time that Scotland stated it was going to use the US CDC or German STIKO as its primary source of advice on vaccines.   We don't need to get caught up in English politics.

11
In reply to AdJS:

>  Nothing to do with our caring government trying to get the Australian government to help them with the UK application to join the Comprehensive and Progressive Trans-Pacific Partnership, the Pacific free trade area I suppose.

Pretty obvious that the main reason they bought 4x as many vaccines as needed for the UK was to use the excess as trading cards.   The cabinet is full of people whose background is hedge funds and the city.  They looked at vaccines and saw a commodity that they could get for cheap if they went in early and which could be in extreme demand later on.

Having said that, although Australia has had low deaths to date, they are in a precarious position.  If delta variant breaks through their quarantine before they get vaccination levels up the death rate and case numbers will grow very fast.

4
In reply to Longsufferingropeholder:

> NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not a strategy.

Bollocks.

As John Maynard Keynes said "In the long run we are all dead."   The 'long run' isn't what is important, not dying or getting ill in the immediate future is what is important.

The NZ elimination strategy doesn't need to work forever.  It just needs to work long enough for something else to take its place.  That could be a virus mutation into a highly infectious but less serious form which burns the pandemic out in the same way as has happened with flu epidemics in the past.   It could be new vaccines which work better than what we have now.  It could be medicines which make catching Covid less of a big deal.  Or it could be a combination of multiple technologies which taken together end the pandemic.

NZ has every chance of getting out of this with near zero deaths.

Post edited at 01:24
5
In reply to VSisjustascramble:

> I find it quite sad to be honest. Clearly the JCVI can’t justify recommending vaccinating 12-15 year olds, but they’re aware that the political pressure is so strong they’ve asked for a second opinion.

Their job is not politics, it's answering the medical questions

> What happened to following the science (whatever that means these days)?

That's exactly what JCVI have done

> The question we should be asking with schools isn’t “should teenagers be vaccinated?” but rather it’s “should kids with Covid be in school?”. 

Which is what JCVI have invited ministers to consider

In reply to tom_in_edinburgh:

> Pretty obvious that the main reason they bought 4x as many vaccines as needed for the UK was to use the excess as trading cards.   The cabinet is full of people whose background is hedge funds and the city.  They looked at vaccines and saw a commodity that they could get for cheap if they went in early and which could be in extreme demand later on.

This is cynical even for you. The reason wealthy nations threw money at vaccine developers was to de risk the development. It was saying crack on and make it, we'll buy it off you whether it works or not. That meant all the candidates got taken forward quickly.

> Having said that, although Australia has had low deaths to date, they are in a precarious position.  If delta variant breaks through their quarantine before they get vaccination levels up the death rate and case numbers will grow very fast.

>> NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not a strategy.

> Bollocks.

Short memory today Tom. Which is right?

 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

Both of Tom's scenarios are way better than the damage done in the UK to health and economy. Australia is more at risk than NZ right now for a serious longer-term lockdown to protect hospitals but even in the worst possible case scenario the deaths and other damage will be way less per capita than we have faced in the UK.  Tom is right that the elimination strategy bought them time. It was the correct thing to do. They do have Pfizer supply problems, so Australia in particular is very busy doing deals. I think Tom's view on deals is realpolitik: when dealing with people like Liz Truss on trade it's hard to be cynical enough.

1
In reply to Offwidth:

> Both of Tom's scenarios are way better than the damage done in the UK to health and economy.

Not denying that.

> Australia is more at risk than NZ right now for a serious longer-term lockdown to protect hospitals but even in the worst possible case scenario the deaths and other damage will be way less per capita than we have faced in the UK.

Nor that 

> Tom is right that the elimination strategy bought them time.

"It buys time. It's not a strategy." were my exact words. 

> It was the correct thing to do. 

Also true. But it's delaying, not solving the problem. It's Muldoon in the "clever girl" scene. I knew there'd be a pile on of "yeh but they died less than we did" when I said it, because internet forum, but that was not the point. Closed borders inevitably leak was the point. It buys time. It's not a strategy. Which is what Tom went on to assert in the post opening with "bollocks". So this is becoming a bit facile again.

Post edited at 07:55
 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

Buying time in a pandemic where the science and way out isn't clear is a great starter strategy. It's not like they didn't do almost everything else better than us in the middle phase (except rejecting AZ). A likely way out is clear now and they are doing their best, given the AZ choice, under the vaccine supply they can access.

Sometimes I think you are just trolling....a shitload less deaths, incomparable levels of resultant strain on health services and way less knock-on effects of lockdown, especially economic, is not an effing Muldoon. The department of health have implemented full on information control in the NHS to keep the public as unaware of the damage done to it as possible (and to pretend what constitutes a new hospital is what Boris says it is).

5
In reply to Offwidth:

You're agreeing with everything I said, and yet disagreeing with a load of stuff that you've imagined hearing from some caricature that writes stuff between the lines for you. When did I say it was a bad idea to buy time??? This started with the implication that NZ strategy was elimination, followed by my pointing out that that's not the end of it. If you read the words, and don't take things out of context, we won't have to go round these circles.

 Si dH 04 Sep 2021
In reply to Offwidth:

I think he was just pointing out the inconsistency between Tom's posts. I don't think the correctness of the content was relevant.

?

Post edited at 08:58
 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

For someone so keen on giving patronising advice on reading skills, maybe just proof read before you post for once and imagine how some of your writing might sound for someone who has genuinely disagreed with you on several important points. This is so obvious by now that either you are in denial or trolling. These include: the 18 to 25 vaccination level not stagnating at 50% (where our disagreements on these threads started and where the data in total didn't say what you thought it did, nor did Mainwood), the effectiveness of masks in real world scenarios being the second most effective tool to prevent indoor public spread as published by SAGE (albeit both of us knowing it was similar to ventilation) and although it was always obvious some mask use was a lot better than others...you dishonestly tried to claim I was talking it up as a magic bullet. Plus now your view that elimination isn't a national strategy. It's not only a strategy, it's the one that has worked best by far to date and just because it likely needs adapting at some point does not invalidate it being a strategy in any way or form. Good strategy always adapts as information changes. Plus in many ways an "elimination strategy" is about public messaging .... what the NZ govenment does is complex and very effective, but overall it's way more honest to its citizens..... as for the coming months they will do their very best to eliminate any outbreak. It looks like NZ  have held off delta in the most recent outbreak... some here implied it wasn't worth trying.

Imagine where everyone would be now if we get a new variant with serious vaccine breakout. Heading towards two years in on a pandemic that could still produce nasty surprises and in England the test and trace and isolate system remains an incredibly expensive mess, our Public Health system is still totally inadequate, Hospitals are in such a state that they are banned from talking about it publicly from the Department of Health. We are told herd immunity is the way and there will be no more lockdowns and the government know that's no better than 50:50 even if nothing new bad thing happens.

3
In reply to Si dH:

> I think he was just pointing out the inconsistency between Tom's posts. 

This.

Anyway, to move on from pissing in the wind, this came up on the RAMP summary. Thought wintertree would especially like it:

https://www.medrxiv.org/content/10.1101/2021.03.08.21253122v1

And in point and click adventure format: https://josh-will-moore.shinyapps.io/Covid_19_Intervention_IBM/

 Helen R 04 Sep 2021
In reply to tom_in_edinburgh:

> The NZ elimination strategy doesn't need to work forever.  It just needs to work long enough for something else to take its place. 

> NZ has every chance of getting out of this with near zero deaths.

Kia ora from locked down Auckland.

Today we sadly registered our first death of someone with Covid in 2021. A lady in her 90s. New cases seem to be dropping (20-30 on the last couple of days) even with delta. Wary, because New South Wales evened out to 50/day before taking off again, so we need to be careful. But cautiously optimistic.

But almost everyone I know has booked vaccinations (as we've finally got the supply), my first is Thursday. People are still in agreement with an elimination strategy even though it's not easy. Will it work? who knows, but it only has to work for a while... Very different from the situation in the UK.

Wish us luck.

Helen (who hasn't left her house for 18 days and counting...)

In reply to Offwidth:

Edit:

> For someone so keen on giving patronising advice on reading skills, maybe just proof read before you post for once and imagine how some of your writing might sound for someone who has genuinely disagreed with you on several important points.

Just stop filling in the gaps with your own assumptions and putting words where there aren't any. You demonstrated your readiness to saddle up the high horse when we talked about avoiding indoor places and you went straight to "it's ok for you but some people...." when I had not said it's ok for me and subsequently pointed out that it isn't.

End edit

> These include: the 18 to 25 vaccination level not stagnating at 50%

Not sure what you're saying I said or didn't say on this.

> the effectiveness of masks in real world scenarios being the second most effective tool to prevent indoor public spread as published by SAGE

Thought we'd cleared this up now, and understood that my issue was with you omitting the "indoor" caveat, which makes it clearly misleading.

> The rest

Not sure what we disagree on here. It looks like we're saying the same things in different words and should probably just stick a pin in it for everyone else's sakes.

Post edited at 09:47
 Offwidth 04 Sep 2021
In reply to Si dH:

I'm aware that's what he was likely trying to do but for someone lecturing us on understanding communication, and as someone who clearly has good intentions, he has a lot to learn himself on producing clear adult and kind communication. I've made mistakes  and apologised. I've not been as clear as I could have been at times, but by now if there is disagrement between posters seriously looking at 'things covid' from a scientific perspective it's unlikely something is clear cut.

5
 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

You acknowledged recently you were wrong on the 50% stagnation, claiming that's what the data showed at the time (I disagreed then and showed why).

The entire policy discussion was about how to prevent covid spread indoors in public so please don't play the 'indoor' pedant excuse. How do we ventilate the outdoors?

Elimination remains a viable strategy for now for the nations that followed it successfully and I'm not closing down discussion if people contradict that.

You accused Tom of cynicism in a vaccine trade in a circumstance where I believe he wasn't cynical enough. My government has acted badly, ignoring its own scientific advice, and caused many tens of thousands of unnecessary deaths and massive knock-on suffering. It has left a badly injured health service and is preventing public scrutiny of that. Public Health has been a joke for a modern western economy since the Lansley reforms and despite the pandemic no big emergency funding boost has occured as that was more important for business mates of ministers to deliver second class emergency covid services without proper public scrutiny.

1
In reply to Offwidth:

> You acknowledged recently you were wrong on the 50% stagnation, claiming that's what the data showed at the time (I disagreed then and showed why).

I'm really not recalling this. Did I say it had or hadn't stagnated at 50%? Or, did I actually only ever say "it's not a supply issue" and you took that to mean something I never actually said?

> The entire policy discussion was about how to prevent covid spread indoors in public so please don't play the 'indoor' pedant excuse. How do we ventilate the outdoors?

You don't, but that doesn't mean you can say masks are the second best way to prevent covid absent any mention of staying outside and not going near people.

> Elimination remains a viable strategy for now for the nations that followed it successfully and I'm not closing down discussion if people contradict that.

It's a delaying tactic. It doesn't work forever. The strategy is still vaccination and becoming resilient. 

> You accused Tom of cynicism in a vaccine trade in a circumstance where I believe he wasn't cynical enough. My government has acted badly, ignoring its own scientific advice, and caused many tens of thousands of unnecessary deaths and massive knock-on suffering. It has left a badly injured health service and is preventing public scrutiny of that. Public Health has been a joke for a modern western economy since the Lansley reforms and despite the pandemic no big emergency funding boost has occured as that was more important for business mates of ministers to deliver second class emergency covid services without proper public scrutiny.

I agree the government have been crap, have made more bad choices than good ones, and I'm not defending them, but a stopped clock is right twice a day, and the decision to throw everything at any viable vaccine candidate was undeniably a good one. Just because they're clowns doesn't mean they're never right, and when they stumble into a good decision Tom will still argue to the death that it's wrong, just because 'the tories'.

 girlymonkey 04 Sep 2021
In reply to Ramblin dave:

The risks of catching covid post vaccine are not limited to the individual. I am currently sitting on a busy train on my way north to guide a group of clients for a week. We will be eating in restaurants, staying in hotels and using public transport. It feels fairly inevitable that I will come into contact with Covid, and I guess the only question is whether my vaccine will stop me contacting it. 

If I contract it, I might be asymptomatic or mildly symptomatic. It would be unlikely to make me very ill. However, next week I have a sleepover shift in the care facility where I work also at the moment, so if I have no symptoms but spread it there, it's a massive problem! 

I am very wary of the risks, as is my employer, so will go in for a PCR test a couple of days before the shift (and will LFT daily while I am away), but the lack of cautious messaging on the subject means many won't take such precautions. We have lost sight of protecting the vulnerable.

In reply to girlymonkey:

You make a valid point, but I think you don’t fully follow through on your logic.

You accept that it’s inevitable that you will be exposed to Covid and might possibly catch it. As will everyone once Covid becomes endemic. This is spot on in my view.

However the same has to be said for the vulnerable in the care facility. They to will inevitably be exposed to Covid. All the current measures do is delay their exposure/ reduce the chance at any given time (set against a background of possible waning immunity).

At some point we’re going to have to remove all Covid control measures (isolation when infected, testing ect) with the possible exception of vaccination. The only real question in my mind is how to do this in a way that minimises the impact on healthcare.

Hopefully public opinion shifts and we can remove all restrictions by late spring/ early summer 2022. As at the moment people are still struggling with the concept of living with Covid i.e. catching Covid is still seen to be something to be actively avoided rather than an inevitability to be accepted.

Afterthought - the elephant in the room with the vulnerable is viral load. Low viral load Covid parties in care homes anyone?

4
 Offwidth 04 Sep 2021
In reply to VSisjustascramble:

That's simply not the case. It's wise to protect the vulnerable for now, if nothing else because a virus will often mutate to a less life threatening form. I'd agree there are real practical problems in doing this as we can't just lock people away.... it exposes how inflexible our care system is that we can't meet outdoors in relative safety. Outside the care system people with compromised immunity are going to need plenty of support that most are not yet getting. Your words might be read as effectively condemning them.

Covid parties? If the body doesn't respond to vaccine it might not respond to the actual infection and even if infection doesn't make someone seriously ill there is a significant long covid risk.

 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

Here is you being reasonable on the young adult group vaccination saturation discussion:

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_39-...e

You refuse to accept elimination does work as an ongoing strategy for countries that have succeeded so far, at least until circumstances change quite a bit. Saying it can't work for ever is just semantic pedantry. Tom was right that what matters is what works now and in the near future. Giving up on elimination is the wrong thing for NZ to consider right now.

Tom may well nearly always blame the tories but he is right way more often than not and a stopped clock analogy is very unfair and him being right on the issue is the important thing rather than being dismissive on the specific with such blanket blame. You claimed the UK overbooked vaccines to help ensure their safe financial development...that seems laughably naive to me. I see our government first and foremost selfishly securing supply for the UK (a bonus being a likely rescue from previous disasterous policy), with an eye on potential future trade advantages being a very real consideration, especially to distract from decreases in international aid. The gloating about initial comparisons with EU supply and replies to critics of international aid cuts certainly tend to confirm that. I'd be amazed if the Australia deal didn't come with any strings.

3
 girlymonkey 04 Sep 2021
In reply to VSisjustascramble:

There is nothing inevitable about them being exposed to covid! There has still not been a single case in our home. The residents still can't go out anywhere, all visits are still in the garden. The care commission has not changed any rules for us. We do 2 lft and one pcr every week, we wear masks at all times. We keep windows open. We still operate in covid lockdown, and this protects the residents. 

Our place is for long term mental health care, they are mostly not that old, but many of them are on a drug which massively affects their immune system. We cannot just let them catch it! We have to protect them, and will continue to do so. They will all get boosters soon, so I guess the next thing is to see what that does in the general vulnerable population, but I don't hold out much hope for our lot. 

1
In reply to Offwidth:

> Here is you being reasonable on the young adult group vaccination saturation discussion:

Not clear what your point is there, and still not clear what you claim I said that was incorrect.

> You refuse to accept elimination does work as an ongoing strategy for countries that have succeeded so far,

No, I don't

> at least until circumstances change quite a bit.

This is exactly what I'm saying

> Saying it can't work for ever is just semantic pedantry. Tom was right that what matters is what works now and in the near future.

Not disputed, except that the near future ends when one case slips through the net.

> Giving up on elimination is the wrong thing for NZ to consider right now.

Show me where is said otherwise. Also show me where I said we shouldn't have tried for it. Then when you can't, please, for the sake of the collective sanity of everyone who has to scroll past all this crap, stop putting words in my mouth.

> You claimed the UK overbooked vaccines to help ensure their safe financial development...that seems laughably naive to me. I see our government first and foremost selfishly securing supply for the UK

One could say that is their job. It might not be in the world's best interest but that's not strictly their remit.

> (a bonus being a likely rescue from previous disasterous policy), with an eye on potential future trade advantages being a very real consideration, especially to distract from decreases in international aid. The gloating about initial comparisons with EU supply and replies to critics of international aid cuts certainly tend to confirm that.

Not ruling any of this out but you can see whatever you want to see in it really. Basically all rich countries threw money at the problem. We bought millions of doses of the ones that don't work too, remember. It was the only way to say "go ahead and develop it, don't worry about bankrupting the company on the way". 

> I'd be amazed if the Australia deal didn't come with any strings.

The 'string' is we get the same back from them with longer expiry dates once we've stopped prevaricating and decided on boosters/teens. Similar deals were mooted with Israel and Japan. Not sure what came of those.

Edit to add: the tories are the stopped clock in my analogy, not Tom. 

Post edited at 12:28
1
 Si dH 04 Sep 2021
In reply to girlymonkey:

I think things could be really tough for people who are not sufficiently protected by vaccination.

If we are lucky, case rates will 'normalise' long term at a relatively low level. This could happen in a few ways. Either they will drop fairly low in the near future anyway (the data isn't clear yet), or will do so after most people have another round of immunity boost this winter (boosters for the vulnerable/over 50s and infection for the rest?), or will do so after someone manufactures a vaccine with improved efficacy against infection/transmission. (Edit to add: I suppose a third possibility is if the current vaccines turn out to be much better after a third dose than they are soon after a second. I did see the example of one of the hepatitis vaccines the other day that gives near-lifelong protection after 3 doses. I don't know whether that's remotely likely here though. Suspect not due to mutations.)

If that doesn't happen then we will be in a position whereby case rates are relatively high on a permanent basis and so everyone is at some risk of catching covid. I think people will essentially then be one of four groups:

(1) no opportunity for vaccine but very low risk anyway, so just treat it like a common cold - this applies to kids, 

(2) had a double shot but having had that are considered to be at very low risk of severe disease for at least 6-9 months and are likely to get an immunity boost from natural infection, so are not offered booster shots - this applies to most younger adults (<50?)

(3) had a double shot and generally well protected by that but at sufficient risk after 9-12 months that they are offered booster shots at regular (annual?) intervals to maintain adequate protection, noting that many will still get infected along the way - this applies to older adults and those with underlying health conditions

(4) had a double shot and regular booster but still at sufficient risk of serious illness or death that additional caution is still warranted - the elderly, those in care homes, those with severe immune conditions, etc. I think for many people this will just mean avoiding crowded places voluntarily on a near-permanent basis but it depends on individuals and the risk where they live. I think it's important that people don't have restrictions imposed on them permanently for their own good; they need to have the choice what risk to take. It'll be tough to work out what's the right thing to do in care homes, for sure.

Of things do pan out like this, I just hope case rates remain low enough that people in group (4) don't feel like they are imprisoned in their own homes forever. I'm reasonably optimistic they will do eventually, but who knows how long it will take...

Post edited at 12:51
 oureed 04 Sep 2021
In reply to Offwidth:

> Tom was right that what matters is what works now and in the near future.

I disagree. One of the key factors in success is the ability to prioritise long-term gain over short-term benefit. This is applicable to most situations and most certainly to health crises.

1
 girlymonkey 04 Sep 2021
In reply to Si dH:

> Of things do pan out like this, I just hope case rates remain low enough that people in group (4) don't feel like they are imprisoned in their own homes forever. I'm reasonably optimistic they will do eventually, but who knows how long it will take...

Indeed. Our residents used to do their own shopping (with staff support), go to the pub/ days out with family members, even went on holiday etc. The current situation is awful for them and they are losing a lot of the life skills that they had, but currently there is no other option. 

As you say, hopefully there will be significant reduction eventually, through vaccinations or infections, which would allow more freedoms but we are not there yet.

 Offwidth 04 Sep 2021
In reply to girlymonkey:

One thing I find really distractingly annoying is not better utilising the very low risks of being outdoors. I have friends in Malaysia and they are still being told to stay at home, which for one with serious mental health difficulties, who uses exercise as a main coping mechanism, is really serious.

 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

It takes two to tango, so for someone who claims they want this discussion to end your not exactly doing what you can to end it. I'm more than happy to keep it going. These threads have not been as friendly to genuine counter views as some claim (aside from the pop-up trolls, which I have no time for). Genuine debate is important and any polite challenging of information that contradicts the mainstream scientific position should be reasoned and sometimes the science isn't at all clear.

It doesn't end when "one case slips through the net" as nearly all the elimination strategy developed countries have had worse than that and still kept things under control (maybe  Australia will lose the battle with delta and /or change strategy). You keep saying I'm putting words in your mouth but what you say 'looks and quacks ducklike'. An example is upthread:

"> Tom is right that the elimination strategy bought them time.

"It buys time. It's not a strategy." were my exact words. "

It also wasn't obvious from your wording which way the stopped clock applied and it's irrelevant. The relevant factor was the fairness or not of Tom being cynical about a vaccine swap with a similar minded populist government. Dismissing this - as he will in your mind always blame the tories - is childish rhetoric. Tom may be heavily biased to his nationalist cause but he is not a bad actor. Liz in particular has form with Australia (as she does with the US private healthcare hawks in undermining the NHS).

https://www.bbc.co.uk/news/business-57478412

Post edited at 14:24
5
In reply to Offwidth:.

An example is upthread:

> Tom is right that the elimination strategy bought them time.

> "It buys time. It's not a strategy." were my exact words. "

You seem to keep ignoring context. You said Tom was right to say this. I pointed out that I said it ages ago, but that you credited it to Tom. It's like I'm refereeing an argument between you and yourself.

1
 girlymonkey 04 Sep 2021
In reply to Offwidth:

Yes, I agree! We have only just been allowed to start taking residents on walks again. Even at that, it's very short and local. I'm not even sure if the care commission have said it's ok yet, but my manager has declared it time to start getting them moving. 

My other frustration is that people can't seem to get their heads around the difference between being outside at a football match or festival vs meeting people in a garden/ park etc for a walk/ picnic. 

 Offwidth 04 Sep 2021
In reply to Longsufferingropeholder:

I agree with Tom when he says elimination is a strategy (for NZ); you said it buys time it's not a strategy!? If we all agree and I need an explanation on context every time you say something your communication is poor.

3
 Offwidth 04 Sep 2021
In reply to girlymonkey:

Many would be happy with a social distanced cup of tea with family under a cheap gazebo. 

 girlymonkey 04 Sep 2021
In reply to Offwidth:

I think all care homes allow that now? We have been doing that for a long time. 

The difference is that our residents aren't old and should be moving a lot more to keep fit. Our youngest is late 40s. It's not reasonable to keep people who should be active confined to watching TV and smoking in the garden!

1
OP wintertree 04 Sep 2021
In reply to tom_in_edinburgh:

> The English JCVI is clearly dithering and useless.  

You appear to have skipped right past evidence, understanding or thought and gone straight to anti-English racism.  Do not pass go, do not collect £200.

Another poster previously broke down the membership of JCVI, it's far from just English.

JCVI are what they are - and what they have long been - and they have neither dithered nor been useless within their remit IMO.  The Scottish government is free to act independent of JCVI any time they wish.  Yet, they don't...  

> About time that Scotland stated it was going to use the US CDC or German STIKO as its primary source of advice on vaccines

There are political decisions to be layered atop the expert vaccine advisory bodies.  STIKO was over-ridden by their politicians on this issue (although I gather from jimtitt they've since brought their recommendations in line with the politics).  I somehow think if the current British government had over-ridden JCVI advice you'd be having an an anti-Tory rant, I somehow doubt there's any way they can make the right decision in your eyes.

Germany isn't alone in having politicisation over expert medical opinion - some high level resignations at the US FDA over this.   Right now I would not like to take advice from either the CDC or the FDA over the British expert bodies, there has been a lot of damage done to the CDC under the Trump administration and the FDA hangs under a big cloud over aducanumab.

https://arstechnica.com/science/2021/09/anger-frustration-at-fda-over-biden... 

> Pretty obvious that the main reason they bought 4x as many vaccines as needed for the UK was to use the excess as trading cards.

That's some heavy duty revisionism IMO.  It seemed to me at the time that we went all in on a large number of candidate vaccines at a time before they were in to phase 3 (efficacy) clinical trials, as we did not know which would succeed and which would fail.  In what came as a surprise to many, most of the candidate vaccines have shown high efficacy.  It's just as well we backed multiple candidates because plenty have not yet made it through conditional marketing authorisation and in to people's arms, and of the ones that have we've barely been able to get the supply levels we need at times - despite pouring massive amounts of money in to production facilities well in advance of clinical trial results.  The buying strategy certainly put us in a much better situation during early 2021 than a certain other bloc bloc that apparently prioritised value for money over lives and so ended up being dithering and useless in comparison.

It seems to me that this was some of the best decision making at a central level in this crisis in the UK, and it appears to have been carried out wisely and to have made a material difference, both at home and internationally (especially through SII outputs so far.)

>  The cabinet is full of people whose background is hedge funds and the city.  They looked at vaccines and saw a commodity that they could get for cheap if they went in early and which could be in extreme demand later on.

I've already explained why I disagree with this, but to give an example of where your view falls down - the Oxford/AstraZeneca vaccine is being produced on a non-profit basis including the transfer of technology to SII in India where massive quantities of vaccine are flowing in to arms beyond our borders.  Hardly "buy low sell high" more "throw cash in up front backing all horse and give the results away form the winner."

> It is pretty shocking that we are already at more deaths than 9/11 every month and it will very likely get worse in winter and they seem to think that is acceptable.

That's what happens with the annual flu season every year.  I don't recall you ever rallying against those as unacceptable deaths?  We've never had a big public outcry about the flu deaths or called for stricter control measures - and one thing the periods of Covid control measures have made clear is that it's within our power to do so.

To be clear: Right now, I think Covid is still taking more life from fully vaccinated individuals than is taken from flu victims, but without a proper analysis of the longitudinal data (which I don't have) how much more is not clear.  We'll see how the winter season goes - all sorts of possibilities.  

In reply to Longsufferingropeholder and offwidth:

If I had a time machine I'd go back and suggest a mild revision to the wording that kicked this all off.  I rater get the impression trenches are dug over whether this word is or is not implicitly read in the sentence.  It seemed clear to me, but it's always clearer and less misinterpretation prone to spell it out. 

NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not an exit strategy.

In reply to Longsufferingropeholder and thread:

> Irt elsewhere: that's reasonable (the dislike isn't from me)

We had a wave of "universal dislikes" at the start of the thread; these disappeared along with a dislike on all my other posts a few days ago.  Then we had another wave of near universal dislikes on this thread before You Know Who's latest account posted, then that account, wave of dislikes and post evaporated.  Now, another wave of near universal dislikes has landed, but they haven't poked their head above the parapet yet.  I'd bet £5 the latest sock puppet is "'k-------k-----k".  I keep hoping their dislike button will wear itself out, heavens know they've been mashing it enough on these threads.  I sometimes wonder if I devote too much time to producing the plots and interpretation for these threads, but I console myself that I'm not spending my time signing up for endless sock puppet accounts just to mash the dislike button...

2
In reply to wintertree:

> NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not an exit strategy.

Yep, that probably would have swerved today's shitshow.

>  I sometimes wonder if I devote too much time to producing the plots and interpretation for these threads...

Gets said a lot but probably not enough that they are still appreciated. Remember to play with https://josh-will-moore.shinyapps.io/Covid_19_Intervention_IBM/ and then remind yourself where you no longer work.

1
OP wintertree 04 Sep 2021
In reply to Longsufferingropeholder:

Sorry; I meant to comment on those pre-print and click stuff links before.  It's great, but...  As Harry Enfield didn't say: "Modelling - Know Your Limits".

I'm still in grumpy old fart territory when it comes to modelling and this pandemic; modelling is a powerful way for people to get a feel for the mechanics and to have a stab at prioritising interventions in terms of importance etc., but I haven't really changed my view from the very start that there are so many unknowns that modelling is rarely anything like as predictive as the eventual people looking at its outputs will believe, and if we knew enough to make it genuinely predictive, we'd not need the models as the answers would stand out.  

Where-as the epidemiological evidence base that can be assembled from the data has been strong since before it all went caca in the UK - it showed us what was coming then, and now it tells us orders of magnitude more, including over workplace ventilation.  As shiny as the allure of modelling is, a public health crisis needs to be led by the data, not modelling.

>  and then remind yourself where you no longer work.

I'm aghast at what I'm hearing from others in the sector.  It's clear where the priorities lie.  

1
In reply to Longsufferingropeholder:

> This is cynical even for you. 

When it comes to Tory ministers and hedge fund operators I have learned that whenever I am cynical about their motives the truth is always worse.

People who give 100 million quid contracts to their friends are very capable of buying more of a commodity than they need because they think it will become more valuable.   Remember Hancock's story about watching the film Contagion and thinking there would be a huge scramble for vaccines.

https://www.independent.co.uk/news/uk/politics/covid-vaccine-strategy-hanco...

> >> NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not a strategy.

> Short memory today Tom. Which is right?

There is no conflict between following a quarantine strategy when you are an island and also vaccinating your population as fast as possible in case the quarantine fails.   They are both good ideas.

4
In reply to wintertree:

> I've already explained why I disagree with this, but to give an example of where your view falls down - the Oxford/AstraZeneca vaccine is being produced on a non-profit basis including the transfer of technology to SII in India where massive quantities of vaccine are flowing in to arms beyond our borders.  Hardly "buy low sell high" more "throw cash in up front backing all horse and give the results away form the winner."

You know SII is owned by an Indian billionaire who made an absolute ton of money from selling vaccines.   According to Forbes SII makes $600million *a month* from the AZ vaccine.

https://www.forbes.com/profile/cyrus-poonawalla

https://www.forbes.com/sites/nramakrishnan/2021/07/31/for-indias-pharma-tyc...

If I was an investigative journalist I'd be wondering about political donations or personal links to the Tories.  Call me cynical but it seems like an unusually large number of Indian billionaires are linked to this cabinet.

5
OP wintertree 05 Sep 2021
In reply to tom_in_edinburgh:

> According to Forbes SII makes $600million *a month* from the AZ vaccine.

They’ve been estimated to have monthly revenues of $600 million.  They’re also outputting massive levels of vaccines.  This gives a per-dose cost of $5.40 per dose.  Given the significant costs of producing a finished dose they may me taking half a billion a month, but I doubt they’re making anywhere near that….  I assume you have some familiarity with doing business…? Making money tends to refer to profit, and you’ve said “makes” and applied if to revenue.  Apparently profit is normally less or much less than revenue.

Latest price for Pfizer is about $25 a dose and the most comparable vaccine in terms of approach is J&J, about $10 per dose.

What utter bastards the UK is giving a non-profit licence to SII to produce a massive quantity of vaccine for between one half and one fifth of the cost of others.

Your post launches one sided accusations against the people involved in the lowest profit vaccine scheme.  Hardly seems a balanced perspective that.

1
In reply to tom_in_edinburgh:

It might, just, be vaguely possible that you could perhaps, be seeing only what you want to see again....

https://www.theguardian.com/business/2021/mar/06/from-pfizer-to-moderna-who...

https://www.forbes.com/sites/aayushipratap/2021/07/28/pfizer-expects-335-bi...

In reply to Longsufferingropeholder:

> It might, just, be vaguely possible that you could perhaps, be seeing only what you want to see again....

Of course Pfizer and Moderna are making money from their vaccines and a lot of it.  They deserve to and they are completely open about being for-profit businesses.  I wouldn't have a problem if AZ made money from its jag too.

The point I am making is that the UK government is underwriting AZ's development and encouraging/directing them to make the vaccine available not-for-profit.  It looks like SII gets the AZ vaccine formula at some not-for-profit rate and then sells vaccine for $600 million a month (assuming Forbes is correct).   SII is privately owned by a billionaire and is very much a for-profit company  $600 million x 12 = $7.2 billion a year off the AZ jag.     

1
OP wintertree 05 Sep 2021
In reply to tom_in_edinburgh:

> The point I am making is that the UK government is underwriting AZ's development and encouraging/directing them to make the vaccine available not-for-profit.

Critically misinformed.  

The IP on this vaccine originates from the University of Oxford.   Who made a decision not to profit from IP during the pandemic, as communicated clearly through their tech transfer body.

https://innovation.ox.ac.uk/technologies-available/technology-licensing/exp...

> $600 million x 12 = $7.2 billion 

In revenue, not profit. For 1.3 billion doses.  With no profit for the IP licence holders and little room for anyone else to profit compared to most other vaccine manufacturers.  AZ also being the only one to take a share price hit during the pandemic.

What a bunch of bastards, ey?

1
In reply to wintertree:

> Your post launches one sided accusations against the people involved in the lowest profit vaccine scheme.  Hardly seems a balanced perspective that.

You've provided no evidence it is the lowest profit vaccine scheme.

You showed Pfizer charges a lot more per dose.  But Pfizer is mRNA vaccine, it is a completely different process with different costs.  Pfizer needs more expensive handling and Pfizer is primarily being manufactured and sold in rich countries with complex regulations, high taxes and expensive labour.   

Costs per dose for AZ in India are very likely going to be much lower.   SII could easily be making a very nice profit off a much lower price per dose.

I don't trust Tories making sweetheart deals with billionaires.

5
In reply to tom_in_edinburgh:

Get your facts straight ffs.

> The point I am making is that the UK government is underwriting AZ's development

Only as much as all the others they pre-ordered

> and encouraging/directing them to make the vaccine available not-for-profit. 

Nope. That was the Oxford Vaccine Group's insistence. AZ weren't the first production partner they approached, but they were the first to agree to that proviso. We've corrected you on this before. You could do to watch the documentary on it so we don't have to again.

> It looks like SII gets the AZ vaccine formula at some not-for-profit rate and then sells vaccine for $600 million a month (assuming Forbes is correct). 

You're clearly not keen on looking very hard once you've seen what you want to see. How much of that is profit?

> SII is privately owned by a billionaire and is very much a for-profit company  $600 million x 12 = $7.2 billion a year off the AZ jag.     

As wintertree points out, you surely know the difference between turnover and profit. In this case, it's the single most important detail and you've chosen to ignore it.

1
OP wintertree 05 Sep 2021
In reply to tom_in_edinburgh:

> You've provided no evidence it is the lowest profit vaccine scheme.

I’ve showed comparative revenue and I’ve linked to the terms from OUIS under which the IP is licensed.  

> You showed Pfizer charges a lot more per dose.  But Pfizer is mRNA vaccine, it is a completely different process with different costs. 

Did you see my mention of the J&J vaccine?  I spelt out my reasons for it.

Anyhow, you’re the one throwing accusations around, the burden of brood lies on you and I’ve brought some numbers and other pertinent facts to the table, you’ve not.

Your point in regulation I think is totally wide of the mark.  Wrong, in fact.  Production at SII will be regulated to a suitable level given its recognition by other regulators.  IIRC we went so far as sending a team over to inspect this at the facility in person.  You’re basically slandering them at this point.

> Costs per dose for AZ in India are very likely going to be much lower.   SII could easily be making a very nice profit off a much lower price per dose.

If they make more than a strictly controlled margin, they would be in violation of their IP licensing terms.  Beyond that, if they profit by making pennies per dose off billions of the most affordable vaccine doses a year, frankly it’s hard to think of a less objectionable profit turned during this whole pandemic.

> I don't trust Tories making sweetheart deals with billionaires.

Yet we’ve heard not a peep from you about their deals with investor driven and for profit vaccine manufacturers.  Just rallying against Oxford/AZ once again.

Post edited at 09:51
3
In reply to tom_in_edinburgh:

> There is no conflict between following a quarantine strategy when you are an island and also vaccinating your population as fast as possible in case the quarantine fails.   They are both good ideas.

The problem is that NZ haven't exploited the excellent situation that quarantine provided them, and got on with vaccination 'as fast as possible'. They are a long way behind. A Kiwi friend of mine came back to the UK a couple of weeks ago. She's a few years older than me. She got her first jab on return here. That's nearly six months later than me. This is not an isolated case.

1
 Offwidth 05 Sep 2021
In reply to captain paranoia:

It's because, like Australia they expected to mostly use AZ but didn't. It's not really due to terrible planning. Supply of Pfizer has been tight. Australia are doing swap deals with various countries. 

For a change of subject a tale from Taiwan on beating a delta outbreak:

https://www.theguardian.com/world/2021/sep/05/speed-decisiveness-cooperatio...

2
 Offwidth 05 Sep 2021
In reply to wintertree:

Tom is wrong on the numbers but Serum Institute are selling AZ licenced vaccine above the not for profit value in several areas.  

https://www.thehindu.com/sci-tech/science/reneging-on-the-no-profit-pledge-...

1
 Offwidth 05 Sep 2021
In reply to wintertree:

"NZ style elimination is the most fragile tactic of them all and is guaranteed to fail one day. It buys time. It's not an exit strategy."

I'd have still argued this but would have regarded the exaggeration as nothing excessive. Bottom line the wording made it sound like the NZ government didn't have a strategy. The problem we have with end games is we have crossed fingers. On the lucky side the 'end game' might be the virus mutates to a form that dominates infection but is much less damaging so vaccines will be enough. On the very bad side none of what we do might matter and vaccines will have only helped keep lockdowns away for a year and working like the elimination strategy may be the only choice (hard lockdown with closed borders and then over to a functional TTI ) .

2
OP wintertree 05 Sep 2021
In reply to Offwidth:

There's a lot of baseless Gish-gallop and intimation in that article around various things, e.g.  the totally never secret intent that pricing of the Oxford/AstraZeneca IP will only be non-profit for the duration of what they deem to be the pandemic phase.  Seems to me that they're trying to paint a certain picture from disparate inference.  I think my favourite parts is this: "She also cited an instance where companies make a profit:" - which goes on to talk about a company/product that has nothing at all to do with Covid.  Smell a rat yet? 

In terms of the price rise, the article suggests its profiteering but does not actually show any evidence for this claim, it just draws evidence free inference.

The last year has seen phenomenal rises in the cost of pretty much everything for a life sciences lab from nitrile gloves to reagents to glassware to pipette tips.  There've been noted shortages of the glass for medical grade bottles.  It's equally possible that the non-profit price has gone up - being such a low price to begin with compared to other vaccines the cost of materials is going to reflect more closely in the final price.

I don't know if this is profiteering or reflecting the not unsurprising rise of biological and laboratory consumables costs during a global pandemic. 

I'm open to evidence either way.  I do note an apparent lack of legal action from the charitable foundation or from Oxford University or OUIS who will have solid contracts in place over this...

> On the very bad side none of what we do might matter and vaccines will have only helped keep lockdowns away for a year and working like the elimination strategy may be the only choice (hard lockdown with closed borders and then over to a functional TTI )

I wasn't trying to get drawn in to this weeks trench warfare between you and LSRH, just suggest how they could have better expressed themselves to avoid the ambiguity of doom.  Given that there was no upswell of support for elimination when we didn't have vaccines, it's hard to see it ever getting traction now.  Immune boosting and modulating therapeutics (not easily evaded) are continuing to come along.  I hope the very bad side is well retired by now. Not least because elimination - from such a high baseline - is going to be nigh on impossible with the new estimates of R0 and growing evidence base over animals and Covid.

1
 elsewhere 05 Sep 2021
In reply to wintertree:

FT

OCTOBER 7 2020

"AstraZeneca vaccine document shows limit of no-profit pledge
Company has right under contract to declare pandemic over by July 2021"

https://www.ft.com/content/c474f9e1-8807-4e57-9c79-6f4af145b686

In reply to Offwidth:

> It's because, like Australia they expected to mostly use AZ but didn't. It's not really due to terrible planning. Supply of Pfizer has been tight.

You could argue that failing to secure supplies of vaccine, and failing to use available vaccine is both poor planning and practice.

I'm no fan of the UK government, but the one (possibly only?) thing they did right was to place orders for vaccines very early on, and support development of a large range of potentical vaccines.

OP wintertree 05 Sep 2021
In reply to elsewhere:

Yes, as I said to Offwidth immediately above that has been known for a long time (“totally never secret”).

There’s a similar clause in Oxford University Innovation’s terms.  I linked those up thread too.  Here it is: “Licence terms for supplying downstream (post-pandemic) commercial markets will be the subject of a separate agreement”.  This has also been known for a long time.  

The article is presenting this as part of some evidence free gish gallop about profiteering during the pandemic.  It’s hardly shocking IMO and it’s certainly not news that the non profit agreements are limited to the pandemic phase only, and the presence of clauses and definitions as pertains to this is 100% normal and to be expected, and in the absence of their activation it doesn’t support the article’s point at all.

AFAIK, neither AZ nor OUI have yet declared the pandemic as over in terms of their licensing agreements.  If they did, they would get a justifiable PR kicking and I’d be on that bandwagon….  

2
 jimtitt 05 Sep 2021
In reply to Offwidth:

> Tom is wrong on the numbers but Serum Institute are selling AZ licenced vaccine above the not for profit value in several areas.  

Non-profit isn't the same as at-cost, since the AZ price span seems to be around 250% (and the EU price is lower than the UK one) there's obviously a certain amount of interpretation being used in the accounts department!

In reply to elsewhere:

> FT

> OCTOBER 7 2020

> "AstraZeneca vaccine document shows limit of no-profit pledge

> Company has right under contract to declare pandemic over by July 2021"

Gasp. FT reports something anyone who was paying attention when they watched the panorama episode about this would know already.

1
 elsewhere 05 Sep 2021
In reply to Longsufferingropeholder:

I thought the specific date in 2021 chosen in 2020 was interesting.

1
In reply to elsewhere:

I did too, but after not much thought I was happy to presume it was just the bureaucrats writing the contracts demanding some line in the sand.

 Offwidth 05 Sep 2021
In reply to wintertree:

I think its almost certain there is a bit of profit taking on Indian licenced AZ. Part of the reason the journalism is the way it is, is because in modern India things are not as transparent as they should be. Like you I'm not especially fussed and the amounts made will be a lot less than the US vaccine producers. I'm just pointing out profits are almost certainly being made and, India being India, that will link to politics. The AZ licence agreement was less interesting to me as back then the pandemic seemed to be expected to be over earlier (when it would seem a more reasonable clause) but then we got the variants.

On elimination, its a real possibility for some nations in the future if there is a highish R0 variant with pretty significant vaccine escape. How many lessons do we need before we realise we can't sensibly predict the future of this pandemic? I'd give similar arguments to the Captain about Australia and NZ on not buying more vaccines earlier....they didn't seem to need to. In  contrast we in the UK were desperate for a way out out of foot shooting at the time and didn't know how well they would work and could sell, trade or donate if we had an excess. It's easier to repaint the foresight quality of these decisions with hindsight. Still the Captain is right that it was one of the decisions the government got right, irrespective of almost being forced (furlough beng another).

Post edited at 19:25
2
 elsewhere 05 Sep 2021

India is vaccinating 10-15M per day, up from 180M total for August. It's a phenomenal achievement.

I assume mostly the domestically produced Oxford vaccine.

Post edited at 20:19
1
In reply to Longsufferingropeholder:

> Nope. That was the Oxford Vaccine Group's insistence. AZ weren't the first production partner they approached, but they were the first to agree to that proviso. We've corrected you on this before. You could do to watch the documentary on it so we don't have to again.

What is happening is that state funded institutions in the UK are handing the profit potential of the vaccine over to a private company in India owned by a politically connected billionaire ex horse trainer whose business model is to chuck out cheap vaccines that other people developed.  The guy has made billions out of vaccines that cost him nothing for the IP.

> You're clearly not keen on looking very hard once you've seen what you want to see. How much of that is profit?

I have no idea how much is profit, surprisingly enough, private companies in India do not open their books to me.  However, according to Forbes the billionaire who owns SII was worth 8.2 billion in 2020 and 12.7 billion in 2021 so my guess is he is making an absolute f*ckton of money from the Covid epidemic.

Now, call me cynical, but when Tories do a billionaire a favour which increases their wealth by 4 billion in a year it strikes me that it is just possible that they might expect something in return.  Like Prince Charles likes to get donations for doing up houses when he hands out honours to billionaires.

> As wintertree points out, you surely know the difference between turnover and profit. In this case, it's the single most important detail and you've chosen to ignore it.

Of course I know the difference between turnover and profit.  Forbes gave turnover numbers and numbers for the owner's estimated wealth.  I don't have access to profit numbers.  But the business model of SII is selling vaccines cheap and the guy has got to be a billionaire doing that so my guess is his company has a very low cost base per dose and it is profitable as f*ck because he's not paying much for IP.

Pfizer and Moderna are respectable public companies that bear the costs of developing their IP, pay scientists and engineers decent wages, pay lots of tax and are subject to expensive regulation by the US and EU.  

The whole give away the IP thing is bullsh*t IMHO.  These guys working for Oxford Uni are making a nice living based on government funding so they don't need to get their hands dirty selling stuff.  Then they hand out valuable IP for free which allows some d*ck in India to undercut western companies that are trying to make a living based on some great science.   This is the kind of thinking that decimated the electronics and software industries and moved the jobs to India and China.  When you devalue the IP then you devalue the services of the people who develop IP - engineers and scientists - which puts downward pressure on their pay and eventually results in R&D jobs moving to cheaper countries.

3
 Misha 06 Sep 2021
In reply to tom_in_edinburgh:

You’re hard to please! Oxford develop a vaccine and stipulate that it needs to be made on a NFP basis. As a result, the cost per dose is a fraction of that for Pfizer and Moderna. You complain about some rich guy who might or might not be making a profit under the licensing agreement (the fact that his wealth may have increased might have nothing to do with this particular vaccine - the Indian stock market has rebounded strongly this year and valuations of life sciences companies are generally high at the moment).

The fact is, the OAZ vaccine is something like 6-7 times cheaper than Pfizer and Moderna. That makes a massive difference. What you appear to suggest is OAZ should be as expensive so that it doesn’t undercut Pfizer and Moderna. That’s just total rubbish, given that there is a general shortage of vaccines. Pfizer and Moderna aren’t exactly cutting down on production due to competition from all the other vaccines.

2
In reply to Offwidth:

> I'd give similar arguments to the Captain about Australia and NZ on not buying more vaccines earlier....they didn't seem to need to. 

That's not quite what i was saying; i think they should have pursued vaccination with the same vigour we did; isolation can not go on forever, so they should have taken the opportunity to vaccinate whilst maintaining low cases and deaths with their quarantine approach.

> furlough beng another

Agreed; furlough was a good decision, even if the implementation was somewhat patchy and inconsistent.

Post edited at 01:23
1
In reply to Misha:

> You’re hard to please! Oxford develop a vaccine and stipulate that it needs to be made on a NFP basis. As a result, the cost per dose is a fraction of that for Pfizer and Moderna.

And this is problematic because it distorts competition in the industry.  Taxpayers funded the R&D to create the vaccine, Oxford Uni's research money comes from government.    When governments give out IP for free to low cost manufacturers in India it reduces the profitability of companies that do their own research, and manufacture in high cost countries.

> You complain about some rich guy who might or might not be making a profit under the licensing agreement (the fact that his wealth may have increased might have nothing to do with this particular vaccine - the Indian stock market has rebounded strongly this year and valuations of life sciences companies are generally high at the moment).

OK, I can't prove it but when the wealth of a billionaire who owns a vaccine factory which makes Covid vaccines goes from $8 billion to $12 billion in a Covid pandemic my guess is it is related.

> The fact is, the OAZ vaccine is something like 6-7 times cheaper than Pfizer and Moderna. That makes a massive difference. What you appear to suggest is OAZ should be as expensive so that it doesn’t undercut Pfizer and Moderna. 

Free IP isn't the whole explanation of the price difference, much of it will be to do with differences in the process for making AZ vaccine compared with mRNA vaccines and lower labour and tax costs in India. Even SII they were paying a fair price for the IP, the vaccine they made would still likely be much cheaper than mRNA vaccines made in the US and EU.   

I don't think an Indian billionaire should be given valuable vaccine IP for free.  There should be a normal commercial process aimed at extracting royalties for the IP and it should be done in the open, not some sweetheart deal behind closed doors based on personal or political connections.   Russia and China have licensed vaccines to Indian manufacturers which compete with SII and there are millions of doses of those vaccines getting made too.  The AZ vaccine is apparently more effective so if there had been a bidding process you'd think it would command a price premium compared to whatever the Russians and Chinese are getting.  

Post edited at 03:10
3
In reply to captain paranoia:

Remember #39?

2
In reply to tom_in_edinburgh:

So were getting to the bottom of this now. You've made up a big fantasy of baseless assumptions and got angry about it.

2
In reply to Longsufferingropeholder:

> So were getting to the bottom of this now. You've made up a big fantasy of baseless assumptions and got angry about it.

It has been amply established that the present government are a corrupt bunch of sh*ts who do deals behind closed doors to benefit their mates.  Let's start with 100 million quid PPE contracts to politically connected companies with no experience.  Ministers doing government business on WhatsApp and accidentally destroying their phones.   There are plenty of connections between this cabinet and Indian money and they've been involved with dodgy Indian businessmen before e.g. Liberty Steel.   

Are you suggesting that this lot should be given the benefit of the doubt when they hand out vaccine IP for free to someone who then makes a ton of money from it in the same way as someone with an unblemished track record would?

Post edited at 07:25
3
OP wintertree 06 Sep 2021
In reply to tom_in_edinburgh:

I was going to reply in detail but it would consist of me laying in to almost every point you’ve made, it hardly seems worth it.

You want us to charge more for the Oxford vaccine to prevent profiteering.  Got it.

I’m glad the IP rights aren’t being used to price it higher, and I’m glad it’s gone royalty free to someone with the capability to make 110 million doses a month.  Why?  Because this makes a material difference to the number of people being immunised globally.  As well as the direct effects, this is in our own enlightened self interest as it reduces the risk (or slows the rate) of variant production.  

It seems you’d rather cut your nose of to spite your face, motivated by some house of cards over academics living the easy life, borderline racist views on the Indian tech industry and the idea the west somehow deserves to profit from vaccines during a global health crisis.

Oh, one bit I will pick in to.  Pfizer as a “respectable company”.  Google their lawsuit history.  A decade ago they paid the then largest criminal fine in United States history, and it’s not a one off incident. In general, big pharma is not a paragon of corporate virtue in the west.  It also seems to me you’re not very aware of how IP is generally brought in after smaller biotechs develop it, keeping the risks and costs of failure out of big pharma.  Hint: Pfizer didn’t develop the vaccine, BioNTech did…

Post edited at 07:59
1
 Offwidth 06 Sep 2021
In reply to captain paranoia:

Vigour improves with supply and motivation.  Delta generated the most urgency on the latter after decisions on AZ made the former tricky.

 Offwidth 06 Sep 2021
In reply to tom_in_edinburgh:

Serum Institute are a family owned business which made a very big investment in a risky venture possible (no problems with banks or shareholders). I think their public position on being able to make more money from other products if profit was their only aim is likely true. Imagine if the vaccine turned out not to be viable! Having said that, being a major company in a country with poorer governance and greater information control means they probably are not saints.

1
In reply to Offwidth:

> Serum Institute are a family owned business which made a very big investment in a risky venture possible (no problems with banks or shareholders). I think their public position on being able to make more money from other products if profit was their only aim is likely true. Imagine if the vaccine turned out not to be viable! Having said that, being a major company in a country with poorer governance and greater information control means they probably are not saints.

Did you read the whole of the Forbes article?

AZ is not the only vaccine licensed to Indian generic manufacturers and it isn't the one doing the most doses per month.   The Russians and Chinese licensed vaccines to multiple manufacturers In India through their state wealth funds.   If there were multiple potential licensees there was no need for a sweetheart deal.

3
 Offwidth 06 Sep 2021
In reply to tom_in_edinburgh:

No I didn't read the Forbes article. I presume the company valuation increases would have been a lot lower if the vaccine wasn't viable. It seems to be a big risk with big potential rewards (unless some of the pre-production cost was underwritten in a way that isn't public). 

The Oxford stipulation makes the job of vaccination in the world's poorer countries a lot easier. That benefits everyone in the world. They were initially in talks with a US company but the government preferred AZ as they were said to be worried about US vaccine hoarding.

By the way Oxford research isn't even mostly funded by government money.

https://www.ox.ac.uk/about/organisation/finance-and-funding

Edit... I've just thought you might be talking about the vaccine development money in Oxford rather than the vaccine research money. This might interest you on the development funding decisions:

https://www.researchprofessionalnews.com/rr-news-uk-politics-whitehall-2020...

Post edited at 10:10
 elsewhere 06 Sep 2021
In reply to tom_in_edinburgh:

Judging the Oxford/AZ/SII deal announced in June 2020 with the knowledge of 2021 is like judging a lottery win of £10 as the result of a wise investment.

2
OP wintertree 06 Sep 2021
In reply to tom_in_edinburgh:

> If there were multiple potential licensees there was no need for a sweetheart deal.

“Sweetheart deal”?

Its interesting, you seem to think the academics don’t need to or shouldn’t profit from their IP because they’ve got such a cushty life.

Yet you object to them deciding not to profit from their years and years of graft (the platform R&D goes back well before the pandemic)

You seem to be arguing that big pharma (“respectable public companies”) should get to profit from the academic’s graft but only if it’s UK big pharma.  Not those Indian “d*cks”.

Seems to keep like you’re arguing for UK corporate profits driven by exploiting the work of academics to the clear detriment of public health.

Wow.

2
 Misha 06 Sep 2021
In reply to tom_in_edinburgh:

You have totally ignored my point that OAZ being a lot cheaper is a GOOD thing because it obviously makes it more affordable for low and medium income countries.

I really don’t think it has reduced profitability of Pfizer and Moderna given they are selling for a lot more and are at production capacity.

I have no idea what margin SII are getting but at a guess it’s the same as they would for any other similar vaccine.

1
In reply to wintertree:

> Its interesting, you seem to think the academics don’t need to or shouldn’t profit from their IP because they’ve got such a cushty life.

How do you work that out.  You are the one arguing that it is good to give IP away and then your saying that I'm the one arguing they shouldn't make a profit.

> Yet you object to them deciding not to profit from their years and years of graft (the platform R&D goes back well before the pandemic)

So you've switched completely.

Somebody was paying their salaries and bills during those years of graft.  That somebody was ultimately the UK taxpayer because one way or another that's where universities get most of their money.  It is obvious the UK government had a lot to say about where this vaccine technology went e.g. AZ was not the Universities first choice as a partner.

Before the academics get all altruistic the guys who funded them should have a think about whether they'd like to get some ROI.

> You seem to be arguing that big pharma (“respectable public companies”) should get to profit from the academic’s graft but only if it’s UK big pharma.  Not those Indian “d*cks”.

Public companies listed on stock exchanges with diverse investors are a different deal from private family companies owned by politically connected billionaires.   The Tories are flirting with Indian billionaires the same way they used to flirt with Russian Oligarchs and Saudi Princes.   

It looks like India is their big Brexit idea - they burnt bridges with the EU, they are going out their way to annoy China, the Democrats in the US don't like them because they are too close to Trump.  India is all that's left and it fits with their Empire 2.0 narrative - except this time it is India that's going to be the main player.

> Seems to keep like you’re arguing for UK corporate profits driven by exploiting the work of academics to the clear detriment of public health.

SII revenue in 2015 was $565 million.  It is now running $600 million per month just on AZ vaccine.

https://accesstomedicinefoundation.org/access-to-vaccines-index/report-card...

Someone decided to do that private company a f*cking huge favour.

The idea that making the IP available at cost is going to mean lower prices for vaccines is simplistic.  The cost advantage could just as easily be going to increase its profit margin.

4
OP wintertree 06 Sep 2021
In reply to tom_in_edinburgh:

> How do you work that out.  You are the one arguing that it is good to give IP away

I think it's great they're willing to share their IP on a non-profit basis for the duration of the crisis, yes.

> and then your saying that I'm the one arguing they shouldn't make a profit.

You previously had this to say:

> The whole give away the IP thing is bullsh*t IMHO.  These guys working for Oxford Uni are making a nice living based on government funding so they don't need to get their hands dirty selling stuff.

You're saying the academics "don't need to" sell their IP.  Perhaps I over-interpreted your highly loaded comments...

> So you've switched completely.

No.  I have not switched.  I'm pointing out that you are both deriding the academics and blowing a fuse that they're not choosing to profit from their work when it can be used to the benefit of all during a global health crisis.  

> Somebody was paying their salaries and bills during those years of graft.  That somebody was ultimately the UK taxpayer because one way or another that's where universities get most of their money.

Is the problem here that you're droning on about something you just don't understand at all?  Hint:  Plenty of life sciences research funding does not come from the UK government or from taxation.  Plenty of postdoc salaries don't derive from UK government or general taxation.  

Once again, you seem to be jumping to wrong conclusions based on a state of being critically misinformed.

> Before the academics get all altruistic the guys who funded them should have a think about whether they'd like to get some ROI.

Do you have any experience of creating IP within a university or moving it beyond a university?  Because this comments suggests you don't have a clue, frankly.

Believe it or not, the interested parties (taxpayer funded research councils, non-government funding bodies, the universities, their employees, the PhD students and so on) don't just let the academics call the shots on a whim re: what to do with the IP they create.  Shocking, I know.  Universities typically have a default policy covering the split in profit for IP between the creators and the institution, funding bodies specify in advance who owns the IP funded by their research, and the general shape of this process has been trod thousands of times.  Mostly, the university owns the IP and calls the shots, the academics get to share in the profit - if there is any.

It's also clear Oxford University is fully behind this - did you read the link from Oxford University Innovation Ltd I posted up thread?  That's the limited company the university has formed as the single "shop front" for all their IP rights, and the vaccine position is bang in line with the OUI position (that I linked) on their wider IP as pertains to the pandemic.

The idea that the academics just decided to give this away without consulting the "guys" who funded them is not beyond simplistic.  It's facile.

A point you seem to be deliberately avoiding here is that one of the major returns on the investment is having an additional 110 million doses of vaccine flowing a month, making a material difference to suffering and death on a global scale and taking a bit notch out of the rate of variant generation.  I'm staggered at the narrow minded view you're taking that the only ROI is money in the pocket when it comes to a global health crisis.  

>  The Tories 

Are secretly running Oxford University and AstraZeneca?

Post edited at 23:35
1
 Misha 06 Sep 2021
In reply to tom_in_edinburgh:

Of course it means lower prices, looks at the facts! OAZ is something like 6-7 cheaper per dose than Pfizer and Moderna. Do you not think that cheaper vaccines are a good thing? I really don’t care if some ‘guy in India’ is getting a cut. The fact is his company can produce a lot of doses and those doses are a lot cheaper.

How about the other side of it - that Pfizer and Moderna are profiteering from a global pandemic? I’ve no idea what their profit margins are but I bet they could lower the price and still make a healthy profit.

The cynic in me says that if OAZ was a ‘Scottish’ vaccine you’d be proclaiming how amazing the SNP are for letting vaccine be produced at cost. 

1
In reply to tom_in_edinburgh:

There's two sides to every story. Neither will be 100% right.

https://text.npr.org/978065736

"Dr. [Cyrus] Poonawalla always said, if I wanted to make money, I would have gone into the business of chalk powder – the filler material for vitamin tablets — or anti-diabetes or anti-blood pressure medicines,"

Thing is you've clearly read neither, but just made shit up instead. And now reaching for a bigger shovel to show us how much you don't know about academia.

1
In reply to Misha:

> Of course it means lower prices, looks at the facts! OAZ is something like 6-7 cheaper per dose than Pfizer and Moderna.

It's a completely different technology, its produced in high labour cost / high tax countries and they did their own R&D.

> Do you not think that cheaper vaccines are a good thing?

No, I don't think artificially making the vaccine business less profitable by reducing the value of IP is the way to address the need.  The rich countries should pay money to subsidise the cost of vaccines for poorer countries and the industry should make a profit.

This is actually a different discussion and it comes from my experience in the electronics industry of free software making it impossible for mid and small sized companies to sell a product for decent money because they have to compete with free and leakage of IP to India and China making many kinds of engineering a sh*tty underpaid job in rich countries.

> I really don’t care if some ‘guy in India’ is getting a cut. The fact is his company can produce a lot of doses and those doses are a lot cheaper.

There are several companies like SII in India.  The Russians and Chinese have licensed SIIs competitors and didn't give IP away for free.  Yet somehow those competitors are shipping more doses than SII, which suggests that their price is not crazily higher than SII's price.

Giveaways to billionaires from Tories generally come with a quid pro quo.  Just like honours to billionaires from royals.   I'd prefer deals like this to be on commercial terms and in the open.

In a few years my guess is we will discover what the quid for the pro-quo is.  Like a few years after Indyref 1 we found the business people making bullshit statements to help the unionists getting honours or put in the lords.

Maybe I am just cynical but it looks dodgy and its not the first time dodgy stuff has happened.

https://en.wikipedia.org/wiki/2013_Indian_helicopter_bribery_scandal

> How about the other side of it - that Pfizer and Moderna are profiteering from a global pandemic? I’ve no idea what their profit margins are but I bet they could lower the price and still make a healthy profit.

Or course they are making a profit and they deserve it.  They've done a stellar job.  I just hope a lot of the money gets down to the engineers and scientists that did the work.

If somebody said to me in March you can have a dose of Pfizer tomorrow for $100 I'd have grabbed it.   The price of these things is already controlled and forced down by government in a completely free market they could get more.

At which point everybody says shock horror that's disgusting, but they don't have any problem at all with dickheads in the financial services sector or people who own land or houses pushing for the absolute maximum for what they have.  I'd rather pay full whack for the useful stuff and have government control the prices and profits of the bankers and landowners.  The worldcould do with a few more rich engineers and scientists and a few less rich landowners and bankers.

Post edited at 07:23
4
In reply to Longsufferingropeholder:

> "Dr. [Cyrus] Poonawalla always said, if I wanted to make money, I would have gone into the business of chalk powder – the filler material for vitamin tablets — or anti-diabetes or anti-blood pressure medicines,"

Call me cynical but IMHO most people who are worth $12 billion want to make money.

And I would place a small wager the chalk business is nothing like as profitable as the Covid vaccine business in a Covid pandemic.  

3

> Call me cynical

What, again?

> And I would place a small wager the chalk business is nothing like as profitable as the Covid vaccine business in a Covid pandemic.  

It's a ton more profitable the rest of the time. Might even be on a par right now tbh. But I'm not going to pretend or suggest it is because I haven't researched it. Every pill made all around the world needs medical grade white powdery crap to bulk it out. It's literally selling junk for top dollar. I could well believe it, but I'll leave it as homework to find out.

1
OP wintertree 07 Sep 2021
In reply to tom_in_edinburgh:

> It's a completely different technology, its produced in high labour cost / high tax countries and they did their own R&D.

Pfizer didn’t do the R&D on the vaccine.

It’s hard to find any pillars in your argument that aren’t based on you jumping to some wrong assumption.

In reply to Longsufferingropeholder:

> It's a ton more profitable the rest of the time. Might even be on a par right now tbh. But I'm not going to pretend or suggest it is because I haven't researched it. Every pill made all around the world needs medical grade white powdery crap to bulk it out. It's literally selling junk for top dollar. I could well believe it, but I'll leave it as homework to find out.

Suggesting chalk is anything like as good a business as Covid vaccines is simply ridiculous.  Stupid to the point of not even being worth talking about it.

5
In reply to wintertree:

> Pfizer didn’t do the R&D on the vaccine.

There's more IP in getting a vaccine to billion unit production than just the original research so it isn't fair to say Pfizer didn't do R&D. 

Sure they licenced the original work from BioNTech, also a respectable traded company in a commercial deal and presumably are paying royalties to BioNTech out of their sales income. 

> It’s hard to find any pillars in your argument that aren’t based on you jumping to some wrong assumption.

It's hard to understand why you are so determined to conclude there's nothing untoward about handing valuable IP to a billionaire's private company for cost.

3
In reply to tom_in_edinburgh:

> Suggesting chalk is anything like as good a business as Covid vaccines is simply ridiculous.  Stupid to the point of not even being worth talking about it.

Is it? Is it though? Have you looked into it? No, thought not. 

The evil billionaire protagonist of your sinuous fantasy says it would make more money. But you know better based on your absolutely zero knowledge and zero research.

2
In reply to Longsufferingropeholder:

> Is it? Is it though? Have you looked into it? No, thought not. 

No.  I've not wasted my time investigating the global market for chalk. 

When somebody says something totally ridiculous I don't feel the need to go look up the financials of chalk companies or go on alibaba and see how much chalk I can buy for $100 in order to disprove it.   

My guess his comment about going into the chalk business was not intended to be taken seriously.

Post edited at 09:04
3
In reply to tom_in_edinburgh:

> No.  I've not wasted my time investigating the global market for chalk. 

This is exactly my point. You're plenty happy to waste your time and ours by assuming, making shit up, coming here to pontificate and getting us to tell you you're wrong. I really wish you'd put a fraction of the effort into googling occasionally.

> My guess his comment about going into the chalk business was not intended to be taken seriously.

Again, this. It's always 'your guess'. Stop guessing; you're usually wrong.

2
 Misha 07 Sep 2021
In reply to tom_in_edinburgh:

I see, so richer countries should line the pockets of the Big Pharma shareholders by giving more aid to poorer counties so they can afford to buy vaccines from Big Pharma for more money. That makes perfect sense.

Richer scientists ans engineers? You are deluded. I don’t think you really understand the concept of Big Pharma - huge listed companies with shareholders who expect a return (many of those shareholders are pension funds of course). Those profits aren’t going to some impoverished scientist… (for a start, by definition, profit is what’s left after paying costs including staff costs).

India isn’t a low tax regime by the way. 

1
OP wintertree 07 Sep 2021
In reply to tom_in_edinburgh:

> It's hard to understand why you are so determined to conclude there's nothing untoward about handing valuable IP to a billionaire's private company for cost

I'm not determined to conclude that.  I don't have the evidence to conclude either way.

What I am doing is:

  1. Pointing out that your argument is built on top of almost entirely nonsensical arguments 
  2. Pointing out that I have no problem with the University of Oxford making the decision to realise a return on their investments through maximising public health and not profits for the duration of the crisis.

As LSRH says, you seem to be just making up things that aren't compatible with reality to argue there may be something untoward going on. 

2
In reply to Misha:

> I see, so richer countries should line the pockets of the Big Pharma shareholders by giving more aid to poorer counties so they can afford to buy vaccines from Big Pharma for more money. That makes perfect sense.

No, the vaccines should sell for market price based on their utility and supply.

Rather than manipulating the price the rich countries should buy vaccines at market price if they want some to give away.

> Richer scientists and engineers? You are deluded. I don’t think you really understand the concept of Big Pharma - huge listed companies with shareholders who expect a return (many of those shareholders are pension funds of course). 

Of course they do but the level of pay and benefits in an industry depends on how much profit that industry makes and the pay and benefits of scientists and engineers is coupled to the value of the intellectual property they generate.   When intellectual property is valuable and skills are rare pay and benefits rise because companies bid them up to get the people with the skills.   If you have specialist knowledge you need to make your money when your skills happen to be the ones that are in demand because it won't stay that way.

> India isn’t a low tax regime by the way. 

India is a developing country with corruption problems.

3
In reply to wintertree:

> As LSRH says, you seem to be just making up things that aren't compatible with reality to argue there may be something untoward going on. 

No you are just a couple of English people determined to close your eyes to what's going on.

If I was having this argument in America or Germany or Ireland or Pakistan it would be really easy to convince people that:

a. the AZ vaccine is not as good as Pfizer and Moderna

b. AZ has significantly more side effects than Pfizer and Moderna

c. For some reason the Tories gave a ton of money to Oxford and used their influence to force AZ as the partner for the Oxford vaccine and very likely SII as the manufacturing partner in India.   They either suggested or didn't resist giving the IP away to SII at cost.

d. The cabinet is full of rich Indians.  The minister involved in the 84 million funding for the vaccine was born in India.

e. SII is the family business of a billionaire.  It's gone from $500 million a year total to $600 million a month on Covid vaccines.   It is very secretive about its pricing methods - that's in the Forbes article.  Also according to Forbes the owners wealth has gone from 8.4 billion to 12 billion during Covid.

f. The Tories are corrupt AF.  The Mohdi government in India isn't much better.  When people who hand out 100 million contracts to their pals and seats in the house of lords to Russian oligarchs do favours on that scale it is reasonable to suspect at some point there will be a quid pro quo.  If this was a normally ethical administration you'd have a point about jumping to conclusions and lack of evidence.  It's not.

Post edited at 11:22
6
 Stichtplate 07 Sep 2021
In reply to tom_in_edinburgh:

> No you are just a couple of English people determined to close your eyes to what's going on.

Jesus, seriously?

Whatever valid points you’re trying to make, you just throw it all away with blatant displays of ignorance and bigotry.

1
OP wintertree 07 Sep 2021
In reply to tom_in_edinburgh:

> No you are just a couple of English people determined to close your eyes to what's going on.

> AZ has significantly more side effects than Pfizer and Moderna

To be clear, you had a hard time convincing over a dozen people including one that identified themselves as Scottish and another who identified themselves as not English, and non of whom have had many supportive things to say about the current government to my memory.

In my opinion, your YCS posts were an utter disgrace that were roundly and robustly called out by over a dozen other posters.

You got a hard time because over a dozen people all independently saw that you were egregiously mis-representing yellow card scheme data in exactly the same way hardcore anti-vaccination campaigners egregiously misrepresent it.

This thread is like that.  Rather than building an argument based on facts - and there's plenty of space for interpretation within the facts in the direction you are arguing - you're just building a tower of cards on near endless and baseless assumptions that go against any sort of evidence in pursuit of your goal.  Rather than defending most of them you move on to the next one.

When people point out that your argument is based on endless baseless or outright wrong assumptions you could either choose to engage with them and pair your argument back to points rooted in evidence, or you could start with the anti-English racism.  Which do you think is going to bring you credibility and help engage others?

I'm almost reduced to my Picard facepalm meme's again and it's not even Friday.

Post edited at 12:50
OP wintertree 07 Sep 2021
In reply to Misha:

Tom has repeatedly referred to "respectable" western pharmaceutical firms, with his "Indian d*cks" on the other side.  An odd kind of superiority really...

https://en.wikipedia.org/wiki/List_of_largest_pharmaceutical_settlements 

https://en.wikipedia.org/wiki/List_of_largest_civil_only_pharmaceutical_set... 


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