Coronavirus Sars-CoV-2/Covid-19 Megathread

[Sheilbh]

I think you might be slipping into little islander mode again and thinking the world puts more thought about the actions of the UK than they actually do.

I do recall when Fauci and Pelosi spoke it was at the same time that the British government was cheering its vaccine nationalism.

Those comments were about the Pfizer vaccine though. And if anything it's the opposite - they don't think about the actions of the UK (even if they're commenting on it).

Pelosi's remark was that she wouldn't want the US to follow if "Boris Johnson decides to approve a vaccine" which isn't how it works and I think it was exactly because she wasn't thinking about the actions of the UK but the actions of Donald Trump who was putting pressure on the FDA at the same time and basically applying that to the UK (because Boris = Trump).

Similarly Fauci I think came out and apologised the day after his remarks about UK regulators rushing it and not really scrutinising Pfizer's data. I think he basically said he was thinking about it from more of a US perspective. In both cases I think they just applied thoughts about the US (and Trump in November-December last year) to the UK.

[garbon]

Yes, as the world saw the UK gunning to approve a vaccine. Here's what the guardian said at the time about Pelosi:
https://www.theguardian.com/society/2020/oct/09/us-wont-rely-on-uk-for-covid-vaccine-safety-tests-says-nancy-pelosi

Amid a race to produce an effective vaccine against Covid-19 that meets broad international acceptance for safety, Pelosi's comments appear partly motivated by concern that any quick and unilateral British approval of a vaccine might be embraced by Donald Trump for political gain, perhaps even before the 3 November election.

Fauci complained/claimed in early Dec that Brits had rushed it and that their system relied to much on reports from drug manufacturers and not doing their own analysis. Something he at least partly must have walked back as he didn't want people fearing the vaccine.

Days later:

[The Larch]

Wasn't the issue that not enough of the older people in the study actually caught corona?
Sounds like a good result to me....

Yeah I think so. From what I've read Oxford university designed the trials and from my understanding didn't think it would be ethical to give older people the vaccine in the first trials which would establish safety. So the first trials inlude only under-65s. Once they came back positive on safety and effectiveness there was a new trial started with 2-3,000 older people. Again from my understanding the way they measure effectiveness is through infection events and at the minute there haven't been enough (which likely reflects that older people are more cautious/likely to be shielding and that infection rates were lower in the early days of the trial - now they're higher). From what I've read they expect this trial to be completed in the next month or so.

So based on that we don't have data on effectiveness in older people because the first trial didn't include them. The perspective of the EMA and the MHRA in the UK is that we know it's safe and there is evidence of an immune response (i.e. presence of antibodies) in older people which is in line with younger people. There is no formal data and some regulators want to wait for that, which makes sense. On the other hand we have evidence that it is as effective in producing an immune response and the absence of formal data doesn't mean it's not effective, so it is very likely it does work at a similar level in older people which is the approach taken by other regulators.

Crucially from what I've seen no person in any of the trials has been hospitalised or died which is huge.

There will eventually be data for over 65s for the Oxford-AZ vaccine (not just the follow up of British recipients of the vaccine, but I believe there was also a separate study being performed exclusively in over 65s in the US that the FDA required for its approval there), it'll just take a bit longer. This limitation of use to only under 65s (or younger, I believe that in Spain it'll only be used for under 55s) will only happen during the first few months, by the 2nd half of the year there should be the additional info required to approve it for use for the general population.

[Zoupa]

The vaccination by itself will not save us from the pandemic considering mutations. The Pfizer and Astrazeneca vaccines look less effective against the South African B1351 variant. So in addition to vaccination we need to finally learn from East Asia and step up track and trace, mandatory quarantine not at home, better screening of travellers, immediate escalation on new outbreaks etc.

From all the data I've seen, all the vaccines are effective 100% for preventing hospitalization and death after about a month, no matter the strain.

They are less effective in preventing mild to moderate symptoms.

[Sheilbh]

There will eventually be data for over 65s for the Oxford-AZ vaccine (not just the follow up of British recipients of the vaccine, but I believe there was also a separate study being performed exclusively in over 65s in the US that the FDA required for its approval there), it'll just take a bit longer. This limitation of use to only under 65s (or younger, I believe that in Spain it'll only be used for under 55s) will only happen during the first few months, by the 2nd half of the year there should be the additional info required to approve it for use for the general population.

Yeah - I think I read that the FDA application will be in April so we will likely see the data in the next month or so.

But we may also start to have indications from the British non-study recipients in that time.

From all the data I've seen, all the vaccines are effective 100% for preventing hospitalization and death after about a month, no matter the strain.

They are less effective in preventing mild to moderate symptoms.

Presumably that mainly matters in terms of spread? So it stops people from going to hospital or dying (which is the main concern), but people who are still infected but have mild symptoms or are asymptomatic could still spread it?

[Tamas]

At this stage in the game, I'd take the deal of being certain to avoid hospital but having to suffer through a couple of weeks of severe flu.

[Razgovory]

A Republican congressman from Texas, Ron Wright, has just died of Covid.

[Valmy]

A Republican congressman from Texas, Ron Wright, has just died of Covid.

Well he also had lung cancer so that is a combination that few are likely to survive. Pity it was looking like he was going to beat the cancer for a bit there.

RIP Mr. Wright. Sure, he was one of the bad Republicans who challenged the electoral result but I am 90% sure his replacement will be just as bad if not worse.

[Sheilbh]

Interesting analysis on death rates in minority communities in the UK. I think the professional side is probably very important for Bangladeshi and Pakistani men (I know Labour and Tories would go spare at me for this but I'd prioritise shop workers getting vaccinated over teachers and police officers because they seem higher risk ).

I also wonder if possibly British-African or Caribbean communities are more likely to work in sectors that are far better protected now than they were in the first wave - for example I wonder if there's higher than average employment in the NHS which now has enough PPE etc. Because I remember reading that Filipino-Brits were the worst hit minority proportionally because they're a tiny community but with a lot of people working in the NHS:

Covid mortality in England still higher for some ethnic minorities, study finds
People from Bangladeshi and Pakistani backgrounds faring worse than black people in second wave of pandemic
Natalie Grover
Tue 9 Feb 2021 06.00 GMT

Evidence that ethnic minorities are at elevated risk of contracting and dying from Covid-19 compared with their white counterparts is well established. But a new sweeping analysis in England shows that between the first and second waves of the pandemic in 2020, death rates in black communities improved, but continued to remain high in people from Bangladeshi and Pakistani backgrounds.

The analysis – which is yet to be peer-reviewed or published in a medical journal – suggests that while the public health messaging focused on ethnic minorities has had a beneficial impact on some communities, others need customised outreach, the authors said.

The study analysed data from the Office for National Statistics (ONS) and from GPs for roughly 29 million adults aged 30 to 100. The researchers examined differences in the risk of death between ethnic minorities and the white population in the first wave (January to August 2020) versus the second wave (September to December 2020).

Their findings took into account factors such as age, geography, socio-demographic characteristics (using 2011 census data), and pre-pandemic health conditions.

In the first wave, all ethnic minority groups had a higher risk than white people, but in the second wave the risk levels improved for black African and black Caribbean groups, while remaining substantially higher in people from a Bangladeshi background, and worsening in people from a Pakistani background, said study author Dr Nazrul Islam at Oxford University's Nuffield Department of Population Health.

Overall, a slightly higher proportion of Covid-related death occurred among white British people in wave 2 (87.6%) compared with wave 1 (83.6%), while the proportion of death decreased from 1.44% in wave 1 to 0.35% in wave 2 among people from the black African community, and 2.4% to 0.89% among people with a black Caribbean background.

The numbers among the Bangladeshi community were roughly the same – 0.9% in wave 2 from 0.7% in wave 1 – but the Pakistani population saw a dramatic rise from 3.36% in wave 2 from 1.86% in wave 1.

Demographic, geographical and socioeconomic factors – how and where you work and live – in many ways determine your exposure to the virus. These factors tend not to favour some ethnic minorities, who also carry a greater risk of underlying conditions such as cardiovascular disease and diabetes. Another possibility under consideration is that people from ethnic minorities are more genetically susceptible to this virus.

Initially, some researchers thought the disproportionate risk of Covid-19 death in ethnic minorities was rooted in underlying health conditions or even genetic differences, said lead author Vahé Nafilyan, a statistician at ONS and researcher at the London School of Hygiene and Tropical Medicine. "But what this [analysis and other research] shows is that it is likely to be driven by infection – because of differences in exposure to the virus."

People from Bangladeshi and Pakistani communities are more likely to live in deprived areas as part of large, multigenerational families – all of which are ingredients for a higher risk of virus exposure, the researchers noted. Adding further risk is that a high proportion of Pakistani and Bangladeshi men work as taxi drivers, shopkeepers and proprietors – more than people of any other ethnic background, they said.

While the study accounted for these socio-demographic factors – such as household composition and occupational exposure – the data used to glean this information comes from the 2011 census and is not necessarily reflective of the situation at the start of the pandemic, the authors cautioned.

Other explanations could be linked to linguistic/cultural barriers that thwart access to public health messaging, behavioural differences, and the relative prevalence of misinformation in different communities, the authors said, suggesting that the disparities are likely to arise from a combination of all of the above.

"I'm really concerned about these two communities ... We can do much better," said Islam. "We need to focus on customised ways of reaching these ethnic minority people."

[Zanza]

The vaccination by itself will not save us from the pandemic considering mutations. The Pfizer and Astrazeneca vaccines look less effective against the South African B1351 variant. So in addition to vaccination we need to finally learn from East Asia and step up track and trace, mandatory quarantine not at home, better screening of travellers, immediate escalation on new outbreaks etc.

From all the data I've seen, all the vaccines are effective 100% for preventing hospitalization and death after about a month, no matter the strain.

They are less effective in preventing mild to moderate symptoms.

Okay, I had the impression that this was not clear yet regarding the new strains. Extra measures like those mentioned support the vaccine campaign in any case.

[Zanza]

https://www.nytimes.com/2021/02/08/world/europe/eu-vaccines-germany.html#click=https://t.co/vnZAvBOfHg

Solidarity Is Not an Easy Sell as E.U. Lags in Vaccine Race

Europe's collective vaccine purchase is an experiment in deeper integration. Despite a rocky start, many countries still stand to benefit, but it's the most powerful who have least to gain.

The people on television were joyous: Jubilant Britons were receiving the world's first shots of the Pfizer-BioNTech vaccine in early December.

Less joyous were many people watching in Germany, where the vaccine was created yet where the government was telling citizens it would be weeks before they could launch their own vaccination program.

"Millions Getting German Vaccine, but We Have to Keep Waiting," read the headline in the Berlin tabloid B.Z. "The World Is Vaccinating — Not Germany," read the newsmagazine Focus.

For Germans and other Europeans, it has been particularly galling to watch as the United States and Britain, which were less disciplined in their lockdowns and pandemic precautions, have vaulted ahead in the vaccine race. In fact, former President Donald J. Trump and Prime Minister Boris Johnson had all the more incentive to grasp at vaccines as their countries became among the worst hit in the world.

There is no doubt that the European Union bungled many of the early steps to line up vaccines. It was slower off the mark, overly focused on prices while the United States and Britain made dollars and pounds no object, and it succumbed to an abundance of regulatory caution. All those things have left the bloc flat-footed as drugmakers fall behind on their promised orders.

But the 27 countries of the European Union are also attempting something they have never tried before and have broken yet another barrier in their deeper integration — albeit shakily — by choosing to cast their lot together in the vaccine hunt.

In doing so, they have inverted the usual power equation of the bloc. Bigger, richer countries like Germany and France — which could have afforded to sign contracts directly with drugmakers, as the United States and Britain did — saw their vaccine campaigns delayed by the more cumbersome joint effort, while smaller countries wound up with better supply terms than they were likely to have negotiated on their own.

For the bulk of E.U. nations, that experiment has been beneficial. But it has not necessarily been greeted happily in the disadvantaged wealthiest countries, and it has left leaders like Chancellor Angela Merkel of Germany and President Emmanuel Macron of France open to criticism at home.

They and E.U. leaders have nonetheless stood by their decision and the impulse for solidarity, even as the finger-pointing has begun.

"What would people have said if Germany and France had been in competition with one another for the purchase or production of vaccines? That would have been chaos," Mr. Macron told a news conference on Friday, after a virtual meeting with Ms. Merkel. "That would have been counterproductive, economically and from a public health perspective, because we will only come out of this pandemic when we have vaccinated enough people in Europe."

But even as the leaders of Europe's traditional power duo talked up the 2.3 billion doses ordered as an indication of the wisdom of a joint approach, they conceded that a full campaign could not be expected before March, leaving the bloc mired in controversy and recrimination, and perhaps a little regret.

With just over 3 percent of E.U. nationals having received at least one dose of a vaccine by the end of last week, in stark contrast to Britain's 17 percent and the United States' 9 percent, nowhere does the lag sting more than in Germany, the bloc's biggest economy and de facto leader.

"I must have called the hotline 100 times," said Klaus Kater, 80, a retired lawyer in Germany who said he spent two days hitting redial before he could get through to health officials in his home state of Lower Saxony.

His efforts landed him on a waiting list, he said. "They asked me how to notify me when my turn is up, so I said to send me a letter, just to be safe." He had no idea when that could be.

To be sure, not all those problems — like underequipped phone lines — are the fault of the European Union. But as frustrations mount the bloc has become an easy whipping boy for all sorts of vaccine-related issues it wasn't meant to solve in the first place.

Experts say that Germany could potentially have been faster to get vaccines for its population had it acted on its own, but ultimately it would have been a disaster to abandon the E.U. joint effort in many other ways.

"It would have been a catastrophe for Germany to break from the joint procurement, politically, but also economically if Germany alone had secured the vaccine and the rest not," said Guntram Wolff, director at Brussels-based research institute Bruegel.

Mr. Wolff added that given Germany was at the heart of Europe's open labor market, and shared borders with nine other countries, ensuring the whole of the bloc was getting vaccines was a matter not just of politics but also of self interest.

"Most of the E.U. countries would have found it very difficult to negotiate the contracts and secure the supply on their own," said Mr. Wolff. "And I think the pharmaceutical companies themselves, they also preferred the centralized approach."

Still, Ms. Merkel has struggled to defend her government's decision to have Germany forgo the opportunity to acquire its own vaccine.

Back in March 2020, when Italians were dying on stretchers outside overwhelmed hospitals, the German and French governments blocked exports of essential protective equipment such as masks.

It was a disastrous moment for Europe, one its leaders quickly decided must not be repeated as the pandemic took hold of the bloc's economies and shuttered its societies, and Britain finally exited the union after four years of painful negotiations.

Public health is usually handled by individual member states, but a decision was made to grant powers to the European Commission, the bloc's much-maligned, stodgy Brussels-based administrative arm, to lead the negotiations to secure vaccines.

By then it was June, and Europe was already four months behind the United States and three behind Britain in approaching pharmaceutical companies.

More recently, the vaccine race has been viewed, correctly or not, through the prism of Brexit. The Johnson government in particular has cited its lead in distributing vaccines as proof that formal exit from the bloc at the start of the new year was the right thing to do.

At a minimum it has put Britain and the European Union in competition, and increased rancor as the British-Swedish firm AstraZeneca informed Brussels in January that it would slash its planned deliveries of vaccines to the bloc because of production difficulties, while providing Britain with its full order.

E.U. officials accused the company of prioritizing its home country, while AstraZeneca said Britain's three-month head start in orders had given the company time to smooth out production glitches similar to the ones that the E.U. supply was now experiencing.

To appease critics, Ms. Merkel resorted to explaining to the public the difficulties involved in producing vaccines, pointing to more production facilities in the United States and Britain as reasons those countries began their campaigns earlier.

"I think that by and large, nothing has gone wrong," Ms. Merkel told the public broadcaster ARD on Tuesday, a day after that meeting. "Of course, the question arises: Why is the United States faster, why is Israel faster, why is the United Kingdom faster? That rankles, of course," she added, without offering an answer.

Other top European leaders have sought to move forward from the tumult of the last few weeks surrounding derailed vaccine deliveries.

Since the bloc's confrontation with AstraZeneca, in which it adopted protectionist measures to squeeze the company and nearly imploded already fragile relations with Britain, a more forward-looking sense of self-reflection and action has taken hold in Brussels.

The European Commission president, Ursula von der Leyen, who came under severe personal criticism for her handling of the vaccine procurement process, conceded that Europe had discounted how difficult vaccine production would be.

"A start of vaccination does not mean a seamless flow of vaccine doses coming from the industry," Ms. von der Leyen told European news organizations this month. "This is a bitter learning part, and this we certainly have underestimated."

Ms. von der Leyen also hired Moncef Slaoui, a Belgian-American senior pharmaceutical executive who worked on the U.S. Operation Warp Speed, as a consultant, and European leaders have tried to gently nudge her toward a more proactive approach with the new vaccines that are showing promising signs.

Making vaccines is complicated, as Germany's left-leaning Süddeutsche Zeitung wrote in an editorial, adding that the government's actual failure had been a failure to communicate that effectively to the public.

"Germany shares the fate of the slow pace of immunization with the rest of the world, with very few exceptions," the paper wrote in an editorial on Tuesday. "Despite all of the impatience and exhaustion, even science and technology have limits."

Still, despite political musings that point to a "mistakes made, lessons learned" moment for the European Commission, the hardest part of correcting the bloc's course and bringing vaccination up to speed will be changing the attitudes inside the institutions that drive the process.

"I would like to say that when we are trying to constantly compare with the U.S., we should not have any complex," the commission's top vaccines official and head of its health division, Sandra Gallina, said in a parliamentary hearing last week.

"I am not jealous of what Biden is doing, because in actual fact the situation here in Europe is, may I say, better," she said.

Interesting take on the EU vaccine rollout. I think mid term we definitely need this European or even global solidarity. So the general approach was right. Even if it puts Germany in a worse state than it could be just looking at itself.

The actual procurement operation was of course flawed as was described many times before.

[Sheilbh]

Interesting take on the EU vaccine rollout. I think mid term we definitely need this European or even global solidarity. So the general approach was right. Even if it puts Germany in a worse state than it could be just looking at itself.

The actual procurement operation was of course flawed as was described many times before.

Yeah. I think it was necessary because without you would have what happened with PPE where I remember France seizing PPE destined for Britain and there were similar incidents in other countries such as the Czech Republic. I think it had to be done on a European level to avoid that re-occurring.

I think the problems on a European level were, in large part, that they'd never done anything like this. Health is a national competence and one member states guard fiercely - the EU has no operational experience in the sector, it's role is purely regulatory (and even then it's one where there is a European regulator and 27 national regulators). So it was new for the Commission and, obviously, member states - no-one had dealt with a pandemic before.

The long-read in Politico said there were a lot of divisions among member states on spending for a vaccine. Some countries thought that innovative mRNA vaccines were being pushed by countries with a pharma industry like Germany and were too risky and expensive, and other countries were just generally very reluctant to spend money on vaccines. I think the Commission can be criticised for too much business as usual procurement-style approach and not focusing early on manufacturing as VdL has said, but they were navigating a lot of different opinions among member states. I think some countries - especially poorer countries who'd had a "good" pandemic in CEE and the Balkans were maybe complacent about the risk of other waves so didn't see much need for spending money on vaccines which were often expensive, using relatively new technology and may not even work.

And I think the hiring of Moncef Slaoui may help a lot and slightly change priorities. There were definitely mistakes - and I think VDL has not won many admirers for her response which to start with seemed mainly about shifting blame/avoiding responsibility - but I really do think the Commission was between a rock and a hard place on this.

The other point is that actually this has an impact on supply which is huge - but I feel like there are probably questions to be asked in some member states about the pace of rollout because that's on them and there's quite a surprising range. I also know Germany bought extra Pfizer because they were put in the pot again because some countries didn't buy their full amount - I know Bulgaria but I think there were others too - which is a dreadful decision because even the most expensive vaccines are cheaper than lockdowns.

In better news there are now pretty clear signs that the vaccine is working in Israel:

[Sheilbh]

Britain continue to weaponise national treasures to encourage people to get the vaccine. This time Elton John and Michael Caine:
https://www.youtube.com/watch?v=8kHYUq0_0YQ

I'm really pleased that Elton John in his late career is very able to take the piss out of himself

[celedhring]

The Catalan government has also unveiled an "emblematic venues" vaccination campaign for when we start vaccinating the general population. You'll be able to get jabbed in La Sagrada Familia or Nou Camp.   

[Sheilbh]

The Catalan government has also unveiled an "emblematic venues" vaccination campaign for when we start vaccinating the general population. You'll be able to get jabbed in La Sagrada Familia or Nou Camp.   

Yeah - I have a friend from Salisbury who was surprised his dad didn't insist on getting vaccinated in the Cathedral.

And despite my doubts and RH's there was an article about how Newcastle have been the most effective roller-outer of the vaccine in the country and a big part of it is the large vaccine centre in the middle of town (plus free transport for people to get there).

Edit: Incidentally - and it's disgrace we're finding out this way - it seems like a PHE paper has been leaked which indicates that both AZ and Pfizer are similarly effective in all age groups. But it takes two weeks to show the immune effect in people up to about 75, for the over 75s it takes three weeks (but the effect is similar). Hopefully it'll be published soon now it's already out there.