Coronavirus Sars-CoV-2/Covid-19 Megathread

[Tamas]

I am not sure it's that helpful, you look at the 30-39 one for example, I could understand people going like "are those really good enough odds improvements to risk getting a stroke before I hit 40?"

Really?

The covid side is only ICU - it doesn't take into account hospitalisations, long covid or not passing it on to others. And, maybe I'm just blase, but I feel like almost every medicine probably has a risk of serious harm of about 0.8 per 100,000 (and that includes all serious harms - not just this issue), no?

Whenever you take medicine my understanding is the common side effects = 1 in 100; the serious side effects = 1 in 10,000. So just looking at a medicine I take every week, thrombosis and embolism is in the 1 in 10,000 category. In the 1 in 100,000 category side effects may include:

aphasia; chills; cognitive disorder; defective oogenesis; dizziness; hemiparesis; leukoencephalopathy; metabolic change; mucositis; nephropathy; pancreatitis; pulmonary oedema; skin ulcer; sudden death; tinnitus

I feel like the severity change from sudden death to tinnitus is extreme

Edit: And I should point out I am one of those sickos who reads the leaflet in all medicines I take to see the side effects

Edit: Also it is harm so this counts all harms, not just death. But I often think of those weird deaths recorded every year. I live in London. I cross the road all the time. I cycle. Lightning exists. I have a very weird and specific theory about being accidentally pushed onto railway tracks in an over-crowded platform incident. And today could be the day that I die in a tragic falling furniture accident. Now if I stayed in my flat I'd improve my odds a lot, but it'd be a kind of shitty life. As I say I think about this every time I have a new course of treatment for a chronic condition that wouldn't kill me but would make my life very uncomfortable and difficult.

I get all that (and as far as I am concerned I did get the AZ knowing the super-rare blood clotting might happen as some of my grandparents were enthusiastic clot-collectors). But having a blood thronbosis not to mention a stroke can be life-changingly devastating so I can't really blame people for thinking they can continue to try and dodge covid a while longer and not a risk AZ for a ten-times improvement in their odds. Because sure that's a lot but you actually have to catch covid before the ten-times higher odds come into play

[Sheilbh]

I get all that (and as far as I am concerned I did get the AZ knowing the super-rare blood clotting might happen as some of my grandparents were enthusiastic clot-collectors). But having a blood thronbosis not to mention a stroke can be life-changingly devastating so I can't really blame people for thinking they can continue to try and dodge covid a while longer and not a risk AZ for a ten-times improvement in their odds. Because sure that's a lot but you actually have to catch covid before the ten-times higher odds come into play

Yeah - and that is the issue with vaccines: healthy people take them. It's why there's more scepticism and reluctance around them because you need to convince someone who is otherwise well to receive a medical treatment they don't need to reduce the risk to themselves (which is small) and people around them (which is higher). It is worth noting the figure on the right is the risk of serious harm from any of the side effects including all the ones identified in clinical trials, not specifically the risk of blood clotting.

I think a more useful comparison might be the extreme side effects that women can get from the pill , which include stroke and blood clotting as well as the more common side effects. But many people take it to avoid the risk of getting pregnant and for the potential benefits to your lifestyle (there is no equivalent for men because they're cowards). It's a bit more of a similar calculation to a vaccine than my medication example.

I also saw one expert on BBC noting that while it's difficult to make a good comparison for vaccines because they're taken for the healthy, but that a 1 risk of harm per 100,000 is about the risk someone in their 20s or 30s has of dying in an accident every month.

Edit: Incidentally I just saw the info on those slides - the top one is the UK now, the middle one is the UK in Feb and the third one is the UK in Jan. That might explain the slightly different approach with the EMA. The vaccine is safe enough to be authorised for use in general, but the risk/benefit to each age group will depend on the context. Because the UK has had a strict lockdown we have quite a low number of cases now, so it makes sense to restrict as there's a cross over with covid risk (which is also age-linked). While in other European countries with third waves picking up, or the UK for the last two months, the risk/benefit might be to use it without any restrictions but in the European context that's a decision for each member state based on their level of covid cases.

In the press conference here they had two sets of regulatory/administrative groups. One was the medicines regulator which I don't think changed their recommendation except to update the side effects list - that is the equivalent of the EMA. The other was the JCVI which decides clinical deployment and provides operational guidance who have changed their decision on deploying and updated their guidance - there is no EU wide equivalent so the equivalent body in each member state.

[The Larch]

EMA concludes blood clotting should be listed as 'very rare' side effect of AstraZeneca jab

EMA's safety committee just put out a statement saying that unusual blood clots with low blood platelets should be listed as very rare side effects of the AstraZeneca vaccine.

Despite the histrionics surrounding the issue, this is AFAIK the normal procedure for new drugs, if side effects not detected during trials are found out once a certain drug hits the market then it gets reviewed and the appropriate caveats added to its administration protocols.

[Tamas]

My uncle's condition seems to have improved greatly since he has been put on oxygen at the ICU. They have already reduced the amount he receives and have been put into the "milder" section of the ICU where he is under close observation but can move about a bit on his own.

It's probably too early to declare victory but the signs are very good.

[Sheilbh]

That is good to hear and sounds pretty positive.

[Syt]

https://www.theguardian.com/world/2021/apr/07/doubts-over-russian-covid-vaccine-doses-delay-rollout-in-slovakia

Doubts over Russian Covid vaccine doses delay rollout in Slovakia

Sputnik V order that led to PM's resignation cannot be used owing to incomplete or inaccurate information

A 200,000-dose order of Russia's Sputnik V vaccine that triggered a political crisis in Slovakia should not be administered yet because of incomplete or inaccurate information from the manufacturer, the national medicines agency has said.

The Dennik N news site quoted the agency as saying it could not properly assess the shots, which it said were different from the vaccine whose favourable peer-reviewed late-stage trial results were published in The Lancet medical journal in February.

The agency said it had carried out several tests on the vaccine but recommended it be administered only after approval by the European Medicines Agency (EMA), which is carrying out a rolling review of the Russian shot.

The Slovakian president, Zuzana Čaputová, last week named Eduard Heger as prime minister after his predecessor, Igor Matovič resigned amid a bitter dispute sparked by his Sputnik purchase.

Matovič had struck a secret deal to buy 2m doses of the vaccine despite the disagreement of many in his four-party coalition, prompting the resignation of at least six cabinet members. Critics said the deal cast doubt on the country's allegiance to the west.

Only one other EU member has bought Sputnik V doses: Hungary, which has started using them. Austria is in talks to buy 1m doses, and autonomous regions in Italy and Spain have also sought to acquire shots.

The two-dose Sputnik V vaccine's reported efficacy was initially greeted with scepticism after Russia approved its use in August last year without waiting for the results of full clinical trials, but based on the trial published in the Lancet it has almost 92% efficacy.

Germany and France have said they are open to using the shot if it is approved by the EMA, although the French foreign minister, Jean-Yves Le Drian, has described it as more "a means of propaganda and aggressive diplomacy" than a medical asset.

The EU's vaccine programme has been dogged by an early shortage of doses, but the shortfall is expected to ease significantly with more than 300m doses of vaccines from four suppliers due to arrive in April, May and June.

The EMA has launched a rolling review of Sputnik V, which according to the Russian Direct Investment Fund (RDIF) has been approved for use in 58 countries. Russia has, however, struggled to produce enough Sputnik V to meet domestic demand.

Next week, the EU medicines regulator will investigate whether clinical trials of the vaccine met so-called "good clinical practice" standards after Russia said soldiers and state employees took part, with some reportedly saying they had been pressured to do so.

[Sheilbh]

A sister of a man who died of the blood clot has come forward in the UK and, on behalf of the family, been talking to the press - Telegraph and BBC so far with his story but mainly to urge people to get their jab:
"Despite what has happened to our family, we strongly believe that everyone should go for their first and second doses of the AstraZeneca vaccine. Emotionally, we are completely and utterly furious. We are suffering. But there's nothing in our minds to be really furious about. My brother was just extraordinarily unlucky."

"If we all have the vaccine, a few of us might have a blood clot but the evidence is that fewer people will die. We trust the process, we trust the regulator, and despite what has happened to our family we don't want people to be scared off. That's the message we want to get across."

It's incredibly public-minded and rational of that family. I very much doubt I'd be anywhere near as coherent if I'd just had a family tragedy like that.

[Tamas]

https://www.theguardian.com/world/2021/apr/07/doubts-over-russian-covid-vaccine-doses-delay-rollout-in-slovakia

Doubts over Russian Covid vaccine doses delay rollout in Slovakia

Sputnik V order that led to PM's resignation cannot be used owing to incomplete or inaccurate information

I was also just reading that the Slovakian authority having encountered the issue of not having information requested it from Hungary (on account of them vaccinating with it already) but they refused to due to the NDA clause in their contract.

Also, this is a bit blurry, but apparently, the Sputnik V approval requested submitted to the EMA confirms that they are sending non-identical batches to different countries?!  No English source, sorry.

[Sheilbh]

Also, this is a bit blurry, but apparently, the Sputnik V approval requested submitted to the EMA confirms that they are sending non-identical batches to different countries?!  No English source, sorry.

I don't see how that works. I know Sputnik is like AZ so they've gone for a global distributed manufacturing model rather than leveraging existing capacity in core locations (like Pfizer, Moderna, J&J etc) but my understanding was that the EMA approves facilities and does batch samples as well to ensure the safety of what they're getting (and that it matches what they've approved)?

[Tamas]

Also, this is a bit blurry, but apparently, the Sputnik V approval requested submitted to the EMA confirms that they are sending non-identical batches to different countries?!  No English source, sorry.

I don't see how that works. I know Sputnik is like AZ so they've gone for a global distributed manufacturing model rather than leveraging existing capacity in core locations (like Pfizer, Moderna, J&J etc) but my understanding was that the EMA approves facilities and does batch samples as well to ensure the safety of what they're getting (and that it matches what they've approved)?

The article is based on the the Slovakian pharm authority's official press release, and I am not sure what they mean but they claim the Sputnik V sample they received is not matching either the Lancet data, or the sample submitted to the EMA.

They also note that their test and measurement are along things like strelity, pH value etc, not efficiacy per se.

I think what's happening is that as expected Russian production standards seem to be matching Russian production standards, and this is getting in collision with a country applying EU review standards on them, as opposed to a more "flexible" country like Hungary just shooting up their citizens' arms whatever Putin tells them to.

[Sheilbh]

Totally agree with this piece by Naomi O'Leary on how key databases are - linked to that thread from a UK journalist about how the bits of the UK response that have worked (furloughing, benefits changes, vaccines) have relied on existing electronic databases while the bits that failed (especially test and trace) tried to build new databases. That journalist suggested that the first question on any proposed policy (including, say, vaccine passports) should be where is the data stored and can the relevant systems talk to each other? It's not to say that building a new database isn't worth doing - just that it will be expensive, probably imperfect to begin with and quite slow, so not ideal in a crisis (e.g. at the heart of the UK vaccine roll-out is probably the 1992 decision to start digitising NHS records) 

Europe's vaccination no-shows: the likeliest explanation
Patchy health infrastructure and siloed databases may explain the leftover vaccines
Naomi O'Leary Europe Correspondent

Across Europe, vaccination efforts are running into the same issue: not everyone who is booked in for an appointment turns up, and vaccine doses are left over at the end of the day.

Understanding why someone is a no-show is not straightforward. They may have already received a vaccine elsewhere, and have been calling all morning trying to cancel. They may never have received the invitation because there was a flaw in the system, or their details were wrong.

In one incident in Brussels, only 3,000 of 11,000 primary care workers turned up for their first vaccine shot. The invitations were sent under a federal communications system, while the appointments were run by a regional health service that could not access the appointment data, and therefore did not know why less than a third of the expected patients appeared.

Aside from such extreme examples, experience across Europe is showing that it is difficult to precisely calibrate the preparation of vaccines so that all doses are used at the end of the day.

In Britain, "vaccinators are turning to police officers, firefighters, taxi drivers, teachers, supermarket staff and family and friends – anyone who can be contacted easily and is free to hotfoot it to the clinic at a few minutes' notice", the Guardian recently reported. A code of omertà prevails over the practice because of the risk of controversy over who is given the remaining vaccines.

In Italy the government issued a decree to address the matter. "Any vaccine doses remaining at the end of the day, if they cannot be stored, may exceptionally be administered to whoever is available at the time in order to optimise use while avoiding waste," it read.

At the heart of the issue is a mundane but crucial piece of healthcare: databases. Having strong digital infrastructure is a secret weapon in the pandemic.

In Estonia, one of Europe's most digitalised countries, 99 per cent of health data is digitalised in a centralised national database that allowed the course of disease outbreaks to be tracked long before the current pandemic. Doctors upload x-rays and test results, make referrals and prescriptions digitally, while the use of a distributed ledger or blockchain technology allows patients to check which doctor has had access to their files.

Ireland is on the other end of the scale, with patient records siloed across different services and an archaic reliance on paper throughout the system, which shocks healthcare workers with experience working abroad. Plans for a single digital patient health record – the most basic of first steps – remain plans. In contrast, Britain's National Health Service began funding GPs to digitalise in the 1980s, and introduced national health infrastructure in 1992.

In this context, it's not surprising that people who should have already been called up for vaccines have been accidentally left behind. The arrival of a vaccination invitation requires a number of steps underpinned by digital infrastructure. Bluntly, you're only Group 3 if the computer knows you're Group 3.

The condition that qualifies you to be in a particular vaccine priority group has to be registered in a recognisable format, in a searchable database, that the administrators of the vaccination programme can access. Your contact details must be correct, and the system for contacting you must work.

Doubling up

If all that functions, it's is very important for the person next in line for a shot that the clinic where you received a jab can inform the database that you have now received your dose. If the system doesn't know, if you are on multiple databases, or if you qualify under more than one priority group, you may continue to be invited repeatedly while others wait to be called – an occurrence that is thought to be behind many of Europe's no-shows.

Then, the system needs to know which vaccine you have been given, and when you need to be called back.

After a variety of system failures thwarted attempts to efficiently get vaccines into arms, Belgium has rigged up a digital patch on the fly.

It's called QVax, and it's an online platform where people can sign up to be put on a "reserve list" to be called up in place of no-shows. Clinics with spare vaccines at the end of the day can call people up from the list, in order of age, and invitations must be accepted within 30 minutes.

The system was mobbed with so many applications when it launched this week that there were hours-long waits to register. How successful it will be in getting jabs into arms remains to be seen. From tracing apps to passenger data forms, new digital systems invented during the pandemic have a mixed record. When emergency hits, it's best to already be prepared.

[Berkut]

From what I'm hearing from the in-laws it's basically a free for all in the US. You just randomly call vaccination locations and hope they happen to have an opening. Some even tried out of state, very Republican areas, and it worked like a charm 

It doesn't surprise me that it's far less regimented than here and there is something incredible in how much vaccine they're manufacturing and using. From what I can see they've used about 170 million doses plus the 30-50 million AZ they've made but not authorised and I've read reports that they're starting to reach the point where supply is outstripping demand. It's real Liberty Ship stuff and the chaos is probably part of that.

I told you guys this was going to happen.

I never once believed the "We won't have enough vaccine in the US until 2022!" crap once we had approved vaccines.

America might be a mess in a lot of ways, but when it comes to mass producing damn near anything, we are really, really, really fucking good at that.

[Sheilbh]

Sputnik really is the Trump of jabs

Sputnik V
@sputnikvaccine
Clarification from #Sputnik V team on 2 fake news today:
1) Report of a special investigation into #SputnikV clinical trials published in FT today is incorrect. Sputnik V team is going through a regular rolling review of EMA, in which good clinical practice (GCP) is a part of the standard procedure for all vaccines.
Sputnik V specifically invited EMA to conduct a rolling review and is showing full transparency. 59 countries already confirmed Sputnik V compliance with GCP and we expect EMA to do so as well.
Fake reports by anonymous sources try to undermine the objective nature of EMA review and we ask media to please follow official EMA and Sputnik V announcement to avoid spreading incorrect information.
@sputnikvaccine
2) Reports that somehow Sputnik V vaccine in Slovakia is different from Sputnik V in clinical trials citing anonymous sources are fake. Unfortunately, we also expect additional fake news and provocations from enemies of Sputnik V in Slovakia who try to undermine the vaccine.

I mean they're not anonymous sources - they're the Slovak regulator, no?

[viper37]

Sweden's pandemic experiment

Seems it is a failure, after all.  Who would have thought?
Oh, and you know the "we do not aim for her immunity at all, it is not a strategy" ?  Yeah, that was crap too.  In private, they admit they were aiming for herd immunity.  Which is still not attained.

On a gloomy afternoon in March, 2020, Angelica Jularbo, a nurse, was in her office at a high school in Stockholm, when one of her students came in complaining of a headache. Jularbo, a mother of four, projects the mixture of sternness and warmth that one expects from a nurse. In the previous month, COVID-19 had begun sweeping across Europe, but Swedish schools remained open. As Jularbo bent to take the student's temperature, the student coughed and then said, "Oh, maybe I should tell you, my partner has been diagnosed with corona." Jularbo ordered the student to go home immediately. "Don't go back to class to get your bag," she said. "We'll have someone bring it to you."

Four days later, Jularbo woke with a fever and a splitting headache. "I understand why people who are really sick, or people who are in excruciating pain, say, 'I just want to die,' " she told me. She was so tired that she couldn't leave her room for several days. One morning, she made tea and sat on the couch, determined to see her children off to school; she woke up to the sounds of them coming home, tea cool on the table. After nine days, the last two symptom-free, she went back to work. But a week later the headache and fever returned. She locked herself in her office to avoid exposing anyone. "I was so, so scared that I had made someone else in the office sick," she told me.
Read The New Yorker's complete news coverage and analysis of the coronavirus pandemic.

Jularbo's illness came at a pivotal time for Sweden. While lockdowns, curfews, and travel bans were being rolled out across the rest of the world, Swedish restaurants, stores, bars, museums, day cares, and elementary schools all remained open. People were encouraged to work from home and to reduce travel, but both were optional. Masks were not recommended and remained rare. Households could mix; until the end of March, even parties of up to five hundred people were allowed. The man behind Sweden's coronavirus response is Anders Tegnell, the country's head epidemiologist. Tegnell worked in Zaire during the 1995 Ebola epidemic, and then served as an expert on infectious diseases for the European Union before being hired by the Swedish public-health agency, in 2013.

The Swedish constitution gives government agencies extraordinary independence, so Tegnell and the public-health agency have led much of the coronavirus response, and, constitutionally, the government has little power to impose restrictions. Tegnell, who is sixty-four and tall, with round glasses, has often said that lockdowns are not supported by science and that the evidence for mask-wearing is "weak." His stance is a startling departure from the scientific consensus, but he maintains that if other countries were led by experts rather than politicians, more nations would have policies like Sweden's. The world has been left gawking. American liberals were shocked that the country of Greta Thunberg could seem so scientifically backward. Right-wing activists in Minnesota held up signs during anti-lockdown protests reading "Be Like Sweden." Within the country, Tegnell has become an icon of Swedish exceptionalism, believed to be excessively reasonable, levelheaded, and rational. Supporters praised him for not giving in to political panic. Wearing a mask in Sweden was sometimes seen as a signifier of being anti-science.

Jularbo has many friends and colleagues who contracted COVID-19, and her case was severe. But I met her in the "Anders Tegnell Fan Club" on Facebook, which contains a smorgasbord of multimedia tributes: T-shirts bearing his face, a chocolate figurine in his image, a poster with his face glowering above the words "Wash your hands." "I prefer to have medical experts making the decisions instead of maybe a prime minister who knows, excuse me, shit, about health and medical issues," Jularbo told me. She's not the only person in the group who has caught the coronavirus. Staffan Hugemark, a fifty-three-year-old who works at a software company, got sick along with his family after returning from a ski trip in northern Italy. Still, he recently had a falling out with an old friend who disagreed with Sweden's policies. "People look at Sweden and think that it's a disaster here, and it's not," he said. Viktoria Ellénius, a forty-seven-year-old former aesthetician, got sick early in the pandemic and couldn't work for weeks, which caused her to lose her skin-care business; she couldn't get a test, but she thinks she had COVID-19. Nevertheless, she believes that Tegnell's policies saved the country from the costs of a lockdown, including economic damage and widespread depression. "At the beginning, I didn't like Anders Tegnell," she said. "But the more I have heard about him, the more time has gone by, the more I love him."

Jularbo is now working with long-haul COVID-19 patients in the rehabilitation unit of a hospital in Eskilstuna, seventy miles west of Stockholm. She suffers from long-term symptoms herself, including lingering fatigue. "I've never been tired like this," she told me. "My alarm goes off, and it's like, shoot me. I don't care if my kids get to school on time. I don't care about anything." Still, she's proud of how Sweden's public-health agency has handled the pandemic. "They've been good. They haven't been running around listening to what everybody else does," she said. This winter, she messaged me, "I'm more worried about you living in the states. The pandemic is hitting hard."

Most mornings, my husband, who is Swedish, FaceTimes with his friends or family in Sweden. Early in the pandemic, the calls seemed like windows into ordinary lives, largely uninterrupted. Children had birthday parties and sleepovers. Adults met in restaurants and bars. A friend sent a video of a gym class in Stockholm—twenty people breathing heavily in a windowless room. My father-in-law is in his seventies and has a severe lung condition, which means that if he's infected with COVID-19, it's more likely to be fatal. But while my husband and I, in California, stayed home, he and my mother-in-law were still going out shopping and seeing friends without wearing masks. They're not reckless or uninformed people. My father-in-law is a retired engineer who reads the paper every morning, and we almost always agree about politics. Yet every time we suggested that perhaps they should be wearing masks when they went to, say, a bar, we were met with polite skepticism. My father-in-law recently discussed masks with his lung doctor, a senior physician at one of the country's top hospitals, whose advice was that the only reason one might consider wearing one was because other people would think you were sick and give you more space. This was the philosophy my in-laws adopted. A healthy person "can't wear a mask in Sweden," my mother-in-law told me, in October. "People will look at you like you are a very strange person." The Swedish health agency communicated to the public that there was insufficient evidence that masks prevent transmissions, that they are often used incorrectly, and that they could be used as an excuse not to distance properly, which would be harmful.

Tegnell introduced the country's light-touch approach to the pandemic in March, as cases were mounting. Internal e-mails obtained by the freelance journalist Emanuel Karlsten show that the government at least considered whether the strategy might lead to more widespread immunity. In an e-mail exchange between Tegnell and the head of the Finnish public-health agency, on March 14th and 15th, Tegnell suggested that keeping the schools open could help the young and healthy develop immunity sooner. His Finnish colleagues noted that their models found that closing schools would decrease the infection rate among the elderly by ten per cent. Tegnell responded, "Ten percent might be worth it?"

[...]

[Threviel]

Yeah, the mortality statistics are crystal clear, Sweden really stands out as an extreme Nurglish hellscape.