Coronavirus Sars-CoV-2/Covid-19 Megathread

[Sheilbh]

Flipping to Tyr's position on supplies to the North-East and Yorkshire and North-West now because we've now had 4 days where things are significantly lower than they were last week and I wonder if it's some places slowing down while other catch up - which is a bad idea. From what I can see the two main theories are that it's either supply issues or slowing down to focus on finishing care homes (which are slower) and the last 20% of the over 80s who may be tough to deliver.

The stats on the weekly update are getting more detailed which is helpful. There's a breakdown of vaccine by ethnicity and age now (plus population estimates of the over 80s per region/NHS Trust area). And there's huge variance - Gloucestershire's done over 90% of the over 80s and the lowest is my area () in South East London which is just over 60%. It feels like part of it is definitely reluctance in minority communities and I understand there are a series of targeted campaigns in those communities - I know black Labour and Tory MPs did a video together encouraging people to get the vaccine and there's other engagement going on. I've read several people say that in their family there's basically the WhatsApp equivalent of chain letters circulating among British-Asian elders, largely alleging that the vaccines include animal product so either aren't halal or contain cow products, and there's a big concerted pushback from Mosques and Temples on this issue in particular.

But it's not clear - as I mentioned before London got a proportionately too small delivery in the last round so I don't know if we're still catching up from that which may be why London in general is around 65% while the rest of the country is 80%, or it may be that London's more diverse and the take-up rate is far lower in BAME communities. It might just be supply because while some of the lower areas are also quite diverse (Birmingham, Leicestershire, Nottinghamshire) on the other hand there are some areas that are similarly low that are nowhere near as diverse (Surrey, Suffolk and Essex, Kent). It's not clear yet and would be interesting to know.

If the issue is very low take up in BAME communities then hopefully we can fix that now because generally speaking I think there are younger cohorts will be a lot more diverse than the over 80s.

[Sheilbh]

UK death rate 7 day rolling average finally started declining and it looks like the number of patients in hospitals and ICUs has peaked.

What an awful, avoidable disaster of a winter (assuming we don't now lift lockdown immediately and start the cycle again which is always a possibility.

Edit: Novavax vaccine shows 90% effectiveness against the new UK and South African variants - still to be approved obviously but very good news. And apparently India as well as ordering a lot of AZ has ordered 1 billion doses of Novavax so that data is great

[11B4V]

UK death rate 7 day rolling average finally started declining and it looks like the number of patients in hospitals and ICUs has peaked.

What an awful, avoidable disaster of a winter (assuming we don't now lift lockdown immediately and start the cycle again which is always a possibility.

Edit: Novavax vaccine shows 90% effectiveness against the new UK and South African variants - still to be approved obviously but very good news. And apparently India as well as ordering a lot of AZ has ordered 1 billion doses of Novavax so that data is great

CNN showing 60% v SA variant

[mongers]

Still early days 81million vaccinated vs 100+ million official cases.

Out of what, 8 billion of us, so about 1%+1% affected so far.

I don't think 'we' can afford to let this spread to 40-80% of the world's population and hope there aren't any more nasty variants that'll evolve out of all those opportunities.

There needs to be a clear international plan decided upon by the world's institutions and major states in order to combat the virus.

Vaccine nationalism seems like the latest toxic variant to emerge from the coronavirus.

[mongers]

UK death rate 7 day rolling average finally started declining and it looks like the number of patients in hospitals and ICUs has peaked.

What an awful, avoidable disaster of a winter (assuming we don't now lift lockdown immediately and start the cycle again which is always a possibility.

Edit: Novavax vaccine shows 90% effectiveness against the new UK and South African variants - still to be approved obviously but very good news. And apparently India as well as ordering a lot of AZ has ordered 1 billion doses of Novavax so that data is great

Good news, but it's still an average at 1,220 per day, down by just 20-30 from the possible peak.

[celedhring]

Spain's GNP fell 11% in 2020. The only two larger drops on record happened during two civil wars (1936 and 1868)...

That's actually better than IMF's 12.8% projection but hot damn.

[Sheilbh]

CNN showing 60% v SA variant

Yeah I misread on the SA variant. They're apparently formulating an SA booster.

I don't think 'we' can afford to let this spread to 40-80% of the world's population and hope there aren't any more nasty variants that'll evolve out of all those opportunities.

There needs to be a clear international plan decided upon by the world's institutions and major states in order to combat the virus.

Vaccine nationalism seems like the latest toxic variant to emerge from the coronavirus.

Absolutely. We need a pretty rapid plan for vaccines to be manufactured and distributed worldwide. It's a moral but also just an economic/pandemic-response  duty. The GAVI commitment is a good start (and the reports that the US will join up could be transformative).

On vaccine nationalism I agree - but I think it's a bit like PPE. When a crisis hits, it's kind of inevitable that states are likely to restrict or limit exports. As with PPE I think the key is probably to support a bit of on-shoring of pharma manufacture, because it's too important to rely on global supply chains in a crisis.

Again I thought Blair's take in the Independent was right and there's some good ideas:

This is not even the end of the beginning – we need a completely new approach to Covid-19
Virus anywhere is virus everywhere – taking global action therefore ceases to be only a matter of altruistic engagement and becomes one of enlightened self-interest
Tony Blair

It is now clear that what we are dealing with is not a crisis with a beginning and an end, but a new state of the world. This is no criticism of governments, which have been struggling with a challenge more profound than any faced in modern history. Yes, some governments have done better than others; but this challenge is unique in complexity and scale.

We should recognise that, so far, the virus has moved with greater agility and intelligence than humanity. The virus has mutated; the new strains are more transmissible yet not apparently less deadly. It will continue mutating. Vaccines will likely require adjustment to beat such mutations; and there is an outside, but not unfortunately negligible, risk that, at some point, unless we get ahead of the virus, there will be a mutation not susceptible to vaccine, in which case we will need a new range of antiviral and other biologics to counter it, as the world has learnt to do with HIV/AIDS.

No country has been able to eradicate Covid-19 except by total isolation – a policy that is neither replicable for countries like Britain, nor sustainable over time. Even in China, South Korea, Australia and New Zealand, despite the most stringent curbs, the disease can't be eradicated completely and in any event, at some point isolation must end for economic reasons. A country's population expects its leadership first to look after them. 

But there is something else becoming obvious if it wasn't already: virus anywhere is virus everywhere. Taking global action therefore ceases to be only a matter of altruistic engagement and becomes one of enlightened self-interest. The world and every country in it has paid a heavy price for the failures of global cooperation in 2020.

The question which should be asked of policymakers in government is not what is possible, but what is necessary. It is true that extraordinary efforts have been made, and that systems have been under the most intense strain doing everything that is possible to combat Covid-19. But the blunt fact is: it hasn't been enough.

This year was supposed to be the year we returned to some sort of normal. Right now, we can't even be sure that this year won't be worse than last year. That is a horrible thing to say, but the sooner we confront reality, the sooner we make that prospect much less likely.

Policy makers essentially believed in March 2020 that there would be three phases to Covid-19. In the first, we would lock down to get the disease under control. In the second, we would keep some restrictions in place combined with measures, such as test and trace, as we kept the disease under control and waited for the vaccines. Then there would be a third phase where we vaccinated over the course of 2021 and we would be ready for "normal".

What has happened is that with mutation, phase two collapsed. The choice we have been left with is: mass vaccination or mass lockdown.

As a result, there has been a disorderly concertina-ing of the timeframe for vaccination. Last year, many countries were negotiating with the vaccine makers as if it was a buyer's market. Now there is a mad scramble for vaccines, with vaccine nationalism more rampant than that of PPE in the early stages of the pandemic.

We need to learn the lessons of the past year in order to make this year different and better.

It is true that getting vaccines to distribution in 10 months is, by conventional standards, miraculous. But the miracle is insufficient measured against the nature of the pandemic. We need to make possible what at present is impossible: getting from analysis of any new strain to vaccine development to vaccine production in a matter of weeks. And to be able to manufacture such vaccines at enormous scale. And the same with antiviral and other biologics.

This requires a completely new approach, which recognises that the present national and global health infrastructure has failed and that the market cannot perform this task. The weaknesses nationally and internationally are manifest, and not correctable without a plan involving a partnership between public and private sector and between governments.

I believe every larger-population nation – certainly in the developed world and many in the developing world – will face a demand from their people that they have national capacity for vaccine production and associated bioscience capability.

And the world must come together to make sure that such capacity exists on every continent, with provision in place for the fair and equitable distribution of all that is necessary to combat the disease effectively.

The capability will contain at least the following elements:
1) Vaccine, antiviral and biologics development at speed
2) Research and development – including the rapid development of antiviral and vaccines platforms that are capable of adding multiple strains quickly
3) Comparable data – the lack of standards has made the surveillance and health management effort harder
4) Distribution mechanisms which are instantaneous
5) Tests for disease which are rapid at point of use and as accurate as traditional PCR
6) Data systems which capture all relevant data fast and in comprehensive form
7) Surveillance systems which allow early tracking and discovery of disease and mutation

In the short term, we must ensure the fast sequencing and clinical characterisation of any new strain; repurposing of bioreactor and other capacity for the manufacture of vaccine; development of better rapid tests; proper coordination between the main credible regulatory bodies for speedy clearance of new drugs; an overhaul of clinical trial procedures; and advice from a high-level group, including science, medicine, pharma industry, manufacturing, distribution and logistics, to guide governments in decision making.

At the same time, we should start to put in place the long-term global health infrastructure which will mean we are on top of future pandemics.

But it all starts with a recognition that up to now, the virus has been smarter and swifter than us; and this is what must change.

[Admiral Yi]

Covid detecting dogs.

https://www.youtube.com/watch?v=YiqUcS3UZVY

[The Larch]

It seems that the Chinese vaccine is not as effective as its makers claimed it to be:

Sinovac: Brazil results show Chinese vaccine 50.4% effective

A coronavirus vaccine developed by China's Sinovac has been found to be 50.4% effective in Brazilian clinical trials, according to the latest results released by researchers.

It shows the vaccine is significantly less effective than previous data suggested - barely over the 50% needed for regulatory approval.

The Chinese vaccine is one of two that the Brazilian government has lined up.

Brazil has been one of the countries worst affected by Covid-19.

Sinovac, a Beijing-based biopharmaceutical company, is behind CoronaVac, an inactivated vaccine. It works by using killed viral particles to expose the body's immune system to the virus without risking a serious disease response.

Several countries, including Indonesia, Turkey and Singapore, have placed orders for the vaccine.

Last week researchers at the Butantan Institute, which has been conducting the trials in Brazil, announced that the vaccine had a 78% efficacy against "mild-to-severe" Covid-19 cases.

But on Tuesday they revealed that calculations for this figure did not include data from a group of "very mild infections" among those who received the vaccine that did not require clinical assistance.

With the inclusion of this data, the efficacy rate is now 50.4%, said researchers.

But Butantan stressed that the vaccine is 78% effective in preventing mild cases that needed treatment and 100% effective in staving off moderate to serious cases.

The Sinovac trials have yielded different results across different countries.

Last month Turkish researchers said the Sinovac vaccine was 91.25% effective, while Indonesia, which rolled out its mass vaccination programme on Wednesday, said it was 65.3% effective. Both were interim results from late-stage trials.

There has been concern and criticism that Chinese vaccine trials are not subject to the same scrutiny and levels of transparency as its Western counterparts.

Both the Sinovac vaccine and the vaccine developed by Oxford University and pharmaceutical firm AstraZeneca have requests for emergency use authorisation pending with regulators in Brazil.

The latest news comes as Brazil is dealing with a major spike in cases. The country currently has the third highest number of Covid-19 cases in the world at over 8.1 million, just behind the US and India.

The BBC World Service's Americas editor Candace Piette says the country is suffering one of the world's deadliest outbreaks but as yet, has not announced when its vaccination programme will begin.

The delay has been caused in large part by the government's haphazard and divided approach to vaccination, says our correspondent.

[The Larch]

And in news that go unconfortably together...

Hungary, which last week became the first EU member to buy Russia's Sputnik V vaccine, has become the bloc's first to approve China's Sinopharm Covid-19 vaccine, Reuters reports.

Prime minister Viktor Orban told state radio his government was closely monitoring the outcome of mass inoculations with the vaccine in neighbouring Serbia. Orban also said he would personally choose the Chinese vaccine as he trusted it the most.

Tamas, there you have more facepalm fodder. 

[Sheilbh]

EU have published the AZ contract. I'm not a Belgian lawyer so it might be different, but having quickly read it I think that AZ are more correct than the briefings from the Commission. There's one point (which is actually kind of crucial) that is arguably a little bit ambiguous. There may be different facts around when AZ knew what and what AZ were telling the EC around this contract, but just based on the terms it doesn't seem like they're in breach.

Honestly it looks (and this is something I have a fair amount of experience in having lived in the UK for the last 5 years) like the Commission is possibly trying to find someone else to blame for issues they're encountering.

Edit: Oh and weekly ONS survey is out and provides further evidence that lockdown works for the new UK variant - this will be relevant for Europe because I think it's definitely present there and will probably become the dominant strand in the next few months in some countries, but also the US where it's now been detected in 26 states. I understand the UK (which does a lot of covid sequencing) have offered to start sequencing for other countries with lower capacity and it might be helpful for some locations just to be aware if this (or the SA variant, or Brazil variant) are out there:

I'm sure there's a good reason but I am slightly stressing out about the "variant not identifiable" which is rising and not identifiable

[Tamas]

And in news that go unconfortably together...

Hungary, which last week became the first EU member to buy Russia's Sputnik V vaccine, has become the bloc's first to approve China's Sinopharm Covid-19 vaccine, Reuters reports.

Prime minister Viktor Orban told state radio his government was closely monitoring the outcome of mass inoculations with the vaccine in neighbouring Serbia. Orban also said he would personally choose the Chinese vaccine as he trusted it the most.

Tamas, there you have more facepalm fodder. 

I am absolutely 100% convinced Orban was among the very first to be vaccinated from the first Pfizer shipment. It would be extremely uncharacteristic both for him and the regime he built not to have been so. I remember the first EU-wide shipment was 10 000 vials for each country. The official Hungarian report said 9 750 vials. So there you go, the leadership is already vaccinated.

He must have made a pretty sweet deal with the Chinese supplier. Today there has also been a government decree that the Chinese vaccine can be imported without the approval of the regulator normally in charge of letting new meds/vaccines into the country. For the Chinese one, signature from the Foreign Minister will be sufficient.

[Sheilbh]

In other good news single-shot J&J vaccine was 66% effective at preventing moderate disease, 85% effective against severe illness and 100% effective at prevent death (in the trials). It performs less well against the SA variant (trials were in the US and SA).

Which is very good news because a single shot vaccine will be really helpful and I think it can be stored at fridge temperature like AZ - and for all the narrative around vaccines in Europe this week, the EU has ordered 400 million doses of the J&J vaccine so it may be a game-changer in many countries.

[Zoupa]

I don't read that as very good news at all. I guarantee you that J&J will delay vaccine roll-out (again) until they get data on their 2-doses study, which will show an efficacy similar to Pfizer and Moderna (I think).

[Sheilbh]

I don't read that as very good news at all. I guarantee you that J&J will delay vaccine roll-out (again) until they get data on their 2-doses study, which will show an efficacy similar to Pfizer and Moderna (I think).

Ah okay - would regulators not be able to authorise both at which point health systems can make their risk decision (and the NHS would choose single dose).

EMA has approved AZ vaccine for all ages over 18, Germany has restricted the use to under 65s only given a lack of data and other countries may follow. But hopefully, once the supply issues are resolved, this will be a big help (and unlike Pfizer there is evidence that the vaccine is still effective after 12 weeks so a delayed second dose policy would be very easy to get behind).

Edit: Incidentally - Serbia is doing really well on rolling out vaccines I don't know which ones they're using but this is great because of the "virus anywhere is virus everywhere" point which seems particularly a risk within Europe in the Western Balkans:
https://ourworldindata.org/grapher/daily-covid-vaccination-doses-per-capita?tab=chart&stackMode=absolute&time=earliest..latest&region=World