Coronavirus Sars-CoV-2/Covid-19 Megathread

[Barrister]

Interesting report last week on a rare blood clot condition reports in the US (so Pfizer and Moderna vaccines) - and it could well be there's something to look at with all the current vaccines. But there's a huge difference in how this has been reported, which I think is more responsible:
https://www.health.com/condition/infectious-diseases/coronavirus/rare-blood-disorder-covid-vaccine-thrombocytopenia

Again no-one's been able to establish a causal connection but interesting nontheless.

So Sheilbh, the article describes a disease called ITP, immune thrombocytopenia.  It's actually the opposite of a blood clot condition - in ITP you don't have enough platelets which cause clotting, which can lead to internal bleeding.

I actually had ITP as a kid, and spent time in hospital.  For me it mostly meant I got lots of nosebleeds, and those nosebleeds could last a really long time before stopping.  Your normal platelet readings are between 150 to 450 according to the article - I once had a reading of 16.

Ultimately for me they tried waiting it out (in kids it often goes away), they put me on low-dose chemotherapy drugs (which made me feel like shit, I had tons of sympathy for anyone who gets that stuff on full dose), and ultimately they had to take my spleen out.

But again the article says 1 in 35,000 will present with ITP.  As the US is now vaccinating millions, it could well be unconnected.

[Sheilbh]

Yeah and there may be nothing to it but it just seems interesting that there are reports on both sides of the Atlantic of all three vaccines possibly interacting with blood clotting/not - especially because I swear that is one of the weird symptoms that some people develop with covid. The EMA have also been had reports of low blood platelet with all three vaccines because there have been ITP cases with all three vaccines.

No-one's identified a causal link. From what I've read it's generally at the level you'd expect in the general population, and I think the far higher risks of covid far outweigh this small risk. It just seems potentially interesting and worth investigating.

[Barrister]

So Sheilbh, the article describes a disease called ITP, immune thrombocytopenia.  It's actually the opposite of a blood clot condition - in ITP you don't have enough platelets which cause clotting, which can lead to internal bleeding.

I actually had ITP as a kid, and spent time in hospital.  For me it mostly meant I got lots of nosebleeds, and those nosebleeds could last a really long time before stopping.  Your normal platelet readings are between 150 to 450 according to the article - I once had a reading of 16.

Ultimately for me they tried waiting it out (in kids it often goes away), they put me on low-dose chemotherapy drugs (which made me feel like shit, I had tons of sympathy for anyone who gets that stuff on full dose), and ultimately they had to take my spleen out.

But again the article says 1 in 35,000 will present with ITP.  As the US is now vaccinating millions, it could well be unconnected.

You know it happened so long ago I never even think abut the fact I have no spleen, but typing this out to Sheilbh reminded me, and I went to look at the Alberta vaccine priority list that was recently announced.  It was literally the first thing on the list (it is an alphabetical list and they listed it under asplenia).

Right now they're still just focusing on older people (they just started on 65-74), but I'm in the next category to be opened up.



BMI of over 40 is also listed.  I don't know what Mrs B weighs but she's at least in the ballpark.  I mentioned it to her but I don't think she wants to admit whether she would or would not qualify.     She's less worried in any event because she did test positive back in the fall. 

[Barrister]

Yeah and there may be nothing to it but it just seems interesting that there are reports on both sides of the Atlantic of all three vaccines possibly interacting with blood clotting/not - especially because I swear that is one of the weird symptoms that some people develop with covid. The EMA have also been had reports of low blood platelet with all three vaccines because there have been ITP cases with all three vaccines.

No-one's identified a causal link. From what I've read it's generally at the level you'd expect in the general population, and I think the far higher risks of covid far outweigh this small risk. It just seems potentially interesting and worth investigating.

I've more usually seen ITP as an abbreviation for idiopathic thrombocytopenia - idiopathic means unknown cause.  So something like that would be really hard to track down of there's a connection.

[Barrister]

You know I'm just kind of freaked out that in the 12 months of Covid it never once crossed my mind I was in a high-risk category.  I'm not sure if I would have done anything differently, but now I'm wondering if I have been overly reckless.   

[Sheilbh]

Did you guys do shielding letters? Here people in the oldest groups and with very high risk clinical conditions were sent letters telling them they were very high risk and needed to shield.

I never got one but did not realise I was considered high risk because of some immune suppressing medication I take until I got asked to schedule a vaccination

[Barrister]

Did you guys do shielding letters? Here people in the oldest groups and with very high risk clinical conditions were sent letters telling them they were very high risk and needed to shield.

I never got one but did not realise I was considered high risk because of some immune suppressing medication I take until I got asked to schedule a vaccination

No, never heard of them before now.  Medical records are centralized but not that automated - someone would've needed to go through everyone's medical records individually.

I mean I'm not in some crazy high risk category - I'm lumped in with cancer patients, pregnant women, diabetes, people on immune-suppressing drugs, serious respiratory diseases, that kind of thing.  They didn't attempt to sub-categorize levels of higher risk.  In any event there's no verification - you don't need a doctor's note or anything.  Which is good because other than an abdominal surgery scar you'd never know I was spleenless.

[Legbiter]

We have vaccinated nearly all of our oldies in the past 10 weeks....meanwhile the old folk die at the rate of roughly 10,000 per week....this means that tens of thousands of Brits died shortly after having their vaccination. Now, what is an innumerate moron to make of these facts? Stop the vaccine now !!! 

Yeah exactly.

Well it looks settled then. The Legbiter family will have this year's beach holiday in...Blackpool.

[PDH]

Well it looks settled then. The Legbiter family will have this year's beach holiday in...Blackpool.

I'm going up the 'Pool
From down the smoke below
To taste me mum's jam sarnies
And see our Aunty Flo.

[alfred russel]

BMI of over 40 is also listed.  I don't know what Mrs B weighs but she's at least in the ballpark.  I mentioned it to her but I don't think she wants to admit whether she would or would not qualify.     She's less worried in any event because she did test positive back in the fall.

So my bro has cerebal palsy and a heart condition...100% would qualify under current Georgia standards. But I would never mention to him the idea of claiming he has a medical condition because he has refused to in any way acknowledge it since he was a kid. He might choose dying of covid before admitting he has a disability.

Alabama and South Carolina seem to have more vaccine than Georgia does, probably due to the higher concentration of idiots, and he got his first shot by going to South Carolina and using up their supply (they have looser standards and no residency requirement).

[Syt]

So Austrian chancellor Kurz addressed the press today, saying the EU needs to find a correction mechanism for the vaccine distribution, because it would be not fair if some members countries finish vaccinating their population months before others.

He's making this demand after
- opting out of parts of the initial distribution, thinking going all in on AstraZeneca would be faster and cheaper
- whining about missing a time window to opt in on the distribution of leftovers of the initial distribution

[Sheilbh]

Yeah - I had some sympathy with some EU countries opting out of bits of their initial allocation. I know that Bulgaria massively cut their amount of Pfizer supplies, because it was the more expensive option. But I think the economic benefit of safe re-opening will massively outweigh the cost of slightly expensive vaccines and I have zero patience with a more well-off country like Austria making that decision

[Zanza]

I read a bit about the Paul Ehrlich Institute that is responsible for vaccine regulation in Germany. Its fairly independent from the health ministry and not a political institution.

They said they have a legal obligation to investigate the potential new side effects and stop the vaccination campaign for that. They even pointed out that the risk of more Covid deaths from stopping now probably outweighs the damage from the potential new side effect. So this was not a political decision, but driven by legal rules.

It is fair to question whether in cases like this the politics should overrule strict legalism and independence of regulatory authorities. But that legalistic inddpendent setup is a defining feature of Germany's constitutional and societal order and generally considered a strength.

[Barrister]

Apparently President Biden said today they are in talks with countries about using up US surplus vaccines and would let people know very shortly.

https://twitter.com/CBCKatie/status/1371891568215490565

(Tweeter is CBC's Washington-based correspondent)

[Sheilbh]

I read a bit about the Paul Ehrlich Institute that is responsible for vaccine regulation in Germany. Its fairly independent from the health ministry and not a political institution.

They said they have a legal obligation to investigate the potential new side effects and stop the vaccination campaign for that. They even pointed out that the risk of more Covid deaths from stopping now probably outweighs the damage from the potential new side effect. So this was not a political decision, but driven by legal rules.

It is fair to question whether in cases like this the politics should overrule strict legalism and independence of regulatory authorities. But that legalistic inddpendent setup is a defining feature of Germany's constitutional and societal order and generally considered a strength.

Yeah - that's important context. And acting now would be politican interference.

Having said that I don't think that a political institution is the only alternative. So from my understanding the duty of regulators in the UK is to make decisions and apply the rules on the basis of risk and harm, rather than a more stricly legalist framework - they're still independent but the approach and sort of theory of what their job is is different. And regulators and public bodies applying their professional judgement have not necessarily had a great year, because there is no perfect system and each one will have blindspots of its own.

But it feels like this will more or less end the AZ roll out in a number of member states. The Italian regulator has admitted that their decision was political - they couldn't keep using a vaccine that France and Germany had suspended. As I say there's been a seizure by the police of 400k doses in Italy and apparently trust in the AZ vaccine has collapsed to 20% in France - I don't see how those countries will be able to go back to getting people trusting and willing to get that vaccine.

FWIW - re Brexit/anti-British sentiment is that that wasn't really a factor - but I think Europeans may slightly think the UK is a cowboy so more willing to believe stories about dodgy decisions here (see the EMA statement when the Pfizer vaccine was authorised, the reaction to the delayed second dose approach and that quote from an EU official that there's a "cultural difference" ). My conspiracy theory is that while the AZ trial data was a mess compared to Pfizer and Moderna, I find it striking that there have been so many negative stories about the vaccine that's being produced at cost v at a profit

Edit: Incidentally interesting take on the PEI's Q&A:

Leonardo Carella
@leonardocarella
German health ministry's statement on the AZ suspension decision. It's worth reading in full to understand the rationale: at the heart of the matter lies a legal, not a medical concern. https://bundesgesundheitsministerium.de/coronavirus/faq-covid-19-impfung/faq-impfung-astrazeneca.html#c20800

I made fun of the idea, advanced by the Minister-President of Baden-Württemberg, that Germany's slow vaccination rollout is because they're Kantians. But this is pure deontological ethics: the mindset of people who'd let the trolley barrel down on the track with 5 people on it.
(I don't want to be That Essentialist Person™, but Germans do seem to have a deep-seated problem with utilitarian trade-offs in government: from nuclear energy to foreign intervention, there's a strong tendency to minimise responsibility even at the risk of greater harm.)
For the record, I think legal positivism is an excellent way to run a country ~90% of the time. Just not in this particular case, verdammt.