Covid

[alec]

Economists are beginning to get a handle on the impacts of long covid -

[alec]

Paper on schools masking study here - www.nejm.org/doi/full/10.1056/NEJMoa2211029?query=featured_home

Masks were able to reduce covid cases by 30%, with is pretty extraordinary for a single public health intervention. The beauty of this study is that it gives a 'before and after' assessment, with all other variables remaining equal, and is one of the most powerful real world examples of the now very substantial body of evidence that masks really do work very well as part of a coordinated public health strategy to suppress airborne virus transmission.

To claim mask wearing doesn't work is now simple anti-science and fake news. Time to move on.

[c-a-r-f-r-e-w]

“Getting Covid more than once doubles the risk of death, a study has found.

Data from almost 500,000 US veterans found that repeated infections also increase the likelihood of issues with a person’s lungs, heart, brain, blood, muscles and digestive system.

People who caught the virus more than once were found to be twice as likely to die and three times more likely to be hospitalised than people only infected once.

Those who were infected repeatedly were three and a half times more likely to end up with lung problems, three times more likely to get a heart condition and one and a half times more likely to have brain problems, compared with those who caught the virus just once.

The risk appears to increase with each infection, with a three-time infected patient more at risk than a two-time Covid sufferer.”


…

“Researchers from Washington University said some people have developed an “air of invincibility” after having Covid and their jabs.

"Some people started to refer to these individuals as having a sort of superimmunity to the virus,” said Prof Ziyad Al-Ali, study author.”



"Without ambiguity, our research showed that getting an infection a second, third or fourth time contributes to additional health risks in the first 30 days after infection, and in the months beyond.

“Even if you've had two Covid-19 infections, it's better to avoid a third, and if you've had three infections, it's best to avoid the fourth.”

…

The study, published in Nature Medicine, involved a database of 5.8 million anonymised medical records from the US.

The team focused on the health outcomes of 443,000 people who had tested positive once and 41,000 people who were infected twice or more between March 2020 and April 2022.

…

“Reducing overall burden of death and disease due to Sars-CoV-2 will require strategies for reinfection prevention.”

…

“Writing in the paper, the study authors said they believe this study to be the first of its kind.”

From the Telegraph.

[c-a-r-f-r-e-w]

Meanwhile from Reuters, on the same study…

"Reinfection with COVID-19 increases the risk of both acute outcomes and long COVID," said Dr. Ziyad Al-Aly of Washington University School of Medicine in St. Louis. "This was evident in unvaccinated, vaccinated and boosted people."

…

“Experts not involved with the study said the VA population does not reflect the general population.

Patients at VA health facilities are generally older, sicker people and often men, a group that would typically have more than normal health complications, said John Moore, a professor of microbiology and immunology at Weill Cornell Medical College in New York.

The researchers said cumulative risks and burdens of repeat infection increased with the number of infections, even after accounting for differences in COVID-19 variants such as Delta, Omicron and BA.5.

However, Dr. Celine Gounder, an infectious disease epidemiologist and an editor-at-large at Kaiser Health News, said there seemed to be a "plateauing effect with multiple infections," with less of a jump in risk after the second infection.”

[alec]

c-a-r-f-r-e-w - interesting. I think this is the formal publication (link here www.nature.com/articles/s41591-022-02051-3 ) of data that has previously been released as a pre print, as the study and numbers look familiar, although I think it looks like it has been updated to include some Omicron infections.

This information really needs to get out there. As the paper states; "Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention."

The science is now very clear on this, with multiple studies from various disciplines and different approaches all pointing to the same conclusion, that covid caused a significantly increased burden of ill health and death, even after vaccination and prior infections.

[alec]

c-a-r-f-r-e-w - this is also apposite - www.medrxiv.org/content/10.1101/2022.05.23.22275458v4

"Deaths among US CYP [children and young people] are rare in general, and so we argue here that the mortality burden of Covid-19 in CYP is best understood in the context of all other causes of CYP death. Using publicly available data from CDC WONDER on NCHS’s 113 Selected Causes of Death, and comparing to mortality in 2019, the immediate pre-pandemic period, we find that Covid-19 mortality is among the 10 leading causes of death in CYP aged 0-19 years in the US, ranking 8th among all causes of deaths, 5th in disease-related causes of deaths (excluding accidents, assault and suicide), and 1st in deaths caused by infectious or respiratory diseases. Covid-19 deaths constitute 2.3% of the 10 leading causes of death in this age group. Covid-19 caused substantially more deaths in CYP than major vaccine-preventable diseases did historically in the period before vaccines became available. Various factors including underreporting and Covid-19’s role as a contributing cause of death from other diseases mean that our estimates may understate the true mortality burden of Covid-19."

[Danny]

Nov 10, 2022 22:23:13 GMT alec said:

c-a-r-f-r-e-w - interesting. I think this is the formal publication (link here www.nature.com/articles/s41591-022-02051-3 ) of data that has previously been released as a pre print, as the study and numbers look familiar, although I think it looks like it has been updated to include some Omicron infections.

This information really needs to get out there. As the paper states; "Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention."

The science is now very clear on this, with multiple studies from various disciplines and different approaches all pointing to the same conclusion, that covid caused a significantly increased burden of ill health and death, even after vaccination and prior infections.

The study is based upon data gatherd by the US armed forces Veterans health organisation? Like....retired soldiers. Like...retired. Ok, soldiers dont keep soldiering till 65, but this is an organisation primarily concerned with administering health and pension benefits for retired soldiers.

The study compares outcomes between subjects reported as catching covid one time, and others reported as catching it twice or repeatedly. Theres a pretty obvious problem with this, because it is not accounting for all the people who caught covid once, were re-exposed to the virus but then failed to show any recordable covid symptoms. if you do a study where you leave out all the people who do well after catching covid once , then its going to report people doing badly after catching covid once.

Put it another way, there is no way from this study of telling how many of the allegedly 5 million control group subjects who are reported as never having covid, were actually never exposed to covid or had covid but either didnt notice anything or never reported covid. It is not a valid control group.

What the study is detecting is a self selecting pyramid of highly susceptible people who because they were at outset highly susceptible, had repeat covid infections.

This is absoultely NOT a proper controlled trial. Its just another example of the problem which has bedevilled covid study since the chinese first reported they had 100 hospitalised patients with a new disease who were all very ill and many like to die. This gave the impression covid is a universally fatal disease which it simply isnt. Rather the reverse is true, 999/1000 people who have been exposed to the disease survive and by now probably most do not even notice they were infected. And once age is taken into account (again with reference to this study which was amongst VETERANS by definition older than the average of the population), the risk of a bad outcome if you are young is WAY smaller, but if you are already old and sick/overweight, then watch out. But if thats true, then your remaining lifespan is already limited, covid is not at all the worst thing you have to worry about.

[alec]

Danny

You should try reading the science before pretending to understand it.

[c-a-r-f-r-e-w]

Nov 10, 2022 22:23:13 GMT alec said:

c-a-r-f-r-e-w - interesting. I think this is the formal publication (link here www.nature.com/articles/s41591-022-02051-3 ) of data that has previously been released as a pre print, as the study and numbers look familiar, although I think it looks like it has been updated to include some Omicron infections.

This information really needs to get out there. As the paper states; "Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention."

The science is now very clear on this, with multiple studies from various disciplines and different approaches all pointing to the same conclusion, that covid caused a significantly increased burden of ill health and death, even after vaccination and prior infections.

Apols I didn’t reply sooner, but been a bit busy. Anyways, well the Reuters comment kind of puts a different slant on things - a sample more likely to have health issues, possible plateauing effect etc. - but I find myself erring on the side of caution for various reasons.

[c-a-r-f-r-e-w]

Nov 10, 2022 22:28:43 GMT alec said:

c-a-r-f-r-e-w - this is also apposite - www.medrxiv.org/content/10.1101/2022.05.23.22275458v4

"Deaths among US CYP [children and young people] are rare in general, and so we argue here that the mortality burden of Covid-19 in CYP is best understood in the context of all other causes of CYP death. Using publicly available data from CDC WONDER on NCHS’s 113 Selected Causes of Death, and comparing to mortality in 2019, the immediate pre-pandemic period, we find that Covid-19 mortality is among the 10 leading causes of death in CYP aged 0-19 years in the US, ranking 8th among all causes of deaths, 5th in disease-related causes of deaths (excluding accidents, assault and suicide), and 1st in deaths caused by infectious or respiratory diseases. Covid-19 deaths constitute 2.3% of the 10 leading causes of death in this age group. Covid-19 caused substantially more deaths in CYP than major vaccine-preventable diseases did historically in the period before vaccines became available. Various factors including underreporting and Covid-19’s role as a contributing cause of death from other diseases mean that our estimates may understate the true mortality burden of Covid-19."

It seems that constituting 2.3% of the leading causes might not be enough for everyone? Some might argue about how one might better spend the money elsewhere etc., though I’m not sure how well that stacks up?

[Danny]

Nov 20, 2022 14:13:26 GMT alec said:

Danny - "And when I point out these failings you do not make a reasoned explanation why I am wrong. You make personal insults."

No I don't.

ok...

"you're obviously too dim to understand them"..... "you do talk shit, don't you?"..." I've concluded that you are a simple troll."

Then I wonder how you address people you are trying to insult if these do not count as insults? And in the same post as you deny doing so. Enough contradictions there to make someone wonder just how accurate any of your posts might be?

Remember all those times I mention the ONS long covid data based on their UK Coronavirus (COVID-19) Infection Survey?....The sample for the survey in England, Wales, and Scotland is primarily drawn from AddressBase, a commercially available list of addresses maintained by Ordnance Survey."

So it is. But no, I do not remember you citing it much. You have time after time cited studies based upon hospital records for your headline conclusions. Its interesting that when I attack these others because they are based upon self reporting samples, you then forget that it was their findings you sought to promote as validated, and start talking about a different study which is much better based?

Randomly selected individuals surveyed over a lengthy time series showing over 2m people with long covid (1 in 30) with over half of these seeing their daily lives adversely affected and 333,000 seeing their lives "limited a lot".

Unfortunately, this still doesnt help us with the generaliseability of the findings. Even the ONS people are not screened to ascertain their background health status. So we dont know if they were sicker than average before they got covid and thus still sicker than average when they did. You are arguing covid has caused a lot of ongoing sicknes, but we dont know if these same people were already sick. So this is not evidence that covid made them sick, rather than that being sick made them catch covid badly.

There is another problem too, that the samples are still self selecting. Although they randomly choose people to invite into the survey, it is likely those agreeing to do so are not a representative sample of the population. In fact, if this is the way they create their sample (as they say), then it is guaranteed not to be truly representative. Polling companies recognise that random joiners will not be representative of the nation, and screen them for whatever groups they think will mae up a representative sample. ONS do not seem to be doing that. Though I'm not really sure just what such criteria should be?

The original base set which ONS sampled came from people they already had enrolled on polling about other things. They then added to this by inviting people from random adresses. The sample overall is heavily weighted towards people who like taking part in surveys, and latterly those who are willing to take part in a pretty intensive medical survey including regular swabbing. Do you think that is likely to be represnetative of the population? I wonder whether people particularly concerned about their health, maybe for good reason, would be more likely to want to take part? Whereas the ones who already had covid with no bad outcomes, or who couldnt afford to test positive, or couldnt care less and were always healthy, would just tear it up?

This is a classic problem with any survey- even if you find a mechanism to choose people randomly (and ONS definitely excluded people with no listed address!), the more people who simply refuse, then the less representative and more biased the results become. Serious pollsters doing this sort of survey go to great lengths to try to get reponses from randomly chosen people who are not initially willing to respond.

I'm not criticising the ONS fr the shortcoings of their original survey. It was mostly intended to track rise and fall of covid prevalence. Tell us if there was lots about or little. Any shortcomings in the nature of the sample didn't matter much for that.

The ONS give some further breakdown of their invitees. In their first tranche of about 20,000 addresses in April 2020, only about half agreed to take part. On average about 2 persons per address took part.

Then in May 2020 they asked another 90,000 and got 40,000 to take part. But by July 2020 they invited 1.4 million addresses, but only 180,000 agreed to take part and only 174,000 actually provided even one swap sample. Thats really not very good, only about 12% of the contactd people agreed to take part at all. 90% of the UK didnt want to. Thats absolutely awful in terms of potential for not being at all representative of real people.

[lens]

Nov 10, 2022 22:28:43 GMT alec said:

c-a-r-f-r-e-w - this is also apposite - www.medrxiv.org/content/10.1101/2022.05.23.22275458v4

"Deaths among US CYP [children and young people] are rare in general,........, we find that Covid-19 mortality is among the 10 leading causes of death in CYP aged 0-19 years in the US, ranking 8th among all causes of deaths, 5th in disease-related causes of deaths (excluding accidents, assault and suicide), and 1st in deaths caused by infectious or respiratory diseases. Covid-19 deaths constitute 2.3% of the 10 leading causes of death in this age group."

I'm left a bit speechless by that. How statistics can be skewed to favour or disfavour any argument.

To say the mortality from Covid-19 is "among the 10 leading causes of death in CYP" sounds really bad. Whilst "Covid-19 deaths constitute 2.3% of the 10 leading causes....." is completely the opposite! Both presumably accurate figures, but.......

OK, it would obviously be desirable to knock off just 1% of deaths, let alone 2%, but let's not get matters totally out of proportion. The whole Covid debate is too often one of glasses being half full or half empty, and in this case (2.3%) it really is much less than half empty. Don't ignore the matter, but time now to put vastly more effort into worrying about the 97.7% of causes of death than worrying about Covid?

A few months ago there were doom laden warnings about a "catastrophic" number of cases first in October, then by mid-November. I've just come back from a week or so away..... to find nothing of the sort has happened. Latest ONS figures seem to have shown an uptick in September (schools returning?) with a drop back to record low figures.

[alec]

lens - I wouldn't disagree at all with any of what you say, except that 'record low cases' are nothing of the sort. That would be zero, if you want accuracy, not the 1m or so infections per week the ONS state.

I take the view that any avoidable death is a tragedy, especially of children, whose deaths are so rare. I then move on to think about how easy or otherwise it would be to prevent that death. In the case of covid, we could eliminate most of those deaths, in my view, with a few simple and cost positive measures. I say 'cost positive' because they would have the added benefit of reducing those millions of infections to properly low levels, cutting staff absence, reducing the risk of permanent withdrawal from the labour market from long covid, and freeing up desperately needed hospital capacity. [Despite what you claim as 'record low cases', NHS England currently (Nov 17th, latest figures) still have 5.5% of it's general purpose hospital beds occupied by covid victims. I really think we could do with squeezing that number as far as practicable, and would have thought everyone might be able to agree on that objective?]. Along the way, tackling airborne transmission of covid would also save the UK an estimated £4bn in lost production by helping to largely eliminate 'flu, as covered in papers I've previously posted.

I don't really agree with your notion that this is a binary debate between two diametrically opposing sides. I'm well aware of the nuances, the trades offs, the costs of mitigating covid. It's just that I've read the science that looks at the benefits of going for an elimination strategy (using the epidemiological meaning of the word) and I think it's a good investment. We'll all earn money from doing so, and for me it's a cold, hard headed financial calculation. Do you want to be poorer? Then don't do the simple things to mitigate covid.

Whenever we get into this we end up agreeing that there are many measures that would be OK to aim for and would be beneficial, and that's all I'm saying. I dont think it's me that is making this into a binary thing.

[lens]

Nov 22, 2022 7:09:02 GMT alec said:

lens - I wouldn't disagree at all with any of what you say, except that 'record low cases' are nothing of the sort. That would be zero, if you want accuracy, not the 1m or so infections per week the ONS state.

OK, maybe my phrasing could have been better.... But looking at the case chart from the ONS, the current number of cases is (roughly) as low as it's ever been at around 1 million. We've been seeing troughs around that level in between peaks as high as 5 million. My point really is that at the end of the summer there were several alarmist reports predicting case rates so high that the health service would be overwhelmed by first mid-October, then by mid-November. Neither has come to pass. On the contrary, a rise from a 1 million trough to about 2 million peak in September, then a steady decline back to about 1 million again.

And this isn't the first time. Remember all the earlier scary reports that with hindsight grossly overestimated what actually came about? It's a shame the people who come out with such reports never seem to publicly say "oh! sorry!" afterwards.

Nov 22, 2022 7:09:02 GMT alec said:

I take the view that any avoidable death is a tragedy, especially of children, whose deaths are so rare. I then move on to think about how easy or otherwise it would be to prevent that death.

Yes, I may sympathise with your view in principle, but childhood deaths are (mercifully) rare anyway - and if Covid is only responsible for about 2% we are talking about a very small number. And how easy is it to prevent such deaths? Personally, I'm inclined to think efforts are better directed towards the other 98%?

There are also the pandemic effects caused by lockdown etc rather than the virus itself. Regrettably, I know of quite a few cases where the persons mental health has been affected by their perception and fear being out of all proportion to the real danger posed (to them) by the virus itself. Indeed in a few cases, they have ended up catching it anyway - only to find it no worse (for them) than a cold may have been.

And that is quite apart from the enormous economic harm caused by lockdown etc in the early period, together with the loss of jobs and businesses.

Nov 22, 2022 7:09:02 GMT alec said:

[Despite what you claim as 'record low cases', NHS England currently (Nov 17th, latest figures) still have 5.5% of it's general purpose hospital beds occupied by covid victims.........

But again - occupied by "Covid victims" - or patients in hospital for other reasons who happen to be "with Covid"? Because I believe the "Covid victim" number is about 60% or so of the total? And I also understand that such is strongly biased towards the unvaccinated and/or those suffering from previous conditions. And that's even more true for those in ICU and deaths.

Nov 22, 2022 7:09:02 GMT alec said:

I don't really agree with your notion that this is a binary debate between two diametrically opposing sides. ........

Whenever we get into this we end up agreeing that there are many measures that would be OK to aim for and would be beneficial, and that's all I'm saying. I dont think it's me that is making this into a binary thing.

No, it's not a case of deciding between complete deniers and conspiracy theorists, and those who are afraid even to ever leave the house. (Unfortunately, I do know one person who is in exactly the latter category, and I do wonder if their mental health will ever recover.) My own opinion is as stated before. The single most important measure by far is to keep up to date with being vaccinated, and I'm afraid I expect such to be an annual event together with a flu jab for the rest of my life. Second, couple that with monitoring such as the ONS programme, and keeping the vaccines up to date. And if cases should start to run out of control again (as in March 2020) to then think again about lockdown. (Which I suspect is very unlikely.) But beyond that, the end game is via general immunity building up in the population - as much as possible from vaccination.

As for "the science", then it's been far from perfect, hasn't it? I take my hat off to those who developed the vaccines and rolled out the programme, but let's not forget other bits of "science" that have been quietly swept under the carpet not to be spoken about, let alone the money spent on them. Such as - cough, cough - "the smartphone app"!? Once much heralded, only to be quietly forgotten about. Which to anyone with a knowledge of RF propagation shouldn't have come as any surprise, before even considering how it couldn't take into account whether a ping was indoor or outdoor, or two people facing or with backs to each other?

[Danny]

Nov 22, 2022 0:35:24 GMT lens said:

Nov 10, 2022 22:28:43 GMT alec said:

A few months ago there were doom laden warnings about a "catastrophic" number of cases first in October, then by mid-November. I've just come back from a week or so away..... to find nothing of the sort has happened. Latest ONS figures seem to have shown an uptick in September (schools returning?) with a drop back to record low figures.

Zoe are still estimating about a million new cases each week in the UK. I wouldnt myself call that low, but it is the new normal. Its not inconsistent with data from pre covid about the numbers of different corona virus infections in the UK in constant circulation, plus a top up because covid is a new one and so still more vigorous even if now rather diminished from the start three years ago.

I have also pointed out before that while we are no longer getting big spikes of deaths with each new wave of infection, the official tally of covid deaths continues to rise slowly but steadily, day by day. If you look at cumulative deaths over time since start, you can just about approximate these as a straight line. Whereas at outset it went up in sharp rises, now its a steady stream, but there is an argument to be made the death toll is currently averaging much the same as at outset.

obviously the streets are not littered with covid dead. The total was never, ever going to live up to the alarmist claims of experts, who stated explicitly they were working to worst credible case scenariosk, but politicians took them as reality. These predictions never happened anywhere in the world, whatever action anyone did or did not take. Covid was disastrously miss managed because it was never anywhere near as dangerous as claimed. we squandered a king's ransom on interventions which we now realise we could not afford.

Oddly no politician seems willing to admit this.

[Danny]

Nov 22, 2022 7:09:02 GMT alec said:

reducing the risk of permanent withdrawal from the labour market from long covid,

There isnt evidence that long covid is causing withdrawal from the labour market. There is clear evidence that most people of working age withdrawn from the labour market did so before covid came along. Quite a few of them subsequently caught covid, but its entirley possible the reason they withdrew and the reason they caught covid badly are one and the same. That they were already ill. I expect its true a some people still FEAR covid and so avoid contact, but thats not at all the same as being at a real risk. Posts such as yours do not seem calculated to reassure them.

I'm well aware of the nuances, the trades offs, the costs of mitigating covid. It's just that I've read the science that looks at the benefits of going for an elimination strategy (using the epidemiological meaning of the word) and I think it's a good investment.

Chinese currently starting a wave of protests against ongoing covid lockdowns. If you really want to eradicte covid, it would probably take a stricter lockdown within the Uk than we imposed in 2020. Perhaps a lot stricter. If you are as you say aware of the costs of trying to eradicate covid, then I am at a loss why you feel national bankruptcy would be better than the situation we have now? It woudld cause the collapase of our society and way of life. Condemn millions to starvation in the Uk. If you did eradicate covid, it would only come back into the country unless we cut off all international travel. The problem the chinese are facing now. And then keep this up forever.

In 2020 the government chose to extend lockdown beyong its initial one month, which had achieved the original stated aim of 'flattening the curve'. Slowing cases so that hospitals would not be overwhelmed. The Nightingale emergency hospital remained empty and were eventually disbanded unused. after that the Uk did try to eradicate covid by maintaining lockdown for months more, or suppress it to such a low level it could be controlled as the chinese are trying now by local interventions. It didnt work. It didnt work. It didnt work then, it wouldnt work now, and it doesnt work in china.

[Danny]

Nov 22, 2022 18:19:37 GMT lens said:

looking at the case chart from the ONS, the current number of cases is (roughly) as low as it's ever been at around 1 million. We've been seeing troughs around that level in between peaks as high as 5 million. My point really is that at the end of the summer there were several alarmist reports predicting case rates so high that the health service would be overwhelmed by first mid-October, then by mid-November. Neither has come to pass. On the contrary, a rise from a 1 million trough to about 2 million peak in September, then a steady decline back to about 1 million again.

And this isn't the first time. Remember all the earlier scary reports that with hindsight grossly overestimated what actually came about? It's a shame the people who come out with such reports never seem to publicly say "oh! sorry!" afterwards.

Exactly.

What I did find interesting was that instead of the october wave being a huge one, it was actually smaller than those in the summer. This strongly suggests the population of susceptible people is indeed being slowly exhausted and they are becoming more immune. Or put it another way, most people who are susceptible to covid have by now already caught it and died...so there are few left to die or be seriously ill in any wave of new infections. There is an argument to be made that people only become susceptible to severe outcomes from covid if they are already immunologically weakened in some way. New people will move into that group all the time, so that when a new wave of covid comes along, there will always be some new susceptibles it can kill. But the original block of such people in the population are now gone and will rechage slowly if we get a lull in the disease. Until then, it is still endemic and carries off some now in a fairly regular manner.

With respiratory diseases the pattern for an established disease is usually a winter outbreak. No doubt various seasonal reasons favour it at that time of year, but with covid its still a fairly virulent new disease and we have ended up with most cases actually in the summer. It has over ridden the seasonal pattern.

Note, that flu too displays this pattern of needing a time period of maybe two or three years after a big wave has struck before another one is able to cause a new big wave. We have changed covid from a disease which killed initially in big spikes to one which kills at a steady trickle, but if you examine the cumulative deaths statistics, actually the 2022 deaths are still comparable to the 2020 deaths. All we have achieved is spreading them out evenly.

[lens]

Nov 23, 2022 18:32:53 GMT Danny said:

Nov 22, 2022 18:19:37 GMT lens said:

looking at the case chart from the ONS, the current number of cases is (roughly) as low as it's ever been at around 1 million. We've been seeing troughs around that level in between peaks as high as 5 million. My point really is that at the end of the summer there were several alarmist reports predicting case rates so high that the health service would be overwhelmed by first mid-October, then by mid-November. Neither has come to pass. On the contrary, a rise from a 1 million trough to about 2 million peak in September, then a steady decline back to about 1 million again.

And this isn't the first time. Remember all the earlier scary reports that with hindsight grossly overestimated what actually came about? It's a shame the people who come out with such reports never seem to publicly say "oh! sorry!" afterwards.

This strongly suggests the population of susceptible people is indeed being slowly exhausted and they are becoming more immune. Or put it another way, most people who are susceptible to covid have by now already caught it and died...so there are few left to die or be seriously ill in any wave of new infections.

Well, I'll agree with you that there is now vastly more population immunity than in the past, ..... but surely, surely a lot of that is due to vaccine immunity? Not just the susceptible having died, not just immunity from previous infection, but a huge amount from vaccination? Indeed, vaccination turning some infections from severe to more like a simple bout of flu, and maybe further immunity being the result - instead of maybe death?

Nov 23, 2022 18:32:53 GMT Danny said:

........... but if you examine the cumulative deaths statistics, actually the 2022 deaths are still comparable to the 2020 deaths. All we have achieved is spreading them out evenly.

Surely not? Look at the excess death figures for the last three years, and the standout feature is two peaks around March/April 2020, and early 2021? In each case we saw death rates roughly double for about a month each time. We've seen nothing like such figures since, certainly not through 2022.

Correlate such (together with graphs for cases) and the obvious conclusion is that it's the vaccination programme in the spring of 2021 that is by far the biggest single factor that's made a difference? The other factors that seem to correlate well are strict lockdowns (to bring cases down) and new variants emerging (to bring cases up) - but it's far less clear of the effectiveness of other measures such as test and trace and lateral flow testing. (Especially when they were removed. There were predictions cases were soar when "free" LFTs were stopped - such never happened, same as the predicted scares about case rates in October and November.)

And in the news tonight about soaring cases and riots in China. I really cannot understand what they are hoping for there. Highly restrictive lockdowns and other measures etc, but a poor vaccination rate with a less effective vaccine.

[Danny]

Nov 23, 2022 23:28:38 GMT lens said:

Well, I'll agree with you that there is now vastly more population immunity than in the past, ..... but surely, surely a lot of that is due to vaccine immunity? Not just the susceptible having died, not just immunity from previous infection, but a huge amount from vaccination?

Thats very hard to say. The published evidence suggests having had covid is as effective in generating protection as is being vaccinated. Then the question arises, just how big a proportion of the population was infected before it was vaccinated? We dont know the answer to that, but early work by zoe suggested ten million people might have caught covid in the first wave. The errors on that are pretty huge ranging from a few million to pretty much the entire population. But also bearing in mind naturally the young get infected much more frequently than the old and were having maybe x10 as many cases at certain peak times, so the high risk have always been protected from covid even while we had absolutely no interventions. Once enough young have had it, a wave dies out thereby protecting the old.

Looking at the example of south africa, they adopted a policy of only vaccinateing about 1/3 of their population, the oldest and high risk, and their outcomes during omicron were no worse than the UK with its mass vaccination campaign. So it also isnt just whether you have been vaccinated or infected, but also whether you were at risk in the first place. Most people were always safe from covid.

And then we have the fact that cross immunity exists with antibodies generated by different corona viruses. There have always been circulating corona viruses in the UK with school kids getting average 3 or 4 a year. They therefore had immunity to covid before either covid or vaccines existed. How effective? Again hard to say, but its striking how the seriousness of covid is the inverse of the pre covid frequency of infection by related corona viruses. Its true the more often you caught a corona virus, then the safer you were from covid. That may be coincidence, or it may be causal.

Nov 23, 2022 18:32:53 GMT Danny said:

........... but if you examine the cumulative deaths statistics, actually the 2022 deaths are still comparable to the 2020 deaths. All we have achieved is spreading them out evenly.

Surely not? Look at the excess death figures for the last three years, and the standout feature is two peaks around March/April 2020, and early 2021? In each case we saw death rates roughly double for about a month each time. We've seen nothing like such figures since, certainly not through 2022.

i have posted the data from the Financial Times covid stats page several times, but here it is again.

Attachment Deleted

Get the image up on your screen and hold up a ruler to it. Its not a bad fit to a straight line steady rate of deaths. I think you can argue the death rate has fallen in the most recent time, but the rate of covid attributed deaths this year has been pretty constant. You could argue this should be two straight lines, the pre and post developed mass immunity average rates of death, but right now there is a pretty steady rate which might by eyeball be half what it was originally, but its still there.

Correlate such (together with graphs for cases) and the obvious conclusion is that it's the vaccination programme in the spring of 2021 that is by far the biggest single factor that's made a difference?

By that time the Uk had already had two major waves of covid. So how many had already been infected? Thats the problem, we dont know.

If you look at my ID picture, you see how Hastings had essentially no covid deaths spring 2020. The only credible explanation is Hastings had that wave early before counting began. What this did demonstrate was hastings did not get reinfected, it was immune, the consequential deaths were therefore over for hastings for that strain. Then when kent strain came along there was indeed a new outbreak in Hastings just as everywhere else. But thereafter Hastings deaths have been pretty small. It seems to have done rather better than other areas which probably had similar immunisation histories, and the obvious difference is because it allowed the first outbreak to run and end naturally. Of course, we dont know how many died from covid in hastings winter 2020, but we do know it wasnt enough to cause concern in the local health service.

The other factors that seem to correlate well are strict lockdowns (to bring cases down) and new variants emerging (to bring cases up) - but it's far less clear of the effectiveness of other measures such as test and trace and lateral flow testing.

Well, NZ and Australia did well with deaths by keeping it out. On the other hand, japan definitely did not keep it out but never had any deaths anyway. Japan didnt take much in the way of special precautions until the olympics. The irony I see is that China probably had a lot more immunity to covid than most nations from outset and should never have used strict lockdown. Its understandable why it did, but in retrospect countries in that region of the world have all done well against covid despite there being no obvious pattern why they succeeded in lowering cases and europe failed. One easy explanation is that their pre existing cross immunity was always better, and maybe that shouldnt be surprising since covid originated from animals in that region and must have had previous human outbreaks, even if they never became widespread. It has also had recent past experience with other more contagious corona viruses.

test and trace was a farce. Even at peak it was never sufficient to significantly reduce spread. So it was pretty much a complete waste of money and Sweden did just as well simply asking people who thought they had covid to stay home. I mean duh, people are well meaning and if they feel sick are happy to stay home anyway. You didnt gain much by formally diagnosing this and you certainly werent catching the cases any quicker.  The phone app trying to trace possible contacts was a disaster because it was as likely to order well people home as sick ones, disastrous for the economy (arguably it ordered more well people home than sick ones).

And in the news tonight about soaring cases and riots in China. I really cannot understand what they are hoping for there. Highly restrictive lockdowns and other measures etc, but a poor vaccination rate with a less effective vaccine.

They are rioting not just because of soaring covid rates, but exactly because cases are high but no one is actually feeling ill despite being infected. They can see for themselves its pointless.

[alec]

Danny - "Get the image up on your screen and hold up a ruler to it. Its not a bad fit to a straight line steady rate of deaths."

What an absolutely stupid thing to say. I can see why you struggle with basic science. It's nothing like a straight line fit. That's a totally idiotic claim to try and make. The idea that you do science by holding up a ruler to your computer screen.....that says it all.

A very cursory glance at the plot for England show two very significant accelerations, in April/May 2020 and then Dec-Feb 2021. Obviously (like doh!) these mirror the early waves of the pandemic, and these are the waves before we achieved high levels of vaccination.

Then, around March 21 we see the cumulative curve starting to adopt a more level approach, and that's for the obvious reason that we moved into the period of high vaccinated populations.

If you really want to make ridiculous claims based on putting a ruler onto a PC screen, trying using the more appropriate data of weekly deaths per 100,000, rather than the cumulative data, which is bound to show a pattern closer to a straight line anyway. Only a fool with no knowledge of statistics would seek a relationship based on such a cumulative plot, when there is perfectly good weekly deaths data available.

On China, the 'high cases' need to be tempered a little. They have 31,000 cases in a day, in a population of 1bn. We had over a million cases last week.

[lens]

Nov 24, 2022 9:18:22 GMT Danny said:

Nov 23, 2022 23:28:38 GMT lens said:

Well, I'll agree with you that there is now vastly more population immunity than in the past, ..... but surely, surely a lot of that is due to vaccine immunity? Not just the susceptible having died, not just immunity from previous infection, but a huge amount from vaccination?

Surely not? Look at the excess death figures for the last three years, and the standout feature is two peaks around March/April 2020, and early 2021? In each case we saw death rates roughly double for about a month each time. We've seen nothing like such figures since, certainly not through 2022.

i have posted the data from the Financial Times covid stats page several times, but here it is again.

View Attachment

Get the image up on your screen and hold up a ruler to it. Its not a bad fit to a straight line steady rate of deaths. I think you can argue the death rate has fallen in the most recent time, but the rate of covid attributed deaths this year has been pretty constant. You could argue this should be two straight lines, the pre and post developed mass immunity average rates of death, but right now there is a pretty steady rate which might by eyeball be half what it was originally, but its still there.

Sorry Danny, I just don't see that, and I'm thinking you're using a lot of imagination...... Straight line fits may be valid (to a point) with limited data sets and high levels of inaccuracy in measurements - but neither of those are applicable here. What you say may be *slightly* true post June 2021, but before that what I see is a graph with two very steep gradients and a much flatter section in between. The number of data sets within that mean a straight line approximation simply does not hold. Plot gradient against time - case nos per day or week - and the result is two steep peaks with troughs in between. The peaks correlate with the initial outbreak and new variant (when "Christmas was cancelled") - as I said before.

The question you should be asking is why subsequent new variants didn't give rise to any appreciable subsequent peaks.

And if you say - as I suspect you will - "infections had by then given rise to natural immunity", then why the early 2021 peak but no others? Isn't it time to consider the far more likely explanation? (At least IMO.) That the absence of futher peaks correlates with the vaccination programme?

Nov 24, 2022 9:18:22 GMT Danny said:

Nov 23, 2022 23:28:38 GMT lens said:

Correlate such (together with graphs for cases) and the obvious conclusion is that it's the vaccination programme in the spring of 2021 that is by far the biggest single factor that's made a difference?

By that time the Uk had already had two major waves of covid. So how many had already been infected? Thats the problem, we dont know.

The flaw in your argument is then why such a big second peak, but nothing substantial afterwards? In your scenario I'd expect to see a succesion of diminishing peaks - we don't. It's two big ones and pretty flat thereafter. Oh, just as the vaccination programme took off........

You are also assuming that a case leads to either a death or a recovery with subsequent boosted immunity, and no other effects. That's not the case. Those peaks put huge strain on the health service, the original argument for "flattening the curve" with lockdown.

Nov 24, 2022 9:18:22 GMT Danny said:

Nov 23, 2022 23:28:38 GMT lens said:

The other factors that seem to correlate well are strict lockdowns (to bring cases down) and new variants emerging (to bring cases up) - but it's far less clear of the effectiveness of other measures such as test and trace and lateral flow testing.

test and trace was a farce. Even at peak it was never sufficient to significantly reduce spread. So it was pretty much a complete waste of money and Sweden did just as well simply asking people who thought they had covid to stay home. I mean duh, people are well meaning and if they feel sick are happy to stay home anyway. You didnt gain much by formally diagnosing this and you certainly werent catching the cases any quicker.  The phone app trying to trace possible contacts was a disaster because it was as likely to order well people home as sick ones, disastrous for the economy (arguably it ordered more well people home than sick ones).

Well, now we may be on far more common ground for agreement!!   Certainly with the phone app. I can't go into any detail, but I did get the opportunity to query someone on what figures were known for how many "pings" later went on to develop an infection. (To be more accurate - "pings" that weren't accompanied by such as a test and trace contact.) The lack of answer spoke volumes to me - though it's not fully clear at that point whether it was just not known or known to be embarrasingly low. It really shouldn't be a surprise, and shows a certain naivety on behalf of those who originally commissioned the idea, not least an assumption that a mobile phone is always with it's owner, that radio waves can travel through solids - viruses cannot, and that "contact" was assumed by the app to be equivalent indoors with little ventilation, to outdoors.

Perhaps most disgraceful is that it's use carried on being promoted even when such figures did become known. It was only when the "pingdemic" was causing the government such huge problems through absenteeism (with so little benefit) that they effectively pulled it. Though of course with no admission of what a failure it had beean. (I've heard unsubstantiated figures since that in the end it only successfully identified 1 in 100 pings that later went on to be infected, and weren't picked up by other means such as T&T.)

Test and trace, and LFTs? Problem there was too little too late. T&T may be successful in the early stages of an outbreak, but in the UK with Covid it already had such a presence through returning ski-ers in February, before it was even realised it had arrived that T&T was forever doomed to play catch up. That's not to say it didn't have an effect - but it's highly questionable whether spending the T&T billions could more effectively have been spent on such as cancer etc research? As one personal anecdote, my youngest son was contacted and told to isolate as a contact - but it took 5 days for them to contact him, by which time he was over half way through the isolation time! Similar story with LFTs - maybe they had some beneficial effect - but was it worth the cost? Speaking to a fellow guest on holiday last year he told me how a friend had advised him to take such a test before going away "to protect him". I did (gently) query as to whether he meant it was to protect others in the hotel in case he had it, but no - he was fully convinced the very act of the test somehow gave protection.

I've also had personal experience of LFTs giving the wrong result (in my wife) with the consequent result of being worse (false sense of security) than no test at all.

And you're quite right that it wasn't "test and trace or nothing". The majority of people upon feeling unwell may likely isolate anyway by default, similarly families. Maybe not everybody - but not everybody followed the T&T criteria anyway, and I know of a couple of people who fell ill but just took themselves off to bed for a few days without going for a formal test and report. Whilst their families carried on much as normal, albeit not going near the infected person.......

I don't blame anyone in early 2020 for going with a scattergun approach - app, T&T, vaccines etc - in the hope at least one will pay dividends. And IMO the only one that really did was vaccination. The irony in China is that they seem to be mainly doubling down on the isolation/lockdown etc measures, without a really effective vaccination policy.

[lens]

Nov 24, 2022 9:45:12 GMT alec said:

On China, the 'high cases' need to be tempered a little. They have 31,000 cases in a day, in a population of 1bn. We had over a million cases last week.

Mmmmm, yeeess....... but against a backdrop of really draconian control, and even then cases rising rapidly, last I saw. Whereas against virtually no measures in the UK nowadays.

Which begs the question of how China will ever "get back to normal', with a vaccination programme seemingly in the doldrums? Worse, the current measures seem to be engendering a total mistrust, hatred even, of those enforcing anti-Covid measures. There was footage yesterday of smashing up and burning a Covid test centre, and those tasked to enforce the anti-Covid measures getting beaten up. Hardly an atmosphere likely to encourage any future big scale vaccination drive?

I just don't see the end game for China. I don't see them ever eliminating it by controls, and even if they did, what then? Closed borders (and a population with little natural immunity) for ever? Personally, I'll stick with UK, even if a million cases versus 31,000!

[alec]

lens - yes, I agree, Chinese policy seems badly thought through. I have read a number of articles (in the western press, but from generally well informed sources) that suggest the measures are being enforced because to remove them would raise questions about the severity of the response which would in turn reflect badly on their leader. Not sure how relevant that is, but autocratic nations can often dig in for fear of losing face with their own people. I also think their vaccine strategy has been wrong. They target working age and soldiers for vaccination, and so in China the proportions vaccinated are flipped compared to here, with low levels of vaccines in the 80+ groups but highest in the 20 - 50s. That kind of makes sense if you can guarantee always keeping covid out, but that leads on to the stringent lockdowns.

In terms of the end game, I think China is going for elimination, which is a perfectly achievable objective for anyone, if vaccine technology comes up with the goods. This is where many in the west remain quite ignorant, I feel. Outwith the west, there is a huge effort underway with the second generation vaccines, with the focus on identifying pan-coronavirus options (several promising routes already identified) which mean variants are no longer a problem, allied to nasal spray application, which holds out the hope for sterilizing immunity. Basically, and end to covid, if we can squirt enough doses up our nostrils quickly enough.

Nasal spray vaccines have been seized on in non western nations as they are potentially cheaper (effective with far lower doses) and are easy to administer. Most western countries are walking away from this technology though, as we've returned to our default position of letting the pharmaceutical companies decide what the priorities for research should be. They love variant specific injected vaccines for covid, 'cos they get billion more orders every year. Even better if the vaccines aren't good at preventing infection.

China is already administering a nasal jab, although how effective that is remains to be seen, but I think that is the end point. I'm actually quite optimistic that we can in due course eliminate covid. Indeed, that optimism is one of the reasons why I get upset that we have just given up. If we launched an 'Operation Warp Speed II' for the second generation vaccines, I'd wager that within a year we would effectively see the end of this. That's why I get upset at seeing everyone give up.

[lens]

Nov 24, 2022 15:58:47 GMT alec said:

lens - yes, I agree, Chinese policy seems badly thought through. I have read a number of articles (in the western press, but from generally well informed sources) that suggest the measures are being enforced because to remove them would raise questions about the severity of the response which would in turn reflect badly on their leader. Not sure how relevant that is, but autocratic nations can often dig in for fear of losing face with their own people.

Ha! I might say not just autocratic nations.....  But the consequences of such a loss of face may not be as severe in a western democracy! But in principle I agree. It's similar in a way to the actions of a gambler who is losing - the smart thing to do is probably to cut losses, too often we see a doubling down "because one last big bet will sort the problem out". Same here - the leadership has bet everything on a policy of elimination by control and lockdown. At least in the UK when a policy has undeniably been seen as a failure (dare I mention the smartphone app again?) it just gets dropped without a word. Not doubling down, regardless of the lack of success.

Nov 24, 2022 15:58:47 GMT alec said:

In terms of the end game, I think China is going for elimination, which is a perfectly achievable objective for anyone, if vaccine technology comes up with the goods. ...........
China is already administering a nasal jab, although how effective that is remains to be seen, but I think that is the end point. I'm actually quite optimistic that we can in due course eliminate covid......... That's why I get upset at seeing everyone give up.

Bit harsh to say "everyone has given up", isn't it? A lot of controls have gone away, but there's still been a pretty big vaccination policy with a fourth shot on offer to over 50's, together with monitoring etc. And I suspect more preparedness now in case something unforeseen suddenly did lead to a big surge. I think the ONS figures at the weekend will be pretty telling - carry on declining, or start to show any resurgence.

As for the comments about elimination, then whilst I'd love you to be right, I'm not holding my breath. I'm also curious as to what makes you think a nasal spray may be far more effective than what we have at present? From all I've heard, the existing Chinese vaccines are much less effective than what we now have in the UK - never say never, but ..... what makes it likely their latest attempt will be good enough to lead to elimination? Why intrinsically better than any injected vaccine tweaked to work across variants? (Genuine question.)

And in such as the UK, there is still roughly 5% who are refusing vaccination. (And disproportionately making up most of the cases in ICU and deaths.) Move to China, where the "anti-Covid" forces are largely hated due to the strict imposition of lockdowns (to the extent of getting beaten up, as recently seen) and I just don't see large swathes of the population agreeing to vaccination - be it nasal spray or traditional. It's not going to be remotely close to 95%, such is the lack of trust. So even if some new vaccine was 100% effective, is elimination by vaccination really achievable? Personally, I don't think so. (Even if some new wonder vaccine did get developed.)

Which leads us back to what is the end game?

[Danny]

Nov 24, 2022 9:45:12 GMT alec said:

A very cursory glance at the plot for England show two very significant accelerations, in April/May 2020 and then Dec-Feb 2021. Obviously (like doh!) these mirror the early waves of the pandemic, and these are the waves before we achieved high levels of vaccination.

yes of course, but my whole point was that whereas at the start there were big spikes of deaths with then gaps in between of few deaths, now we have a steady daily average. What we achieved was to spread the same number of deaths evenly over every day. Whoopy-do!

Then, around March 21 we see the cumulative curve starting to adopt a more level approach, and that's for the obvious reason that we moved into the period of high vaccinated populations.

We also started relaxing restrictions, and as i pointed out had already had two major waves of infections whih may have already infected essentially most of the population granting immunity. It is certain a significant fraction of the population already had immunity to covid before being vaccinated. I do, i have never been vaccinated save by catching covid in 2019. And then I had it again (this time test confirmed) early 2022, and this time much milder.

If you really want to make ridiculous claims based on putting a ruler onto a PC screen, trying using the more appropriate data of weekly deaths per 100,000, rather than the cumulative data, which is bound to show a pattern closer to a straight line anyway. Only a fool with no knowledge of statistics would seek a relationship based on such a cumulative plot, when there is perfectly good weekly deaths data available.

as far as I am aware, the total deaths data is probably the most reliable and consistent measure we have of the ongoing severity of covid. There are some major problems about the definition of a covid death, but it seems to have been consistent. I dont realy see what is worng about plotting this cumulatively instead of per week. This explicitly allows someone to examine the gradient of the plot, which was exactly my purpose. The gradient is the average rate at which people are dying, and my exact point is that it hasnt changed much.

I am puzzled why you think 'cumulative data [is] bound to show a pattern closer to a straight line'. Why do you say 'bound to'. You seem to be saying you EXPECT this to come out as a straight line, which means you agree the death rate has not changed!

On China, the 'high cases' need to be tempered a little. They have 31,000 cases in a day, in a population of 1bn. We had over a million cases last week.

if as they say most people tesing positive have no symptoms, presumably most people with no symptoms never get tested and arent being counted. They would need to be doing maybe 200 million tests a day to be certain how many cases they really have. Similarly, we needed to be doing more like ten million tests a day to determine numbers here, and we maxed out at about 1 million.

[Danny]

Nov 24, 2022 14:47:28 GMT lens said:

Perhaps most disgraceful is that it's use carried on being promoted even when such figures did become known. It was only when the "pingdemic" was causing the government such huge problems through absenteeism (with so little benefit) that they effectively pulled it. Though of course with no admission of what a failure it had beean.

Interesting to see you make this argument. I make the argument that if government realised lockdown had truly been a pointless disaster, it would react exactly the same way as it did to the pingdemic. Never admit there had been a mistaken policy.

Test and trace, and LFTs? Problem there was too little too late.

yeah, to make it work you needed to screen everyone perhaps twice a week. 20 million tests a day? In the end the limit on 1 million a day was pretty much determined by lack of resources and sheer cost. If someone had done some sums at the start, they might have realised it was totally pointless. Except...that it made government look like it was doing something. Which was also the point of lockdown. Government simply did what sage suggested. Sage brainstormed ideas of how to try to manage an overwhelming epidemic, which was their worst credible case scenario, and never happened anywhere in the world whatever anyone did. The scenario they worked to could never have happened. No one in this process stepped back and looked at cost or actual likely effectiveness and called a halt because something was absurd. Politicians may well have relaised this was the case, but believed they had to be seen to be following SAGE advice. Whereas SAGE relied upon government to say an idea was ridiculously expensive, and they deliberately and explicitly told government they were not considering this.

T&T may be successful in the early stages of an outbreak, but in the UK with Covid it already had such a presence through returning ski-ers in February, before it was even realised it had arrived that...

yes, I agree. Except I am certain covid was in hastings winter late 2019, its the only reasonable explanation of both my experience, others experiences locally, the recorded deaths data for Hastings, and frankly it would be extraordinary if covid was NOT in the UK somewhere this early because it definitely reached other locations in late 2019. Early enough, for example, to have comprehensively infected that ski resort so that visitors could be catching it there. I also think Hastings was perfectly placed to have widely infected London, wheras the similar suspicious lack of spring 2020 cases down in Devon would probably not have been feeding London cases. But it would explain why SW region had such low cases generally in first half of 2020.

he was fully convinced the very act of the test somehow gave protection.

I wonder how government information messages carefully designed by experts to have the effects they wanted, could have left him so badly informed?

I've also had personal experience of LFTs giving the wrong result (in my wife) with the consequent result of being worse (false sense of security) than no test at all.

I seem to recall that early on doctors were rejecting negative test results when they could see their patient had covid. i doubt that was lateral flow testing. The Uk standard LF test was rejected in the US as too unreliable.

And you're quite right that it wasn't "test and trace or nothing". The majority of people upon feeling unwell may likely isolate anyway by default, similarly families. Maybe not everybody - but not everybody followed the T&T criteria anyway, and I know of a couple of people who fell ill but just took themselves off to bed for a few days without going for a formal test and report. Whilst their families carried on much as normal, albeit not going near the infected person.......

yeah, when i say government could have achieved as good a result simply by doing nothing, I am allowing that people will take the usual measures they do if they have a cold/flu. Including not visiting granny till they are better, which automatically protects the high risk. People in an early study from Holland mostly infected people their same age. Smaller peaks for 1 generation younger (their kids) or 1 generation older. But the biggie is your own generation. Youngsters socialise more, and all that seems to account for the actual age pattern of infection...most cases and most frequent reinfections amongst the youngest.

I don't blame anyone in early 2020 for going with a scattergun approach - app, T&T, vaccines etc - in the hope at least one will pay dividends. And IMO the only one that really did was vaccination.

Whatever the benefits of vaccines, i do not believe lockdowns mitigated the first two waves in the UK. The Hastings evidence tells me it would have ended similarly without lockdowns, just cheaper. This isnt the only evidence, in 2020 decisions when to impose lockdown were made based on average case numbers across the UK. Which meant the earliest places infected were already seeing peaking and drops before ever there was a lockdown. Hastings in the Kent wave actually had cases rising during the october lockdown, then falling during the November relaxation (or was it November lock, december relaxation? I think it probably was). Thats because the lockdown was a late response to the schools return wave, too little too late, but at the moment it was imposed kent was just getting going unacknowledged. You can track it in different towns locally at staggered times. So simultaneously hastings was infected by kent and had a peak and had  lockdown, which peak then fell away naturally despite lockdowns release.

There were other examples. When local restrictions were tried earlier in the year, they simply didnt work. Maybe people cheated, but maybe they didnt work because they didnt work. there was little evidence people really did cheat, certainly not that early on. Lockdowns simply had little effect on the evolution of the disease in the UK.

The irony in China is that they seem to be mainly doubling down on the isolation/lockdown etc measures, without a really effective vaccination policy.

i think the irony is that had they done nothing, their outcomes would have been like Japan. No restrictions, no deaths (comparatively). China has an incredibly low death rate and i doubt it will ever get big even if they dont vaccinate anyone.  It seems likely china has had covid amongst animals forever, and its people had significant immunity anyway.

[Danny]

Nov 24, 2022 18:39:34 GMT lens said:

Ha! I might say not just autocratic nations.....  But the consequences of such a loss of face may not be as severe in a western democracy!

So just what would be the result of conservative ministers announcing that lockdown was a failed policy which cost a fortune, created a world recession but didnt actually reduce deaths? That everyone gave up a year or two of their lives ...for nothing?

At least in the UK when a policy has undeniably been seen as a failure (dare I mention the smartphone app again?) it just gets dropped without a word. Not doubling down, regardless of the lack of success.

It really did not just get dropped. It did double down. i recall they said they had reduced sensitivity so it would work now without false positives, and then carried on exhorting people to use it. They never withdrew it, the public stopped using it. In the Uk when 1 month of lockdown failed to bring down infections, they added a month. Then another month. What actually happened was that community cases collapsed (or maybe became invisible in the face of limited testing), but hospital cases stayed high. Given this years data, hospital cases have also stayed high all year just as have community cases. So maybe both did then too. But anyway, lockdown kept on not working but they kept on using it.

[alec]

lens - I suspect we'll see ONS infections decline again this week, although it's notable that recently the hospital figures have been running ahead of the ONS data. The NHS England figures show that the decline in hospital cases has now all but bottomed out, but with some sharp rises in one or two regions. This is a bit odd, as cases should have been moving up by now to get to this stage with hospitalizations, but that's how the recent data has been going.

On the vaccines, there is very good evidence to give hope that nasal spray vaccines can be much better. The issue is that intra muscular injections don't create any antibodies in the mucosal membrane, so the patient needs to effectively get infected before the bloodstream antibodies get to work. It also means that you need to pump a very substantial dose in the jab to get the required immune response. Nasal sprays have already been demonstrated to create sterilising mucosal antibodies against covid in several small scale animal trials, and if we can achieve widespread sterilizing immunity then we're a long way towards suppressing infection to the point when R is below 1. Not sure the Chinese are there yet, as their nasal spray is the same formulation as one of their not so good jabs, but they did report some encouraging early results.

I think this also helps with the number of people not taking the jab. There is a persistent 6% or so who have only had a single jab, (eg not completed the primary course). My wife is in that category, not because of any anti vax sentiment, but because was was proper ill for three months after her jab, with a further 3 months recovering. The reaction sparked an existing condition, and she hasn't been allowed to get an alternative jab that has a better record on side effects. For a small group of people like this, getting a nasal spray with 10% of the dose of a jab is likely to be a godsend.

[Danny]

Nov 24, 2022 18:39:34 GMT lens said:

And in such as the UK, there is still roughly 5% who are refusing vaccination. (And disproportionately making up most of the cases in ICU and deaths.)

yet at the same time, the age profile of those dying remains much the same. Despite takeup being highest amongst the oldest. I am intrigued just who this cohort of unvaccinated people is and why they are unvaccinated. To what extent is this a group who for medical reasons are refusing vaccination, but for the same medical reasons are also at risk?

I had a disease with all the right symptoms for covid in about November 2019, in hastings. It was traceable to someone coming from Wuhan, and i was one removed from the original source. About 400 others were in the same workplace, so whatever it was, it got a good start. Someone who was an elderly relative of an older worker was hospitalised with pneumonia and the actual bug could not be identified. Two probables hospitalised I know of, one who died. At the time I thought this was just flu, and continued to believe so until we started to get better details of the actual symptoms of covid, particularly loss of taste and smell. And then covid just didnt happen in hastings in spring 2020.

So by start of 2021 when vaccinations began, I first thought there was no point my getting an early vaccination because I reckoned i had already had it. No point wasting it on me.

Then i thought it would be interesting to see what happens if I was now exposed to covid. And i have at least one answer to that, I was mildly ill start 2022 and tested positive. Not ill enough to stop me doing anything. Its entirely possible I was also exposed to other strains of covid or repeat infections, we had a new one then, but that I just didnt notice the others.

My partner had covid in 2019 same time I did. In 22 he had had three vaccinations but also tested positive. he probably gave it to me both times anyway. he was sicker than me both times. So if you judged the effectiveness of vaccinations on my example, it was useless. If you dont believe we had covid in 2019, then two people caught covid 2022 one of whom had been triple vaccinated and one none, and the unvaccinated one had the better experience of a very mild cold.

You will recall government banned covid antibody test sales to the public in 2020, so although I considered getting one to see if i had had covid, it was illegal to buy one. When they did start to be available they had peculiar restrictions requiring to be administered by a medical professional and were expensive. i did get one in 2021. The test for covid nucleus antibody came back (from memory, might not be quite right) at about 0.05. The test company explained that 1 was deemed enough antibody to be protective against covid. That a score of about 0.1 was deemed to mean the person had more likely than not had covid. So where does that leave 0.05? The minimum score was about 0.01, or maybe 0.001. When I looked into rate of decay of antibody, then 0.05 might be a reasonable score for an infection 18 months previously. But given the claimed minimum score, it was anyway well above baseline. I had no other infection which could credibly be mistaken as covid between the test and the one in 2019.

Either I had covid in 2019, or i had something exactly like it. If i did have some other disease imported from Wuhan which was not covid, i am puzzled how it took off locally but then fizzled out without infecting london and then the rest of the country. It would have exactly coincided with the actual covid epidemic. Could have been very tricky facing two different viruses at once.

[Danny]

Nov 24, 2022 21:57:24 GMT alec said:

On the vaccines, there is very good evidence to give hope that nasal spray vaccines can be much better. The issue is that intra muscular injections don't create any antibodies in the mucosal membrane, so the patient needs to effectively get infected before the bloodstream antibodies get to work. It also means that you need to pump a very substantial dose in the jab to get the required immune response. Nasal sprays have already been demonstrated to create sterilising mucosal antibodies against covid in several small scale animal trials, and if we can achieve widespread sterilizing immunity then we're a long way towards suppressing infection to the point when R is below 1. Not sure the Chinese are there yet, as their nasal spray is the same formulation as one of their not so good jabs, but they did report some encouraging early results.

The problem I see with nasal antibody is that they will inevitably decay in the same way blood born antibody does. After a few months there isnt enough left to prevent an infection. That is likely to be a fundamental property of the human immune system and will apply in nasal mucosa too. So an arriving virus has a good chance of settling in the nose and entering a cell before it encounters any antibody.

Once in a cell, there is evidence virus can spread directly from cell to adjacent cell with no opportunity for antibody to intervene. Both nasal and blood antibody are therefore powerless to prevent further spread. The threat will eventually have to be dealt with by killer cells destroying the infected cells. At this point i see a big problem, because if a person has nasal antibody but not blood antibody, then virus released into the blood has free reign to spread around the body on the inside. The dangerous spread might not be contained, and the vaccination might prove ultimately ineffectual in preventing deaths as well as preventing infection. Even if it is more effective at preventing infection, it could still be worse at protecting against deaths overall.

Really, you should not count your chickens just yet.