Covid

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

alec

I’m still learning about it all, but a few things I have come across include a link between spike protein and long Covid, a paper on how gut bacteria may affect vaccine responses…

gut.bmj.com/content/71/6/1106

…And even a paper on a hypothesis that Ivermectin might help by feeding bifidobacteria to boost immunity. But haven’t had time to check this stuff out

www.ncbi.nlm.nih.gov/pmc/articles/PMC9309549/

and here is the paper on the spike protein in the brain:

SARS-CoV-2 Spike Protein Accumulation in the Skull-Meninges-Brain Axis: Potential Implications for Long-Term Neurological Complications in post-COVID-19

www.biorxiv.org/content/10.1101/2023.04.04.535604v1

[alec]

c-a-r-f-r-e-w - bad news on the ACE2 binding - erictopol.substack.com/p/the-virus-is-learning-new-tricks

The virus has now managed two simultaneous F to L mutations, on different sites and in opposite directions, which has now been termed the 'Flip' mutation. This enhances ACE2 binding. Interestingly, it isn't seen in the EG5.1 variant which appears to be the main variant driving increased cases at present, but has started to spread quickly (from a low base) in Spain and Brazil.

As ever, we don't know how each variant will play out (and now likely different in different countries, depending on previous variant waves etc) but it shows there is no end in sight to the viruses ability to surprise.

[alec]

Interesting paper here that adds weight to the idea that we're probably undercounting the effect of covid on the deaths statistics - www.nature.com/articles/s41591-023-02521-2

Alongside finding that long covid symptoms can persist for at least 2 years, the paper is noteworthy in that it finds an elevated risk of death after covid infection that lasts for 6 months in non hospitalised cases but persists for at least 2 years in more serious cases. The paper uses the US Veterans database, so this is more skewed to older people, so these numbers don't necessarily translate to all age ranges, but that doesn't undermine the issue around the mortality impacts. All the data is now pointing to the fact that even in people who don't appear to have long covid, the increased mortality following a covid infection extends way beyond the acute phase and the 28 day cut off most statistics adopt.

[alec]

Here is the paper on reinfections - www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00325-5/fulltext

It's a Canadian study of care home residents, vaccinated 4 times. They weren't looking to test reinfection frequency, and were surprised by the results, which showed a substantially elevated risk of reinfection after an Omicron infection. Given that the residents all shared the same environment, this can't really be explained away by anything other than the weakening effect of covid on the immune system.

This is the latest study with similar findings. Others have found substantially higher risks of reinfection correlating with the number of vaccination doses, with some speculation that once infected, the current vaccines over stimulate the immune system with the effect that it is weakened for a while afterwards, in a similar way that infection dents immunity.

But the bottom line is increasingly clear - getting infected with covid weakens you, and makes future reinfections more likely. Several studies have also found that reinfections are on average more severe than the first round, so the implications are clear - the more you get infected, the more you're likely to be reinfected, unless you initiate behavioural changes, and the more you get infected the more likely you are to suffer severe consequences.

[leftieliberal]

Lockdowns and face masks ‘unequivocally’ cut spread of Covid, report finds
www.theguardian.com/world/2023/aug/24/lockdowns-face-masks-unequivocally-cut-spread-covid-study-finds

The review found social distancing and lockdowns were the most effective category of NPIs. Stay-at-home orders, physical distancing and restrictions on gathering size were repeatedly found to be associated with significant reduction in Sars-CoV-2 transmission. The more stringent the measures were the greater the effect they had, the experts found.

[alec]

leftieliberal - yes, despite the concerted attempts to rewrite history, the facts aren't playing along.

It's no surprise that such measures worked. They were just different versions of what we've always done when faced with disease; covering faces, keeping apart, avoiding crowds and isolating the sick have been the go to measures for disease control for as long as human history has been recorded. England even closed schools in the 1959 flu epidemic. The efforts to make these appear something new and radical were all part of a right wing, anti-science, anti-public health campaign which has culminated in the acceptance of the idea that we need to get repeatedly sick in order to stay healthy.

[alec]

leftieliberal - one thing that does amuse me about pandemic responses and history; it's just one of those odd paradoxes, that the one thing - the one thing - that humans never used to do when faced with infectious disease, was wash hands. But in a hugely distorted example of how society can sometimes go backwards, that's the primary method we're now advised to use to staop and airborne disease.

[leftieliberal]

Aug 24, 2023 15:45:24 GMT alec said:

leftieliberal - one thing that does amuse me about pandemic responses and history; it's just one of those odd paradoxes, that the one thing - the one thing - that humans never used to do when faced with infectious disease, was wash hands. But in a hugely distorted example of how society can sometimes go backwards, that's the primary method we're now advised to use to staop and airborne disease.

Hand-washing was recommended because it was believed that fomite transmission was important. Despite it now being understood that it is not, the authorities do not seem to be able to backtrack on this (actually I suspect that most people don't wash their hands often enough or effectively enough, so maybe it the authorities using the fear of covid to get people to do what they should do in the absence of covid). 

[alec]

leftieliberal - yes, I think reversing a previous tenet is difficult, and I can also see that they wouldn't want to give a message that hand washing isn't important either, for other reasons.

[alec]

Very good study regarding risk of covid infection discussed here - www.nature.com/articles/d41586-023-02715-1?utm_medium=Social&utm_campaign=nature&utm_source=Twitter#Echobox=1693410497

The researchers had the bright idea of using prisons as their data source, where exposure to cellmates, test results and vaccine/infection history are all tightly monitored, so the findings are widely held to be pretty robust.

What they found is that - as expected, but not yet proven - the risk of infection is contingent to a degree on the viral load at exposure. The results are something of a good news/bad news story. The researchers found that vaccination and prior infection appeared sufficient to protect from infection if the exposure was low, but the effect of vaccines and prior infection was not sufficient to prevent infection under high viral load conditions.

While this proves the lack of protection from vaccines/hybrid immunity, I still take this as broadly encouraging, as it means that we don't have to be so concerned about fleeting contacts, and if we then target those areas where prolonged exposure is likely - crowded, indoor areas, etc - then we really have an avenue to greatly reduce infection levels. It also suggests that masks can play a significant role. They don't have to be perfect - they just have to work a little, and so long as they reduce the overall viral load, even without eliminating it, the ability to cut infections remains.

[alec]

Interesting developments on the new 'super scary' variant now known as Pirola (BA.2.86). While is appears to be globally well dispersed, suggesting active spread, the numbers aren't rocketing, despite a little more active searching. This could just be limited sampling, but very rapidly the scientists have swung into gear and run a series of tests. While there is substantial immune escape, some cross reactivity to XBB 1.5 has been found, which may mean that the autumn boosters have more effect than at first feared.

Also firmly in the 'good news' column are the findings that Pirola has lost quite a bit of infectivity in the process of acquiring the mass of mutations, so while highly immune evasive, and potentially more severe (we don't yet have data on this) it appears currently less likely to be as infectious. That helps, but how much will depend on the balance between greater immune evasion and lower transmissibility, as there are multiple combinations of these factors that could lead to similar outcomes. However, the relative slow pick up in samples suggests that overall, we're not going to see a rapid and large wave from BA.2.86. One caveat though, is that these data are derived from pseudo viral assays (eg lab based measurements) rather than actual human test results, so they are not necessarily completely representative of real world outcomes.

There is one very substantial warning though. This is evolution in action. Pirola was as big a jump as Omicron was, but although the overall effect of Pirola is probably not going to be as bad as feared, Pirola won't stop evolving. According the JP Weiland, one of the variant trackers who has a good record at prediction of waves (and avoiding hyperbolic scaremongering) we are already seeing distinct lineages of Pirola evolving, and he believes there is a very good chance that it will evolve to recover it's lost transmission capabilities.

This wouldn't be the first time this happened. Delta was originally viewed as a slow moving but widely divergent variant. It was quickly identified as immune evasive and potentially more severe, but only appeared in low numbers, with slow spread, for over three months. During this time, it quietly evolved, recovering infectivity and then it exploded into one of the worst waves of the pandemic to date.

[leftieliberal]

Dr Phil Whittaker in New Statesman on the threat of new covid variants:  www.newstatesman.com/politics/health/2023/09/new-covid-variant-wave-infections-omicronworried 
He ends the article with the following:
Most concerningly, the NHS no longer has a consistent policy for infection control. Hospital colleagues with Covid over the past few weeks report bizarre guidance: stay away if you have a high temperature or feel unwell, but otherwise it’s up to the individual to decide whether to come in. Vaccination may have reduced rates of severe illness and death, but where it still occurs is among the elderly and those with co-morbidities – people found in great numbers in healthcare settings. In wider society, it has become anathema to suggest we’re doing anything other than blithely “living with Covid”. Within the NHS we owe it to patients to continue to treat the virus with the respect it deserves.

[alec]

leftieliberal - good to see that there mounting concern at the appalling lack of concern in parts of the NHS. The head of the UKHSA has said anyone who is suffering respiratory symptoms should avoid contact with others, but the NHS is asking sick people to come to work and the schools minister is telling parents not to keep their kids off school if they have mild symptoms.

Barking mad.

[alec]

Various bits of news about the new Pirola variant BA.86.2.

Antibody neutralization assays (several) have come back with results suggesting it is significantly less immune evasive than other current strains, which would be good news, but - and this is a big but - these are from pseudo virus assays, which have in the past been highly unreliable. For example, Delta came out between 7 and 2.5 times less immune evasive than the original strain, and the first Omicron results showed it to have a 30 fold drop compared to Delta, and then we had the biggest wave of the lot. So these early data need to treated with great caution; it could be good news, but we really don't know.

What is clear is that it is spreading. I've heard that there are 30 cases just added in England, which look like a cluster (not yet confirmed). That doesn't necessarily mean anything other than extensive targeted testing, but it could indicate a high attack rate, so is some cause for nervousness until we get a clearer picture.

We also have the first Pirola descendant, now officially named BA.2.86.1. Again, this is a sign of the rampant ability of Sars-Cov-2 to mutate, which is one reason why it remains so dangerous, and will always be far more dangerous than flu. With Delta, the original strain didn't do a great deal, for quite some time, but it was the descendants of Delta that found fitness and really caused the damage.

Quick reminder though; masks, ventilation and air filtration are bomb proof against all variants, and unlike vaccines and antivirals, they do not create any evolutionary pressure on the virus.

Edit: Just picked up a couple of experts suggesting that if Pirola is spreading despite lower immune evasion, then that is not a good scenario. They seem to have identified that it evolved over some time period within a chronically infected individual, before making the change required to allow inter host transmission. Intra host adaptations tend towards greater severity, (eg better able to infect cells) so this may be behind it's spread, even if is is technically less immune evasive.

[Danny]

Aug 21, 2023 21:13:32 GMT alec said:

Interesting paper here that adds weight to the idea that we're probably undercounting the effect of covid on the deaths statistics - www.nature.com/articles/s41591-023-02521-2

Alongside finding that long covid symptoms can persist for at least 2 years, the paper is noteworthy in that it finds an elevated risk of death after covid infection that lasts for 6 months in non hospitalised cases but persists for at least 2 years in more serious cases. The paper uses the US Veterans database, so this is more skewed to older people, so these numbers don't necessarily translate to all age ranges, but that doesn't undermine the issue around the mortality impacts. All the data is now pointing to the fact that even in people who don't appear to have long covid, the increased mortality following a covid infection extends way beyond the acute phase and the 28 day cut off most statistics adopt.

You're missing the point again. Anyone who has covid severe enought to become registered on one of these databases was always in a hogh risk group. Thats why they had bad covid. So this becomes a study amongst people selected for being unhealthy, and it finds thay are more unhealthy than average. Gee.

The whole story of the mistakes made in trying to combat covid is about assuming that a minority group with severe covid is representative of the whole population. It has been so.

[Danny]

Aug 22, 2023 7:53:44 GMT alec said:

Here is the paper on reinfections - www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00325-5/fulltext

It's a Canadian study of care home residents, vaccinated 4 times.

Thats really rather a lot. Likely to cause imprinting of the immune system on the specific makeup of the vaccine?

They weren't looking to test reinfection frequency, and were surprised by the results, which showed a substantially elevated risk of reinfection after an Omicron infection.

Again this is all rather chicken and egg. This was a study of people in retirement and care homes. If people caught omicron the first time because they already had a poor immune response, then they are more likely to catch it again precisely because they are known to have a poor immune response. The whole reason old people die after catching covid and young people do not, is because young have a better functioning immune system. So it does make sense to study the people at risk, ie those in care homes, but the results are not transferrable to the general population, because it was never a study of the general population.

Given that the residents all shared the same environment, this can't really be explained away by anything other than the weakening effect of covid on the immune system.

Again you are assuming homogeneity, when there is no basis for doing so. People in care homes are NOT all the same. One person might have a broken hip and cant walk, but have an excellent immune system. Another dementia. Another very poor immunity. It is reasonable to assume the subset with poor immunity catch covid repeatedly, wherea the subset with bad legs do not. Does the study examine this, no evidence in the summary that it does.

This is the latest study with similar findings.

Yes indeed, and similar flaws. None of them are population studies applicable to the whole population.

[alec]

Danny - "You're missing the point again. Anyone who has covid severe enought to become registered on one of these databases was always in a hogh risk group."

It's comments like this that really show how naive you are when it comes to interpreting papers. Read the paper. The cohort, for both those with and those without covid, was those having two 'contacts' with the healthcare system within 6 months over the preceding 2 years. That covers most people, in reality.

As has always been the case, the data is against you and your offbeat interpretations of what is happening with covid, and constantly rehashing the same discredited arguments doesn't denote someone who actually thinks.

[alec]

A markedly less positive set of findings here o the new variant out in the last hour -

"Altogether, it is suggested that BA.2.86 is one of the most highly immune evasive variants ever and should have the potential to be considered as a variant of interest."

I remain somewhat neutral about the various findings on BA.2.86 as the lab studies have a habit of being confounded one way or aother by real world experience, but this doesn't look so good.

[alec]

A sign of how immensely complicated immunity to covid-19 is, and the origins of log covid - www.science.org/doi/10.1126/scitranslmed.adf6598

The rather quaint idea from March 2020 that we would all develop immunity to covid was always hope triumphing over reality, but this paper shows how the complexities extend further. Here, they found what they think is evidence that for a certain group with existing autoimmune conditions, infection by the common cold coronavirus OC43 can lead to a form of immune imprinting that leads to long covid, through failure the properly clear covid 19.

So many things we just don't know about the human immune system.

Another thing we don't know is what the effect of having 10 covid infections is going to be.

[alec]

A long but fascinating thread about the benefits of the Novovax protein based jab over the mRNA alternatives -

It's very surprising that so many countries have opted solely for the mRNA vaccines, when all the evidence tells us that Novovax is better, both for it's efficacy, lower sie effects and ease of handling.

[lens]

Sept 7, 2023 21:09:22 GMT alec said:

A sign of how immensely complicated immunity to covid-19 is, and the origins of log covid - www.science.org/doi/10.1126/scitranslmed.adf6598

The rather quaint idea from March 2020 that we would all develop immunity to covid was always hope triumphing over reality, .............

But doesn't that make the mistake of believing "immunity" to be a binary choice - either "immune" or "not immune"? Believing a person is either in a state as we all were in March 2020, or alternatively in an "immune" state where Covid exposure would not lead to any infection at all?

Whereas in reality - through vaccination and/or past infection - surely the truth is that nearly everybody *HAS* acquired (relative to March 2020) a very significant immunity to Covid? Even if short of 100%?

To the extent that in the first year an infection would typically lead (even in an otherwise healthy individual) to a couple of weeks of incapacitation, whereas now (and even with little or no overt precautions) an infection is 1/ far less likely after an exposure, and 2/ far less likely to have a serious outcome if it does occur?

So isn't the reality that we all have acquired considerable immunity - even if not 100%?

[alec]

lens - yes and no. We did develop reasonable immunity to severe acute disease from the earlier strains, and to infection as well, but the virus has changed massively, and the entire immune landscape has changed accordingly.

Recent data I have read tells me;

- Infection/vaccination does increase the viral load infection threshold for a period of time, but does little to protect against infections under high viral load challenges
- The period of immunity is getting shorter. Reinfections within 90 days are becoming increasingly common.
- Data from the ONS, CDC and several other sources shows that the more vaccinations and infections you have, the more re-infections you are likely to experience. Some are arguing that this is evidence of immune system damage.
- Protection from long term symptoms (long covid and other long term health effects) does not appear to be enhanced by more infections, although Long Covid risks are slightly reduced by vaccination, although this protection wanes rapidly.
- More recent variants are becoming progressively better at evading prior immunity.
- Re-infections are increasingly showing signs of greater severity. Some argue that the evidence of subsequent infections being milder was more an artifact of timing, with the early papers largely looking at Delta era first infections and Omicron repeats, when Delta was more severe than Omicron. There is ample evidence now to show that for a proportion of people, subsequent infections are more severe.

I think you've massively simplified the situation, and in some ways your statements are just plain wrong. We are obsessed with the acute phase only, but SARS viruses are well known as long term infective agents, where much of the damage can be done months or years later. This is why the discussion over immunity is so poorly focused and understood. Whatever it is though, immunity is not growing with constant reinfection.

[lens]

Sept 13, 2023 18:21:31 GMT alec said:

I think you've massively simplified the situation, and in some ways your statements are just plain wrong. We are obsessed with the acute phase only, but SARS viruses are well known as long term infective agents, where much of the damage can be done months or years later. This is why the discussion over immunity is so poorly focused and understood. Whatever it is though, immunity is not growing with constant reinfection.

In essence I'm saying that at present the Covid situation is nowhere near as bad as it was during the first (pre vaccine) year. How is that a "massive simplification"? Is it wrong in any way? And that in spite of little to no restrictions in the sense of lockdowns, or even such as Test and Trace etc. If such is not due to Covid immunity now being much greater overall than in March 2020 - then please tell us why? Yet you find the idea that we've developed any such immunity "quaint"?

I once heard the definition of good health referred to as "dying as slowly as possible". Tongue in cheek, yes, but think about it. Covid may still be with us - but so are many other illnesses and conditions prejudicial to our health. So why obsess over the risk from Covid, relative to other issues?

But really, what's the alternative? I fully intend to take up the offer of an autumn booster when offered, but other than that? History shows that even when the strictest other measures are enforced (eg hugely strict lockdown in China) the result is only to delay rather than prevent. And as China found, such a policy is totally impossible to sustain in the long term, and when it was inevitably relaxed cases, illness and deaths caught up. So was the huge economic and psychological harm caused by the draconian measures worth it? I'd argue not.

New Zealand is an interesting case. Arguably lockdown there was worth it as the delay gave time for vaccination to be developed and administered to thos who wanted such. But after that? Again, measures couldn't go on for ever, (though did for 6-9 months longer than was sensible) and eventually had to be relaxed. But at least the delay meant the NZ death toll is only now about a third (per capita) as such of the UK. (And in practice the figure is better than first appears, as a much higher percentage are amongst the unvaccinated than in the UK - the message from that should be clear.)

[alec]

lens - "How is that a "massive simplification"? Is it wrong in any way?"

It is a simplification and it may well turn out to be totally wrong. Whether it does or not I don't know. Like I say, you seem to be focused only on the acute phase. We are now in a position where we have applied leaky vaccines and a similarly leaky herd immunity via infection approach, and we have therefore encouraged the virus to develop in transmissibility and severity. We are probably in a significantly worse situation now than in 2020 as a result, not so much from the acute phase, but from the issues of viral persistence, immune system damage and long term health effects of covid.

"But really, what's the alternative?"

Now that is actually rather simple. I posted a good while ago an expert assessment on the ease or otherwise of eliminating covid (in the epidemiological meaning of the term, so not the same as eradication). There is a way of scoring pathogens on their attributes that provides a mark of how easy or hard they might be to eliminate, and covid was actually a relatively good candidate for elimination. We have all the means we need to severely restrict transmission with existing technology, and the costs of this would be cheaper than the present approach with all it's financial consequences. When we add in next generation tech, like the development of air sensors that can alert to the presence of SARS-CoV-2 in real time, the 30 second breath tests with very high accuracy, and then nasal spray vaccines that elicit a better immune response and could deliver sterilizing immunity, then we can start to imagine a world largely without covid, as well as having far fewer other airborne diseases.

None of this is overly complicated or difficult, and it is less costly than what we are doing at present. What prevents us from acting is nothing more than a crushing lack of imagination and ambition.

[lens]

Sept 13, 2023 20:40:21 GMT alec said:

lens - "How is that a "massive simplification"? Is it wrong in any way?"

It is a simplification and it may well turn out to be totally wrong. Whether it does or not I don't know. Like I say, you seem to be focused only on the acute phase........... 

!!! Well - "only focused on the acute phase"! Strip away the technical language, and "the acute phase" really translates into deaths, hospitalisations, ventilators, and people (like a friend of mine in April 2020) left with immediate, severe and life changing problems - and don't you think that's what should be focused on!!? For heaven's sake! You may well spend inordinate amounts of time hunting through scientific papers, but in the real world it's rare to find a situation remotely comparable nowadays. No, I'm not saying "it's completely over", not saying "Covid doesn't exist anymore", but for you to say "We are probably in a significantly worse situation now than in 2020 as a result" is simply absurd.

And I'm still waiting for you to provide any explanation for this improvement other than a much increased level of immunity in the general population? I'm told that in early 2021 the great majority of ambulance callouts was for acute Covid - for months now a Covid callout is an outlying rarity. And that comes first hand. Even if it's not 100%, to dismiss this level of immunity as a "quaint" misconception from March 2020 is just wrong.

Sept 13, 2023 20:40:21 GMT alec said:

"But really, what's the alternative?"

Now that is actually rather simple. ........When we add in next generation tech, like the development of air sensors that can alert to the presence of SARS-CoV-2 in real time, the 30 second breath tests with very high accuracy, and then nasal spray vaccines that elicit a better immune response and could deliver sterilizing immunity, then we can start to imagine a world largely without covid, as well as having far fewer other airborne diseases.

None of this is overly complicated or difficult, .........

Oh, "actually rather simple"...... not "overly complicated or difficult"!!??

Alec, that's the sort of thing that was said in 2020 about various measures that were wheeled out then. I well remember the optimism about what the app could promise - and it's now known that any overall benefit was tiny. Test and trace? People I know who were contacted typically told of a delay of about 5 days from their contact, and (fortunately) normally didn't go on to develop an infection unless via a family or close contact that they were already aware of, well before T&T were in contact.

That's not to say such tech as you describe may not have specialised usage, may be worthwhile in such as care homes, say. But in general? Who is going to fund it? And where to draw the line? Let's just think of one hypothetical example. A restaurant decides to splash out on one of your real time sensors, and after a couple of days that detects what it considers a positive result. Firstly, what does the equipment do? Emit a loud warning for all to hear? Or quietly page the manager? And if the latter, what does he do? Evacuate the restaurant, telling everyone to immediately leave their meals and go outside? And effectively lose an entire evenings worth of revenue? I suspect the second time such happened the device would be quietly sabotaged...... Or what about in a theatre or nightclub? Or a pub - you've bought your drinks and next you know an alarm is telling you to evacuate - will the landlord reimburse the cost?

Such measures sound such a good idea at first sight, but the devil's in the detail. Such detail as "what to do if a positive happens" just cannot be glossed over hoping it'll come out in the wash.

Let's face it, LFT tests were fairly easily fiddled if anyone really didn't want the inconvenience of being barred. All such measures may have use in very controlled situations, but are never going to really work in a general societal setting. They may help in care homes, but to think such will help "imagine a world largely without covid" is the same sort of pie in the sky thinking as lay behind such as the app.

It's also worth asking whether it would be cost effective anyway, or better to spend the money on more general non-Covid healthcare measures. I would certainly argue that would have been true for the app, and probably much of what was spent on T&T and LFT testing.

[alec]

lens - "..but for you to say "We are probably in a significantly worse situation now than in 2020 as a result" is simply absurd."

No it's not, because I'm taking a reasonable view of where this is going, as well as addressing the here and now. We've still got around 1,000 in hospital because of covid, clogging up valuable bedspaces and resources, and on the last available figures we're seeing 200 per week die with covid as a causal factor. We're only accepting this because it isn't as bad as an arbitrary point earlier in the pandemic, but 200 deaths is just bad. It would count as a crisis in any other circumstances. On top of that, the excess deaths for the corresponding week were over 800, the majority of which will be related to covid, according to the detailed research. At a time when we should be seeing negative excess deaths, we're running at 5% more deaths than pre-pandemic, which is directly causing a fall in life expectancy, and with the biggest proportionate impacts on young adults. Lots of other countries are now recognising this as a covid outcome, but the correct framing of these astonishing figures is not yet getting through within the UK. So we remain in a very serious situation, but we are convincing ourselves that we're not, only because our chosen metric - immediate pressure on the NHS - does not adequately capture the ongoing impacts of covid.

On top of that, we need to examine the likely trajectory of the pandemic going forward, and the evidence of immune system damage and the shape of the viral mutations caused by untrammeled infection is alarming. I'll post a thread shortly suggesting that the non-spike mutations of SARs-CoV-2 are regularly throwing up some specific mutations in long term chronically infected people that make it more like SARS1 in severity (mortality rate c 50%). So far, these mutations lead to reduced fitness (eg lower ability to infect another host) but they have identified another mutation which is also happening independently of this which is likely to enable the first mutation to occur without the loss of transmissibility, if the two happen simultaneously. We're watching this happen in real time, and the chance of SARS2 ending up more like SARS1 is a very real possibility.

"I'm told that in early 2021 the great majority of ambulance callouts was for acute Covid - for months now a Covid callout is an outlying rarity."

Again, you are ignoring the well established science that shows that whereas previously the impact of covid primarily on the acute phase respiratory symptoms, which vaccination has greatly eased, we're now seeing massive increases in multiple vascular diseases, most notably strokes and heart attacks, which are heavily correlated with prior covid infection but not being recognised as covid related. Again, it's well established that emergency department demands increase for months following covid infection. So a hefty proportion of the increased pressure on the NHS now will be a direct result of infections, but won't be recognised as such.

You could choose to explore a different metric - say, the overall health of the nation, or the number of pediatric hospitalisations, or the number of people unable to work due to chronic health conditions, and you would see that everything is heading in the wrong direction, with covid the main driver for these trends.

On mitigations, yes, there are all manner of problems. Some of these will be surmountable, but none will be perfect. In your restaurant example, if entry was contingent on passing a 30 second breath test, then the owner might find she gets more business because people like me will have confidence in a safe environment. But protections need to be layered, and people need to understand the full risks of infection.

[alec]

lens - as promised, a massive thread demonstrating the complexity of SARS-CoV-2 mutation capabilities, with hints that it could pick up features of SARS1 -

The whole immunity thing is hugely complex, little understood and very risky to rely on.

[lens]

Sept 14, 2023 7:08:40 GMT alec said:

On mitigations, yes, there are all manner of problems. Some of these will be surmountable, but none will be perfect. In your restaurant example, if entry was contingent on passing a 30 second breath test, then the owner might find she gets more business because people like me will have confidence in a safe environment. But protections need to be layered, and people need to understand the full risks of infection.

Alec, you can't have your cake and eat it! A couple of replies back you said regarding mitigations "Now that is actually rather simple. ........... None of this is overly complicated or difficult......." Now you do at least admit "there are all manner of problems". (Which I'd still call an understatement.) I'm not claiming the situation wrt covid is perfect - but the question remains......... "what's the alternative"?

And I totally fail to see that any alternative you've come up with is "actually rather simple". Hopefully you are now appreciating what a totally bonkers idea (except for niche applications) the idea of widespread real time sensors are in terms of practicalities in general public areas, but is even the 30 second breath test at all feasible? How much does the machine cost? Is there also a cost per test (even if just for a disposable mouthpiece)? Can the machine be fooled (smoking/drinking beforehand maybe?)? And who is going to be responsible for the test? (I can just see it at a busy self service cafeteria!)

And the restaurant was only one example from the top of my head. What about a theatre, or a tube train? I can see it now. We need to test 300 passengers before they can get on the tube. 30 seconds per test, and the same to change mouthpieces and reset means 5 hours for the trainload. That's going to work well. Or use real time sensors - and we're back to the question of the detail of what to do if the sensor goes off in one carriage? Or do we just say it's OK to stop any transmission in a restaurant, but to hell with public transport!?

It was not stopping to think about potential pitfalls in advance that led to the app being such a waste of money. Don't let's make the same mistake here.

[alec]

lens - yes, apologies for an excess of flowery language. My mistake.

The principle is simple; we need to reduce transmissions. Some of the necessary measures are simple to enact - like a sensible approach to supported isolation when sick, better access to testing, rigorous airborne infection protocols in medical settings, air quality standards in public indoor spaces etc. All of these measures are currently being applied somewhere in the world, and they aren't rocket science.

Other possibilities could also have benefits, but carry some practical issues, and breathe tests etc may fall into that category. But part of this is providing the public with information. We've been told that as individuals it's up to us to assess our risks, but how can we do this with effectively zero information? So, for example, in the theatre or train example, having a display or warning system linked to a real time air sensor that flashes up a risk level when covid is detected enables service users to leave or put on a mask, if they so choose. What's wrong with that? If venues find that this dents their business, well fine - we'll see more venues invest in air filtration systems, which will keep people healthier.

I notice in these discussions you normally skirt past the science, because I think you're still stuck at the point of focusing on the problems of transmission reduction, rather than taking the time to understand the multifaceted impacts covid is having. I'm more interested in working out how we can mitigate the harms from covid, possibly because I follow the science a bit more on this and I see what's actually happening.

I am seeing more and more official guidance around the world starting to move in that direction though, as the long term risks of covid become more and more apparent in the scientific literature.

[Danny]

Here's an interesting anecdote Alec might find interesting. Its from a random website I was looking at about life on board submarines.

"Something I’d forgotten about until I started thinking about it and haven’t seen here. A little over 1-2 months without pulling into shore, nobody gets sick again until we pull in. This is for boomers who stay out three months only. Can’t speak for fast attacks. My understanding is that the infected pool is small enough, the electrostatic filters etc strong enough, we were closed off from any outside new vectors enough that people’s immune systems catch up to the viruses before viruses can mutate after 1-2 months in. Nobody really paid much attention to it but it did come up in conversation with people new to boats who noticed it. "(boomer is a nuclear missile submarine)

He is giving some credit to electrostatic filters, but aside from that he is demonstrating how a community can completely eradicate a virus from catching it and rapidly passing it round so they all become immune. Whereas what we did with covid was try to slow it down, so that there were still new infectable people available for months, giving it lots more opportunity to mutate. We managed to create the situation where covid infections are now very largely constant all year round. Fantastic.