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Thoughts going forward from here?

The home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
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This is the home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
redsturgeon
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Thoughts going forward from here?

#498830

Postby redsturgeon » May 6th, 2022, 10:08 am

We are not done with this yet but certainly in the UK we are approaching a different phase of the fight. Where do we go from here?

All things being equal and barring the emergence of a particularly vicious strain in the next few months what do we do regarding vaccinations for the autumn/winter.

It seems that the existing vaccines show little value in preventing spread of the disease but are more successful in reducing severe outcomes. Is there therefore any benefit going forward in vaccinating low risk populations. Should vaccines in future only be given to at risk individuals, so nobody who is healthy and under say 60 gets one from here?

Are there new vaccines being produced that will be more effective than the existing ones? Are steps in place to "pandemic proof" our health service, eg. have lessons been learned regarding PPE and testing. What role should isolation play in future? Are we now save to "let things rip" from now? What should be done regarding international travel if there are local outbreaks? What about vaccine passports when should these be phased out?

What will happen in China, who seem to be ploughing a completely different furrow?

Lots of questions, some answers I hope.

John

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Re: Thoughts going forward from here?

#498833

Postby Itsallaguess » May 6th, 2022, 10:13 am

redsturgeon wrote:
It seems that the existing vaccines show little value in preventing spread of the disease but are more successful in reducing severe outcomes.

Is there therefore any benefit going forward in vaccinating low risk populations.

Should vaccines in future only be given to at risk individuals, so nobody who is healthy and under say 60 gets one from here?


I think it might be a little more nuanced than that.

In the absence of a more dangerous strain developing, I think there's likely to be a relatively substantial section of the population who might end up being offered a further vaccination opportunity, but who choose not to take up the offer based on a personal balance of risks.

I'm fully jabbed, and have also had COVID, and in the absence of a more dangerous strain emerging, I think I'd turn down the offer of a future vaccine at this stage, and I suspect there will be many people in the middle-aged brackets and younger who might take a similar view...

Cheers,

Itsallaguess

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Re: Thoughts going forward from here?

#498838

Postby pje16 » May 6th, 2022, 10:26 am

I would take another vaccine if offered, they don't roll them out for fun

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Re: Thoughts going forward from here?

#498845

Postby 88V8 » May 6th, 2022, 10:42 am

redsturgeon wrote:We are not done with this yet but certainly in the UK we are approaching a different phase of the fight. Where do we go from here?

It's not really up to us.
The virus will decide, by continuing to evolve, and the general attitude that we are done with it, as evinced by the fall-off in masking, together with the waning effect of vaccinations and natural immunity, means that we will have another round of infections and hospitalisations, albeit less severe.
Given that the NHS is already in a mess, that should be a big red flag but will not be.

We are not good at big-picture things. Cop26 might as well not have happened, the way the chattering classes are talking about their holiday plans.
We all want the big problems to go away or be handled by someone else, and the media with its trivia obsession does nothing to help.

As regards a further round of vaccinations, that has been complicated by the rise of a new sub-lineage of covid, BA.2.12.1 as discussed here...

The preprint study analyzing these emerging Omicron subtypes indicates it is possible the immune escape properties of BA.4, BA.5 and BA.2.12.1 will lead to new waves of reinfections. And maybe a variant-specific vaccine targeting BA.1 will not be optimal at protecting against these increasingly immune-evasive lineages of Omicron.

“This poses a great challenge to the currently established herd immunity through WT-based vaccination and BA.1/BA.2 infection,” the new research explains. “Similarly, this observation also suggests that Omicron BA.1-based vaccine may not be the ideal antigen for inducing broad-spectrum protection against emerging Omicron sublineages.”


https://newatlas.com/health-wellbeing/omicron-subvariant-ba-2-12-1-spreading-disease-severe-infectious/

This will make it more difficult for govts to decide the way forward in terms of vaccination, and I do agree that uptake may be poor.

One way and another I suspect that the prevailing 'business as before' attitude may prove wishful thinking.

V8

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Re: Thoughts going forward from here?

#498900

Postby funduffer » May 6th, 2022, 3:03 pm

South Africa seems to be the "canary in the coalmine".

Guess what, a new wave is taking off there (BA4 & BA5), with the previous omicron wave having subsided.

https://www.theguardian.com/world/2022/ ... ns-omicron

https://www.worldometers.info/coronavir ... th-africa/

It seems that a previous wave of omicron does not provide much protection against BA4 & BA5.

BA4 & BA5 starting to take off in the UK just as omicron subsides, so watch South Africa to see what happens next.

Going forward, I would take another vaccine, if offered (at age 66). Can think of possible upsides, but no downsides.

FD

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Re: Thoughts going forward from here?

#498936

Postby Dod101 » May 6th, 2022, 6:01 pm

Of course I would take another vaccine if offered. Why on earth would anyone refuse it? I think the vaccines to date have been amazingly successful and I am sure that our scientists will be well prepared for another strain coming along.

I would have thought though that short of a real killer strain, the most likely scenario is that all say over 65s will be given/offered a vaccine for Covid alongside the now routine vaccine for flu.

We need to live with this and get on with our lives.

Dod

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Re: Thoughts going forward from here?

#498941

Postby Hallucigenia » May 6th, 2022, 6:26 pm

For those who don't follow the "do you mask" thread, I posted some thoughts on where we are over there. In particular I recommend a read of this feature in Nature from December on where SARS2 might go next.

That evolutionary path, towards immune evasion and away from gains in infectivity, is common among established respiratory viruses such as influenza says Adam Kucharski, a mathematical epidemiologist at the London School of Hygiene and Tropical Medicine. “The easiest way for the virus to cause new epidemics is to evade immunity over time. That’s similar to what we see with the seasonal coronaviruses.”...

scientists are investigating how quickly a population becomes newly susceptible to infection, says Kucharski, and whether that happens mostly though viral evolution, waning immune responses, or the birth of new children without immunity to the virus. “My feeling is that small changes that open up a certain fraction of the previously exposed population to reinfection may be the most likely evolutionary trajectory,”...

a document prepared by a UK government science advisory group in July raised the possibility that SARS-CoV-2 could become more severe or evade current vaccines by recombining with other coronaviruses. Continued circulation in animal reservoirs, such as mink or white-tailed deer, brings more potential for surprising changes, such as immune escape or heightened severity.

It may be that the future of SARS-CoV-2 is still in human hands. Vaccinating as many people as possible, while the jabs are still highly effective, could stop the virus from unlocking changes that drive a new wave. “There may be multiple directions that the virus can go in,” Rambaut says, “and the virus hasn’t committed.”


I think we've still got a few waves ahead of us, with increasing amounts of immune evasion - I think an autumn wave is inevitable, probably 70:30 that we get one over the summer as well.

For those that haven't come across antigenic cartography, it's an attempt to visualise how similar or different strains are as seen by the immune system. This article from a year ago gives you some background pre-omicron :
Image

and this more recent update now shows how different omicron is :

Image

So there was some debate last year about whether we needed a new vaccine for delta and although they were created, the general feeling was that a vaccine against the "original" Wuhan strain was good enough at the time, because it was more "central" so should give a better "umbrella" of protection against any new strains. But with omicron representing such a "leap" in antigenic space, and with the way that the efficiacy of Covid vaccines fade with time it looks like we need regular boosters and that the next one should be some kind of omicron-specific one.

But as I said in the masking thread we still need to do so much more on ventilation and air filtration - if a couple of dads at a primary school can essentially stop Covid transmission in a weekend of work, we should be able to do something similar in all our "essential" public spaces like schools and supermarkets.

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Re: Thoughts going forward from here?

#498978

Postby 88V8 » May 6th, 2022, 8:26 pm

Hallucigenia wrote:But as I said in the masking thread we still need to do so much more on ventilation and air filtration -

I spent a good deal of time before Xmas two years ago emailing the SAGE members asking them to underline the importance of ventilation. I think I mentioned it on here....
I also tried to get the meeja interested.... what a waste of space those people are.

Overall it fell on largely deaf ears.
Or if not, the ears do not seem to have committed any funds to the matter that I've heard of.

V8

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Re: Thoughts going forward from here?

#499038

Postby redsturgeon » May 7th, 2022, 8:50 am

88V8 wrote:
Hallucigenia wrote:But as I said in the masking thread we still need to do so much more on ventilation and air filtration -

I spent a good deal of time before Xmas two years ago emailing the SAGE members asking them to underline the importance of ventilation. I think I mentioned it on here....
I also tried to get the meeja interested.... what a waste of space those people are.

Overall it fell on largely deaf ears.
Or if not, the ears do not seem to have committed any funds to the matter that I've heard of.

V8



Probably no friends of the government are in the ventilation business :lol:

John

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Re: Thoughts going forward from here?

#499081

Postby Julian » May 7th, 2022, 1:55 pm

88V8 wrote:
Hallucigenia wrote:But as I said in the masking thread we still need to do so much more on ventilation and air filtration -

I spent a good deal of time before Xmas two years ago emailing the SAGE members asking them to underline the importance of ventilation. I think I mentioned it on here....
I also tried to get the meeja interested.... what a waste of space those people are.

Overall it fell on largely deaf ears.
Or if not, the ears do not seem to have committed any funds to the matter that I've heard of.

V8

Well as someone who agrees with your thoughts on ventilation I should start by thanking you for the time you spent, sadly seemingly in vain, in emailing the members of SAGE on this matter.

I know that hindsight can be 20/20 but whenever this topic comes up I keep remembering two aspects of the pandemic response, firstly the highly publicised early government call out to industry to design and presumably then manufacture affordable ventilators in high volume and secondly the vast amounts of money spent of furlough and other financial support for hospitality and non essential retail that was kept closed for so long. I do wonder how things might have been different if at least some of that money and publicity had been redirected towards initiatives to make indoor spaces safer so that those types of spaces didn't have to be closed down for so long.

I'm thinking in terms of a call out to industry to provide effective, low cost mass-producible designs for ventilation aids that could scrub viruses out of the air e.g. by HEPA filtration and/or non-ozone-releasing UV scrubbing and then, assuming good designs were forthcoming, redirect some of the money spent on keeping various premises closed to subsidising those businesses to fit such devices so that at various stages of the pandemic more stuff might have been able to stay open or some of the severe lockdowns could have been relaxed slightly earlier.

Not only would that have been better for people's wellbeing by keeping some stuff closed down for shorter periods of time (thus also saving the government furlough and other costs hence the air-scrubbing subsidies might well have been funded within the spending we have already seen) but it would also have left us with that air purifying infrastructure in place which would be of immense value assuming the next pandemic to hit us again has a strong airborne transmission component.

Oh well, if wishes were fishes, and admittedly I am not factoring in the timing of the various revelations about this virus, e.g. when the call went out to industry for ventilator designs we really did think that was the most effective treatment for severe cases (I assume) so I suppose it was a reasonable initiative at the time even if events did overtake it. Once we realised how dominant airborne transmission was however lockdown restrictions began to explicitly acknowledge the fact outdoor spaces were safer than indoor spaces, e.g. the stages of the restrictions when we were only allowed to meet outside, and at that point some blue sky thinking along the lines of "could we make indoors more like outdoor spaces?" would seem to me to have been a very valuable line of thought to pursue. Maybe people somewhere were doing that and somehow they hit roadblocks in implementing some sort of grand vision like the one I proposed above, I accept that proper research might show it to be totally impractical, or perhaps it could have been practical but they never managed to get the government's attention.

- Julian

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Re: Thoughts going forward from here?

#499103

Postby Hallucigenia » May 7th, 2022, 3:49 pm

Julian wrote:firstly the highly publicised early government call out to industry to design and presumably then manufacture affordable ventilators in high volume


The basic idea of a "Nightingale" ventilator was sound enough, it was just that the advisor pushing it was a slave to the Silicon Valley "break things" mentality which he interpreted as "ignore the experts" and so you ended up with the likes of Dyson producing kit that just wasn't fit for purpose - for instance AIUI they just didn't get the reliability requirement and so had single points of failure that weren't acceptable. Hopefully now that things have calmed down people are working on a "field hospital" ventilator that can be mass-produced but also built from common components and maybe a bit of 3D printing - electronics like Arduinos and Pi Picos are cheap enough you can have them in triplicate and still have a cheaper, more reliable solution than a custom board, and they're piled high in warehouses around the world. Same with the reporting - they talk to an iPad/generic tablet at a central nurse's station that allows the nurse to monitor 20+ patients at a time, you have a spare tablet and if one breaks you just go down to Argos for another one rather than paying £5000 for something that is half as capable from one of the medical suppliers.

Get it all optimised and approved now, when we don't need it, so that it can be readily scaled up when we do.

Julian wrote:I'm thinking in terms of a call out to industry to provide effective, low cost mass-producible designs for ventilation aids that could scrub viruses out of the air e.g. by HEPA filtration


Such a device was already being developed on Twitter in August 2020 by a professor of engineering at UCD and it was rapidly tweaked and improved by various professors of aerospace engineering and the like. See this article for more about the Corsi-Rosenthal box, which is simple enough to be made at home, just a fan, duck tape and four filters which don't even have to be HEPA grade, even MERV filters make a big difference. In fact, you get people holding Corsi box-building parties at universities etc. Works out at maybe £10 per pupil?

But even if you go for commercial units, you're looking at no more than £20/pupil - see Corsi's calculations (Allowing extra for VAT, more expensive electricity etc here) :
Image

And ventilation and filtration work, as demonstrated by my favourite primary school, the only caveat being it's a lot easier to have the windows open in Brisbane than in January in Bristol.

And yet this kind of stuff has been almost entirely absent from the debate in the UK. So one question is why that it is, and there's lots of reasons for that. But some of it is just plain incompetence, and a lack of leadership - just read this("archived" version) and try not to get angry with the lazy, incompetent oaf at the top, less worried about Covid than his divorce and media treatment of his dog.

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Re: Thoughts going forward from here?

#500999

Postby Hallucigenia » May 17th, 2022, 3:22 pm

Michael Saunders of the Bank of England MPC worrying about the jump in people unable to work because of long-term sickness.

There is no tradeoff between health and the economy, they're the same thing.

Since Q4-19, the number of people aged 16-64 years that are outside the workforce and do not want a job has risen by 525,000 (1.3% of the 16-64 age population). This largely reflects increases in long-term sickness (roughly 320,000 people) and retirement (90,000), with smaller contributions from lower participation among students (65-70,000) and short-term sickness (30-35,000 people). The share of the 16-64 population who are outside the workforce and do not want a job because of long-term sickness is a record high, with an especially sharp rise among women (see figure 6). I suspect much of this rise in inactivity due to long-term sickness reflects side effects of the pandemic, for example Long Covid] and the rise in NHS waiting lists.

Image

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Re: Thoughts going forward from here?

#501129

Postby servodude » May 18th, 2022, 1:10 am

Hallucigenia wrote:There is no tradeoff between health and the economy, they're the same thing


If that were true we'd have known it going in to this by looking at what happened with previous pandemics!
<mumble mumble, spanish flu>

Oh! what? we did.... ? Really?
<mumble, wave hands, point at graphs>

Well why were they still spouting that stuff about it being a choice between being destitute or fighting this thing?
<mumble mumble F&*^Sn9 t#ick de^10us pr%cks>

That's not very nice... but I can see your point

- sd


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