Covid-19 Current Situation 22/11/2020

I’m doubtful about the numbers coming down before the proposed end of substantial lockdown on the 2nd December, more like starting to fall around the 5th and continuing to fall until the new year before they start rising again to current levels near the start of February, but this sounds like good news for Christmas, as long as long as people don’t go mad. Wild celebrations wouldn’t be good, however much everybody wants to.

Figures around the world:

Andorra has had 8% recorded as having had the disease, so this gives a maximum unknown to known ratio of 11:1 and falling day by day, having done the equivalent of testing everybody in the country twice. It’s still only a small subject population though.

Belgium has 0.13% of the whole population having died from the disease since the 4th February and continuing, 92% of those having died within a 3 month period of non-restriction.

Mexico has had 9.8% die of those recorded as infected, with cases continuing at the same rate.

USA has had 12.4 million cases and still continuing at +12% a day.

Every major country except China is showing a resurgence, and the data they have been providing since March is very suspect.

12 countries have done the equivalent of testing their whole population, some more than once, and finding on average about 2.4% have been infected, the same ratio as in the UK, so the vague guess of widespread unknown infection that was very weak, is still getting weaker day by day.

If you take equivalent numbers based on a UK population for cases, the UK is number 43, the top ones having twice the number of cases compared to their size. For deaths, the UK is number 8, the top ones having 50% more deaths compared to their size.

There is a real and definite threat, the ones claiming that there isn’t likely to die from it or infect other people at risk at some time. Anybody can pull out discredited articles as evidence of a scam because their motives are choosing to ignore the mounting evidence and have decided that as such.

But the threat is still distant for most, the majority of the population not at risk until they get ill or old. Then it becomes a very real and immediate risk that will be around for decades and everybody is going to join this group at some time, not if, but when.

The UK has a population of 68 million, the world 7,800 million, with about 1/3rd needing effective long-term vaccines, so we need to work out how long it will take to get those vaccines to such a proportion if this thing does exist. Add to this the longer it takes the bigger the numbers that will come into that group and the shorter the long term effectiveness the more often you will need to go around this group again.

A yearly vaccine would not be much better than not having one overall, at least for a few years or up to a decade.

So, for the UK, 23 million will be in definite requirement, the world, 2.6 billion doses of a single injection, 46 million and 5.2 billion doses of a double injection. Some will refuse to have any vaccines, and we don’t know the effects of the vaccines long term or that they will be effective more than short term.

We have two opposing beliefs. At one end we have the belief in the new vaccines, without long term and widespread use, so there is sparse evidence to support possible adverse effects, as some are as novel as the coronavirus, and at the other we have the belief that vaccines are all dangerous so won’t use them, ignoring the long- term evidence to the contrary. One end wishing to force the new ones upon everybody, the other end to stop everybody using them.

At the current rate of increased production looking at the influenza rates, the world is capable of increasing production of a Covid-19 vaccine at a rate of about 20% of doses a year. For double dose vaccines this works out to 10% a year. Anything more and production of other vaccines would need to be reduced, with knock on mortality in the diseases those vaccines cover. So a good estimate for increased vaccine production covering the number required in the world would be about 8 years for a single dose vaccine and lifetime effectiveness, 19 years for a 5 year effectiveness one, and 46 years for an annual dose one. For a double dose vaccine, the number required in the world would be about 15 years for a lifetime effectiveness one, 31 years for a 5 year effectiveness one, and 90 years for an annual dose one. Herd immunity may mean years of production required reducing to 7, 14 and 34 years for a single dose type, and 11, 27 and 66 years for a dual dose type.

Main frontrunners for provision of vaccine to UK:

BionTech/Pfizer, 90% claimed effectiveness after second dose, waiting for approval, 10 million doses available for the 11th December start? 40 million by end of next year.

Oxford/AstraZeneca, claimed 93% effectiveness, hopefully finishing by end of the year, 100 million doses by end of next.

Moderna, hopefully finishing early next year with 5 million doses by mid next year.

Novavax, hopefully finishing early next year with 60 million doses by end next year.

Janssen, hopefully finishing mid next year with 30 million doses by end of year.

Valneva, hopefully finishing mid next year with 60 million doses by end 2022.

GSK/Sanofi/Pasteur, hopefully finishing mid next year with 60 million doses by end 2022.

But there is another fly that seems to be creeping into the ointment, the assessing of effectiveness. From new results we have the figure of 90% effectiveness coming out for the Oxford/AstraZeneca vaccine, the Pfizer/BionTech and Moderna now claiming 95%. But if you investigate on, the 90% for the Oxford one comes from 70.4% effective on average, up to 90% after 2 doses, one half of the first, with 2 full doses giving lower protection (62%) than 1 1/2 doses. This doesn’t make sense in a lot of ways, and there could be the possibility that being exposed twice to the adenovirus that was used as the carrier reduces your immunity. Or is it that being exposed twice to this pattern of coronavirus does the same. What about 3 times, 4 times, 5 times, and more importantly what about exposure to measles?

With the testing, are we talking about volunteers in the field who are being exposed to the full effects of a present and current virus that is now widespread and endemic to an area, so constant exposure and re-exposure, or are we just talking about theoretical exposure that is not being tested in real situations, and in areas of lockdown and restrictions, reducing contact where there is little real chances of being overcome? A calculation of 90% effectiveness if nobody comes close that’s got it.

It’s interesting that 24,000 is quoted as taking part in the study, but this does mean that in a double blind study only 12,000 actually get the vaccine, 12,000 do not, and you need to compare like for like on not just fit and healthy people who are not the main target of the disease, and may skew results. For the under 30’s the difference between having the disease, not having the disease, and having the disease after one or more vaccinations is trivial, you are talking about comparing all sub 1% figures, so probably the difference in the outcomes of 20 people.

So this would be a solution for those countries that could afford the vaccines, but would not be suitable for 75% of the world, which will probably experience the full effects of the virus over the next 3 years.  If vaccinations or immunities are lifetime, then all well and good for the more wealthy countries, but if the immunity is not semi-permanent then probably every 5 years the virus will outstrip the vaccine availability, until it is tolerated or take the toll of older people, 3% of the population every year going into the risk group.

With vaccines we might see something like the UK median age reducing from 80 years to about 78 years, with logistics problems or lack of long-term effectiveness 75 years. For the world, median ages going down from 70 to 65 or as low as 62 years.

The first of these, the Russian one, we have not heard from for quite a while, quite possibly not living up to its hype, or having logistical problems of manufacture and distribution, the Russian figures continuing as before.

The second one, 10 million doses, so 5 million treatments of a dual type low temperature version is supposed to be around by the end of the year, but approval hasn’t even happened yet. And the deadline for the start of distribution and use is now 11 days away, so immunity even for the group that gets it may not now be until about 7th January under perfect conditions for an accepting, ill, and very elderly group. For the 30 million still at risk they will probably need to wait until April-December. If it works on people who are by level of health not really equivalent to those who the results of safety and theoretical short-term effectiveness the data was based on. At best long-term is months of testing at the moment, not years.

You ask if all of the super low temperature transport vessels have been manufactured and supplied, or are they still on order, with promises of delivery?

Logistics may or may not be the problem, even if the psychology of the moment is ignored.

We have had some very optimistic views that the UK will get back to normal by spring. The trouble is they haven’t informed the virus of these plans, which will probably still be around for years, and judging by the influence of other types of coronavirus they are unlikely to be content with just one bite from the human apple.

By what is missed by the application of this 90%? Effective vaccine is what is the virus going to be doing amongst all the logistics of getting all the people in close proximity with all the people that needs to transport them there while this is going on, and what all the involved people performing it need to do to stay safe. 1,000 vaccinations a day for each site?

10% failure is still a lot with a lot of highly vulnerable people in one place.

But it does seem that the current race for a suitable vaccine is like trying to get to a destination quicker by putting our foot down on the accelerator, trying to outrun the amber at each stage.

Trading off levels of safety for the sake of expediency, reducing the safety overall.

The world is still not getting together to deal with the problem though, trying to deal with it piecemeal and locally, and for those who can pay. It’s not the end of our way of life and our current ‘civilised world.’ That’s probably at least 100 years away and for great grandchildren to be worried about.

That we are getting 3 vaccines coming on line, the Oxford/AstraZeneca (Oxford, UK), the Pfizer/BioNTech SE (Mainz, Germany USA/German) and the Moderna (Massachusetts, USA), is good news but there is still something bothering me. To get the +90% effectiveness you still need two doses for all of them, but this ‘serendipity’ of discovering that a half dose produces a 90% effectiveness, whereas a full second dose produces 67%, is something that should have been discovered as part of a phase 1 trial where varying levels of doses and second or third doses are calculated.

Things don’t just happen just by chance whatever people claim, and that having a smaller dose that causes less side effects is perfectly logical, but in this case we don’t have just that, having a lower overall dose being more effective. It would be like having 3 pints of beer getting you drunk, whereas 6 pints makes you 23% more sober, or having 1 followed by half a painkiller is better than having two subsequent full amounts.

As the cost of the Oxford/AstraZeneca vaccine is so low there wouldn’t be any real advantage to a half over a full dose in terms of manufacture, needing a splitting of production lines for the appropriate version, full or half dose, but the mechanism is still unclear. Is it the carrier that is reducing the effectiveness, or is it an exposure to more of the target viral pattern? The latter might not be so good as it might suggest a short term or reducing effectiveness for repeat exposure to the live virus.

What would be the effects of 2 full doses if a yearly version is required, or will it need a full original one, followed by a half dose second and a quarter a year later, and so on?

I don’t like random chance as an answer, and wonder if the other vaccines also show this effect?

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