Northern Europe during Pandemic -- Summers 2020 & 2021 & onwards

[GordMay]

Researchers are divided over strategies to extend the time between jabs of two-dose COVID vaccines. Some virologists worry that the approach will create large groups of people with partial immunity. These people might have enough antibodies to slow the virus and avoid developing symptoms — but not enough to wipe it out. This might give SARS-CoV-2 more time to mutate in ways that could compromise vaccine efficacy. Other experts say the risk (which is still just theoretical) doesn’t outweigh the benefits of protecting more people during out-of-control outbreaks. “It’s carnage out there,” says evolutionary microbiologist Andrew Read. “Twice as many people with partial immunity has got to be better than full immunity in half of them.”
Official guidelines say the Pfizer-BioNTech vaccine is meant to be given as two doses, 21 days apart, while Moderna recommends spacing doses 28 days apart.


“Could too much time between doses drive the coronavirus to outwit vaccines?” ~ by Meredith Wadman
➥ https://www.sciencemag.org/news/2021...d3502-45020405

“Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host”
➥ https://www.nejm.org/doi/full/10.1056/NEJMc2031364




Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination (UK)
➥ https://assets.publishing.service.go...20-revised.pdf

Remarks at Operation Warp Speed Briefing (USA)
➥ https://www.hhs.gov/about/leadership...-briefing.html

Statement from the Council of Chief Medical Officers of Health: Implementing COVID-19 Vaccination in Canada — Vaccine Dose Interval (Canada)
➥ https://www.canada.ca/en/public-heal...-interval.html

[Seaworthy Lass]

Originally Posted by GordMay

Researchers are divided over strategies to extend the time between jabs of two-dose COVID vaccines. Some virologists worry that the approach will create large groups of people with partial immunity. These people might have enough antibodies to slow the virus and avoid developing symptoms — but not enough to wipe it out. This might give SARS-CoV-2 more time to mutate in ways that could compromise vaccine efficacy. Other experts say the risk (which is still just theoretical) doesn’t outweigh the benefits of protecting more people during out-of-control outbreaks. “It’s carnage out there,” says evolutionary microbiologist Andrew Read. “Twice as many people with partial immunity has got to be better than full immunity in half of them.”
Official guidelines say the Pfizer-BioNTech vaccine is meant to be given as two doses, 21 days apart, while Moderna recommends spacing doses 28 days apart.


“Could too much time between doses drive the coronavirus to outwit vaccines?” ~ by Meredith Wadman
➥ https://www.sciencemag.org/news/2021...d3502-45020405

“Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host”
➥ https://www.nejm.org/doi/full/10.1056/NEJMc2031364

Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination (UK)
➥ https://assets.publishing.service.go...20-revised.pdf

Remarks at Operation Warp Speed Briefing (USA)
➥ https://www.hhs.gov/about/leadership...-briefing.html

Statement from the Council of Chief Medical Officers of Health: Implementing COVID-19 Vaccination in Canada — Vaccine Dose Interval (Canada)
➥ https://www.canada.ca/en/public-heal...-interval.html

Hi Gord
You are certainly skilful in finding useful links! Thanks for hunting these up.

I have read all the articles.
The delay with giving the second dose is being debated, as expected. At least the UK is delaying this a limited time (max of 12 weeks instead of the trialled 3 for the Pfizer vaccine and instead of the trialled 4 for the Oxford-AstraZeneca). I have not been able to find how the time frames were initially selected for the trials. They don’t seem to have been based on any data regarding the specific vaccines. It is so very hard making decisions when trials have been so limited so far.

The logic behind the rollouts were particularly interesting. Also how strategies are different between the UK and US. Maybe part of this is due to the type of vaccine initially used predominantly? It will be much harder to reach outlying communities with the mRNA vaccines due to storage issues, so maybe the US has decided to vaccinate all those over 65 as it is easier to organise this and more people can be vaccinated as quickly as possible. This is less of an issue in the UK where the easier to store AstraZeneca vaccine will be used predominantly.

Priority in the UK is divided into the 9 highest groups at risk of dying from COVID-19 in Phase I.
“It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19.”

The UK does not make it clear what percentage of each group will need to be vaccinated before they move to the next group (or at least not that I saw).

Interestingly, no decision has been made yet regarding if or when healthy people under 50 (who are not medical or care home workers) will be vaccinated. They are planning to wait before more data is available before later in the year in Phase II tackling the healthy 16- 50 year olds who are at negligible risk of dying. This will be “subject to consideration of the latest data on vaccine safety and effectiveness.”

Also very interesting I could find no mention that herd immunity through vaccination was an aim. It has been clearly stated this is the aim in Australia once any vaccines are finally approved and rollout starts. This is despite the lack of transmission data.

Again, thanks Gord. That gave me a few hours of good reading.

[Dockhead]

Originally Posted by Seaworthy Lass

. . . Interestingly, no decision has been made yet regarding if or when healthy people under 50 (who are not medical or care home workers) will be vaccinated. They are planning to wait before more data is available before later in the year in Phase II tackling the healthy 16- 50 year olds who are at negligible risk of dying. This will be “subject to consideration of the latest data on vaccine safety and effectiveness.”. . . .

You know what that sounds like to me?

It sounds like they are going for the "let 'er rip while protecting the vulnerable" approach of the Great Barrington Declaration.

I at first really questioned why the hell they would be wasting time vaccinating people in nursing homes, when they should be going after the spreaders. We discussed this.

And then the light bulb went off. That approach looks quite different when you have such a powerful way to protect the vulnerable -- HOW you protect the vulnerable was, to my mind, the fatal flaw in the Great Barrington Declaration approach.


They're not trying to stop the pandemic (although they eventually will). They're trying to reduce the consequences of its being out of control.

[Seaworthy Lass]

Originally Posted by Dockhead

You know what that sounds like to me?

It sounds like they are going for the "let 'er rip while protecting the vulnerable" approach of the Great Barrington Declaration.

I at first really questioned why the hell they would be wasting time vaccinating people in nursing homes, when they should be going after the spreaders. We discussed this.

And then the light bulb went off. That approach looks quite different when you have such a powerful way to protect the vulnerable -- HOW you protect the vulnerable was, to my mind, the fatal flaw in the Great Barrington Declaration approach.


They're not trying to stop the pandemic (although they eventually will). They're trying to reduce the consequences of its being out of control.

Not sure if they will "let 'er rip while protecting the vulnerable". Restrictions are likely to still be in place? Although maybe very few if they want to get the economy going again and kids back at school.

But it is interesting that there was absolutely no mention of herd immunity in UK’s policy. Preventable mortality is the focus for now. This is repeated over and over. The media have not cottoned onto that.

I had a quick look at figures here:
https://www.statista.com/statistics/...lation-by-age/

In 2019 the population in the UK was 66.82 million.
41.6 million were under 50 (62%). I don’t know how many of these are classed as vulnerable, but I doubt it is a high number for the relatively young group.

At least for part of this year they are not consideration vaccinating nearly 62% of the population. This is not just due to availability of vaccine issues. They state they are awaiting more data. They have not mentioned how much more. The AstraZeneca trial is currently planned to run for a year.

Teachers, workers in the food industry, military etc are not included at all in Phase I unless they fall into one of the 9 at risk groups. Not what I expected at all.

Even for the Phase II, herd immunity is not mentioned as an aim. Instead “The Committee is currently of the view that the key focus for the second phase of vaccination could be on further preventing hospitalisation.”

[Seaworthy Lass]

By the way, this is vastly different to Australia’s policy. Herd immunity is the aim.

A few days ago the Australian and New Zealand Society for Immunology stated “the federal government should immediately pause the planned rollout of the AstraZeneca vaccine because it may not be effective enough to generate herd immunity.”

https://www.smh.com.au/national/scie...12-p56tjt.html

This comment was retracted soon after (probably as we have little choice but to use the
AstraZeneca vaccine predominantly at least initially), but it illustrates the difficulty faced when eradication has been the aim.

[UFO]

Originally Posted by Seaworthy Lass

By the way, this is vastly different to Australia’s policy. Herd immunity is the aim.

A few days ago the Australian and New Zealand Society for Immunology stated “the federal government should immediately pause the planned rollout of the AstraZeneca vaccine because it may not be effective enough to generate herd immunity.”

https://www.smh.com.au/national/scie...12-p56tjt.html

This comment was retracted soon after (probably as we have little choice but to use the
AstraZeneca vaccine predominantly at least initially), but it illustrates the difficulty faced when eradication has been the aim.

I think eradication is almost impossible if you want to return to a normal planet/country any time in the next few years, otherwise you will need to keep testing and quarantine on international (and internal borders in Oz) borders or face an outbreak and as we have seen once it gets a good foothold, its pretty hard to stop. Even with a good level of herd immunity not everyone will be covered and outbreaks will occur and on top of this if it mutates beyond a current vaccine or its effects wear off you have to vaccinate EVERYONE again, which is no simple task.


I think the UK has the right idea, as I have said from Day 1 protect the vulnerable and at risk with vaccinations like they currently do with the flu and let everyone else have the choice to vaccinate or not - Protecting those at risk should massively reduce hospitalisations and deaths.


If we treat it like we do the flu and remove the fear, paranoia and the BS of eradication then when can possibly get back to a more normal way of life.

[fxykty]

Originally Posted by UFO

I think eradication is almost impossible if you want to return to a normal planet/country any time in the next few years, otherwise you will need to keep testing and quarantine on international (and internal borders in Oz) borders or face an outbreak and as we have seen once it gets a good foothold, its pretty hard to stop. Even with a good level of herd immunity not everyone will be covered and outbreaks will occur and on top of this if it mutates beyond a current vaccine or its effects wear off you have to vaccinate EVERYONE again, which is no simple task.


I think the UK has the right idea, as I have said from Day 1 protect the vulnerable and at risk with vaccinations like they currently do with the flu and let everyone else have the choice to vaccinate or not - Protecting those at risk should massively reduce hospitalisations and deaths.


If we treat it like we do the flu and remove the fear, paranoia and the BS of eradication then when can possibly get back to a more normal way of life.

Isn’t one of the problems with treating Covid-19 infections like flu infections that the consequences of non-mortal Covid-19 infection (not sure about the latest mutations) for a reasonably high number is the extended long-Covid symptoms? That’s certainly unlike catching the flu.

[Dockhead]

Originally Posted by UFO

. . . If we treat it like we do the flu and remove the fear, paranoia and the BS of eradication then when can possibly get back to a more normal way of life.

I agree with you that there is a lot of fear and paranoia and bad thinking concerning this pandemic.

However, I do not agree that we can just "treat it like the flu". If you don't take effective measures of some kind or another hospitals overflow and a disproportionate number of people die, and also die from other diseases which can't be treated because the health care system is overwhelmed. We do NOT want this; and we've seen it happen so it's not paranoid to try to prevent. it.

And the flu itself is a nasty thing which kills a lot of people some years. Some of the recent flu pandemics are associated with more excess deaths in some countries than COVID.

This is not a non-problem. Objectively.

[Seaworthy Lass]

There are clearly no easy or “right” solutions. Experts worldwide disagree on best strategies. It makes discussion interesting .

I have held the view (and I am very flexible with changing this once new data becomes available) that the vulnerable need to be protected and the rest of us learn to live with the virus by taking precautions or being vaccinated or simply accepting the minor risk of serious problems (as with influenza). This is an unusual virus as a large number of people may be asymptomatic and this does affect things.

This whole issue is complicated further by the lack of complete trials with any of the available vaccines. This will happen in 2021.

The other consideration is that although the concept/technology has been around for decades, the approval for human usage is new for the Pfizer vaccine (an mRNA vaccine) and relatively new for the Oxford-AstraZeneca vaccine (a viral vector vaccine). Both these ultimately end up working in a similar way by having mRNA that encodes the SARS-CoV- 2’s spike protein stimulate the body to produce this spike protein and induce an immune response.

I don’t want to freak people out with any of this because as with any vaccine or any medication taken, the risks must be weighed with benefits. This is absolutely nothing new and must be viewed sensibly, not with fear.

I encourage people to do some reading themselves to help make informed decisions. Also don’t be dogmatic about what you will or won’t do. This is a constantly changing situation.

Just my two cents .

[Dockhead]

Originally Posted by Seaworthy Lass

Not sure if they will "let 'er rip while protecting the vulnerable". Restrictions are likely to still be in place? Although maybe very few if they want to get the economy going again and kids back at school.

But it is interesting that there was absolutely no mention of herd immunity in UK’s policy. Preventable mortality is the focus for now. This is repeated over and over. The media have not cottoned onto that.

I had a quick look at figures here:
https://www.statista.com/statistics/...lation-by-age/

In 2019 the population in the UK was 66.82 million.
41.6 million were under 50 (62%). I don’t know how many of these are classed as vulnerable, but I doubt it is a high number for the relatively young group.

At least for part of this year they are not consideration vaccinating nearly 62% of the population. This is not just due to availability of vaccine issues. They state they are awaiting more data. They have not mentioned how much more. The AstraZeneca trial is currently planned to run for a year.

Teachers, workers in the food industry, military etc are not included at all in Phase I unless they fall into one of the 9 at risk groups. Not what I expected at all.

Even for the Phase II, herd immunity is not mentioned as an aim. Instead “The Committee is currently of the view that the key focus for the second phase of vaccination could be on further preventing hospitalisation.”

I didn't mean to argue that the AIM of the UK policy is to happily allow the spread of the virus so long as the vulnerable are protected. I think this is clearly NOT the aim. I just meant that it starts to look to me like they don't have confidence in suppressing the spread of the virus, and perhaps for that reason they are concentrating on protecting the vulnerable rather than on stopping the epidemic sooner. And I even think that may be sensible, contrary to my earlier thoughts. How long will it take to vaccinate everyone over 65? The deaths are so extremely age skewed, that you will dramatically reduce the death rate even before you accomplish anything with suppressing the spread.


Once people aren't dying, then you can kind of tolerate the continued spread of the virus, and you can keep off the damaging measures and let people work and go to school and have cultural and social life. Open the pubs and cinemas. Then gradually choke off the pandemic as you move through the rest of the population with vaccination; at the same time natural immunity will be constantly increasing.



I just bet that's what they are thinking.

[Seaworthy Lass]

Originally Posted by fxykty

Isn’t one of the problems with treating Covid-19 infections like flu infections that the consequences of non-mortal Covid-19 infection (not sure about the latest mutations) for a reasonably high number is the extended long-Covid symptoms? That’s certainly unlike catching the flu.

No, that is not correct. Just google “Post viral syndrome following influenza” and a mass of info will come up. Fatigue lasting weeks or months is very common following influenza, but more severe neurological problems may occur:
https://pubmed.ncbi.nlm.nih.gov/22889537/

There is also speculation that post viral effects may cause issues even years down the track. Association with several serious diseases has been found, but this does not necessarily imply causation. This question is still unanswered.

[Seaworthy Lass]

Originally Posted by Dockhead

I didn't mean to argue that the AIM of the UK policy is to happily allow the spread of the virus so long as the vulnerable are protected. I think this is clearly NOT the aim. I just meant that it starts to look to me like they don't have confidence in suppressing the spread of the virus, and perhaps for that reason they are concentrating on protecting the vulnerable rather than on stopping the epidemic sooner. And I even think that may be sensible, contrary to my earlier thoughts. How long will it take to vaccinate everyone over 65? The deaths are so extremely age skewed, that you will dramatically reduce the death rate even before you accomplish anything with suppressing the spread.


Once people aren't dying, then you can kind of tolerate the continued spread of the virus, and you can keep off the damaging measures and let people work and go to school and have cultural and social life. Open the pubs and cinemas. Then gradually choke off the pandemic as you move through the rest of the population with vaccination; at the same time natural immunity will be constantly increasing.

I just bet that's what they are thinking.

Yes, I agree.
We don’t know anything about how effectively spread can be suppressed. This is coupled with vaccine trials not having been completed yet, so waiting before making it available to anyone at low risk of severe disease seems sensible to me, particularly since this group is “young”.

There are only around 12 million people above 65 in the UK (population around 67 million). It won’t take long to get through those at highest risk.

[UFO]

Originally Posted by Dockhead

I agree with you that there is a lot of fear and paranoia and bad thinking concerning this pandemic.

However, I do not agree that we can just "treat it like the flu". If you don't take effective measures of some kind or another hospitals overflow and a disproportionate number of people die, and also die from other diseases which can't be treated because the health care system is overwhelmed. We do NOT want this; and we've seen it happen so it's not paranoid to try to prevent. it.

And the flu itself is a nasty thing which kills a lot of people some years. Some of the recent flu pandemics are associated with more excess deaths in some countries than COVID.

This is not a non-problem. Objectively.

My point about treating it like the flu is in regard to the vaccination protocol, which is simply to vaccinate those in the risk categories, along with those that chose it - If you did this then Covid deaths (if the vaccine works) would be like the flu. If you aim higher than this for covid, then why have we not aimed higher than this for the flu? In aiming higher we are going to struggle in getting back to any resemblance of normalcy as the fear and paranoia will not go away and it will not be business as normal - We have to accept that people die and whether its covid, Flu, heart attack or one of a million ways to die, its is going to happen whether we like it or try to stop it or not - It is simply a part of life.

[Dockhead]

Interesting peer-reviewed work on the efficacy of lockdown:


https://onlinelibrary.wiley.com/doi/10.1111/eci.13484

[Capn Jimbo]

A Public Health Perspective:

This abstract (not the article itself) does not define or even use the descriptor "lockdown". Rather it discusses just two of literally thousands of possible interventions, namely "mandatory stay‐at‐home and business closures".

Until or unless this hypothesis and study is actually published, it is premature to come to any definitive conclusion. The term "lockdown" alone is meaningless, and tends to be used politically, especially in this thread.



CJ
Public Health, 30 years