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

[GordMay]

A recent study [1], from Public Health England (PHE), looked at just how effective the first vaccine dose is against the delta [B.1.617] variant.
Experts agree the biggest threat at the moment isn't variants — despite the dizzying pace of research being released worldwide — it's not being vaccinated at all.
More ➥ https://www.cruisersforum.com/forums...ml#post3424808

[Seaworthy Lass]

Originally Posted by Dockhead

Finland and Germany are approaching 50% of people with at least one dose in them; Denmark and Sweden around 40%. Inasmuch as the original strain and the UK strain are still dominant here, it might still make sense to be stretching out the second doses somewhat. Provided vulnerable people are fully vaxxed. You'd have to model it to really know.

In the UK it has taken about 6 weeks from having 98% of detected cases with the Alpha variant and 2% with the Delta, to this being almost exactly reversed (96% of cases is apparently the very latest estimate for the Delta variant). This has moved at lightning speed.

If the demographics of other European countries are similar to the UK, 99% of deaths are accounted for by less than 50% of the population. It makes sense to me to target these with first doses ASAP, but then rather than focussing on vaccinating those at low risk, aim to fully vaccinate those at higher risk, particularly given the characteristics of the Delta variant. As 43% of the population has now received a first dose, the EU is close to that stage now if the most vulnerable actually make up that group.

I think it very likely the Delta variant will take over in Europe as the Alpha did a few months ago. Europe has a short window of opportunity to change their strategy and shorten the time between the two doses so those at highest risk are protected.

Originally Posted by Dockhead

Also, the idea that one dose is spectacularly ineffective against this strain, whereas two doses are fine -- sounds weird, and comes as far as I know from one, non-peer reviewed study. Maybe it's wrong?

Possibly. It is such early days. One dose is not “spectacularly ineffective” though. It is just significantly less. On the other hand, I have now found that few cases hospitalised so far in the UK have been fully vaccinated. There is a stark contrast. The next few weeks will tell us much more. For now decisions need to be made based on current information.

Originally Posted by Dockhead

I wouldn't want to be the health authority guy making these decisions right now.

Me either!

The people making decisions have tough, tough choices. It sounds melodramatic, but it is not an over exaggeration to say lives are constantly in the balance, hinging on the short and long term impacts of both medical and economic policies. Few decisions are clearcut and each one has drawbacks. This must be hugely stressful. It is easy for me to sit back and comment from the sidelines, but I would just hate to be in the position of having to make decisions.

Originally Posted by Dockhead

In other great vaccination news, the U.S. is donating a billion (!) doses to Covax. It's about time. The G7 should simply pony up and vaccinate the entire third world. It would cost comparative peanuts, would more than pay for itself, would stop further profileration of variants, and is right from an ethical point of view. The carnage will be terrible in some of those countries without decent hospitals. As the supply problems are more or less over in the developed world, surely we need to turn to this and with vigor. We should have done it earlier. As soon as we had vaxxed our own vulnerable and front line health care workers, we should have started helping poor countries to do theirs. Instead we waited until we had substantially vaccinated the whole population. I'm not sure this was a good decision.

My view from the onset has been that this pandemic needs global solutions. I think there is little point vaccinating those at next to no risk of serious illness hoping to stop mutations when billions are still unvaccinated in other countries. I have expressed the opinion since last year that I think first step is to globally protect those at risk of dying so I agree that donating vaccines to less wealthy countries is vital.

[Dockhead]

Originally Posted by Seaworthy Lass

. . . If the demographics of other European countries are similar to the UK, 99% of deaths are accounted for by less than 50% of the population. It makes sense to me to target these with first doses ASAP, but then rather than focussing on vaccinating those at low risk, aim to fully vaccinate those at higher risk, particularly given the characteristics of the Delta variant. As 43% of the population has now received a first dose, the EU is close to that stage now if the most vulnerable actually make up that group. . . .

Well, that kind of gets us back to the Great Barrington thesis, doesn't it? Do you protect the vulnerable, or do you try to stop the virus or do you do both and in what combination?


I don't think there's an obvious answer to that question, notwithstanding all the passions expressed about it. If we had perfect or at least pretty good knowledge about vectors of infection and fatality rates we could model it and see. My own guess is that the optimum approach is a certain combination of both approaches, in a proportion determined by modelling.



I've written this before, but I'll say it again -- I don't think enough attention has been paid to identifying those people in what professions are more likely to spread the virus. I guess the range of variation in potential for infection according to profession and social patterns must be in the orders of magnitude. From people living alone who go to the shop once a week -- on the one hand -- to sex workers, bus drivers, grocery store clerks, airline stewards, choir directors, prison inmates, etc., on the other.


I guess a vaccination program optimized in a complex way would be profoundly more efficient in reducing death and snuffing out infection, than the way we've done it. I guess much research will be done and many many books will be written and seminars will be held about all of this, after the dust settles. I hope therefore we'll be better prepared for the next one.

[Seaworthy Lass]

Originally Posted by Dockhead

Well, that kind of gets us back to the Great Barrington thesis, doesn't it? Do you protect the vulnerable, or do you try to stop the virus or do you do both and in what combination?


I don't think there's an obvious answer to that question, notwithstanding all the passions expressed about it. If we had perfect or at least pretty good knowledge about vectors of infection and fatality rates we could model it and see. My own guess is that the optimum approach is a certain combination of both approaches, in a proportion determined by modelling.



I've written this before, but I'll say it again -- I don't think enough attention has been paid to identifying those people in what professions are more likely to spread the virus. I guess the range of variation in potential for infection according to profession and social patterns must be in the orders of magnitude. From people living alone who go to the shop once a week -- on the one hand -- to sex workers, bus drivers, grocery store clerks, airline stewards, choir directors, prison inmates, etc., on the other.


I guess a vaccination program optimized in a complex way would be profoundly more efficient in reducing death and snuffing out infection, than the way we've done it. I guess much research will be done and many many books will be written and seminars will be held about all of this, after the dust settles. I hope therefore we'll be better prepared for the next one.

I think the strategy very much depends on whether it is conceivable that this virus can be snuffed out. Personally, I think the chance of this is next to non existent.

If it cannot be eradicated or at least suppressed so that any outbreaks are small and easily contained, then I think the highest priority is protecting the vulnerable from dying, not simply preventing this virus from spreading (that can only be achieved short term). Protecting the vulnerable in turn stops hospital systems from being overwhelmed, which results in the quality of care for other conditions being maintained.

Whatever is done is most effective done globally.

COVID-19 is an unusual infection in that it affects people dramatically differently. The vulnerable groups have been known for well over a year now and death rates have been horrifically high for these groups. For the rest, if healthy, the effects usually range from being out of action for 2-3 weeks to no symptoms whatsoever. There are exceptions, but these numbers are low. The media has jumped on these, so that they have been perceived out of proportion.

I recognise you could be right. I am not an epidemiologist, and the above is just a personal opinion. The only thing I have been truly passionate about is that I think it is very risky to be mass vaccinating people at low risk (healthy & under the age of 40-50) with very new vaccines that have not been trialled long term, using dramatically different modes of action to any other vaccines or drugs. This is highly experimental and in my view highly dangerous, even if the chance of problems years down the track is low.

[Dockhead]

Originally Posted by Seaworthy Lass

I think the strategy very much depends on whether it is conceivable that this virus can be snuffed out. Personally, I think the chance of this is next to non existent.

If it cannot be eradicated or at least suppressed so that any outbreaks are small and easily contained, then I think the highest priority is protecting the vulnerable from dying, not simply preventing this virus from spreading (that can only be achieved short term). Protecting the vulnerable in turn stops hospital systems from being overwhelmed, which results in the quality of care for other conditions being maintained.

Whatever is done is most effective done globally.

COVID-19 is an unusual infection in that it affects people dramatically differently. The vulnerable groups have been known for well over a year now and death rates have been horrifically high for these groups. For the rest, if healthy, the effects usually range from being out of action for 2-3 weeks to no symptoms whatsoever. There are exceptions, but these numbers are low. The media has jumped on these, so that they have been perceived out of proportion.

I recognise you could be right. I am not an epidemiologist, and the above is just a personal opinion. The only thing I have been truly passionate about is that I think it is very risky to be mass vaccinating people at low risk (healthy & under the age of 40-50) with very new vaccines that have not been trialled long term, using dramatically different modes of action to any other vaccines or drugs. This is highly experimental and in my view highly dangerous, even if the chance of problems years down the track is low.

Possible widespread side effects from the vaccine are yet another dimension of this terrible calculus. I discount this, considering the nearly billion doses administered -- quite a bit better than the biggest clinical trial you could imagine But we can't be ENTIRELY sure yet.

[Alan Mighty]

Originally Posted by Dockhead

Possible widespread side effects from the vaccine are yet another dimension of this terrible calculus. I discount this, considering the nearly billion doses administered -- quite a bit better than the biggest clinical trial you could imagine But we can't be ENTIRELY sure yet.

The northeastern chunk of Eurasia is of course not Northern Europe, with different genotypes for example, but ...

https://www3.nhk.or.jp/nhkworld/en/news/20210613_01/

[boatman61]

Originally Posted by Alan Mighty

The northeastern chunk of Eurasia is of course not Northern Europe, with different genotypes for example, but ...

https://www3.nhk.or.jp/nhkworld/en/news/20210613_01/

And this..

https://lockdownsceptics.org/2021/04...%20vaccination.

[Dockhead]

Originally Posted by Seaworthy Lass

I think the strategy very much depends on whether it is conceivable that this virus can be snuffed out. Personally, I think the chance of this is next to non existent.
. . .

I forgot to comment on this -- I should not have used the phrase "snuffed out", in the sense of eradicated. I didn't mean that, necessarily. I meant supressing the pandemic by eliminating vectors of contagion.

To give an example on a micro level -- take a nursing home. Where the residents are very little in proximity to one another but very much in proximity to the front line staff. There are 500 of the former and 20 of the latter. Vaccinating the residents first would be a very inefficient approach compared to vaccinating the staff first. You get the staff vaccinated and you eliminate the main vectors of contagion in the population.


I think it's similar on a macro level. 80/20 Rule most likely applies here -- 20% of the population have 80% of the social contacts. I guess that if you could give a certain priority to finding and immunizing those 20% you would cut down the R0 much faster. Vulnerable people are probably by and large NOT the ones who spread the virus the most. So I think there is some combination of vaccination of vulnerable people and people with a propensity to spread which would have the greatest effect of saving lives and stopping the pandemic (not eradicating the virus, but getting the rate of spreading down to a low enough level that society can function normally).


All that being said, I also do not exclude that full herd immunity might be possible. No ones knows what percentage of immune people that would take, and even that is probably a moving target given the varying properties of the variants, but why wouldn't we eventually achieve it? With some combination of natural immunity and vaccination?

[Dockhead]

Originally Posted by Alan Mighty

The northeastern chunk of Eurasia is of course not Northern Europe, with different genotypes for example, but ...

https://www3.nhk.or.jp/nhkworld/en/news/20210613_01/

7 people out of 10 million vaccinated? I said WIDESPREAD side effects.

That rate of side effect can be ignored entirely.

Let's do the numbers:

1. Suppose you have a choice between getting vaccinated or sooner or later getting infected.
2. Suppose you are in a low risk age group -- let's take a REALLY low risk age group -- 35-39.

Do you avoid vaccination in order to avoid the risk from heart inflammation?

Well, the IFR for 35-39 in the U.S. is 0.40 (see: https://www.acsh.org/news/2020/11/18...-and-age-15163).

That means that 0.4% of those infected will die. Out of 10 million people in that cohort, it means that 40,000 will die.

Compare that to 7 people with heart inflation (none of which actually even died).

That's what we call a total no-brainer. That's like 4 orders of magnitude difference in risk.

And it's actually a much bigger difference than that, because none of the 7 died, whereas there are many more than 40,000 who will be seriously ill once infected, and some of the long-term consequences of infection (long COVID) are very serious. So getting vaxxed is just a total no-brainer, in my view, even for 35-39 age group, even if you are perfectly healthy with no co-morbidities.

SeaworthyLass's point was different -- she thinks that although the side effects we know about are negligible, we don't have enough testing or experience to know whether there might be something else which is actually widespread. No one knows whether this will turn out to be the case or not. I think it is exceptionally unlikely considering the 2.33 billion (!) doses administered to date and half a year to time since mass vaccination started. Unlikely enough in my opinion not to hesitate vaccinating as many people as possible, considering the very serious risks from the disease, even for young and healthy people. But it's a guess, so no one can say that SWL is wrong, for sure.

[Jonte]

Did some daysaling yesterday and saw flags from Germany,Dutch and Finland so the season has started here in Sweden so it seem. At last.

[GordMay]

Originally Posted by Dockhead

I forgot to comment on this -- I should not have used the phrase "snuffed out", in the sense of eradicated. I didn't mean that, necessarily. I meant supressing the pandemic by eliminating vectors of contagion ...

A very interesting & informative Op-Ed:
“COVID Elimination or Eradication?” ~ by Christopher Martin, MD, MSc
It comes down to the collective investment the world is willing to make.
➥ https://www.medpagetoday.com/infecti.../covid19/92025

On the other hand:
“Can COVID-19 ever be eradicated?” ~ by Lee Hampton, MD, MSc
Ideally, humanity would eradicate COVID-19 so there are no new cases globally even in the absence of preventive measures. However, experience with other disease eradication programmes suggests that this will be very challenging and may not be technically feasible.
➥ https://www.gavi.org/vaccineswork/co...-be-eradicated

[Dockhead]

Originally Posted by GordMay

A very interesting & informative Op-Ed:
“COVID Elimination or Eradication?” ~ by Christopher Martin, MD, MSc
It comes down to the collective investment the world is willing to make.
➥ https://www.medpagetoday.com/infecti.../covid19/92025

On the other hand:
“Can COVID-19 ever be eradicated?” ~ by Lee Hampton, MD, MSc
Ideally, humanity would eradicate COVID-19 so there are no new cases globally even in the absence of preventive measures. However, experience with other disease eradication programmes suggests that this will be very challenging and may not be technically feasible.
➥ https://www.gavi.org/vaccineswork/co...-be-eradicated

Indeed. But I don't think we care very much, at least not at this stage.


What we need to do is protect vulnerable people so people aren't dying in large numbers, and get the rate of infection low enough that the virus isn't shooting around society. That will be enough for life to go back to normal. I guess in the developed world, at least, Europe and the U.S., we will reach that state by the end of summer.



Then we can see whether we need to go further and go for eradication if it's even possible. I guess it's not necessary. We have superb vaccines and people can just get booster shots every year or whatever it takes, which is just not a big deal. Together with the flu shot.



Also viruses which cause pandemics tend to mutate to less harmful forms over time. I think this has happened in every single case, actually, so far as we know.



So my guess is that eradication is really not necessary. We just need to protect the vulnerable and get life back to normal. Vaccinate enough people that we don't have widespread outbreaks any more.

[goboatingnow]

Originally Posted by Dockhead

I forgot to comment on this -- I should not have used the phrase "snuffed out", in the sense of eradicated. I didn't mean that, necessarily. I meant supressing the pandemic by eliminating vectors of contagion.

To give an example on a micro level -- take a nursing home. Where the residents are very little in proximity to one another but very much in proximity to the front line staff. There are 500 of the former and 20 of the latter. Vaccinating the residents first would be a very inefficient approach compared to vaccinating the staff first. You get the staff vaccinated and you eliminate the main vectors of contagion in the population.


I think it's similar on a macro level. 80/20 Rule most likely applies here -- 20% of the population have 80% of the social contacts. I guess that if you could give a certain priority to finding and immunizing those 20% you would cut down the R0 much faster. Vulnerable people are probably by and large NOT the ones who spread the virus the most. So I think there is some combination of vaccination of vulnerable people and people with a propensity to spread which would have the greatest effect of saving lives and stopping the pandemic (not eradicating the virus, but getting the rate of spreading down to a low enough level that society can function normally).


All that being said, I also do not exclude that full herd immunity might be possible. No ones knows what percentage of immune people that would take, and even that is probably a moving target given the varying properties of the variants, but why wouldn't we eventually achieve it? With some combination of natural immunity and vaccination?

Yes but this assumes the staff were the vectors. Here the vectors were old people decamped from hospital into nursing homes to clear trauma hospitals , its was the old folks that were the vectors not the staff

[Seaworthy Lass]

Originally Posted by Dockhead

7 people out of 10 million vaccinated? I said WIDESPREAD side effects.

That rate of side effect can be ignored entirely.

Let's do the numbers:

1. Suppose you have a choice between getting vaccinated or sooner or later getting infected.
2. Suppose you are in a low risk age group -- let's take a REALLY low risk age group -- 35-39.

Do you avoid vaccination in order to avoid the risk from heart inflammation?

Well, the IFR for 35-39 in the U.S. is 0.40 (see: https://www.acsh.org/news/2020/11/18...-and-age-15163).

That means that 0.4% of those infected will die. Out of 10 million people in that cohort, it means that 40,000 will die.

You missed out one pesky little zero .
It is 0.04%. So that is 4,000 per 10 million, or 40 per 100,000.

Critically, how many of these have no co-morbidities? The only figure I have seen was a general one Gord found a while ago. It was 6%. If this is the case, if healthy, only 2 people per 100,000 infected are likely to die in this age group.

Current rates with cardiac problems have reported as 1 in 100,000 for males under 30 with mRNA vaccines in Israel where a significant number of young people have been vaccinated: https://www.timesofisrael.com/israel...-men-under-30/

Unusual blood clots (with low platelets) for DNA vaccines is generally roughly around 1 in 100,000 as well.

Now if it is actually a lot less than 6% of this age group that have died with no co-morbidities (and I think it is likely to be as this figure covers all age groups), suddenly the odds swing in favour of not being vaccinated. This is comparing death to serious side effect, but these side effects do leave long term health problems.


Then take the under 25’s:
The % likely to die if infected averages 0.003 %.
That is 3 in 100,000.
If only 6% of these are healthy, this means the risk of dying if healthy becomes 2 in a million if infected.

For me, it is clearly a no brainer NOT to vaccinate this group if they are healthy.

And this is only considering issues that have cropped up within 6 months of vaccination.

Originally Posted by Dockhead

SeaworthyLass's point was different -- she thinks that although the side effects we know about are negligible, we don't have enough testing or experience to know whether there might be something else which is actually widespread. No one knows whether this will turn out to be the case or not. I think it is exceptionally unlikely considering the 2.33 billion (!) doses administered to date and half a year to time since mass vaccination started. Unlikely enough in my opinion not to hesitate vaccinating as many people as possible, considering the very serious risks from the disease, even for young and healthy people. But it's a guess, so no one can say that SWL is wrong, for sure.

Yes, my main concerns are long term problems, not the clots and cardiac issues. Numbers and time are needed to determine this, not merely high numbers over a very short period. This applies for any vaccine or drug, but is even more critical when the mode of action of these drugs is light years away from anything used in the past.

In my opinion, worldwide mass vaccination of those with negligible risk of dying from COVID-19 is insanity.

[goboatingnow]

Originally Posted by Seaworthy Lass

You missed out one pesky little zero .
It is 0.04%. So that is 4,000 per 10 million, or 40 per 100,000.

Critically, how many of these have no co-morbidities? The only figure I have seen was a general one Gord found a while ago. It was 6%. If this is the case, if healthy, only 2 people per 100,000 infected are likely to die in this age group.

Current rates with cardiac problems have reported as 1 in 100,000 for males under 30 with mRNA vaccines in Israel where a significant number of young people have been vaccinated: https://www.timesofisrael.com/israel...-men-under-30/

Unusual blood clots (with low platelets) for DNA vaccines is generally roughly around 1 in 100,000 as well.

Now if it is actually a lot less than 6% of this age group that have died with no co-morbidities (and I think it is likely to be as this figure covers all age groups), suddenly the odds swing in favour of not being vaccinated. This is comparing death to serious side effect, but these side effects do leave long term health problems.


Then take the under 25’s:
The % likely to die if infected averages 0.003 %.
That is 3 in 100,000.
If only 6% of these are healthy, this means the risk of dying if healthy becomes 2 in a million if infected.

For me, it is clearly a no brainer NOT to vaccinate this group if they are healthy.

And this is only considering issues that have cropped up within 6 months of vaccination.





Yes, my main concerns are long term problems, not the clots and cardiac issues. Numbers and time are needed to determine this, not merely high numbers over a very short period. This applies for any vaccine or drug, but is even more critical when the mode of action of these drugs is light years away from anything used in the past.

In my opinion, worldwide mass vaccination of those with negligible risk of dying from COVID-19 is insanity.

Sure lets pack the hospitals to the gills with the sick (but not dying ) COVID

Forget about all the other people needing hospital access

I’ve just been taking to a 32 year old suffering from COVID. It’s not a “ nice “ disease by any manner of means

Quite frankly not getting vaccinated is just freeloading of those that do.