Coronavirus in the UK - news, lockdown and discussion

[2hats]

Az is a bit shit on this stat

Not really.

As stated multiple times before, the vaccines aim to prevent severe disease, not infection. They will reduce incidence of infection to varying degrees - from person to person and (gradually, decreasingly) over time. The important detail is that all the vaccines promote (in the healthy) a strong cellular immune response thereby greatly reducing the severity of disease and the risk of requiring medical assistance.

The measurements of (eg binding antibody units per unit volume) are steps on the ladder of standardisation towards correlates of protection such that vaccine development can be accelerated and emergency use authorisations granted based on phase 2 immunogenicity trials rather than time consuming and logistically complex phase 3 efficacy trials (which might struggle to meet their endpoints as more of the general population are vaccinated). This type of approval has already just happened in Taiwan (post #1413), though that was based on a relative comparison of immunogenicity with a previously approved vaccine that had proven results via phase 3 efficacy trials.

 

[elbows]

I think it would only really be fair to describe any of the vaccines used in the UK so far as 'a bit shit' is if you have been massively oversold on what these vaccines should achieve.

When it comes to the real details the relevant UK authorities havent really oversold anything.

But when it comes to headlines and the amount of weight the government decided to let vaccines carry via their relaxation of measures policies this year, the wrong impression may have been given. When dickheads like Hancock and Johnson insisted on using words like severed to describe the link between cases and hospitalisation/deaths in the vaccine era, that was misleading, to give just one example.

Take for example the risk assessment for Delta, including what it does to vaccine effectiveness. The risk assessment sheet is quite grim in some ways, but I dont think headlines and rhetoric did proper justice to this detail at all. https://assets.publishing.service.g...ment_for_SARS-CoV-2_variant_DELTA_02.00-1.pdf

As for AstraZenica, right from the earliest trial data there were certain numbers that were not super dooper amazing. Not bloody awful, but enough to get plenty of people to lower their expectations. Since those early days a lot of the subsequent studies have been better news for that vaccine, so people like me actually found their impression of AZ improving over time rather than declining. There are limits to this though, I probably still prefer mRNA vaccines on paper to the likes of the AZ one. But in the years ahead we may learn a lot that changes my impression considerably.

 

[elbows]

Take for example the risk assessment for Delta, including what it does to vaccine effectiveness. The risk assessment sheet is quite grim in some ways, but I dont think headlines and rhetoric did proper justice to this detail at all. https://assets.publishing.service.g...ment_for_SARS-CoV-2_variant_DELTA_02.00-1.pdf

Actually there is one detail from that which was actually captured pretty well by the headlines and the rhetoric. The first dose numbers not being great against Delta, and the resulting emphasis on people getting second jabs.

In other news, I dont see much new in todays figures. There is still the big drop in positive case numbers after the 15th July.

Scotland finally published some more hospital admissions data so can now see what looks like a peak in those figures. Now just have to wait to see number in hospital drop there, and for number in intensive care to show a clear plateau and decline.

I havent looked at the vaccine figures yet and how much they've been changed by updated population estimates.

 

[elbows]

I havent spent much time reading twitter this week as its been too warm. Has anybody seen any theories in regards the drop in positive cases?

I think I saw one person who decided that confidently declaring that July 15th was the peak was the approach to take. I cannot rule that possibility out but I would avoid making confident claims like that at this stage. Especially as the drops appear to have happened everywhere at the same time, which might point towards at least some of the drop being down to testing system factors.

 

[Supine]

I havent spent much time reading twitter this week as its been too warm. Has anybody seen any theories in regards the drop in positive cases?

I think I saw one person who decided that confidently declaring that July 15th was the peak was the approach to take. I cannot rule that possibility out but I would avoid making confident claims like that at this stage. Especially as the drops appear to have happened everywhere at the same time, which might point towards at least some of the drop being down to testing system factors.

Not much conclusive but a quick look on gov for positivity rates seemed to show an increase. So i suspect testing or something and cases to rise.

 

[StoneRoad]

I think the current appearance of a peak is more or less wishful thinking / statistical artifice.

As soon as the mask-free shenanigans on Monday got underway, it is only a matter of time before there is an affect on case numbers. I don't think there has been enough take up in vaccines among the younger age groups nor long enough for sufficient immunity to develop.

However, locally (seems to me at least) there does seem to be a continuance of mask-wearing and social distancing behaviours. Our case rate peaked a few days ago [5 day lag in data] ...
The weather (very hot and dry) seems to be helping, although having the germ-factories school kids [and educational settings in general] breaking for the summer hols on 16th July 2021 will be a significant reducing factor ...

[and the local council website says first day of autumn term will be 6th September, pushed back from the 2nd ... I wonder why ?]

 

[Supine]

First good analysis for consideration

 

[kabbes]

Not really.

As stated multiple times before, the vaccines aim to prevent severe disease, not infection. They will reduce incidence of infection to varying degrees - from person to person and (gradually, decreasingly) over time. The important detail is that all the vaccines promote (in the healthy) a strong cellular immune response thereby greatly reducing the severity of disease and the risk of requiring medical assistance.

The measurements of (eg binding antibody units per unit volume) are steps on the ladder of standardisation towards correlates of protection such that vaccine development can be accelerated and emergency use authorisations granted based on phase 2 immunogenicity trials rather than time consuming and logistically complex phase 3 efficacy trials (which might struggle to meet their endpoints as more of the general population are vaccinated). This type of approval has already just happened in Taiwan (post #1413), though that was based on a relative comparison of immunogenicity with a previously approved vaccine that had proven results via phase 3 efficacy trials.

I’ve heard it characterised that the injections are more “treatment” than true vaccine, at least in the way we have previously tended to understand the latter. They are an extremely effective pre-loaded treatment that will likely stop your disease from becoming serious. They are not designed to be a full stop to the infection. It’s an interesting way of looking at it, that I think would encourage a more realistic public response.

 

[IC3D]

be

I’ve heard it characterised that the injections are more “treatment” than true vaccine, at least in the way we have previously tended to understand the latter. They are an extremely effective pre-loaded treatment that will likely stop your disease from becoming serious. They are not designed to be a full stop to the infection. It’s an interesting way of looking at it, that I think would encourage a more realistic public response.

I think that is becoming the common understanding despite it never being explicitly said by health or govt spokespeople

 

[Supine]

I think that is becoming the common understanding despite it never being explicitly said by health or govt spokespeople

Or has been explicitly said by healthcare professionals and government agencies throughout. Maybe not fully understood by journalists or politicians though.

 

[IC3D]

Or has been explicitly said by healthcare professionals and government agencies throughout. Maybe not fully understood by journalists or politicians though.

That's simply not true

 

[zahir]

Witnessing England’s response to Covid at first hand has profoundly shocked me | William Hanage

On a visit to the UK from the US, I have seen how incoherent government policy is allowing Delta to run rampant, says Harvard epidemiologist William Hanage

www.theguardian.com

 

[Supine]

That's simply not true

It simply is true.

As one small example, the FDA - which is a government agency - set the bar at 50% for vaccines being effective for approval.

 

[prunus]

I’ve heard it characterised that the injections are more “treatment” than true vaccine, at least in the way we have previously tended to understand the latter. They are an extremely effective pre-loaded treatment that will likely stop your disease from becoming serious. They are not designed to be a full stop to the infection. It’s an interesting way of looking at it, that I think would encourage a more realistic public response.

That sounds like it’s based on a misunderstanding of what a vaccine is - most vaccines work in this way - flu vaccines are generally about 50% effective; measles around mid 90s after a boost. Polio can reach close to 100% but that takes a prime and 3 boosts over 8(?) years.

Vaccines just prepare the immune system with information to allow it to swing into action faster when it encounters the pathogen. They don’t convey special powers.

 

[elbows]

That sort of misunderstanding is a big part of the reason why I have been boring on since the early days of the vaccination programme along the lines of "I dont like the giddy nature of the UK vaccine rollout", "binary thinking about vaccines is a problem", "there are limits to how much heavy lifting we can expect vaccines to do in this pandemic".

What hasnt happened much is the opportunity for me to directly talk here to someone who has actually adopted overly simplistic thinking about the effects of vaccine. Here I mostly get to talk to people who do understand some or all of the limitations. Some of them may talk about other people who have got the wrong end of the stick about vaccines, but these views are largely theoretical and I lack manifest examples of such thinking that I can confront here.

 

[Cloo]

Entertained by dispairing tweets I've seen today from people (aka selfish idiots) going 'Oh my God I went to the shops and almost everyone was wearing masks, it's so terrible!'

 

[Cat Fan]

First good analysis for consideration

An alternative view

 

[elbows]

First good analysis for consideration

Thanks. I've not much to add since its a pretty good fit with stuff I went on about too much already. She oversimplified the end of term date for England, and perhaps I would have placed more emphasis on the extent to which changing mood music, number of self-isolation requests etc could have made a difference. I could also probably find at least one example of modelling output that does have an earlier peak than the ones she mentions (eg certain scenarios that fall within the confidence intervals of the best case scenario from the autumn/winter planning document by the Academy of Medical Sciences), but its certainly true that most of the ones we've seen via SAGE dont have a peak this early.

But these small details aside, certainly the theme of 'different factors pulling in different directions' is the overriding one she mentions that I agree with, one that can easily confound simplistic expectations about this period.

With that in mind I wouldnt personally want to echo her words "I dont think this is the peak" nor the words of those who have confidently claimed that the 15th was the peak. Both seem plausible to me at the moment, and so I cant say either with confidence. Although if there is a real peak in there somewhere then its unlikely to be as abrupt as the current data indicates. There are probably multiple stories at work here and I dont know if we will be unable to unpick them until I know what happens next.

It might be reasonable to claim that at least a chunk of the recent falls are data/test system/peoples attitudes towards getting tested related. Because they seem to have happened everywhere at exactly the same time, and although some of the things that have changed affect everywhere in England simultaneously (eg end of Euros), others do not.

Hopefully if the temperature in my room comes down enough in the next day or two I can explore the recent positive test data by age group, to see if it helps ascertain any of the reasons for the fall. But Im sort of expecting to find out that the falls were similar in all the data at the same time, which will be another sign that the underlying reality is not being properly reflected by recent data. At least when Scotlands numbers started to fall we saw the sort of variations in timing and rate of decline between different age groups that we'd have expected to see if it were a real peak.

Another potential problem with the current situation is that in theory we could have multiple peaks I suppose, but I probably shouldnt go on about that in depth unless it looks like its actually happening.

 

[Supine]

An alternative view

hahahahaha. Alternative lol.

 

[elbows]

An alternative view

What I'd say about that is:

Big questions about state of immunity in the population are one of the reasons I dont exclude the possibility of early peaks. That and what happened so far with Scotland are the reasons why I have been very keen to prepare people here not to be surprised if the peak happens at a stage they were not expecting it to.

I'd also say that studies of the levels of antibodies within the population are probably not perfect, it can be hard to get a genuinely representative sample because certain groups may be mostly out of reach, much less likely to participate. And those groups may also have other differences that affect their risk and pandemic outcomes compared to the segments of society that are much easier to reach in antibody studies. Chuck in some remaining uncertainties about immunity waning, Delta, and vaccines, and I end up not being a fan of people coming out with confident population immunity claims. But I dont reject such possibilities either, or how messy and prolonged the period could be where people still arent sure which factors are driving the developments of this wave, eg whether a decline is a sign of 'herd immunity' or not.

 

[elbows]

Also if people want to go on about wonderful levels of immunity in the population, they should really use the percentages for the population, not adults only. Or at least explicitly point out the difference.

This matters less if they are not explicitly trying to make a point about reaching a 'herd immunity' threshold unlocking further benefits of vaccination, reducing waves to less disruptive size etc. In this case that single tweet does not offer me clues as to whether they are trying to run in a particular direction with that claim, I suppose I will go and see what else they are saying. On its own I dont see it as an alternative view to what Christina Pagel said because it is not discussing the peak or placing obvious assumptions on top of the fact they think the immunity figure is great news.

 

[elbows]

Oh, he is a Telegraph fan and a member of the 'if not now, with these levels of immunity, then when?' brigade.

There are usually certain details in these sort of peoples stance which I can find some redeeming features of, or at least some angle to keep in mind, but I have no desire to read their output all the time and their overall sense of balance usually winds me up a treat. So no more exploring the views of Dr Levinson for me at the moment.

 

[2hats]

An alternative view

9 in 10 adults are estimated through modelling to have antibodies (antibody status of ~3 in 10 of the population not modelled). A binary SARS-CoV-2 antibody positive/negative (and a modelling estimate at that) tells us nothing about the antibody titres across the population, their potency, nor longitudinal evolution of such, let alone degree of immunity (see: correlates of protection). It only tells us, at best, this fraction of adults likely have been recipients of vaccines and/or were previously infected.

 

[elbows]

Despite going on for about a month about the disruption and self-isolation brakes that have been left in place for this wave, and why that was quite deliberate, I've now completely forgotten whether I actually stumbled on any modelling of the effects of that stuff, SAGE discussions of it etc.

Anyway, I see the following was mentioned in a Guardian story about the latest changes to the self-isolation regime:

Ministers had been reluctant to act despite lifting most pandemic restrictions on Monday, insisting that time was needed before dropping the self-isolation rule as coronavirus infections soar. The government had been warned that waiving the requirement on 19 July would result in cases being up to 25% higher than waiting another four weeks to do so.

Limited number of critical workers to be allowed to avoid self-isolation

Separate pilot daily testing programme will be expanded to up to 500 food and drink supply chain employers

www.theguardian.com

 

[IC3D]

I think the data is going to become more foggy as covid is passed around as a nasty cold and no one does anything about it. At least that's what I see happening going forward.

 

[elbows]

The link between infection and hospitalisation will have to become much weaker than it is at the moment before authorities would be too keen to promote that level of change in attitude towards the virus.

I think right back at the very start of this forum discussing this virus I somewhat unwisely chose to draw attention to the long term future of the virus, colds etc, and since then it hasnt really felt appropriate to go on about that eventuality. A long time will probably still have to pass before I go on about that much.

Should we reach a point where routine testing at scale isnt a thing any more, or attitudes towards the system weaken it, we'll still have other forms of surveillance, population sampling and sentinel stuff, which will give us some kind of laggy but fair estimates. I much prefer having both, except on weeks like this one where we arent being given an official explanation for the drop in daily case numbers of recent days, arent quite sure what to make of them, and have to wait quite some time for other forms of surveillance to give us some answers. Or perhaps a load of positive case data will show up and fill in some gaps, or an official narrative will come.

 

[IC3D]

I always liked the idea of sewage as a measure of infection rate but seeing as it's not gained any solid pft exeptance I guess it's dodgy as a method
As policy has changed, tracking stopped and public behaviour will be more blasie surely r rate will become vague and hospitalisation will be it

 

[elbows]

I always liked the idea of sewage as a measure of infection rate but seeing as it's not gained any solid pft exeptance I guess it's dodgy as a method

Its not dodgy as a method and surveillance by that means has been incorporated into the UK Covid surveillance system to a fairly significant extent.

However the authorities in England have so far not shown much desire to routinely publish all the pertinent data from that system, so it appears largely invisible to us. It may be in the hands of the new entities that have been created that, unlike PHE, dont seem to have a built in remit to share stuff with the public in a timely way. In Scotland they have published some of the data from wastewater surveillance, especially recently when they had cause to want to use it to see if they could see a peak like the one they saw in their positive test numbers. We were talking about it here quite recently, though I dont have a link handy right now.

 

[elbows]

OK I checked and it was Sunday afternoon when we were discussing wastewater surveillance on this thread in relation to Scotland.

Coronavirus in the UK - news, lockdown and discussion

Johnson can sit in a hot office on zoom all week like much of the rest of the country Is there a pool at Chequers? Where he is holed up for the duration.

www.urban75.net

But you should keep reading posts after my initial post because 2hats quickly found more detailed stuff including graphs that came from a different Scottish document, stuff that left me with a different impression of whether they were starting to see a peak in that data.

 

[elbows]

Also in regards the future of other forms of routine mass testing, do keep in mind that the government seized on the idea of building more of a diagnostics industry and permanent capacity once they came to terms with how useless the original capacity was in this sort of situation.

Now obviously there are very few things that are really unshakeably permanent. But given the business links to this stuff and things like the first Megalab opening, I would be more likely to bet on this stuff being around at fair scale for quite a long time, and that even aspects of the Covid threat retreat, they will have other uses they can put this sort of capacity to. Depending on quite how far they go with this stuff they could be looking for a permanent change in a bunch of attitudes towards a range of infectious diseases, and so I find it much too early right now to predict what the future holds for mass testing. At the very least this is not an area where I would assume that a rapid return to the old normal is on the cards.

Certainly if I were a capitalist with a plan to get in on the act with testing, I would be tempted to develop a brand called 'Rapid U-Turn'. Perhaps each test could come with an amusing collectable card or sticker featuring caricatures of government figures performing any one of a number of famous pandemic u-turns.