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Are all the vaccines spike protein based?
No, some are inactivated virus. The first from Sinopharm showed only 50% efficacy, but a more recent one from Sinovax gave a much more impressive 80%. This is for symptomatic infection counts, not hospitalisations and deaths.
One of the experts on the Zoe Webinar stated that there are only so many mutations possible in key parts of the virus whilst maintaining the ability to transmit to humans.
That's true to an extent, but the surface of the spike protein is highly plastic, with more than 500 mutations recorded on the GISAID sequence database. I think that the expert is right in that it is not influenza, but wrong in that the plasticity is enormous whilst still retaining ACE2 engagement.
The next generation vaccines will code for multiple mutations, specifically the immune-evading E484K mutation that escapes the most potent (bit not all) antibodies and defines the SA and Brazil strains. This may be with multiple spike proteins or multiple strands of mRNA.
Sorry to post off the timeline, but going back to "what's next", I'm not buoyed by Chris Witty's interview this morning. Essentially predicting another spike after this release of lockdown, I logically acknowledge that cases may no longer equate to serious illness or death for most, but emotionally I'm quite anxious about the fact that there's yet another spike to manage. I guess we have to learn to live with it but I'm finding it very hard to de-scale "living with C19" to be the same as "living with Flu".
This doesn't really need a response I guess, its just an anxiety driven brain dump.
Perfectly valid concern, but as TiRed has said all along, we will have to learn to manage this the way we learnt to manage flu.
And we are well on the way to that, only 12 months on from the start.
we will have to learn to manage this the way we learnt to manage flu
Yes we will. Some people think that we'll be at that stage this spring. I now doubt we will.
I’d assumed the latter. Do it with the flu jag. Maybe extend the age qualification slightly as they already did this year.
Whilst i agree thats probably what they may do, it kind of negates the point of vaccinating everyone now if they take that approach. Way I see it the virus will be rife in society for years to come. A one off vaccination for non risk groups only pushes health implications for younger folks a year down the line.
A one off vaccination for non risk groups only pushes health implications for younger folks a year down the line.
Why is that? If everyone has had their initial exposure, or vaccination, the assumption is there are likely to be less ill, if at all, if exposed to future variants. Everyone benefits from the two jabs this year, even if they don't have (or need) boost jabs after that. No one knows if we will chose mass boosting, or targeted boosting, yet, anyway. Other countries do mass vaccinations rather than targeted vaccinations for flu already, for example. Wait and see...
Release from lockdown will naturally increase transmission. So cases will rise. But the case mix, the age breakdown of symptomatic infection, will not be the same as last time. The elderly and most at risk will have protection from morbidity, so the rise in hospitalisations will, one hopes, not follow the same past trend.
Now how big is the trade off? Does five times more infections in people who are twenty times less likely to go to hospital, a good strategy? The government is betting that this is the case. And I think it’s reasonable too.
Next winter. Will present a challenge on healthcare as things come back to more normality and influenza decides to return. But this is progress.
Why is that
Because I had assumed immunity from vaccines will be 12 months at max even if no additional variants.
If thats the case, and assuming the virus is still kicking about in 5 years, I'm struggling to see how those who haven't received a booster will be in any way protected?
I think it's clear to a minority that this is far from over. This year is the litmus test of vaccines. The next winter could be just as harsh as what we've just gone through. My anxiety is all over the shop. Some days I'm alright and the next day I'm really quite bad. It's very hard to feel settled these days about what is around the corner.
I really don't think we will be anywhere near normality at the end of June.
and influenza decides to return
Someone (Whitty?) mentioned this the other day: next winter's flu season.
After we've spent 18 months hiding indoors our herd flu immunity is going to be down.
On the other hand, will some sort of (inherent, if not mandated) social distancing and better use of basic hygiene reduce flu transmission?
I’m struggling to see how those who haven’t received a booster will be in any way protected?
Because it won't be as a first exposure. They are likely to get less ill, if they get ill at all.
I really don’t think we will be anywhere near normality at the end of June.
No, but we will be a much better situation over the summer than we are now. We'll be meeting up for rides, and drinks with mates in beer gardens... even if many of us are still avoiding queuing indoors for things we can well do without. Not back to normal, but with much more in our lives than just our work and homes lives. Tough time for many businesses still. Better times for seeing people and getting out of our heads*.
[ *not like that ]
Because it won’t be as a first exposure. They are likely to get less ill, if they get ill at all.
Even after a lengthy period of time? Everything ive ever read about the vaccines suggest that there is a limit set on how long protection lasts for.
So in 12 months you may have good protection, less so after 24, and after 3 years you'd have none whatsoever.
Perhaps tired can give us his thoughts.
Conjecture... it all depends now what you mean by "protection"... time will tell. Hoping for less severe illness, but not expecting either no illness, or assuming significantly lower transmission, after a long period without a booster... seems the way to go into planning/deciding if/who/when to do boosters. How those boosters perform in tests will also inform how we use them. I'd guess at everyone who wants to being given a booster year one... and then a decision being made about whether to drop to targeting groups in following year... probably the elderly and medical and care staff... maybe young adults.... who knows this far out? No-one.
So in 12 months you may have good protection, less so after 24, and after 3 years you’d have none whatsoever.
Average time between endemic coronavirus infections is 30 months. So very much this I am afraid. Animals do not live long enough for waning protection to be a thing. Hence we will see booster vaccinations, tied in with influenza vaccination.
"Protection" is really measured by hospitalisations. That burden has been hugely reduced in trials. But duration of that protection is unknown. This is the first cycle really, we are nowhere near endemic, seasonal infection.
This is the first cycle really, we are nowhere near endemic, seasonal infection.
Can you push that comment towards someone who can should it loudly, please?
I believe Witty is on message 😉
This is the period between infections of the four endemic coronaviruses. Line is median
This is SARS-CoV-2
After we’ve spent 18 months hiding indoors our herd flu immunity is going to be down.
Will it? It seems immunity to a particular strain can last your entire lifetime. For example a recent seasonal flu was very similar to the Spanish flu and people who had survived the Spanish flu were immune to that particular strain. Also this study showed that survivors of the Spanish flu still had their immunity to a reconstructed Spanish flu virus almost a lifetime later http://content.time.com/time/health/article/0,8599,1835907,00.html
Two things - does each circle represent a number in the graph above @TiRed? If so, what?
Also, wrt Influenza, this is an interesting infographic -
Each dot is one infection data point. There were 10 subjects followed for up to 35 years with serial serology. So across the four viruses people tended to be reinfected about every two and a half years, but with a long tail. I can’t see why this coronavirus will be any different, other than we can boost immunity if we have to between infections. With an annual or biannual vaccine.
Mrs Tired has her appointment. She’s 51, I’m still waiting. Perhaps they sorted ascending not descending age.
So based on that we can expect a big C19 issue around 6, 12 & 15 months time then, which coincides with Flu seasons 2022 & 2223 respectively, with Lockdown easing contributing to the first also. So pretty much the waves as we've experienced so far repeated for several years mitigated by preventative measures.
Kryton that would be without intervention - ie vaccine. So with updated boosters we can avoid another wave.
Is it possible to vaccinate at the same time with the C19 jab and which ever flu is prevalent in that particular season? (in the future). In other words 2 during the same appointment.
Edit - without lessening the effects of the 2 different vaccines (sorry I'm not being very articulate).
This is the Last Chance Saloon for restrictions, isn't it? I can't see there being any widespread public support for another tightening up, regardless of infection/death rates.
time with the C19 jab and which ever flu is prevalent in that particular season? (in the future). In other words 2 during the same appointment.
They are looking into a combined jab already so it must be feasible. Obviously the big issue there is under 50s don't currently get offered the flu jab, but assuming you can do both jabs at same time it would certainly massively cut down on additional resources required.
Certainly good for me if they did that, I'm eligible for flu jab but not the covid one!
Whilst i agree thats probably what they may do, it kind of negates the point of vaccinating everyone now if they take that approach.
Part of the point of mass vaccination in adults is to reduce the number of people in whom the virus is circulating over the next six months. Each one of those represents opportunities for the virus to mutate, and thereby the chance of producing a vaccine evading strain even sooner.
Next winter will be challenging, without a doubt, but even more so if these strains are popping up too regularly to incorporate into a booster for the vulnerable.
Obviously, we are also vulnerable to imported strains, which is why a mass exodus abroad this summer isn't necessarily the best idea.
Our performance this year is key to the kind of winter we're going to experience going into next year.
Each one of those represents opportunities for the virus to mutate, and thereby the chance of producing a vaccine evading strain even sooner.
Rate of mutation within an infection is a lot higher than people think. In the Lilly studies of symptomatic infection, about 1% of patients developed E484K mutants DURING their infection on placebo (so untreated). And 22% had persistent high viral load. So hope they don't spread... For antibody treatment it was >10% due to selection pressure.
Table 8. This is a highly plastic virus, but cross-reactivity is tending to keep it in check.
Test and Trace is coming in for a kicking today.
Especially worrying is the description of it having "No clear impact" on infection rates and the lack of people contacted actually respecting the isolation periods.
I must not have been paying attention with regards to the t&t situation as when I saw the amount i assumed it would have cost quite abit more than 37 mil
Then I reread the figure...and almost fell off my seat. That's almost 750 quid per every adult in uk...
Where has that cash gone to??
It doesn't even cover Scotland. I've not seen any costs for the Scottish version but I'll bet its nowhere near 1/10th of that.
"Then I reread the figure…and almost fell off my seat. That’s almost 750 quid per every adult in uk…
Where has that cash gone to??"
Most of the spend has been on "Test" not "Trace". The UK has done close to 100m tests to date - more than twice as much as Germany. That's reagents, systems, sample collection staff, lab staff, lab premises, lab equipment, logistics etc etc.
That said, I think the headline £37B is a budget for two years rather than actual spend to date.
If the sheer volume and scale of the logistics involved in rolling out the mass testing in schools is anything to go by I can see where at least some of that money has gone.
I cant defend the app / contact tracing and its associated gubbins, but the quantity of testing kits, their delivery (on time), their design, their quality, the results reporting via email / txt etc has all been great - We've processed approx 3000 tests on staff and secondary school pupils (with about 2000 left next week) and its gone without any major issues - and its all through the test and trace system.
Its easy to knock it, but at least in our little world its helped to break chains of transmission, and potentially saved lives.
Obviously, we are also vulnerable to imported strains, which is why a mass exodus abroad this summer isn’t necessarily the best idea.
Our performance this year is key to the kind of winter we’re going to experience going into next year.
That seems so obvious to some of the population, but not to many
This is the Last Chance Saloon for restrictions, isn’t it?
I think "yes" covers it.
They're reducing slowly obvs, not dropping off a cliff, but once the level goes down I can't see the Johnson circus bringing the level back up.
I could definitely see local restrictions coming in over the course of the year. Not nationwide.
I was out on a rare site visit today, which was great actually, and the roads were pretty much as I'd expect them to be at normal times. But it was nice to be out in the car and interacting with people again like I'm used too. Customer had a very nice 456 EVO Ti!
I could definitely see local restrictions coming in over the course of the year.
I just think it'll have to be at zombie apocalypse level folk will start to pay any attention to restrictions.
Shapps response is amazing- from "world beating" and "worth every penny" to "Well it's better than nothing".
Apparently new study shows that the new UK variant is twice as deadly as the initial strains.
That's not great news..
Apparently new study shows that the new UK variant is twice as deadly as the initial strains.
That’s not great news..
The one thats been the dominant UK strain since late autumn, sometimes called the Kent strain?
Or is there a new new strain?
The Kent strain which is now the dominant variant in uk
Have you got a link for that @tpbiker ?
More transmissible we knew but more deadly?
Ok cheers. I don’t read any papers and there was nothing on the beeb. I’ll have a look at the bmj when it plops through the letterbox though!
In fact found it on bmj.com
Main outcome measure Death within 28 days of the first positive SARS-CoV-2 test result.
Results The mortality hazard ratio associated with infection with VOC-202012/1 compared with infection with previously circulating variants was 1.64 (95% confidence interval 1.32 to 2.04) in patients who tested positive for covid-19 in the community. In this comparatively low risk group, this represents an increase in deaths from 2.5 to 4.1 per 1000 detected cases.
Conclusions The probability that the risk of mortality is increased by infection with VOC-202012/01 is high. If this finding is generalisable to other populations, infection with VOC-202012/1 has the potential to cause substantial additional mortality compared with previously circulating variants. Healthcare capacity planning and national and international control policies are all impacted by this finding, with increased mortality lending weight to the argument that further coordinated and stringent measures are justified to reduce deaths from SARS-CoV-2.
Yep it was the bmj article that originally popped up on my feed. I don't understand the details, but the key numbers didn't look great
Well I’m just a gp not a clever dr but I think hazard ratio 1.64 means for every death resulting from the old school variant there is 1.64 from the new strain. Not quite twice as deadly but significantly more.
However it’s still low overall. Increase from 2.5 to 4.1 deaths per thousand cases. Mortality rate of 0.0041 instead of 0.0025
would that be across age group populations, or skewed to the most susceptible? If we are vaccinating the more susceptible, and the vaccine remains effective against the Kent strain, is that increase materially important 'in the real world' ?
No idea but digging a bit deeper into the paper:
We cannot exclude a selection bias. Community testing is largely self-selected, or driven by contact tracing. A potential bias remains if a higher proportion of patients with S gene negative infections without symptoms were undetected than patients with S gene positive infections. In this event, patients infected with VOC-202012/1 might be at a more advanced stage of disease when identified and have a higher apparent mortality. This could be consistent with the lower N gene cycle threshold values observed in S gene negative participants. Our analysis, or any retrospective study based on patients with symptoms, would not be able to detect this; however, early survey data suggest that people with S gene negative infections are, if anything, more likely to present for testing.22 Dealing with this potential bias requires a study design capable of detecting asymptomatic infections in participants who are negative or positive for the S gene.
Some of the increased risk could be explained by comorbidities. Information was not available about comorbid conditions in the data we analysed, although this would be partly controlled for by matching on age, ethnicity, and index of multiple deprivation. Currently there is no evidence of a mechanistic reason why people with certain comorbidities would be infected with one variant and not another. It is possible, however, that people with certain comorbidities are at a higher risk of infection with VOC-202012/1 and have a higher mortality rate. This would tend to reduce the hazard ratio attributable to VOC-202012/1 alone.
Like all science this is a tiny piece of a big jigsaw.
This was everyone over 30 with a positive test in the community, randomly split into the 2 genotypes and then followed up by counting numbers of deaths.
If we are vaccinating the more susceptible, and the vaccine remains effective against the Kent strain, is that increase materially important ‘in the real world’ ?
There will always be a small slice of the vulnerable groups who either don't receive the vaccine or it doesn't work for them, so yes, it's relevant. No data yet, but you'd also perhaps suspect that if you were seeing more serious illness in older people that younger patients would potentially be more seriously impacted as well, perhaps with more hospitalisation and morbidity.
Plus if a mutation with this feature of the original Kent strain, plus some more vaccine-evading ability emerged, it will get much more relevant.
However, the Kent strain is pretty much the only game in town in the UK now, so in that sense, it is what it is.
Well if it’s so deadly, our vaccines & lockdown truly are world beating, because deaths are plunging much faster than wave 1.
I imagine the cases rising in the last few days is the result of testing millions of schoolkids?
Aren't deaths per admission also lower?
Well if it’s so deadly, our vaccines & lockdown truly are world beating, because deaths are plunging much faster than wave 1.
Despite an (even) shit(tier) lockdown, and lower compliance with the rules, and more people in work, and it being the middle of a wet feburary rather than sunny spring; deaths per day is declining at double the rate of wave 1.
Up until the last few weeks we seemed to be tracking quite well with the TiRed rule of thumb of proportionality to "cases 2 weeks ago". And it has since improved.
I do wonder how mass testing all schoolkids three times a week is going to affect the cases number going forwards.
I imagine the cases rising in the last few days is the result of testing millions of schoolkids?
Cases rising where? In the uk They've been consistently falling the last week compared with numbers on the same day the previous week.
Apologies if this is a bit of a derailment, a do I need to isolate question...
Ex wife has tested positive (works in a school - who'd of thought it) we don't live together but I do go round to pick up kids. Both myself and two children had covid in December and I also had my first vaccination last month. I appreciate the vax doesn't prevent infection. I do lat flow tests for work (NHS) and the kids do them at school.
Do we isolate for the full 10 days or can we depend on the results of the lat flow tests? I'm keen not to transmit it to anyone or break any rules.
Thanks
I do wonder how mass testing all schoolkids three times a week is going to affect the cases number going forwards.
Up, whether that's right or wrong we won't know...
BBC News - Covid-19: False test results 'ruining' return to school
https://www.bbc.co.uk/news/health-56349116
Myti - cases risen slightly last 2 days. Schools started Lateral flow tests this week, with results fed into T&T.
They always rise as the week progresses. They have fallen each day though compared with the same day last week so actually cases are still falling. This is a good source for keeping track.
https://www.worldometers.info/coronavirus/country/uk/
I would imagine that with increased testing there will be a rise in cases. Given that cases will be predominantly in the younger demographic it will hopefully have a limited increase in hospitalisation. Well until Junior goes to meet Grandma and Grandad.
Well until Junior goes to meet Grandma and Grandad.
Who should hopefully be vaccinated.
Ah, good point. Though not the 2nd one yet perhaps.
I thought the AZ vaccine was a two shot vaccination. Originally the second shot within 3weeks but now UK gov has said up to 12weeks. I am aware that a good amount of protection comes from shot1.
It's semantics I know but BBC now refer to second Jag as a booster as opposed to....
Just sounds a bit less important.
The last Jag in a rabies series isn't the booster it's completing the treatment.
That's the guidance at the mo irrespective of vaccination status, testing, and previous infection.
Lateral flow tests can and do give false negatives. The purpose of lateral flow testing is to find asymptomatic carriers and pull them out rather than act as an 'all clear so that means I can go on a grab a granny night'
BBC has an article today about the surge in Brazil, over 2000 deaths in a day "concerned that Brazil has almost become a "natural laboratory" - where people can see what happens when coronavirus goes relatively unchecked." and "breeding ground for new variants of the virus".
Brazil has over 3 times the population of the UK, where the peak daily deaths reach 1820. The total deaths per head in the UK so far are about 50% more than Brazil. Worldometers suggests that the number of infections in Brazil is about 1 million, and the peak in the UK was 2 million (so six times as high, allowing for difference in population). The only area where Brazil is worse than UK is that their rates are still rising.
It astonishes me that the party in government in the UK is ahead in the opinion polls.
https://www.bbc.co.uk/news/health-56351084
Just a little heads up for vulnerable that have had 1 jab.
Latest study shows it's not giving protection as hoped in cancer patients using the 12 week gap. Three week gap recommended. Stay safe.
Dr Sheeba Irshad, oncologist and senior study author from King's College London, said the findings were "really worrying" and recommended an urgent review of the timing of doses for people in clinically extremely vulnerable groups.
"Until then, it is important that cancer patients continue to observe all public health measures in place such as social distancing and shielding when attending hospitals, even after vaccination," she said.
BBC reporting Denmark halting AZ vaccination programme over blood clots in patients. Surely this would have flagged up before now if a valid issue?
BBC reporting Denmark halting AZ vaccination programme over blood clots in patients. Surely this would have flagged up before now if a valid issue
You'd like to think so given he number of folks in UK who have received it so far, many of whom I imagine don't have arteries in the best of shape.
It astonishes me that the party in government in the UK is ahead in the opinion polls.
Yes, but they were doing their best....
Sometimes the drugs DO work...
Been a little busy of late. But the submission work for approval just begins. For some perspective, this is the THIRD clinical test of an anti-SARS-CoV-2 antibody to show protection in symptomatic patients at risk of serious COVID19. Unlike Regeneron and Lilly, it is a single antibody, and appears to have a high hurdle to resistance. We shall see.
What is pleasing is that if you have some potent neutralising antibodies, your infection course is less severe. Most likely such antibodies will also protect against catching symptomatic infection too. The translation to vaccines is also relatively straightforward: Antibodies good, from where - probably doesn't matter.
Thanks - sounding positive. Good work 👍👍
Brazil has over 3 times the population of the UK, where the peak daily deaths reach 1820. The total deaths per head in the UK so far are about 50% more than Brazil. Worldometers suggests that the number of infections in Brazil is about 1 million, and the peak in the UK was 2 million (so six times as high, allowing for difference in population). The only area where Brazil is worse than UK is that their rates are still rising.
Brazil looks (at least to me) to be on the front end of wave #2.
I would revisit that assessment in three months time and see where the numbers have gone.
BBC reporting Denmark halting AZ vaccination programme over blood clots in patients. Surely this would have flagged up before now if a valid issue?
My mums friend in is the hospital now for issues with her blood platelets clotting and very low count, blood clots in her lungs and all over her body which has came up black n' blue all over, she had the astra Zeneca vaccine in early February and experienced crippling pain in her joints and all over her body since, over the previous few weeks the hospital has ruled out leukaemia with bone marrow.lumbar puncture and she is currently still in hospital getting platelets and plasma by iv. She has suffered from breast cancer a few years ago and was on steroids etc and her immune system was/is somewhat compromised to begin with. So far the consultants at the hospital haven't a clue as to what is causing the issues which given the hospital/consultants involved is par for the course, they've done 3 weeks of testing so far and no diagnoses as to why she is suffering - should this possibility of a reaction to the vaccine be raised with the consultants?.
Before this she was extremely healthy being a hill walker/hiker etc and easily managed 15miles+ a day but now she can barely get out of bed.
It will be hard to prove causality. 1700 people die daily in the uk. Most of them have had the vaccine.
That sounds awful @somafunk, horrible position to be in. I'd definitely mention it to the consultants, even if it's just so they can put your fears at rest.
Latest study shows it’s not giving protection as hoped in cancer patients using the 12 week gap. Three week gap recommended. Stay safe.
Been on to the phone to my dad about this trying to calm him down. He's intent on suing the NHS for falsely telling him he'll be protected by the first jab! It's his mind going rather than an actual threat, he knows that 80-90% effective means some don't work but it's horrible to listen to him say it all the same.
I know someone between first op and first round of treatment. When given the first vaccine jab it was made very clear to her that she should continue to act as if she hadn't had the jab at all, in terms of shielding for herself and testing to protect others when visiting hospitals. Listen to the professionals treating you, not news headlines.
Listen to the professionals treating you, not news headlines.
Very much this. I was initially told I wouldn't be offered the jab as the chemo would kill off the antibodies and also potentially any antibodies from my recent Covid infection just before I started treatment. But then a couple of weeks later I was offered the Pfizer jab and went ahead and was told in no uncertain terms they couldn't guarantee how effective it would be so I should continue to shield. 'Live' vaccines are not generally given to people having cancer treatment but as the Covid vaccines are not live the experts have decided it should be given. Bit of a bugger that it's not that effective, especially for blood cancers.
Sorry to hear of your struggles @shinton 😔
Looking at today's figures....cases are up by 1000 compared to Tuesday, and up compared to the corresponding day last week too. Is it down to the mass testing in schools?
I went back in today to teach guitar after 51 weeks teaching remotely. It was fantastic, if a little strange!
I would imagine so. Look at the number of tests processed & it’s jumped by 30% the last 3 days. More you test, more you find. Nobody thought the gov.U.K. Number was every case in the U.K.
Thanks @Tom-B and good you are back in the classroom again. I've been out on the bike 3 out of the last 5 days so not all bad 😉
They are the same as last week, but to state they are rising again is correct. Lookat the North West on the map here...
https://www.travellingtabby.com/uk-coronavirus-tracker/
... and I suspect yes schools testing of millions of school kids adds to the case count.
Lets remember what TiRED said, its about admissions and deaths, not cases. Deaths are down today but we need to wait until the 22nd for admissions and mid April for evidentially related Deaths... which is right when the natural "circuit breaker" of half term happens.
I would imagine so. Look at the number of tests processed & it’s jumped by 30% the last 3 days. More you test, more you find. Nobody thought the gov.U.K. Number was every case in the U.K.
Is there are way of finding out the breakdown of tests into:
Workplace routine testing
Symptomatic walk-in and postal testing
and the recent addition of School compulsory testing
And the positive ratio of each?