current affairs, medical

Covid #3

Let’s have another catch-up on some of the Covid-19 news (as of yesterday).
[References at the bottom of the page.]

Vaccination Programmes

There have been a number of news reports recently about how the NHS is going to meet the challenge of a mass vaccination against Covid-19 – when we do eventually get a vaccine.

As already hinted, this no trivial task.

  1. There is the question of space – real estate – to do the work. Space which is secure, safe and can be easily disinfected; and available for an extended period.
  2. Then, as we’ve discussed before, a large number of heavyweight freezers may be required to store the Pfizer vaccine at around -75°C ±15°C. Your domestic freezer can’t get near that! And of course the cold supply chain.
    Even if vaccines are stable long-term at domestic fridge temperatures (2-8°C) large numbers of commercial-grade fridges will be needed.
  3. And not least there is the question of manpower. Pulling doctors and nurses away from their day-to-day work will be essential, but will have a knock-on effect on “normal” healthcare:

    Health leaders warned that surgeries will not be able to offer their full range of care for patients from next month as doctors and nurses will be immersed in administering jabs at more than 1,200 mass vaccination centres across England, potentially including sports halls, conference centres and open air venues.

  4. All of which assumes there is enough vaccine, in the right places, at the right time, every time, with no supply issues.

The availability of manpower is why the programme will take the length of time (up to 18 months) that’s being discussed. Here’s my very rough demonstration of why (in very crude figures and assumptions; but it is a demonstration):

  1. The UK population is around 70 million and every one will need two doses of vaccine.
  2. Assume we have 7000 FTE** clinicians sticking needles in people.
  3. And assume each of those can give 70 injections (1 every 5 minutes) in a single shift. (That’s 6 productive hours in an 8 hour day, which is fairly standard productivity.)
  4. That means we need (70 million x 2) / (7000 x 70) or roughly 300 days to complete the work.

    5. [** FTE = Full Time Equivalent. 1 person working 5 days a week is 1 FTE. 5 part-timers each working 1 day a week is also 1 FTE.]

    But it isn’t that simple because:

  5. No-one can work flat out, every day, for the duration (a year plus). They need time out, rest days etc. Add 20% (ie. let them have “weekends” off).
  6. Then there is sickness and other absences. Add another 15%.
  7. And you’ll never achieve 100% occupancy; there will always be gaps in the schedule where people don’t turn up, the appointment can’t be filled, people decline, etc. Add another 20%.
  8. That means we need to increase the time by 55%, which gives us 465 days.
    Or 67 weeks (15-16 months) if working 7 days a week.
    Or 93 weeks (21-22 months) if working 5 days a week

You see why this is such a huge logistical challenge. As one of the Guardian articles linked below says:

[There is] concern that the NHS does not have enough staff or infrastructure, such as freezers to store vaccines and lorries to transport them, and could become embroiled in the sort of “desperate scramble” for kit seen in the spring with personal protective equipment (PPE) and ventilators.

This is very complex stuff. Two jabs, three weeks apart, with people having to recover somewhere for 15 minutes after they have it – that is far more complex than administering the winter flu jab.

That’s before one even starts thinking about the priorities – and you’d better have some bloody good reasons why the priorities are what they are, because whatever they are they’ll be challenged.

Herd Immunity

Looking at the other side of the coin, there is a long article by Dr Tara C Smith, an academic epidemiologist and infectious disease researcher, discussing why The Concept of Coronavirus Herd Immunity is Deadly and Dangerous. This looks at, inter alia, issues with the Great Barrington Declaration.

[T]he actual implementation of this strategy would fail for a number of reasons … First, “vulnerable people” is not limited to just the elderly … There are no details to how we would protect these people other than requiring them to stay in lockdown indefinitely … separating the “vulnerable” from the rest of society is, essentially, impossible. Both our lived experiences and data say that we cannot separate the vulnerable from others. We share homes and workplaces with them … We need to consider whether asking these people to isolate from society will compound the disadvantages many already experience in society.

Add to that … We don’t yet have a vaccine to help speed up any herd immunity. We don’t have a firm handle on how long any immunity might last; so there is no guarantee that herd immunity is even possible for Covid-19. There’s a significant minority of people who have “Long Covid” – is it fair to knowingly inflict this on more people, or indeed to knowingly increase the number of deaths? How and where do you draw an ethical line?

Basically the idea of herd immunity without a vaccine is a non-starter.

https://www.theguardian.com/world/2020/nov/11/thousands-of-hospital-staff-to-be-deployed-in-covid-vaccine-rollout
https://www.theguardian.com/world/2020/nov/10/gps-in-england-will-scale-back-care-to-deliver-covid-vaccines
https://www.bbc.co.uk/news/health-54902909
https://www.self.com/story/coronavirus-herd-immunity