Category Archives: current affairs

amusements, current affairs, personal, ramblings

Predictions for 2020: The Results

This time last year I made a long series of predictions about what would happen during 2020. So what did I get right, and what wrong?

[Some of the items remain redacted to protect the sensitive and innocent.]

UK

  1. Look out for natural disasters around 9-10/02 (snow), 9-10/03, 7-8/04 (very wet Easter), 6-7/05 (financial crash) (all of these dates are moon at perigee and full). CORRECT for 9-10/02 with Storm Ciara bringing heavy rain and high winds, with snow in the north. CORRECT for 9-10/03 which was again very wet and windy. VOID for 6-7/05 as this was an erroneous date for moon at perigee.
    Also 30-31/10 (plane crash) (moon is at apogee, full and a Blue Moon). WRONG
  2. Penumbral lunar eclipse (visible in London) 10/01, 05/06, 05/07, 30/11 may also presage problems. CORRECT for 10/01 with the beginnings of the emergence of Covid-19. WRONG. for the other dates.
  3. UK leaves EU on 31/01: UK will not request a further extension and anyway the EU wouldn’t grant it. CORRECT
    Leave deal will be unsatisfactory (basically the deal of 10/2019, passed due to Tory majority in the new parliament) containing many Henry VIII clauses (many of which will be abused before YE). CORRECT
  4. Government cannot agree a trade deal with EU by YE. WRONG
    If the EU proposes an extension beyond YE 2020 the UK government will refuse it, thus cementing a total “no deal” Brexit. CORRECT; no extension was offered; indeed the UK government indicated it didn’t want any extension.
  5. Boris Johnson continues to believe in unicorns and will ride out the economic turmoil following Brexit. CORRECT so far.
  6. Corbin is replaced as Labour Leader by a woman; possibly one of Yvette Cooper, Stella Creasy, Angela Eagle, Angela Rayner. (Predicted before the runners and riders were declared.) CORRECT in that Corbin was replaced. However WRONG that the new leader would be female. Also WRONG that the named females would be in the final running for leader.
  7. Despite attempts by UK and Ireland, the parties in Ulster are unable to agree a power sharing administration. WRONG; a new administration was agreed in January.
  8. There’s a move to reunite Ireland as the post-Brexit border is unworkable. This could stimulate Sinn Féin take their seats at Westminster to try to push through the reunification. WRONG on all counts there.
  9. Scotland is denied an independence referendum in 2020 by Westminster and fails to get a Supreme Court ruling in it’s favour. CORRECT that BJ would deny Scotland another referendum.
    The SNP will build resentment against Westminster in order to win elections (and maybe a referendum) in 2021/22. WRONG in that there is no major sign of SNP building discontent (more than normal).
  10. Increasing calls for reform of electoral system (to some form of proportional representation) but they’re continually blocked by the government who implement boundary changes to cement their position. WRONG
  11. HS2 gets the go-ahead and a feasibility study into extensions to Edinburgh/Glasgow and Cardiff. CORRECT; HS2 was given the go-ahead in February, with a proposal to extend to Glasgow surfacing in June.
  12. Fracking is allowed to restart. WRONG; in fact Cuadrilla (who have the only UK fracking licence) have surrendered the fracking part of their licence.
  13. Sadiq Khan wins a second term as London Mayor – but only just. VOID as the elections have been postponed to 2021 due to Covid-19.
  14. Nigel Farage gets a peerage; John Bercow, Kenneth Clarke and Dominic Grieve do not. WRONG about Farage and Clarke. CORRECT about Bercow and Grieve.
  15. Appointees to the Supreme Court (eg. the replacement for Lady Hale) are seen as being clearly political appointees, rather than appropriate legals. WRONG as far as I am aware.
  16. Because of the economic turmoil the UK is in recession by YE. CORRECT; UK officially in recession by August, largely due to Covid-19.
    Unemployment hits 10%. WRONG; September’s unemployment was just 4.8%.
    Bank of England Interest Rate returns to 0%. WRONG; base rate was reduced but only to 0.1%.
  17. Sterling plummets against dollar and Euro following the UK’s exit from the EU. CORRECT for Euro which fell from €1.18 to €1.11. WRONG for US Dollar which rose from $1.32 to $1.37.
  18. Inflation rises to at least 10% by YE, mainly due to large cost increases in the food industry and hospitality sector. WRONG
  19. FTSE falls 10% cf. start of year – due to Brexit and the financial crash. CORRECT; due to Brexit and Covid-19 the FTSE100 fell by 12.8% over the year.
  20. Financial crash, probably in early May, with the possibility that a bank will fail. WRONG
  21. S&P and/or Moody’s downgrade UK creditworthiness by two levels. WRONG
  22. Mortgage interest rates hit 10% before YE. WRONG
    Average UK house prices fall by at least 10%. WRONG according to the ONS they increased by around 5%.
    Repossessions double. WRONG; repossessions fell dramatically although there was a significant rise in home owners with serious payment arrears.
  23. Pensions (private & state) are compulsorily frozen. WRONG
  24. Drug prices double as the US buys up the NHS. WRONG; if this has happened it’s been well hidden.
    Prescription charges are extended to everyone with no exemptions. WRONG
  25. Either ASDA or Morrison’s fails or is taken over. CORRECT; ASDA was bought from Walmart.
    Debenhams finally fails. CORRECT
    Major problems for M&S and/or John Lewis – a partnership between the two looks likely. CORRECT about problems for both M&S and JLP although WRONG about an M&S/JLP tie-up.
  26. Major drug/alcohol or fraud/fixing issue uncovered in one or more of UK athletics, rugby, cricket. WRONG
  27. Extinction Rebellion fizzles out. PARTLY CORRECT in that ER have gone very quiet although they’re still around.
  28. Diane Abbott and Theresa May are diagnosed with long-term illnesses. WRONG as far as we know.
  29. Magnitude 4 or greater earthquake somewhere in UK. PARTLY CORRECT as there was a Mag 3.9 quake in Uxbridge in September.
  30. At least 200 deaths in illegal migration attempts to the UK. VOID as I’ve been unable to find any consolidated data.
  31. Plans announced to replace the Thames Barrier; work to start 2025 and complete 2040. WRONG
  32. Announcement that London congestion charge zone will be expanded out to N & S Circulars in 2025/6. PARTLY CORRECT; this was proposed by government (and sooner than 2025/6) as part of a deal to provide extra funding for TfL; however it was eventually removed.
  33. Relatively mild wet January/February followed by a cold wet spring & summer thus ensuring a poor fruit and grain harvest. WRONG as the winter was not especially warmer or wetter than of late; but CORRECT about the cool, wet Spring and Summer and the ensuing poor harvest.
  34. Death of the Queen and Prince Philip. Possibly also Prince Charles, in an accident. William becomes King by YE. WRONG on every count.
  35. Other Deaths: Edwina Currie, Gordon Brown, a royal duke, Kenneth Clarke, Jeffrey Archer, Dennis Skinner, Lord Heseltine, Lord Gowrie. WRONG on every count.

World

  1. Trump wins 2020 Presidential election due to Democrat dissent over their candidate. WRONG
  2. Saudi Arabia drastically cuts oil exports amid internecine turmoil. CORRECT; Saudi Arabia did cut oil exports but due to a fall in demand because of Covid-19.
  3. Zimbabwe finally succumbs to outright civil war which spills over into South Africa. WRONG
  4. South American countries descend further into right-wing government. WRONG
  5. Rate of Amazonian deforestation increases. CORRECT
    Global temperature and CO2 emissions continue to rise. CORRECT
    The COP26 climate talks in Glasgow (in November) end in disagreement and failure. VOID as the talks were postponed due to Covid-19.
  6. Major violence (civil war?) in Turkey. WRONG
  7. Violent uprising continues in Hong Kong and India. CORRECT for both Hong Kong and India.
  8. Russia annexes one of the Baltic states. WRONG
  9. Big solar geomagnetic storm causes major breakdown of satellites and infrastructure, probably across North America but possibly elsewhere. WRONG
  10. Collision between two operational satellites (maybe as a result of geomagnetic storm). PARTLY CORRECT in that two (non-operational) satellites had a very close near-miss in January.
  11. Boeing Starliner and SpaceX Crew Dragon both launch crewed capsules. One of them fails with loss of the crew. CORRECT in that SpaceX did launch crew, and in fact took crew to ISS. WRONG about a Boeing Starliner crewed mission and loss of crew in a failure.
  12. At least one other major space mission fails. PARTLY CORRECT; with 10 orbital launch failures out of 112 (9%) this has been the most mission failures in a year since 1971.
  13. Magnitude 7 or greater earthquake in California and another in Peru. WRONG
  14. Greta Thunberg is burnt out and sinks out of sight to complete her education. PARTLY CORRECT in that Thunberg has gone very quiet although she’s still around.
  15. At least one major global IT company fails (or is saved only by a takeover). WRONG
    Also a major airline and a shipping line. CORRECT for airlines; see, inter alia, Air Italy, Flybe, Virgin Atlantic.
    VOID for shipping as again I can find no good data, but given the state of the shipping industry it seems likely there were major failures.
  16. Major plane crash in western Europe – possibly France – possibly controlled flight into terrain. PARTLY CORRECT Ukrainian Boeing came down near Tehran; all 176 onboard lost.
  17. Ebola flares again in central Africa. CORRECT; there was an outbreak in DRC between June and November.
  18. Significant new disease emerges (as MERS and SARS did); concern at possible pandemic. CORRECT (in Spades!) with the emergence of pandemic Covid-19.
  19. Number of western countries ban vaping or include it in their anti-smoking regulations. WRONG
  20. Amazon and/or Facebook is involved in a major anti-trust or privacy law suit. CORRECT; Facebook is facing major (anti-trust?) law suits in USA.
  21. Deaths: Jimmy Carter, Bill Clinton, Dalai Lama, Angela Merkel, Bill Gates, Rupert Murdoch. WRONG on all counts.

Personal

  1. Personal (a), (b): [[REDACTED]] WRONG
  2. Neighbours1 (a), (b): [[REDACTED]] WRONG
  3. Neighbours2: [[REDACTED]] WRONG
  4. Neighbours3: [[REDACTED]] WRONG
  5. Local Community1 (a), (b), (c): [[REDACTED]] (a) & (c) WRONG; (b) CORRECT
  6. Local Community2 (a), (b): [[REDACTED]] (a) CORRECT; (b) WRONG
  7. Local Community3: [[REDACTED]] WRONG
  8. Friends1 (a), (b): [[REDACTED]] WRONG
  9. Friends2 (a), (b), (c): [[REDACTED]] (a) CORRECT; (b) & (c) WRONG
  10. Friends3: [[REDACTED]] WRONG to the best of my knowledge
  11. Friends4 (a), (b): [[REDACTED]] WRONG
  12. Friends5 (a), (b): [[REDACTED]] WRONG but only just
  13. Friends6: [[REDACTED]] CORRECT
  14. Friends7: [[REDACTED]] WRONG to the best of my knowledge
  15. Deaths: 11 named individuals [[REDACTED]] CORRECT for two individuals; WRONG for the other nine to the best of my knowledge.

These have all been redacted as the content is bound to be sensitive to people I know, however they are documented in my files and will be reported on at the end of the year.

Yet again this is a pathetic hit rate, although in my defence I suggest that really all bets were off this year due to Covid-19.

Tomorrow I’ll post my predictions for 2021. Watch this space.

current affairs, medical, science

Are You Ready for False Side Effects?

A few days ago Derek Lowe** over at In the Pipeline, had a short post about the dangers of apparent side effects being wrongly attributed to the Covid-19 vaccine(s) – ie. false side effects.

We’re talking about treating very, very large populations, which means that you’re going to see the usual run of mortality and morbidity that you see across large samples. Specifically, if you take 10 million people and just wave your hand back and forth over their upper arms, in the next two months you would expect to see about 4,000 heart attacks. About 4,000 strokes. Over 9,000 new diagnoses of cancer. And about 14,000 of that ten million will die, out of usual all-causes mortality. No one would notice. That’s how many people die and get sick anyway.

But if you took those ten million people and gave them a new vaccine instead, there’s a real danger that those heart attacks, cancer diagnoses, and deaths will be attributed to the vaccine. I mean, if you reach a large enough population, you are literally going to have cases where someone gets the vaccine and drops dead the next day (just as they would have if they *didn’t* get the vaccine).

We need to remain alert for this, and ensure that others understand this. Because people get sick and die constantly. As Lowe goes on to say:

The key will be whether they are getting sick or dying at a noticeably higher rate once they have been vaccinated. No such safety signals have appeared [during] the first [vaccine trails] … we should be seeing the exact opposite effects on mortality and morbidity as more and more people get vaccinated …
I certainly think mass vaccination is the most powerful method we have to knock that back down to normal. That’s going to be harder to do, though, if we get screaming headlines about people falling over due to heart attacks after getting their vaccine shots. Be braced.

Yes, we need to be alert and realistic, but not ignore possible side effects. Remember that in the UK possible adverse reactions to any pharmaceutical can be reported by patients as well as clinicians through the Yellow Card Scheme.

** Derek Lowe gained a PhD in organic chemistry from Duke University. Since 1989 he’s worked for several major pharmaceutical companies on drug discovery projects against schizophrenia, Alzheimer’s, diabetes, osteoporosis and other diseases.

current affairs, medical, science

More on Covid Vaccines etc.

[Warning: LONG READ]

Last week’s New Scientist carried several good articles on Covid-19 vaccines etc. If you have access to New Scientist or their website (which is paywalled) they’re worth reading. As usual, as they’re paywalled I’m going to be a little naughty and give you a key extracts from three of the articles. (Links to the articles are at the foot of the page.)

We can’t be certain the coronavirus vaccines will stop the pandemic

So things look good. But we are still a long, long way from a vaccine that will get us back to life as normal. That is in no small part due to the huge challenge of manufacturing, distributing and administering one … plus the reluctance of a significant minority of people to get vaccinated.

How long will immunity last? … We simply don’t know yet how long protection from any vaccine will last.

Vaccine efficacy does not always predict vaccine effectiveness … various reasons …a major one is that the deployment of a vaccine on the ground, to millions or billions of people, is much more challenging than administering it within a tightly regimented clinical trial. That is especially true of a two-shot vaccine that relies on people showing up to two appointments, often weeks apart.

The trials aren’t going to tell us what, if any, effect a vaccine has on severe illness … unless urgent changes are made to the way the trials are designed and evaluated, we could end up with approved vaccines that reduce the risk of a mild infection but do not decrease the risk of hospitalisation, [ICU] use or death. This seems outlandish, but … it comes down to the trials’ end point. In all the phase III trials, this is defined as the prevention of mild covid-19 symptoms … such a result tells us next to nothing about whether the vaccine is stopping infected people from getting really sick.

The trials appear designed to answer the easiest questions in the least amount of time, not the most clinically important ones … It is possible to do a Covid-19 clinical trial with severe disease as an end point … but it would be a major undertaking because that outcome is still quite rare. The studies do not have adequate numbers of patients to be able to reliably tell us if they prevent severe disease.

We don’t know how people who have had the virus and recovered will respond to any of the vaccines … We also don’t know whether the vaccines will put pressure on the virus to mutate.

The seemingly simple question “does this Covid-19 vaccine work?” is surprisingly hard to answer.

The Biggest Logistics Challenge in History: What will it take to get a covid-19 vaccine to the world?

Vaccines don’t save lives … Vaccination does.

When a Covid-19 vaccine is approved, it will trigger a staggeringly complex chain of events. These events must occur in perfect lockstep using a global supply chain that needs to reach even the planet’s most remote areas – the same supply chain that left parts of the world in desperate need of things like disposable gloves and protective equipment just months ago. The scale and magnitude of what we’re talking about doing is just unparalleled.

The key to overcoming complexity is planning and planning early.

How many people need to be vaccinated to end the pandemic depends on how effective the vaccine is, and how long the immunity it provides lasts … that figure [may be] 60 per cent. Given we now number 7.7 billion, and most of the vaccine candidates in late-stage trials require at least one booster, that is a staggering 9 billion or so doses.

Pfizer and BioNTech plan to make enough doses to vaccinate 25 million people by the end of 2020, and 630 million people in 2021 … Making all this vaccine requires a lot of upfront cash.

The US government has invested $6.5 billion in Covid-19 therapeutics and vaccines … [and] … will own more than 700 million doses from at least six different companies. The UK government has signed [deals] agreeing to buy a total of 340 million doses at set prices from at least six firms.

Once vaccines have been approved and manufactured … the challenge remains to package, ship and administer them to more people and in a shorter … time than ever before. While supplies like alcohol swabs, gloves, bins for used needles, pallets, plastic wrap and syringes can all be made by a wide array of manufacturers, the scale of the demand may be hard to cope with.

One of the challenges … is that vaccines are shipped by air and can arrive almost anywhere on the planet in one to three days. Syringes, being bulkier and with a shelf life of around five years, are typically sent by boat and truck. They can take two to four months to reach their destination.

Covid-19 vaccines will be stored and shipped in special glass vials. These are resistant to shattering at temperature extremes and less chemically reactive than standard glass … almost exclusively made from borosilicate glass. The main worry is that this glass requires special sand … and a breakdown at any point in the chain could bring vaccination efforts to a halt.

Once the vials are filled, they will need to be distributed – and quickly. The … airline industry … has estimated that providing a single dose to everyone on the planet would require enough vaccine to fill 8000 Boeing 747 cargo planes.

How they are transported is another challenge: all 12 of the leading vaccine candidates will need to be kept cold to stabilise the sensitive ingredients. Moderna’s [vaccine] will need to be stored at -20°C, a temperature that can be reached by most household freezers. [Pfizer’s] vaccine will need to be far colder: -70°C. That requires special freezers that can reach -80°C, the kind used to store things like bacterial cells in labs or sperm in fertility clinics. Pfizer has designed new insulated, suitcase-sized containers that will be packed with dry ice to maintain temperatures below -70°C and can keep the vaccine stable for up to 15 days. Each container can hold up to 4875 doses and will need to be refilled with 23 kilograms of dry ice every five days.

At some air hubs in the US and Europe, UPS is building freezer farms. Each of the 600 freezers in one of its farms will be able to hold 48,000 doses of vaccine.

Things get trickier when products are on the road … it gets most difficult in the “last mile” … In low and middle-income countries, drivers on motorbikes typically deliver vaccines and other medical products to villages in remote areas.

More worrisome are unanticipated shortages … there are a lot of hypotheticals and you have to plan and prepare for all of them … you need to have the right infrastructure and capacity in place to handle what’s going to be a relatively short, sharp shock to the supply system … coordinating the administration of a vaccine and booster on a global scale isn’t something the world has experience with … at [the scale] needed to open up society.

Political challenges to overcome, not least the willingness of people to actually get vaccinated.

In the UK … there are concerns that changing trade agreements under Brexit could delay the transit of vaccines or even leave them stranded at the border.

As long as we leave a region or country without access, the virus will come back

Heidi Larson interview: How to stop covid-19 vaccine hesitancy

One of the reasons rumours and misinformation are getting more traction now is because we have a lot of uncertainty. Things are changing every day, and people are anxious and want an answer. We have a perfect storm for rumour spread.

In the UK, the US and other countries, in May only 5 per cent said they would definitely not take a vaccine. Now, that’s up to more like 15 per cent.

Across the UK and US is if you are lower income … you are non-white and female, you are more likely to refuse a Covid vaccine … These communities could benefit the most but they are the least trusting of government.

We don’t have a misinformation problem as much as we have a relationship problem [between the public and health systems].

What reasons do people give for not wanting to use the vaccine?
Safety … It’s “too new” … Could we get long covid from the vaccine?

We have to do a better job of explaining why things are moving faster. We are not short-cutting old processes. It’s because we have brand new [vaccine] platforms, new technology.

On the health authority side you get more formalistic “everybody do this” messages, it’s almost monotone. The public has a lot of different questions. So when they hear the same message they think we [public health officials] really don’t hear them, that’s not answering their questions.

The Covid response is a real opportunity to change [health authorities’] relationship with the public. If we rebuild our relationship with the public so they feel we are a caring, listening health authority or government, that will make a huge difference.

https://www.newscientist.com/article/mg24833093-100-we-cant-be-certain-the-coronavirus-vaccines-will-stop-the-pandemic/
https://www.newscientist.com/article/mg24833093-800-what-will-it-take-to-get-a-covid-19-vaccine-to-the-world/
https://www.newscientist.com/article/2259876-heidi-larson-interview-how-to-stop-covid-19-vaccine-hesitancy/

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

current affairs, medical

Covid & Others News Update

1 Comment

For those that have missed it, a quick update of yesterday’s news on the Covid-19 vaccine, as a follow-up to my post of yesterday.

First of all the Guardian expands on the huge logistical problems distributing a vaccine: Pfizer and BioNTech’s vaccine poses global logistics challenge. The scale of the operations required is just mind-boggling.

Secondly the Guardian also reports that GP clinics are expected to administer 975 injections a week in 12-hour days, 7 days a week – roughly one every 5 minutes. (That’s 975 per clinic, there will be one clinic per area.)

The same Guardian piece reports Health Secretary, Matt Hancock, sounding some good words of caution in the House of Commons:

[T]he best way to liberate and to get life closer to normal is a vaccine … [but] … We do not have a vaccine yet but we are one step closer … There are many steps still to take. The full safety data is not yet available and our strong and independent regulator, the MHRA, will not approve a vaccine until it is clinically safe. And until it’s rolled out we won’t know how long the effect lasts for or its impact, not just on keeping people safe, but also on reducing transmission.

(One fly in that ointment is that the MHRA is not entirely independent, as it’s a government funded body.)

In other news former Prime Minister, Sir John Major, that as a result of the stupidity and ineptitude of the current government, the outlook for next year is bleak:

It now seems that on 1 January next year, Brexit may be even more brutal than anyone expected.

current affairs, medical

Covid-19 Vaccine

I didn’t blog this yesterday as I wanted to catch up on all the news reports …

Pfizer/BioNTech have announced that their vaccine against Covid-19 is 90% effective. So of course everyone is jumping about in delight and expecting that everything is going to be fixed by next week (slight, but only slight, exaggeration).

[T]he results are preliminary, have been shared only by press release, and the trials are not yet complete.

Frankly I consider this scientifically and medically irresponsible as it will get many people demanding the vaccine now, create disenchantment when they can’t, and undermine the current lockdown. The trials are continuing, the final data has not been analysed, nor peer-reviewed, nor published, nor submitted to the regulators. Press release is not the way to publish scientific research; it is purely a mechanism for bumping up a company’s share price.

So for once I was pleased to see Boris Johnson adding a touch of realism to the proceedings. Here are some more of the key snippets from the news items which show why this is not a magic bullet (references at the bottom).

[T]the announcement is just the first hurdle of many … regulatory hurdles will have to be overcome – and that is before we even think about manufacture and distribution.

Nothing in medicine is 100% safe – even something we take without thinking, like paracetamol, poses risks.

We also don’t [yet!] know how protective the vaccine is in different age groups.

[I]t must be approved by licensing authorities.

The prime minister said “if and when” the vaccine was approved for use, the UK “will be ready to use it”.

[W]hen scientists succeed in making a coronavirus vaccine, there won’t be enough to go around.

[A] huge level of production will be required, and then there is the matter of who gets the vaccine first and how mass vaccination would be rolled out.

Each … country will have to determine who it immunises first and how it does that.

[S]hould the Pfizer vaccine pass all the vigorous safety checks … older people would be first in line for the vaccination.

As the initial supply will be limited, reducing deaths and protecting health care systems are likely to be prioritised.

In the UK, older care home residents and care home staff are top of the preliminary priority list. They are followed by health workers such as hospital staff and the over 80s.

There are also logistical challenges, not least as the vaccine needs to be stored at -80°C, meaning that even in developed countries there could be difficulties in distributing the jab.

The Pfizer/BioNTech candidate … needs -80°C storage, and that is not available down at your local pharmacy [or GP]. Pfizer has been rounding up as many ultracold freezers (and as much dry ice production) as they can, but … this is going to be a tough one … the press release talks about getting 1.3 billion doses of this vaccine during 2021, but actually getting 1.3 billion doses out there is going to take an extraordinary effort, because you’re getting into some regions where such relatively high-tech storage and handling becomes far more difficult … With demanding storage requirements, the more people that are within a short distance of a Big Really Cold Freezer, the better. And the more trucks (etc.) that you have to send down isolated roads to find the spread-out patients, the worse.

Given that this vaccine needs two shots to be effective 1.3 billion doses is a nowhere near what is needed; it would provide enough to fully vaccinate only about half of India and nowhere else!

Maintaining vaccines under cold chain is already one of the biggest challenges countries face and this will be exacerbated with the introduction of a new vaccine … You will need to add more cold chain equipment, make sure you always have fuel (to run freezer and refrigerators in absence of electricity) and repair/replace them when they break and transport them wherever you need them.

Frankly, we’re in the middle of the second wave, and I [Prof Jonathan Van-Tam, England’s Deputy Chief Medical Officer] don’t see the vaccine making any difference for the wave we are now in. I’m hopeful that it may prevent future waves, but this one we have to battle through to the end without vaccine.

WHO has said it does not expect to see widespread vaccinations against Covid-19 until the middle of 2021.

[Boris Johnson] added it was “very, very early days”. He warned people not to “rely on this news as a solution” to the pandemic. “The biggest mistake we could make now would be to slacken our resolve at a critical moment,” he said.

So yes, this is good news and there is light at the end of the tunnel, but it is a very long tunnel! We will get out of the tunnel, but meanwhile stay safe!

https://blogs.sciencemag.org/pipeline/archives/2020/11/09/vaccine-efficacy-data
https://www.theguardian.com/world/2020/nov/09/uk-rollout-of-covid-vaccine-could-start-before-christmas
https://www.theguardian.com/world/2020/nov/09/what-has-pfizers-covid-vaccine-trial-found-and-is-this-a-breakthrough
https://www.bbc.co.uk/news/uk-54879676
https://www.bbc.co.uk/news/explainers-54880084
https://www.bbc.co.uk/news/health-54027269

current affairs, thoughts

They Think It’s All Over

So the Biden supporters in America are jubilant that he has ousted Trump as President. They think it’s all over! But I wouldn’t be quite so jubilant yet …

  • Has there been a handover of power?
  • Are there any outstanding lawsuits relating to the election?
  • Has Trump been physically removed from the White House?
  • Has the fat lady sung?

Answer “no” to any of these and a Biden Presidency is not assured.

Trump will do everything he can to stay in power; it is the way of tyrants.

Watch out for a confetti of lawsuits – all spurious but outwardly plausible – on top of the usual tirade of abuse, misinformation and lies.

Oh and of course there are over 70 days before the Inauguration. Time enough for Trump to wreak untold damage and havoc.

A pessimistic outlook? Certainly. And I hope I’m wrong. But Trump doesn’t have a good track record for acting decently.

current affairs, medical, thoughts

On Vaccine Logistics

Let’s think first about flu vaccination – not the vaccine itself but the logistics involved to get a needle stuck in my arm.

It is very tempting to ridicule the NHS and the UK government for failures to supply sufficient vaccines – especially flu vaccine – in sufficient quantity, and on time, when the requirements are apparently well understood. And indeed there have been supply failures in recent years. However it is salutary to consider the complexities of the logistics involved.

Somewhere around 30 million doses of vaccine have to be manufactured, packaged and shipped. Those 30 million are split between six different vaccines, made by five different companies. And there are tens of thousands of shipping endpoints (almost 10,000 GP practices in England alone, plus pharmacies, hospitals, …), all with differing requirements.

30 million doses can’t be manufactured, packed and shipped in the twinkling of a politician’s brain. It takes time, and the NHS isn’t the only customer of the manufacturers. So the supply from manufacturer to NHS warehouse will be phased; so the final shipping to the endpoint will also likely be phased. Which means at any time a given vaccine may not be available at every outlet, even if they did get their requirements correct the first time.

Keep in mind too that these vaccines are temperature sensitive and must be held in refrigerated storage at all times. That too complicates the distribution.

All of that is before one even thinks about the GP identifying, and calling those eligible for vaccination, and making enough clinic time (space, appointments, clinicians) available to actually stick needles in arms. Oh and chasing up those who don’t respond.

I know from experience of logistics at a much simpler level it is almost impossible to get this 100% correct every single time — hard though one might try! It’s almost inevitable that on this scale things will go wrong; and the further back in the chain the problem occurs the bigger the knock on effect out at the clinic.

(Incidentally it’s the same with supermarkets and getting things like loo roll on the shelves. Don’t just blame people for panic buying – although, yes, they do – but think about the logistics and supply chain involved.)

Amazingly this works the vast majority of times in developed countries. For instance, the UK currently has among the highest national coverage of flu vaccine in the world, vaccinating around 75% of the over-65s against flu every year; most countries either do worse or have no vaccination programmes for older people. But in places where the infrastructure and healthcare systems are more fragile, things break down quite quickly.

Now let’s extend this to vaccine(s) for Covid-19.

First of all let’s say that all of the above logistics still apply, but things get worse …

We don’t yet have a vaccine (or vaccines), so as yet we have no clue how many of what we are trying to deploy, or where, or how.

We don’t know if the vaccine(s) will require refrigerated storage, or actual cold storage. If cold storage (ie. freezer temperatures) is required – and this seems likely for many of the vaccines currently being trialled – this hugely complicates the distribution chain (and makes it pretty much impossible in developing countries).

How many shots of vaccine are required to provide immunity? Will just a single shot be enough? Or will patients need a booster (or two, or three, …). Again it looks as is many of the potential vaccines will need a booster shot after a few weeks. That doesn’t just double the amount of vaccine required; it doubles everything right down to ensuring patients get their booster.

And who is eligible for the vaccine? And when? Government is likely to plan on getting the vaccine to the most important people (eg. healthcare workers, food supply people) first, followed by vulnerable groups, and then everyone else. Ultimately they will want to catch everyone (barring the small number of nay-sayers): that’s 60+ million in England alone, with potentially two shots of vaccine – so four or five times the flu programme.

That’s a potential 120+ million doses of vaccine for England alone together with a huge amount of distribution and a great deal of clinical effort. That deployment will take time; maybe as much as an elapsed year! By which time the first recipients may need repeat vaccination if the immunity decays, as it well may.

All of that is before we even think about … How effective the vaccine(s) are (no vaccine is 100% effective). How many vaccines are available. Are particular vaccines (in)appropriate for particular groups of patients. How do we handle the case where the first vaccine available is followed up by one which is much more effective? – Do we revaccinate the first recipients now, or later, or not at all? What advertising campaign, or other incentives (maybe even legislation?), do we need to ensure the vast majority of people get vaccinated?

Of course, we don’t yet have a vaccine to deploy. The front runners are all still in Phase III trials which are unlikely to complete until at least the end of this year. Even if one (or more) of the candidate vaccines looks really good, it is very unlikely we’ll see an emergency approval much before next Spring. And then there may be the question of how that affects other ongoing trials.

Now you can be pretty sure that there will be people in the Department of Health and the NHS sweating blood to try to work all this out, now, even before we have a vaccine. And however well they do their job you can be sure they will get some of it wrong – because the problem is just too complex and contains too many risks and pitfalls. It isn’t at all easy, and it’s human nature to complain when things don’t work perfectly, but it helps to try to see the bigger picture.

So … (a) cut the healthcare system some slack when things don’t work 100% every time, but (b) do call the government to account if it’s their policies which cause the failures, and (c) don’t pin all your hopes on a Covid-19 vaccine being available to everyone (anyone?) real soon.

Further Reading

  1. Derek Lowe; “The Vaccine Tightrope”; Science Translational Medicine; 21 October 2020; https://blogs.sciencemag.org/pipeline/archives/2020/10/21/the-vaccine-tightrope
  2. David Salisbury; “If you’re pinning your hopes on a Covid vaccine, here’s a dose of realism”; Guardian; 21 October 2020; https://www.theguardian.com/commentisfree/2020/oct/21/covid-vaccine-immunisation-protection
  3. Jeremy Farrar; “Let’s get real. No vaccine will work as if by magic, returning us to ‘normal’”; Guardian; 6 September 2020; https://www.theguardian.com/commentisfree/2020/sep/06/lets-get-real-no-vaccine-will-work-as-if-by-magic-returning-us-to-normal
  4. Derek Lowe; “Cold Chain (And Colder Chain) Distribution”; Science Translational Medicine; 31 August 2020; https://blogs.sciencemag.org/pipeline/archives/2020/08/31/cold-chain-and-colder-chain-distribution
  5. Derek Lowe; “Preparing For the Vaccine Results”; Science Translational Medicine; 25 August 2020; https://blogs.sciencemag.org/pipeline/archives/2020/08/25/preparing-for-the-vaccine-results
  6. Megan Scudellari; “How the pandemic might play out in 2021 and beyond”; Nature; 5 August 2020; https://www.nature.com/articles/d41586-020-02278-5
current affairs, thoughts

Horrible Times 12: Business doesn’t Matter

1 Comment

I’m thinking, again, about Covid-19 and the overall scheme of things.

What I suspected long long ago is still true.

No-one gets it! Not just the government, but YOU, out there 🠞 🠟 🠜 🠝 🠞

In the overall scheme of things, BUSINESS DOESN’T MATTER!

Yes, that’s right: protecting business, in these troubled times, is NOT the first, or even a high, priority.

What has to be done is to protect, and look after, the people. Get the people through this pandemic. And do that at the expense of almost anything else!

Yes, that’s a draconian – and no doubt unpopular – view. And I make no pretence it will be easy or comfortable.

But look at it this way … Businesses are expendable. It doesn’t matter if they fail. Businesses can be rebuilt, started afresh, etc. but only if there are people there to do it. There is no point in having a business if there is no-one there to run it or buy from it. And if the people are there then at least a core of businesses will survive. And when all this is over those surviving businesses can grow to fill the new demand, along with new start-ups and resurrections.

Business is secondary to people. No people = No business.

Yes, OK, there are a core of businesses which are essential: specifically utilities (water, electricity, gas, sewerage, rubbish collection), food supply (farm to shop), healthcare (drugs, doctors, hospitals), and transport (haulage, some public transport, fuel).

Beyond that it isn’t important if pubs, restaurants, car manufacture, garden centres, tailors, fashion houses, gunsmiths, jewellers, publishing, and so on, cease. It doesn’t matter if I can’t buy Epsom salt, a mousetrap, or a new camera. All these can, and will, be rebuilt to the extent that the post-pandemic world, and it’s population, needs them and there are people to work them. If there aren’t the people (either as employees or customers) then the business isn’t viable.

Even education (all of it from kindergarten to university) isn’t essential. Yes, we need educated people, because educated people feed business. But missing a year or two won’t be a tragedy, as many who’ve been long-term sick demonstrate. You can catch up on education later. Although again it may not be easy or pretty.

People’s ability to survive has to be supported and protected, first and foremost.

So wake up governments. People first. Then education. And business later.

current affairs, environment, thoughts

Reforming Society

2 Comments

Following on from my post of some weeks back where I looked at a model for Environmental Reform, I’ve now had a go at writing flows for the other areas which need to be reformed together if we are to truly change the way our society works – and thus save ourselves and the planet.

As I see it, the four main arenas for reform are:

  1. Environmental
  2. Economic
  3. Political
  4. Social

They are, of course, highly interdependent.

The diagrams below are my attempt to capture and codify what needs doing.
You’ll see that I have marked with “IN” arrows those places which it seems to me are the simplest and most obvious starting points. Linkages between the areas are shown with lettered lightning flashes.

Click the images for larger views
Environmental Reform

Economic Reform

Political Reform

Social Reform

Yes, it’s very complex; and I don’t pretend I’ve yet got my head round it, nor that the models are necessarily complete. Others may very well disagree with me, be able to add key areas for attention, or linkages between items.

None of this is going to be easy. In fact even the “input points” are going to be fought over. There are too many vested interests amongst the “not-so-great and not-so-good” who hold all the wealth and power worldwide. But also because those of us in the western world have been (relatively) comfortable until now and embarking on this will both threaten that comfort and involve major change – neither of which mankind, as a species, is instinctively equipped to handle as over the aeons it would have been an evolutionary disadvantage. [See, inter alia, Ryback, Lee and Pianka.]

Well perhaps the Coronavirus pandemic can give us a kick start in helping us overcome our (now dangerous) instincts by showing at least the western (developed) world:

  • We can significantly reduce travel, especially air travel, for both business and leisure: business doesn’t need to do it and it will likely be neither affordable nor attractive for leisure.
  • We don’t all need to commute for 2+ hours a day to pile into an office. Sure, many jobs (eg. shops, manufacturing, farming) have to be done from your employer’s premises, but by far from all do.
  • We don’t need to consume stuff at the greedy rate we do (that too is no longer an evolutionary necessity); we can manage with less. Much (especially personal) technology is not essential, merely nice to have. We need to go back to “make do and mend” rather than “throw it away and buy a new one”. Most consumption (beyond the basics) is no more than “cake and circuses” which enriches the already wealthy.
  • There is more to life than earning ever more money; by working longer and longer hours; to show you think you’re two steps better than the guy next door; striving to continually climb the greasy pole; and kidding yourself you’re important. [See Hutnik.]
  • But perhaps most critically, we might come to understand how important it is to have open and ethical government – and that this is possible, though not inevitable. [See Mair.]

Will any of that happen? I hope it will. But I fear it won’t. I suspect this current panic hasn’t hit nearly hard enough, so not enough people are sufficiently shit-scared (or dead), and so the will (or necessity) for change won’t be there. Even the Great Plague and Great Fire of London (1665 & 1666 respectively) didn’t really hit very hard (they were too localised); the two World Wars came somewhat closer; but only the real devastation of losing 30-50% of the population in the Black Death (1348-50) really caused major reform. And who remembers back 670 years?

The will for change may be there amongst (some of) those of us who think and care. However I suspect that after this current Coronavirus panic is over “the people” will go back to their old ways, rejoicing at having escaped the demon bug (‘cos it never happens to them!), demanding what they had before, and being as selfish as ever.

Judging by recent behaviour, the signs are not good.