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.

[** 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

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.

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