We look back at last week’s coronavirus situation in the UK, the number of infections remaining high during the lockdown, vaccine nationalism, the gap between vaccine doses, the South African variant, the NHS, and more...


First published in February 2021.


Far From Over...

Are lockdowns of value, is it important to wear a mask, keep an appropriate physical distance, wash hands, follow government restrictions, and get vaccinated? Yes! And one fact from today’s data perhaps explains why: 31,431 deaths in 28 days. Covid-19 has now claimed no less than 111,264 lives since the first reported case just over a year ago!

What’s more, Covid-19 cases are not declining as rapidly as we may think. In the last 28 days the UK has reported 954,106 new cases!

The REACT-1 study, the largest population surveillance study being undertaken in England that examines the prevalence of the virus causing COVID-19, has recently found that coronavirus infections has remained high three weeks into the third national lockdown.


As Imperial College’s Professor Paul Elliott said, “If infections aren’t brought down significantly, hospitals won’t be able to cope with the number of people that need critical care.”

From important research to the challenging experiences and amazing work of those thousands of healthcare professionals working directly with patients suffering form this dreadful (new) disease.

Professor David Oliver, an experienced NHS consultant physician who has worked on acute Covid-19 wards throughout the pandemic, wrote: Lockdowns might be an admission of failure of other health protection measures. But they are based on what we know about the routes of covid-19 transmission, they have been adopted by numerous nations and when implemented, at least in the short term, covid infection rates do fall.”

The seventy-sixth SAGE meeting on Covid-19 that took place on 14 January 2021 reported that, “Vaccines are not 100% effective, and there will not be 100% coverage. The relaxation of non-pharmaceutical interventions (NPIs) could lead to a further epidemic wave if it is not done cautiously.

“The risk associated with a further wave is reduced if there is high vaccine coverage, particularly amongst the most vulnerable groups, and if community prevalence and hospital occupancy are reduced to low levels before relaxation happens. Any changes should be gradual and carefully monitored.”

A forecast paper prepared by the University of Warwick on the impact of vaccinations at SAGE 76 also found that, “Even in the best case assumptions for vaccine efficacy, vaccination alone proves insufficient to allow complete NPI release within the year without significant further disease burden.

“With the new aggressive covid strain, likely transmission efficacies prove insufficient to prevent further infection outbreaks across the population. This means that the proportion of individuals that do not accept the vaccine together with the proportion for whom it is ineffective in protecting, may still account for significant further severe disease even after the program is completed.

“We see that even with the highest possible uptake and fastest vaccination program, full relaxation by the time schools return in September would still result in significant further disease.”

Kingston upon Hull, 27 April 2020. | Geograph/Bernard Sharp


Vaccinations: Why Should The Winners Take All?

One other especially important tool is the development, promotion, and use of vaccines to protect people from infection by the disease. Herein sits another ethical and moral dilemma... about supply, demand, research, and efficacy of the vaccines being developed.

The world’s richest countries, 16% of the world population, have acquired 60% of the vaccines. So, the most vulnerable will suffer most, infection will rage, more new variants will arise. For both moral and pragmatic reasons, we must do more to distribute vaccines more equitably.

How and when will lower-income countries get access? This enormous task can’t be overstated.

For everyone on this planet, or at least 90%, to be vaccinated, it is going to be at least 2024, according to Adar Poonawalla, CEO of the Serum Institute of India (SII).

Governments, responsible to their own citizens, must avoid vaccine nationalism. Leaving hundreds of millions of people unvaccinated could increase the risks of new, more contagious, more leathal variants emerging all the time.

COVID vaccine nationalism: History shows when countries act selfishly, everyone loses.
Selfishness was also a problem when the world was developing vaccines for swine flu and bird flu.

As Bloomberg Opinion columnist Lionel Laurent puts it, it’s time the rich world set the example and worked out how best to share its own supply. Is it better to vaccinate the most vulnerable people in a neighboring country before the least vulnerable in one’s own? Contracts won’t tell us. Cooperation will.”

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Jeremy Farrar, Director of the Wellcome Trust, agrees with that statement: There is no place for vaccine nationalism, vaccine apartheid, vaccine inequity. It is in no one’s interest. Vaccinating vulnerable communities and healthcare workers is a priority for all countries. Making sure equitable global access is seen as an urgent issue is critical.

The longer we wait greater the chance new strains will emerge that evade natural infection and vaccines. Imagine a world where there is a delay and by the time vaccines are shared it is too late. Recent data around world shows how perilously close we are to that now. It will not be long.”

Wealthy countries take all. | Wikimedia/Antoine Taveneaux


Does Time Between Doses Matter?

Nearly 11 million people have now been given a first dose of Covid-19 vaccine in the UK. It would be interesting to see how many of those have caught Covid-19 since their first jab as they await their second dose. It would also confirm whether the UK Government’s vaccine strategy to allow for a gap of 42 days between doses was the right one.

Should we question the government’s strategy of delaying the second dose for up to 12 weeks (something Pfizer is against)? After all, is this disparity between doses that important?

The BMJ published a report in which it stated that data from Israel appeared to suggests 14 days after the first dose of the Pfizer vaccine, patients only have 33% protection. However, after the second dose the vaccine is 92% effective.

However, AstraZeneca recently published in The Lancet a preprint of vaccine data that eased worries over the second dose delay. According to their report, single-dose efficacy was 76% for up to three months, whilst with a 3-month gap between the two doses (the UK guidance) efficacy was then 82.4%.

Only time, more data, and more studies will tell whether the 12-week gap between jabs was the right strategy.

PM believes gap between doses does not matter. | Number 10


Full Vaccination: The UK Trails Behind

Whilst the UK’s strategy differs from the rest of Europe (and the world), it is interesting though to see that the EU appears largely ahead of the UK on the number of people fully vaccinated against COVID-19 (doses 1+2).

So far, the EU has indeed fully vaccinated 3.9 million people, whilst the UK has fully vaccinated nearly 8 times less people (505,993).


Upset that UK trails behind the EU? | Number 10


Community Transmission of the South African Variant

The South African COVID variant recently found in Surrey has to be of great concern. It has reached the UK because of weak restrictions and behaviours.

Are the restrictions effective enough? Could we have another year similar to 2020, with new variants wreaking havoc on our healthcare system and our economy? What is the government doing about it?

Is Downing Street panicking over the South African Covid-19 variant?
A mix of flawed strategy and dreadful vaccine nationalism — the libertarians are in charge of the country at the worst of time to our peril. In panic mode, a door-to-door testing blitz has been launched to urgently stop the spread of the South African variant. But could this situation have been aver…

We not only still have much to learn about the disease, we also continue to have much to learn about vaccines that are being developed to protect against the disease.

It is important in doing so, that our politicians learn to follow the science, not the soundbites! It is also important that scientists are able to continue their work, independently, objectively, with assessments based on sound scientific evidence, and that they do not end up following the politics!

Variants landing in the UK? | Geograph/Thomas Nugent

Finally...

In addition to the vital work of our healthcare professionals, we have a number of other key tools that need to be employed in our fight against the pandemic. One is in our own hands! It is all about us, following the science, using masks, keeping the right distance from others, using good ventilation, and following the rules to the letter (no excuses).

Another key element is the responsibility of politicians. Not using idle semantics about following the science, but actually listening and making sound and timely judgements.

It is clearer than ever that our NHS and care services will now be changed forever as the result of this pandemic.

Too many hospitals needing to be upgraded or rebuilt, too many healthcare resources requiring a radical rethink, a workforce (as a whole) that has gone through an experience not witnessed to this extent since the two World Wars, and even then perhaps not with such widespread impact and intensity.

Claps don’t pay the bills.  



Further Reading:



Dr Joe Pajak, professional experience scientific research and development, principal of a community college, director of education, then director of a national children’s charity, trustee of a disability charity, and governor of NHS foundation trust hospitals.
J.N. PAQUET, Editor of PMP Magazine.





[This piece was first published in PMP Magazine on 5 February 2021. | The authors write in a personal capacity.]

(Cover: Shutterstock/Dana.S.)