First published in April 2021.


Vaccines a key ‘part’ of the solution

On Tuesday 13 April, the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) issued a statement regarding the Johnson & Johnson vaccine, tweeting, “We are recommending a pause in the use of this vaccine out of an abundance of caution.”

This came after the FDA said it would investigate six reported cases of “rare and severe” blood clots in women who have received the jab. More than 6.8 million Johnson & Johnson shots have been administered in the United States so far.

The New York Times explained that, “on Tuesday, the Australian government announced it would not purchase Johnson & Johnson vaccines. They cited the fact that Johnson & Johnson, like AstraZeneca, used an adenovirus as the basis of its vaccine. But there is no obvious reason adenovirus-based vaccines in particular would cause rare blood clots associated with low platelet levels.”

Is the adenovirus vaccine technology, used by AstraZeneca and Johnson & Johnson, causing blood clots?
If one adenoviral vaccine is linked with blood clots, it doesn’t mean all vaccines in this family will have that same effect. But it is definitely worth health authorities assessing the data.

The controversy about particular vaccines continued with the UK Government publishing updated guidance, which included this information on 15 April 2021:

Extremely rare cases of blood clots with low levels of platelets have been observed following vaccination with COVID-19 Vaccine AstraZeneca. The majority of these cases occurred within the first 14 days following vaccination but some have also been reported after this period. Some cases were life-threatening or had a fatal outcome. It is important to remember the benefits of vaccination to give protection against COVID-19 still outweigh any potential risks.”

Meanwhile other countries have taken a range of views, including Norway which on 15 April confirmed its assessment of the situation via its Institute of Public Health: “Since use of the AstraZeneca vaccine was put on hold on 11th March, the Norwegian Institute of Public Health has considered further use of the AstraZeneca vaccine in Norway, together with other experts.”

Geir Bukholm, Director of the Division of Infection Control and Environmental Health at the Norwegian Institute of Public Health explained that, “we now know significantly more about the association between the AstraZeneca vaccine and the rare but severe incidents with low platelet counts, blood clots and haemorrhages, than when Norway decided to pause use of the AstraZeneca-vaccine in March.

“Based on this knowledge, we come with a recommendation to remove the AstraZeneca vaccine from the Coronavirus Immunisation Programme in Norway.”

The positive news is that more vaccines are coming on line, including the Moderna vaccine which is now being used in the UK, as announced on 8 April 2021.

The Johnson & Johnson’s Janssen vaccine. | New York National Guard



Variants, more of concern.

It is also becoming clear that as the virus continues to mutate different vaccines and booster vaccines are likely to become a necessary way of life.

BBC News⁩ reports concerns that the South African variant can spread faster and that current vaccines may not work quite as well against it. First detected in the UK just before Christmas, by 15 April there has been more than 600 confirmed cases. Concerning.

On Monday 12 April 2021, enhanced coronavirus (Covid-19) testing in Lambeth was announced. On its website, Lambeth Council explained: Everyone over the age of 11 who lives or works in Lambeth should take a Covid-19 PCR test as soon as possible.

“We’re asking people to get tested to help us track any potential infections after new cases of the Covid-19 variant first identified in South Africa were detected in south London.”

Whilst on Friday 16 April, KentLive reported that, “a coronavirus variant (known as ‘Brazilian variant’ or P1) that appears to be particularly dangerous for younger people was detected in the South East region for the first time last month.”

“The Brazilian strain known as P1 has concerned scientists, initially because it contains the E484K mutation that makes it able to evade antibodies, potentially making vaccines less effective.”

The latest data available from Public Health England available shows that, so far, 44 cases of P1 have been recorded in the UK.

Another significantly concerning variant is the ‘double mutant’ variant from India. A total of 77 cases have been identified in the UK so far.

Covid-19 Variants in the UK. | PHE

It is not looking good from the perspective of the potential impact of the emergence of new variants of concern.

At last Boris Johnson cancelled his India trip due to virus surge in India, we learned on Monday morning.

Covid-19 virus. | Wikimedia/HFCM Communicatie



No ‘wave’ goodbye?

The UK Government’s “Roadmap out of Lockdown” is beginning to look like it needs to find an alternative route, or two, or at the very least a roundabout that takes a different approach. It has always appeared a contradiction to some that the strategy was based on the data, not the dates – yet a change in direction when the road ahead is being blocked was ruled out. Ruled out by the ‘irreversibility’ of the roadmap, and the irrational unbending, and intransigence, of the pilot.

In an interview published in the Guardian, Dr Catherine Smallwood, a senior emergency officer at WHO Europe, said the UK is still seeing a “significant number” of coronavirus infections and that “very restrictive measures” (the current lockdown) were holding them down.

“The UK still has potential to develop its own sort of renewed resurgence of cases without any involvement from the rest of Europe.” In her opinion, the lockdown is “what’s keeping the cases down at the moment – it’s not the vaccination.

“The population groups that are really driving transmission are still in the majority sense the ones that have not yet been vaccinated as a whole.

“Transmission can still happen in the UK without any washing up on the shores of the European outbreak.”

The UK government roadmap may not be as irreversible as the PM has suggested it must be – time to change route to avoid further serious problems?

PM Boris Johnson. | Number 10



Roadmap irreversibility, solution or part of the problem?

So, how is the roadmap doing? According to LBC, “Boris Johnson insists there is ‘no reason’ to change the lockdown roadmap.”

Yet, Mr Johnson admits that there will be consequences for lifting the lockdown. As we unlock, the result will inevitably be that we will see more infection, sadly we will see more hospitalisation and deaths, and people have just got to understand that,” he said.

The problem is, Covid-19 is becoming entrenched as a disease of poverty:

  • Outbreaks will be more likely as people mix more;
  • Worse access to safer outdoor spaces;
  • Differential vaccine uptake means poorest communities will be less protected once outbreaks occur.

Has the UK Government buried its head in the sand? We are inextricably linked to the rest of the world, especially with our front and backdoors unlocked to visitors and travellers. As Dr Tedros Adhanom Ghebreyesus, the director-general of the World Health Organisation (WHO) said on 16 April 2021:

Coronavirus cases are continuing to rise globally at “worrying” rates and noted that the number of new cases confirmed per week has nearly doubled during the past two months.

The number of new cases is approaching the highest rate of infection that we have seen so far in the pandemic.”

Dr Tedros Adhanom Ghebreyesus. | UN Geneva



Other key parts of the Covid-19 solution

It is becoming clearer that Covid-19 is likely to be with us for many months, if not years to come, and learning to live with this fact requires some major rethinking.

Rethinking and learning, in the short, medium and long term, about restrictions, about vaccines, about how the virus is transmitted, about the need to remodel health and care services for the management and treatment of millions affected by Covid-19 and Long Covid. Rethinking, and learning, about how to remodel the world of work, leisure and sports facilities, and travel and tourism.

The Huffington Post highlighted one of these aspects as the week drew to a close:

“If we want to stop the spread of Covid-19, we should focus on tackling airborne transmission and improving indoor ventilation, a group of respiratory experts have said. Airborne transmission is when the virus survives in aerosol droplets – tiny particles that linger in the air after we talk, cough or sneeze – then infect other people when they breathe them in. It’s considered to be the primary route for coronavirus to spread – however, globally, there’s reluctance to talk about, or acknowledge, this.”

As Dr Gabriel Scally, public health physician, visiting professor of public health at the University of Bristol and a member of Independent Sage, wrote in the Guardian this week and tweeted: “We’re not safe until we are all safe. We must think globally on COVID-19. Financing vaccine development is mostly public/charitable funds. A patent waiver is needed to radically increase vaccine supplies, stop variants and save lives. #PeoplesVaccine.”

Hopefully the government is already addressing these issues in developing a strategy for the future. Or is it? 

Pixabay


Dr Joe Pajak, previously scientific research & development, principal of community college, dir. of education, dir. of a children’s charity, disability charity trustee, now governor NHS foundation trust hospital.
J.N. PAQUET, Author & Journalist, Editor of PMP Magazine.






[This piece was first published in PMP Magazine on 19 April 2021. | The authors write in a personal capacity.]

(Cover: Flickr/Number 10. - PM Boris Johnson visits Lemon Street Market, Truro, Cornwall. | 7 April 2021. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)

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