Tuesday, December 21, 2021

Coronavirus 61 A Great Wrong

In January 2020, Sarah Gilbert and her colleagues had done the work to show that a covid vaccine was possible and it was soon apparent that it would be needed. During that year production facilities should have been built on such a scale that by the time the vaccines had been demonstrated to be safe and effective, towards the end of 2020, doses could have been manufactured on a scale that befitted the task of vaccinating everybody, some 7.9 billion of us.

The task would have been unprecedented but so was the need. It would have involved the greatest switch of industrial effort, at least since World War II, but it would have been possible.

We have been taught to congratulate ourselves on the 'success' of the vaccine roll-out, but it is illusory. The world's governments failed their task in 2020. They failed to do it again in 2021. Most people in the poorer parts of the world remain unvaccinated. That has allowed the pandemic to continue, the virus to mutate to ever more infectious variants, and the disease to come back and bite us again.

Our lack of ambition in production effort and our greedy and selfish maintenance of intellectual property rights have been the biggest own goal in human history.

It has been a Great Wrong.

In an end of year discussion on DiEM TV Yanis Varoufakis invited Noam Chomsky to reflect on the situation. Here is a transcript of Chomsky's response

Take Omicron, it’s perfectly clear why this happened and why it will happen again. The rich countries have monopolized vaccines for themselves and have insisted on preserving the outlandish property rights agreements, patent rights, assigned to the basically monopoly pricing rights, assigned to the pharmaceutical corporations in the mislabelled free trade agreements, which means that, for example, Moderna, which was a small company, was able to use extensive government funding, government research. To develop a very effective vaccine. Propelled several of the management up into the super billionaire category. But they will not permit South Africa, which has a pharmaceutical industry to produce their vaccines. It means that South Africa could not vaccinate the population sufficiently to withhold the ongoing mutations. It means that in the unvaccinated South there’s a potential for a mutation which can lead to serious consequences. Of course, will spread back to the west. The wealthy and the powerful are – who recognize all this, they understand it – are willing to place the profits of the major pharmaceutical corporations and their prerogatives - given in the improper trade agreements – place that above the lives of many millions of people and even the welfare of their own populations. It’s an interesting value system.

Saturday, December 18, 2021

Coronavirus 60 Two Choices

How do you get to Birmingham? I wouldn't start from here.

We should have stopped the virus spreading in January 2020 before it became a pandemic, but the same argument still applies.
We have choices.

1. End the pandemic.
2. Allow the pandemic to continue.

Let's look at option #2 first. By continuing with the government policies and citizen behaviour adopted so far in many western nations we can look forward to a massive spike in omicron cases. Even if the death rate in a population that is largely vaccinated and/or has some natural immunity because of earlier SARS-CoV-2 infections, is an order of magnitude lower than earlier in the pandemic, it will still result in thousands more deaths.
Importantly, it will do nothing to prevent a new variant. There is an evolutionary advantage for a variant that is more infectious, better at escaping natural immunity within the population or the vaccine. There is no evolutionary advantage to become either more or less pathological. That could go either way. That a new variant is milder is wishful thinking, that it becomes worse is something the precautionary principle demands we prepare for.
Covid so far has shown a case fatality rate of less than 1%. Omicron in a mostly vaccinated population may have a case fatality rate an order of magnitude less, but a future variant could plausibly have a worse outcome. MERS has a case fatality rate at least an order of magnitude greater than the worst outbreaks of SARS-CoV-2. Ebola, albeit a very different virus, has a mortality rate nearer 50%.
There's no easy end in sight to the arms race between variants and our vaccination programme. It would mean learning to live with the deaths and morbidity that the virus causes, a very different world to that we have previously known.
It's a bleak outlook, so let's turn to option #1.
But we can't 'End the pandemic'! Oh yes we can. The pandemic ends in a few weeks if nobody meets anybody outside their own household. That, of course, is impossibly hard to achieve, but with proper planning and support, a very strict lockdown could be acceptable, driving R well below 1 and keeping it there. The pandemic would then inevitably come to an end. It would require people's trust in their governments, earned by sufficient and appropriate support from governments. It involves the rigorous application of what we have long known to be the effective route to infectious disease eradication: a combination of finding cases, isolating with sufficient support, and vaccinating.

The other option really is too bleak to contemplate.

Picture attribution: W. Carter

Saturday, December 11, 2021

Coronavirus 59 Omicron part 2

In the fortnight since my first blog about Omicron we have learnt a little more and little of what we have learnt is good news. 

Firstly, let's dismiss the reports, based on wishful thinking rather than science, that this variant is 'milder'. Here's a sketch by Dr Natalie Dean that explains a quirk of the data. 

If it's not immediately obvious, read her explanation here.

Of course it might turn out to be milder, but we don't have the evidence for that and there's no particular reason why it should be. While uncertainty rules let's not base action on wishful thinking but stick to the precautionary principle.

Effectively, Omicron adds an extra pandemic to the Delta pandemic that has been producing some 40 to 50 thousand new covid cases per day. Delta has been spreading with an R close to 1 since the fateful 'Freedom Day' last July. Now we have a virus that appears to be doubling in less than three days, with an R closer to 4. Adding this to the underlying Delta, Professor Christina Pagel, at the Indie-SAGE briefing on Friday 10th December, presented this graph:
She points out its simplicity, but while all models are wrong, some can be useful. This graph shows that unless we take quick and decisive action to change our behaviour we are heading for a disaster on a similar scale to that seen at the start of this year.

Unfortunately, the UK Government has demonstrated, repeatedly, its inability to take swift and decisive action. It persists in ignoring the advice of those who know what to do, such as the scientists contributing to Indie-SAGE. Here's their latest report, spelling out just what should be done:
And to underline the urgency, here's a new paper, an unreviewed pre-print, as is the way of things these days, from the Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine by Rosanna C. Barnard et al.,
"In all four main scenarios, we model a policy of compulsory mask wearing in shops and on public transport from 30th November 2021, as well as introducing “Plan B” measures from 12th December 2021. Under these control measures, our most optimistic scenario projects peak daily hospital admissions of 2,400 (95% projection interval: 1,700–3,600) in England occurring in January 2022. Our most pessimistic scenario projects peak hospital admissions of approximately twice the size of the January 2021 peak."