Most news is ephemeral – vide
the European Super League, the death of Prince Philip, or
possibly the frostiest April for 50 years. By
contrast, one news story has remained steadfastly
persistent for the last year and more – Coronavirus.
No other topic holds such significance. We want more
information, more facts and more analyses. We also
want to ask more questions – there are 44 of them in this
article. Read on!
The Covid-19 numbers
During April, the world passed yet another devastating
milestone – 3 million deaths attributed to Covid-19.
Those are from a global total of 140 million cases.
As the World Health Organization (WHO) reported, this
worldwide pandemic remains on a steep upward curve.
In mid-April, the Director-General of the WHO, Dr Tedros
Adhanom Ghebreyesus, warned that, ‘Around the world, cases
and deaths are continuing to increase at worrying rates …
globally, the number of new cases per week has nearly
doubled over the past two months.’ This pandemic is
far from over.
Whereas the global situation is dire, the UK continues
with mostly good news, sort of. During most of
April, Covid-19 cases, hospital admissions and deaths
continued to fall and vaccinations continued to
rise. Throughout the latter half of April, new case
numbers remained at a low but stubborn 2,500
plateau. That figure was 6,000 during March.
Moreover, at the end of April only 1,700 UK residents were
hospitalised with 240 on ventilators – those figures were
5,000 and 600 respectively in March. By late-April,
daily deaths from Covid-19 stood at less than 30.
Vaccine news is also positive. By the end of April,
34 million UK residents had received one dose – that is
equivalent to 50% of the population, and is the second
highest in the world, behind Israel’s 62%. And
another 13 million in the UK had had their second dose, so
one in four (25%) UK adults are now fully
vaccinated. And from 30 April, all those over 40
have been able to book a jab. This good news is
tempered by the fact that 20 million UK adults still have
not had even one dose of vaccine.
Even so, Oxford scientists have recently confirmed that
the UK’s vaccination roll-out is showing promising signs
of reducing Covid-19 transmission. After following
almost 400,000 vaccinated Britons during the first four
months of the roll-out, they reported that a single dose
of either the Oxford-AstraZeneca or the Pfizer-BioNTech
vaccines prevented about 65% of all infections.
Moreover, Public Health England (PHE) reported that those
given a single vaccine dose are up to 50% less likely to
pass the virus on compared with unvaccinated people.
India – what has gone wrong?
For much of January, February and March, cases of Covid-19
across India were relatively low, at about 11,000 each day
and with less than 100 daily deaths. Indeed, the
pandemic appeared to be under control, which, for a
country of 1.3 billion people, was remarkable. Then,
boom! A second wave hit. From mid-April, new
cases rose to about 250,000 a day and by late-April an
unenviable world record figure of 350,000 had been reached
with over 2,700 daily deaths. Alas, these figures
are widely considered to be underestimates.
Hospitals overflowed, the rich jumped the queues, poor
patients were turned away, oxygen and drugs were in short
supply and traded on the black market, deaths soared with
bodies stacked up for mass funeral pyres and piecemeal
lockdowns were hastily arranged. And the worst is
yet to come with a projected daily peak of 500,000 cases
sometime in May.
What has gone wrong? India’s prime minister,
Narendra Modi, is partly to blame. He relished
attending huge election rallies, rejected lockdowns,
supported massive religious festivals and allowed bathing
in the Ganges and other super-spreading events. In
addition, India’s vaccination roll-out has been slow with
only about 130 million doses administered, its health
system is meagre, social distancing has been patchily
observed in this densely-populated country, plus political
incompetence and public complacency have all played their
part. Yet, Modi, regarded by some as a ‘vaccine
guru’, has previously claimed that India has ‘defeated’
the virus. But TV and other media reports tell a
very different, frightening story.
In the midst of this disaster have come reports of a new
double-variant mutation, the so-called Indian
variant. But it is not so simple. This B.1.619
variant has two mutations called L452R and E484Q, which
may allow the virus to escape Covid-19 antibodies.
The former mutation have been previously detected in
variants from California and Denmark and the latter in the
South African and Brazilian variants. Inexplicably,
it may be that the second E484Q mutation has disappeared
in some cases. Even so, there is convincing evidence
that the Kent variant, B.1.1.7, is playing a significant
role by increasing transmission of the disease. And
this Indian variant has arrived in the UK – towards the
end of April, 132 cases had been confirmed, up from 73 in
the previous week. However, officials from Public
Health England (PHE) insist that strict border control
measures have it in hand.
Poor India. More viral data are needed – the human
figures across India are all too obvious. There is
an awful irony here – India is the largest vaccine
manufacturer and exporter in the world, yet its own people
are largely unvaccinated.
Has India been abandoned? Initially, help from other
countries has been sluggish – the ‘me first’ approach is
apparently contagious. It has recently
improved. The US originally turned a blind eye, but
has now promised to supply components essential for
vaccine manufacture. And the UK has eventually
shipped small quantities of ventilator equipment and
drugs. Even hostile countries, like Pakistan and
China, are now helping out.
If this second wave’s predicted peak of 500,000 daily new
cases is imminent, India has few alternatives but to
battle on – help is already too late for many. But
at last, Narendra Modi has admitted that a ‘storm has
shaken the nation.’ Hopefully India, and the rest of
the world, will learn some tough lessons to prevent that
terrifying third wave.
Blood clots and vaccines
The hallmarks of a good vaccine are high levels of
efficacy and safety. Comparing the efficacy of
different vaccines is a complex task because such studies
are typically conducted by each manufacturer and therefore
comparisons are confounded by various factors, such as
different patient ages, number of doses, dosage intervals,
times of post-vaccination assessment, and so on.
If measuring vaccine efficacy is complex, then determining
and comparing vaccine safety is an even more complex
undertaking. Most adverse safety issues will have
been identified and assessed in the Phase 1, 2 and 3
clinical trials. So researchers are now hunting for
what are inevitably rare conditions, ‘adverse
events’. And if identified, it is fiendishly
difficult to establish whether an apparent link between
such an event and the vaccine is merely a statistical
association or a causative feature. In mid-March,
the Oxford-AstraZeneca vaccine was suspected of harbouring
such a safety flaw, following reports that some people had
developed blood-clotting disorders, known as thrombosis
with thrombocytopenia syndrome (TTS), after receiving the
jab. Hence the question – were the clots caused by
the vaccine or, only statistically connected?
As a result, several European countries paused
distribution of the Oxford-AstraZeneca vaccine. The
evidence was based on results from around 20 million
vaccinated people in the UK and the EU, 25 of whom had
experienced serious blood clots with lowered platelet
counts, resulting in 9 deaths. However, after
reviewing the cases, the European Medicines Agency (EMA)
could not state categorically that the adverse reports
were linked causally to the Oxford-AstraZeneca
vaccine. Instead, the EMA concluded, along with
health regulators worldwide, that the benefits of the
vaccine in fighting the dangers of severe Covid-19 far
outweighed any risks of blood clotting in the brain.
Though initially this blood-clotting alarm centred on the
Oxford-AstraZeneca vaccine, it was quickly followed by
doubts about the Janssen vaccine produced by Johnson &
Johnson. Both vaccines rely on adenoviruses to carry
the DNA for encoding the characteristic spike protein into
human cells. Is this common feature
significant? Are mRNA vaccines, like the
Pfizer-BioNTech and Moderna, safer? Such questions
are, as yet, unanswerable. But again several
countries, including those of the EU and South Africa,
paused their roll-out use, though they later resumed
distribution of both vaccines, but restricted them to
younger age groups, those under 60, on the basis of the
precautionary principle.
On 13 April, Johnson & Johnson issued a statement
which included, ‘We are aware of an extremely rare
disorder involving people with blood clots in combination
with low platelets in a small number of individuals who
have received our COVID-19 vaccine. The United
States Centers for Disease Control (CDC) and Food and Drug
Administration (FDA) are reviewing data involving six
reported U.S. cases out of more than 6.8 million doses
administered. Out of an abundance of caution, the
CDC and FDA have recommended a pause in the use of our
vaccine. In addition, we have been reviewing these
cases with European health authorities. We have made
the decision to proactively delay the rollout of our
vaccine in Europe.’
On 23 April, US regulators lifted the pause they had
announced 10 days earlier. They recommended that
healthcare providers resume using the Janssen vaccine
after concluding the benefits outweighed the risks of
serious blood-clotting issues. However, doctors have
now been warned about the potential problems, especially
with women aged under 50, since of the original 6 cases,
all were under 60 and it was mostly women who became
seriously ill, with one fatality, within days of receiving
the vaccine.
Moreover, a US study, published in mid-April, reckoned
that the risk of naturally-occurring severe blood clots in
the brain of Covid-19 sufferers is about eight times
greater than the risk associated with taking the
Oxford-AstraZeneca vaccine. Using a database of half
a million Covid-19 cases in the US, the researchers found
that about 40 in a million people suffered blood clots in
the brain two weeks after a Covid-19 infection. Of
those, about one in five were fatal. Regulators
believe that the Oxford-AstraZeneca vaccine is linked to a
four to five in a million risk of similar clots.
The practical implications of such statistics are often
hard to grasp. The BBC has helpfully devised a neat
analogy based on figures from the UK’s Medicines and
Healthcare products Regulatory Agency (MHRA). It
goes like this, ‘If 10 million imaginary people were given
the Oxford-AstraZeneca vaccine you might expect to see 40
of these clots – with about 10 clots having fatal
consequences. Ten deaths out of 10 million people
vaccinated is a one-in-a-million chance. That's
roughly the same risk as being murdered in the next month
or – if you get in a car and drive for 250 miles – the
risk of you dying in a road accident on that
journey.’ Does that give some perspective and
comfort?
A mix and match trial
A major so-called Com-COV2 vaccine trial, led by the
Oxford Vaccine Group’s Matthew Snape, is about to start
studying the use of different combinations of approved
Covid-19 vaccines for the first and second doses. At
the moment, the vaccines used in this trial are the
Oxford-AstraZeneca, Pfizer-BioNTech, Moderna and Novavax.
The study’s purpose is to see how well people’s immune
systems respond when they are primed with one type of
vaccine, then boosted with another, and to see how good
the response is when the second dose is separated from the
first dose by different periods of time. Another
aspect of the study will be looking at how common adverse
reactions, such as fever and fatigue, are after such
‘mixed’ schedules.
This type of information is important, because being able
to combine different vaccines would create more flexible
vaccination programmes, potentially allowing more people
to be immunised more quickly.
Fancy volunteering? The team is currently recruiting
1,050 participants at multiple locations across the
UK. In order to be enrolled in the study you must be
aged 50 and over and able to provide documentation that
you had your first dose of Covid-19 vaccine, either the
Oxford-AstraZeneca or the Pfizer-BioNTech, through the
national immunisation programme between 25 January 2021
and 20 March 2021. In addition, you must be willing
to tell the trial staff about your medical history, and
you may be asked to allow the trial staff to check this
with your general practitioner (GP). If you are able
to become pregnant you must be willing to practise
continuous effective contraception during the study and
have negative pregnancy tests on the days of
vaccination. And you must agree not to donate blood
during the study.
Interested? Do you fit the bill? Then why not
do your bit for medical science and global health?
Hurry, because 800 people have already signed up.
You can learn more about the trial at
https://comcovstudy.org.uk/about-com-cov2
Another new vaccine – Valneva
‘What’s in a name?’ asked Juliet. Stories of adverse
effects with named vaccines, whether true or false, can
have an adverse effect on their uptake. The
blood-clotting sagas of the Janssen vaccine with its
10-day pause in the USA and of the Oxford-AstraZeneca in
the UK and elsewhere, as well as questionable efficacies
against variants has demonstrably increased vaccine
hesitancy towards these two vaccines, albeit probably
temporarily. Is it a case of ‘give a vaccine a bad
name’? Then maybe it is a good strategy simply to
move on and employ novel vaccines with no adverse
backstories.
Is that part of the UK government’s strategic
thinking? Recently it has ordered 100 million doses
of a novel vaccine produced by the French pharmaceutical
company Valneva, which has only just, in late April,
entered its Phase 3 trials in the UK and therefore yet to
be approved. The trial’s plan is to vaccinate
approximately 4,000 participants with two doses of either
the Valneva or the Oxford-AstraZeneca vaccine and directly
compare their immune responses. The trial is
appropriately named ‘Cov-Compare’. The Valneva
vaccine – technically known as VLA2001 – is the only
Covid-19 vaccine in the West that relies on the more
traditional vaccine technology involving an inactivated
virus, like several of the current Chinese Covid-19
vaccines. It is hoped that Valneva will produce a
more robust immune response than others and eventually be
effective against numerous variants.
Compulsory vaccinations?
Want to start a heated discussion? Then try
chit-chatting about compulsory vaccinations. In
mid-April, the UK government announced plans that staff in
care homes in England would be required to have Covid-19
vaccinations. Such mandatory jabs could be
introduced by the summer. The concern is that too
few staff are being vaccinated to stop the spread of the
virus to their vulnerable residents. Nationally,
just under 80% of care home staff have been vaccinated,
four months after they were first offered jabs.
Government advisors say that 80% of staff and 90% of
residents would need to be vaccinated to protect against
Covid-19. So far, only 53% of care homes in England
have met this threshold.
The plan would also require care home providers to hire
only vaccinated workers in the future. Care home
bosses and trade unions are divided by the
proposals. Questions arise. Is there a
difference between compulsory and mandatory? Would
this ‘heavy-handed’ approach backfire leading to
additional troubles in recruiting staff leading to the
provision of a poorer quality of care? What is the
extent of the sector’s duty of care? Is persuasion
better than legislation? Will the proposals be
extended to NHS workers? If not, why not? Will
it be, no jab, no job? Already the Royal College of
General Practitioners (RCGP) has rejected the idea of
mandatory Covid-19 vaccinations for GPs and practice teams
warning that it could lead to 'resentment and
mistrust'. A five-week government consultation
entitled, ‘Making vaccination a condition of deployment in
older adult care homes’ has already been launched.
The findings, and subsequent actions, will not be
simple. Will they be a prelude to broader Covid-19
legislation and restrictions?
What's happened to herd immunity?
In the early days of the Covid-19 pandemic, one of the
ways out was considered to be by herd immunity. That
is, if enough people got vaccinated, generated sufficient
antibodies and thereby gained resistance to the virus, its
transmission would be blocked and society could return to
normal. This was popularised as the strategy of ‘let
the disease just go’, encouraged by some specialists,
notably from the USA. That concept has since fallen
out of general favour.
The so-called ‘herd immunity threshold’ was reckoned to be
between 60 and 70% of a population. In other words,
two-thirds of people would have to exhibit immunity either
from vaccination or past exposure to Covid-19.
However, this is beginning to look like an unlikely
prospect. Why? For several reasons, including
vaccine hesitancy, the emergence of new variants, a lack
of vaccine supplies and waning immunity. This means
the pandemic will probably develop into more localised
epidemics, much like that of influenza.
One of the foundations of the concept of herd immunity is
that an infected person is isolated from susceptible
others so breaking the chain of transmission.
Current vaccines are good at preventing symptomatic
Covid-19, but it is generally unclear to what extent they
protect people from catching the disease, or from
spreading the virus to others. If vaccines cannot
block transmission, then herd immunity will only be
obtained by vaccinating everyone.
Another reason for herd immunity failure is that the
vaccine roll-out has been uneven and uncoordinated
worldwide. While in theory, a global mass strategy
could have controlled, even wiped out, the virus, this was
never going to happen. Starting in December 2020,
Israel was first and fast out of the blocks – and by
mid-March had vaccinated at least 50% of its adult
population with the required two doses of the
Pfizer-BioNTech vaccine. By contrast, Israel’s
neighbours, such as Egypt, Lebanon and Jordan have yet to
vaccinate even 1% of their citizens. In addition,
while countries are targeting the elderly, there remains
the problem of vaccinating children.
Pfizer-BioNTech, Moderna and Oxford-AstraZeneca have now
started clinical trials with teens and children as young
as three, but the results are months away.
Geography also plays a part. Covid-19 typically
occurs in localised clusters. Some of this depends
upon community vaccination policies and community
hesitancy. As resistance to the measles vaccination
has demonstrated, pockets of disease resurgence do
occur. On the larger scale, if surrounding countries
have low vaccination rates and populations are allowed to
mix, new outbreaks are more likely.
New variants pose a continuing threat. Will they be
more transmissible and more resistant to current
vaccines? The longer they are allowed to spread, the
more time these and other variants will have to emerge and
scatter. The case of the city of Manaus in Brazil
provides a cautionary tale. Apparently Covid-19
cases in that city slowed down last year, perhaps due to
herd immunity because at least 60% of the population had
been infected. But in January 2021, a huge surge of
cases occurred after the emergence of the new P.1
variant. In other words, previous Covid-19
infections did not grant protection – in fact, all the new
cases were caused by P.1. It seems that even high
levels of immunity cannot protect against Covid-19 variant
resurgence. In fact, high levels of immunity can
create an environment favourable to new variant
production, even of a type capable of infecting vaccinated
people.
It is clear that immunity comes from either vaccines or
infection. But the big question is, how long does it
last? Knowledge of other coronaviruses – and other
disease vaccines – suggests that immunity wanes with
time. As yet, there are insufficient data to make a
realistic assessment of Covid-19 vaccines. If
vaccine-based immunity is ephemeral, say only months, then
booster doses of vaccines may become essential over time,
as with influenza.
Finally, changes in human behaviour need to be factored
in. For instance, if Israel is close to a ‘herd
immunity threshold’, lockdowns are likely to be eased,
social distancing and mask wearing become more relaxed,
more people interact with one another, more people are
exposed to the virus. The outcome will be bad.
By contrast, as a positive spin-off of such behavioural
changes, the recent flu season has been unusually
mild. Why? Probably because of the widespread
use of non-pharmaceutical interventions, like distancing
and mask wearing. But as the lockdown rules ease it
will be difficult to stop people reverting to pre-pandemic
behaviours. Whereas neither vaccination alone nor
herd immunity will make Covid-19 disappear, the
combination of vaccines plus behavioural changes are
likely to make its dominance diminish.
And what about the future?
We all know about Monday 21 June, the first day of summer,
but more especially ‘freedom day’, when all Covid-19
restrictions are planned to be lifted across the UK.
Many, including the government, consider that social
distancing, mask wearing and so on should continue
cautiously, perhaps into 2022. Yet in April, a group
of senor scientists, many of whom have consistently
opposed lockdown measures, wrote an open letter, published
in The Mail on Sunday (25
April), calling for all restrictions, including,
‘Mandatory face coverings, physical distancing and mass
community testing should cease no later than 21 June along
with other controls and impositions.’ And they
declared, ‘It is more than time for citizens to take back
control of their own lives.’ Is this foolhardy and
overhasty? Are they not concerned about the
possibility/probability of new variants and/or a Covid-19
resurgence while the disease runs wild worldwide?
Bill Gates, the man largely responsible for the benefits
(and otherwise!) of Windows computing, has predicted the
world will be back to normal by the end of 2022. In
an interview on Sky News, he explained that his optimistic
forecast was based on the success of vaccination
programmes in the US and UK freeing up supplies, ‘… so
that we’re getting vaccines out to the entire world in
late 2021 and through 2022.’ Really? That
fast?
Some adverse effects of Covid-19 will take even longer to
repair. For example, the pandemic has disrupted
programmes of prevention and treatment for a host of other
diseases. As countries went into lockdown last year,
mass vaccination campaigns for measles, polio, meningitis
and other diseases ground to a halt. Millions of
children have been left at increased risk of contracting
these deadly diseases. Health facilities have closed
as health-care workers were redeployed to fight the
pandemic. Shipments of medicines and medical devices
have been delayed and fewer people have sought treatment
at clinics for fear of catching Covid-19. In other
words, our current battle against Covid-19 has caused
serious long-tern losses in the war against polio and
other preventable diseases. Such stalled
preventative medicine will surely require catch-up time
way beyond 2022.
The elderly and the vulnerable in the UK are likely to be
offered a third Covid-19 vaccine dose this autumn along
with their seasonal flu jab. The UK government is
about to finalise the purchase of 40 million, plus an
extra 60 million, doses of the Pfizer-BioNTech
vaccine. It is believed that these extra doses will
be used for the vaccination of people in their twenties,
who will be advised not to take the Oxford-AstraZeneca
vaccine because of its possible link to blood clots.
There are reports that the Joint Committee on Vaccination
and Immunisation (JCVI), which advises on the strategy for
the UK, is still deciding whether or not to recommend use
of the Oxford-AstraZeneca vaccine for people in their
thirties. So, will the excess stock of
Oxford-AstraZeneca vaccine be used as the winter booster
jab for the elderly, or will we be offered a new,
reconfigured anti-variant vaccine? Time will tell.
The origin of Covid-19
Just a gentle reminder, strictly speaking, SARS-CoV-2
(Severe Acute Respiratory Syndrome coronavirus 2) is the
name of the virus and Covid-19 is the disease caused by
that virus.
We now know many of the negative features of the
coronavirus SARS-CoV-2, including its devastation of human
health and its global reach – it is truly a disease
without borders. But where did it all start?
It is a question with, so far, no satisfactory answers.
In mid-January 2021, the World Health Organization (WHO)
sent a team of experts on a month-long fact-finding
mission to Wuhan, China to investigate the origins of the
Covid-19 pandemic. Its Report, long overdue because
of political and scientific difficulties, was published on
31 March. The USA, UK and 12 other countries
responded by implicitly accusing China of ‘withholding
access to complete, original data and samples.’
Nevertheless, the Report concluded that the virus probably
originated in bats and was passed to humans through an
intermediate animal. But fundamental questions
remain about when, where and how SARS-CoV-2 first infected
people. In order to trace the origin of the virus
the team sought to track down the earliest human
cases. It determined that the first person known to
have Covid-19 was an office worker in Wuhan, who began
showing symptoms on 8 December 2019. But it was
reckoned that the virus had been spreading in that city of
11 million people before then, because it was
well-established by later that month.
Yet evidence for such an earlier spread is vague.
Chinese researchers had previously examined patient
reports from hospitals in Wuhan written between October
and December 2019, and identified fewer than 100 people
who had symptoms of Covid-19. They then tested the
blood of 67 of those people for antibodies generated by
past infection with SARS-CoV-2, but, contrary to
expectation, found none. This suggests that a
cluster of Covid-19 infections did not exist before
December 2019. But were all the records examined
meticulously so that all Covid-19 cases were
identified? Stored blood samples from across China
should also have been examined to show if the virus was
spreading in the general population before December 2019.
There is evidence that examination, albeit not
sufficiently precise, of blood-bank samples from southern
China had tested positive for antibodies against
SARS-CoV-2. This is the region where close relatives
of the SARS-CoV-2 virus have been previously found in bats
and pangolins.
To complicate the search, scientists in Europe had
reported finding antibodies against SARS-CoV-2 in samples
taken at European blood banks from November 2019
onwards. Does that suggest Europe as the
origin? Not necessarily, because Wuhan is a
well-connected city, so it could still be the seat of the
virus with travellers spreading it to Europe and
elsewhere.
It is commonly thought that the markets in Wuhan played a
key role in the origin and spread of the virus.
Maybe it was here that the intermediate animal that passed
the virus from bats to people was located, though it has
not been identified. Nevertheless, researchers think
it might have been a wild species of some sort that are
typically sold live as human food in such ‘wet
markets’. Early in the pandemic, investigators
proposed that the Huanan Seafood Market in Wuhan was the
culprit, because it sold fresh and frozen animals and many
of the earliest infections were in people who had visited
there. But other early cases were not associated
with this market. Viral material was identified in
drains and sewage at the market, but none was found on any
animal carcasses. Yet, how did the virus get into
the market? And was it via an animal?
The WHO team identified ten stalls selling wildlife,
either wild or farmed, that could have brought the virus
from farms in southern China. Some wild animals,
such as rabbits and ferret-badgers, are susceptible to
SARS-CoV-2 or related viruses. These farms and their
workers needed to be inspected. And what other
animals were sold in other Wuhan markets?
The WHO team concluded that the virus probably jumped from
live animals to people, or maybe from infected frozen wild
animals, again from farms in southern China. On the
other hand, the route could have been from infected
people, who handled wild animals.
One of the key unknowns is which animal was the
intermediary that passed the virus to people? First,
of course evidence is needed to prove that the virus can
exist in that particular animal species. During 2019
and 2020, researchers in China tested some 30,000 wild,
farmed and domestic animals, but found no evidence of
active or past SARS-CoV-2 infections, except in a few
Wuhan cats during March 2020. Again, the WHO team
questioned the thoroughness and scope of this testing.
So what is the outcome of this visit by the WHO
investigative team? Sadly, not much. It has
raised lots of questions, but provided few answers.
What next? There may not be a ‘next’. The
passage of time will have diminished memories, degraded or
destroyed many samples, changed patterns of trade and
sales outlets – the centre of Wuhan will have been
irrevocably altered and cannot ever be recaptured.
Just as crime scenes need immediate investigation, so do
scenes of biological mystery. We will now probably
never definitively know the origin of the SARS-CoV-2
virus. All we are left with is little more than a
handful of speculations.
Antivirals Taskforce
At the end of April, the UK government launched an
Antivirals Taskforce. Its primary remit is to
identify treatments to be used at home by people who have
tested positive for SARS-CoV-2 infection, or who have had
contact with a confirmed case, to stop the virus spreading
and to speed up their recovery time.
The aim is to find at least two effective treatments this
year, in either a tablet or capsule form. Such
putative drugs will go through clinical trials and could
be rolled out as early as this autumn. The hope is
that these novel treatments will prevent future waves of
infection and limit the effect of new viral variants,
especially during the coming winter.
The government’s chief scientific adviser, Patrick
Vallance, said, ‘Antivirals in tablet form are another key
tool for the response. They could help protect those
not protected by or ineligible for vaccines. They
could also be another layer of defence in the face of new
variants of concern. The Taskforce will help ensure
the most promising antivirals are available for deployment
as quickly as possible.’
There are already dozens of antiviral drugs (most with
near-impossible names) used for other diseases that could
be repurposed for treating Covid-19 patients. For
example, there are oseltamivir and baloxivir currently
used for treating influenza, dexamethasone as a general
anti-inflammatory steroid and also sarilumab and
tocilizumab as monoclonal antibody medicines for
rheumatoid arthritis. It is somewhat odd to see
tocilizumab listed as a potential Covid-19 treatment since
a recent report in the New England
Journal of Medicine (2021, 384:
1503-16) by Rosas et al., concluded that, ‘… the use of
tocilizumab did not result in significantly better
clinical status or lower mortality than placebo at 28
days.’ In addition, there are new drugs, such as
molnupiravir, a protease inhibitor. And there are
already approved drugs, such as casirivimab and imdevimab
to be administered together for the treatment of mild to
moderate Covid-19 in adults. Those pharmacy shelves
look ripe for harvesting.
Overcoming vaccine hesitancy
Vaccine hesitancy is still a global problem. How to
convey the seriousness of Covid-19 and the benefits of
vaccination? The UK has taken the coercive route
with TV propaganda adverts and heart-to-heart pleadings
from ‘celebrities’.
Boston, Massachusetts has taken the reward approach.
Several businesses there are now offering freebies to the
vaccinated. For example, you can get a free 2-hour
bike hire from the Bluebikes company, or a free beer from
Budweiser, or a free glazed donut from Krispy Kreme, or a
free ride to and from a vaccination site with Lyft, the
second largest ride-sharing company in the US. Or
presumably all four at once. Just flash your
vaccination certificate.
This is called ‘incentivization’ and I’m all for it.
That notwithstanding, I didn’t even get a sticker after
either of my two jabs. But I did get free protection
from Covid-19.