Hip, hip, hooray,
this is the very last of my Coronavirus updates.
They started in October 2020 as a one-off piece
concentrating on the bioethical issues of vaccines
made with the help of tissue components derived from
aborted human foetuses. They were never meant to
stretch to Part 2 let
alone Part 20.
So why stop at Part 20?
It is certainly not because Covid-19 has gone
away. Even in the UK, there has been a recent
resurgence of cases. Nor is it particularly
because of a lack of Covid-19 news, but this has,
perhaps inevitably, become somewhat samey – a new
surge here, a sub-variant there, new vaccines here,
something weird there. By now, we are all
familiar with these sorts of themes. And
moreover, by now, I think I have said all I want to
say about the wretched virus. I want to move
onto new projects.
During this 20-month sojourn, I have sought to report
on and interpret the fundamental topics – vaccine
safety, Covid-19 symptoms, serious human trials, novel
strategies, likely causes, promising treatments,
potential cures, and so on. Nor have I shied
away from censuring anti-vax rhetoric, conspiracy
theories and diverse doubters. Overall, I have
taken a mostly cautious, risk-averse, scientific
approach. Some have disagreed with my stance,
but thankfully, more people have expressed their
appreciation. I am grateful for all who have
bothered to read these articles and contact me.
It has been a fascinating and educational road
trip. Thank you! Until the next pandemic!
Covid-19 numbers
Welcome to the UK’s
Coronavirus statistical switchback. Most of June
had been a month of consistent decline in Covid-19
cases, hospitalisations and deaths. A very
encouraging trend. But then, in late June, the
unexpected reverse occurred. This contrary virus
and its adverse symptoms were back with seeming
vengeance.
By the end of June, the latest figures from the Office
for National Statistics, estimated that 1.7 million UK
people were infected. That is about one in every
35 people – an increase of 23% on the previous week,
after a 43% rise during the week before that. What
was happening? The rise is thought to be
predominantly due to two fast-spreading sub-variants of
Omicron, known as BA.4 and BA.5. These two now
account for more than half of new Covid-19 cases in the
UK. We are firmly in the grip of a third wave of
Omicron.
This upward trend may have been partially caused by
increased socialising over schools’ half terms and the
Queen’s platinum jubilee weekend celebrations. By
contrast, the recent transport strikes and their
associated increases in WFH (working from home) may yet
bring about a statistical fall.
The weekly death toll in the UK during mid-June was 334
bringing the total pandemic figure to 180,800.
Will it ever reach that quarter of a million mark?
Hospital admissions have also been creeping up to almost
6,400 from 4,200 in May. The big vaccine roll-out
continues with 150 million jabs given to 53 million
people – that means about 93% of those aged 12 and over
have received at least a first dose. Some 50
million people have had second jabs and 39 million have
had booster doses. An extra autumn booster jab
roll-out for the over-75s and the vulnerable is about to
get underway.
Globally, the figures are mixed, but mostly
gloomy. According to the Johns Hopkins Coronavirus
Resource Center the worldwide totals are now 550 million
cases with 6.3 million deaths. At the end of June,
the USA was top of the league table with 87 million
cases and 1.02 million deaths. The UK was in
eleventh place with 22.8 million cases and 180,800
deaths.
There seems little point in rehearsing more
details. Instead, remember that unremitting
refrain – this Covid-19 pandemic is not over. Much
of the world is still in its grip.
What has Covid-19 taught us?
We have now lived through more than 2 years of the
Covid-19 pandemic with some 6.5 million, but perhaps
as many as 15 million, deaths and about 550 million
cases. In addition, we have witnessed this tiny
microorganism destabilise healthcare systems,
unbalance economies and confound government leaders
worldwide.
The pandemic has indisputably changed our world.
This has been a long and uncertain journey. Yet
we now seem to have arrived at a crossroads. The
pandemic is subsiding in many places.
Restrictions are being lifted. Testing has
dwindled. The return to something like
pre-pandemic life and work is evident. In other
words, we have begun to move from living under Covid-19
to living with Covid-19.
Where do we go from here? It is a baffling
question. Some months ago we thought that if we
tolerated a few lockdowns and some personal
restrictions, the pandemic would blow over. But
that has clearly not been the case. The pandemic
marches on and we have yet to experience Covid-19
closure.
True, reported cases and deaths have been declining in
many countries, but more than 3 million cases are
regularly reported each week. Even that, because
of less surveillance and testing, is a numerical
underestimate. Global deaths hover around 10,000
each week. Covid-19 is killing hundreds of
people every day. This is a miserable and
unsustainable situation for both the rich and the poor
of this world.
Though we wish otherwise, the virus persists.
But there are now other pressing issues to occupy our
brains and news media – Brexit, national strikes,
monkey pox and polio, a global recession, rising
inflation, the cost of living crisis, abortion in the
USA, war in Ukraine. Small wonder that Covid-19
is so easily supressed or disregarded.
Yet the pandemic is not over – maybe it never will
be. So, what has the wretched virus taught
us? Or, more significantly, what have we learned
from it? Here are four weighty lessons.
First, have we been too parochially minded?
Covid-19 is not equality driven – its unequal toll has
left tens of millions in poverty and its greatest
effects have been exerted on already-disadvantaged
groups. The world has not suffered evenly, so
while we in the UK, and the West in general, may think
that Covid-19 is largely over and wish to forget it,
many other countries are still in the thick of it –
think China, North Korea and most African
countries. And do not forget that every
devastating pandemic is followed by a devastating
aftermath.
Second, have we been too smug? We in the rich
world have been offered, and mostly accepted,
effective vaccines and other treatments, such as
anti-viral medicines. They can reduce the risk
of severe symptoms, hospitalisation and death.
Yet these have not been universally available and
effective global protection strategies have not been
implemented. The World Health Organization (WHO)
once had the aim of vaccinating 70% of the world’s
population by June 2022. That policy had clearly
hit the buffers. Whereas, some 60% of people
have now been double jabbed, in at least 40 countries
less than 20% have. Good intentions are
praiseworthy, but robust policies and workable systems
are needed to deliver them.
Third, are we sufficiently variant-aware? The
possible / probable emergence of new and dangerous
variants is a continuing threat, even for those fully
vaccinated. Think of the Omicron BA.4 and BA.5
sub-variants first reported in South Africa and now
potently dominant here in the UK and elsewhere.
Mutations creating new Covid-19 variants with high
transmission rates, more severe outcomes and the
ability to bypass the antibody protections from
vaccines and previous infections could rock our world
again. New and better targeted vaccines will
help. But immunity forever wanes. Will our
world need to be boostered forever?
Fourth, are we now planning for the next
pandemic? Think monkey pox and polio, though
their reach is probably limited. Nevertheless,
surveillance and preparedness are key. These
will require tough science (what is long Covid, etc.?)
and resilient healthcare plans (who should get booster
vaccinations, etc.?). It will all cost money,
but hopefully well-spent money, not like the
eye-watering financial wastes in the wake of the
current Covid-19 pandemic – the UK bill presently
stands at £321bn with an additional £55bn due
soon. Learning from the mistakes and failures
over Covid-19, we should be personally, nationally and
internationally better prepared to face the next
biological onslaught.
The official UK Inquiry into the Covid-19 crisis
should be revealing as well as educational.
However, its publication is unlikely to be before
2024. Too late? Not really. We
already know largely what to do for a better
future. Wash hands, avoid crowds, isolate if
positive – you know the drill whenever it will be
needed. We have already learned great lessons,
but our general ignorance is still prodigious.
Omicron sub-variants BA.4 and
BA.5
BA.4 and BA.5 were first designated as Variants of
Concern in the UK during mid-May 2022. They
appeared to be more infectious than the previously
dominant Omicron BA.2 variant. The UK Health
Security Agency (UKHSA) now reports that BA.5 is
growing 35% faster than BA.2 whereas BA.4 is growing
only 19% faster. In other words, BA.5 is likely
to become the prevailing variant in the UK.
Is this of concern? Researchers at Beth Israel
Deaconess Medical Center of Harvard Medical School
think so. They have recently reported that BA.4
and BA.5 appear to escape antibody responses among
people who had previously had Covid-19 infections and
among those who have been fully vaccinated and boosted
with the Pfizer-BioNTech vaccine. The levels of
neutralizing antibodies produced were several times
lower, by a factor of 21, against the BA.4 and BA.5
sub-variants compared with the original coronavirus.
The relevant paper is entitled ‘Neutralization Escape
by SARS-CoV-2 Omicron Subvariants BA.2.12.1, BA.4, and
BA.5’ by Nicole Hachmann et al.,and
was published in the New England
Journal of Medicine (22 June,
2022).
The researchers concluded, ‘These data show that the
BA.2.12.1 [the dominant variant of BA.2 in the US],
BA.4, and BA.5 sub-variants substantially escape
neutralizing antibodies induced by both vaccination
and infection. Moreover, neutralizing antibody
titers [concentrations] against the BA.4 or BA.5
sub-variant and (to a lesser extent) against the
BA.2.12.1 sub-variant were lower than titers against
the BA.1 and BA.2 sub-variants, which suggests that
the SARS-CoV-2 omicron variant has continued to evolve
with increasing neutralization escape. These
findings provide immunologic context for the current
surges caused by the BA.2.12.1, BA.4, and BA.5
sub-variants in populations with high frequencies of
vaccination and BA.1 or BA.2 infection.’
In other words, if BA.4, and especially BA.5, become
dominant within a population, will the antibodies
elicited by both vaccinations and previous infections
be sufficient to destroy them? Or will these
sub-variants slip through the defensive wall and wreak
havoc?
Autumn jabs
When will we get the next jab? The UK’s spring
booster programme for vulnerable people and over-75s
is still running. The autumn booster programme
will start in September and is likely to include the
over-65s as well as vulnerable people.
Government advisers are weighing up whether to extend
this to the over-50s. Younger people are
unlikely to be eligible. The advance campaign is
already underway. The two mRNA vaccines selected
to be used are from Moderna and Pfizer-BioNTech.
GP practices will soon be invited to sign up for this
autumn booster roll-out now that NHS England has
confirmed it will offer a fixed payment per jab with a
supplement for housebound patients.
By September, Moderna’s new vaccine should be
available for UK residents. This is a bivalent
jab that consists of the original Moderna vaccine plus
a newly-formulated component designed to boost
protection against the BA.4 and BA.5 variants.
The current contract with Moderna ensures that the UK
will automatically receive the newest version of the
vaccine. Other companies are gearing up
too. Pfizer-BioNTech has recently announced
enhanced results for its tweaked vaccine, though it
may not be ready by September. A new bivalent
vaccine jointly developed by the French and British
drug firms, Sanofi and GSK, has also been shown to
generate substantial immune responses against some
Coronavirus variants. Other manufacturers are
working on joint influenza-Covid-19 vaccines, but they
are unlikely to be obtainable before late next year.
The push to boost immunity across rich income,
developed populations, before the winter sets in, has
become a large-scale crusade. Countries, such as
Germany and Israel, have started their autumn booster
roll-outs. Others, like the USA, are on the cusp
of announcing their intentions.
Covid-19 reinfections
Covid-19 is not a one-off disease. Everyone
currently has a different level of immunity depending
on their infections, vaccinations, both or
neither. Some people have had two jabs, others
four. Different mixes of different
manufacturer’s vaccines have also been deployed.
A report from the Office for National Statistics (ONS)
in May suggested that Covid-19 infections provide a
stronger and more durable protection against further
infection compared with vaccinations.
This is important because most people have by now had
their Covid-19 antibody levels raised naturally and/or
artificially. So reinfection, or what has been
termed ‘Covid rebound’ has become a key issue.
The ONS report showed that people who had been
infected with Omicron (or the BA sub-variants) had a
77% reduced risk of reinfection. Those infected
by Delta had 57% protection, the Alpha figure was 41%
and that of the early Wuhan strain was 40%.
Strange to say, having a disease apparently offers
advantages.
Loss of smell
Anosmia, or loss of smell, was once an early
diagnostic feature of Covid-19 infections. As
the virus has evolved this effect has become less
important.
An interesting study entitled, ‘Decreasing Incidence
of Chemosensory Changes by COVID-19 Variant’ and
conducted by Daniel Coelho and colleagues at the
Virginia Commonwealth University has been published in Otolaryngology
- Head Neck Surgery (3 May
2022).
These researchers surveyed a database of 616,318
people in the United States who had had
Covid-19. They found that compared with people
infected with the original virus, those who had
contracted the Alpha variant were 50% less likely to
lose their sense of smell. Moreover, such
chemosensory disruption was 44% for the Delta and only
17% for the Omicron variants.
As the authors concluded, ‘These data strongly support
the clinical observation that patients infected with
more recent variants are at a significantly lower risk
of developing associated chemosensory loss.’
There is bad and good news. Smell problems can
be long lasting – perhaps for years. As
Valentina Parma, a research psychologist has stated,
‘For these people, help can’t come soon enough.
Simple activities such as tasting food or smelling
flowers are now “really emotionally distressing”.’
The positive news is that our understating of the
interaction of Covid-19 and anosmia is improving, but
still inchoate. Accumulating evidence suggests
there may be some genetic mutations, specifically in
two genes called UGT2A1 and UGT2A2,
in anosmatic people. Or are structural changes
somehow caused by Covid-19 in the brain’s olfactory
centre the cause?
Nevertheless, treatments are elusive. Small
clinical trials are currently testing a range of
potential remedies, including steroids to reduced
inflammation, and blood platelet-rich plasma that
contains many therapeutic biochemical compounds.
For the moment only ‘smell training’ is on offer, but
maybe additional and improved therapies will soon
become available. The estimated tens of millions
of patients with lingering smell difficulties will
certainly hope so.
Vaccinations for children
Children are not adults. True. This is an
important distinction when it comes to drug testing
and drug administration. Moreover, the
volunteers in clinical trials have long been
predominantly men, often students of a certain
age. In other words, women and children have
typically been side-lined. If a new medicine is
designed to treat whole populations then it should be
rigorously tested on the representative whole.
Age and sex are important.
So, early on in the development and production of
Covid-19 vaccines, it was clear that the distinction
of child and adult medicines must be recognised.
And for children the demarcation has arbitrarily been
regarded as from 5 to 15 years old. In the UK,
the NHS recommends two ‘adult’ doses for that age
group, with a 12-week intervening gap. Similar
strategies have been authorised elsewhere, for
example, in the USA.
And so attention has now turned to the under-5s.
And, of course, in the medically-informed USA, this
has been a hot topic of concern. The upshot has
been that during mid-June, the White House announced a
highly-anticipated Covid-19 vaccine roll-out plan for
children aged between 6 months and 5 years – the first
nation in the world to permit such a medical
practice. This means that an extra 18 million
people in the US will now be eligible for Covid-19
vaccinations.
The US Food and Drug Administration (FDA) has
authorised the use of both the Pfizer-BioNTech and
Moderna vaccines for these young children. The
Pfizer-BioNTech’s vaccine for children aged six months
to four years old is a tenth of the adult dose and
requires three shots. Moderna’s vaccine for
children aged six months to five years old is a
quarter of the adult dose and requires two shots.
Vaccine hesitancy is a potent American trait.
Only 67% of US adults, 60% of children aged 12 to 17
and 29% of 5 to 11 year olds have been fully
vaccinated. So, unsurprisingly, only 18% of
parents plan to have their under-5s vaccinated right
away, while 38% want to wait and see how the vaccine
roll-out progresses. Meanwhile, 27% say they
will definitely not proceed. So how successful
will this childhood vaccination campaign be? At
the moment, it looks uncertain.
The greatest loss from
Covid-19
Who, or what, should have the last word in this series
of Coronavirus updates? Let it be the children,
the next generation, who must live with the fallout of
this current Covid-19 pandemic.
The pandemic has brought about many devastating losses
– of human life, global economies, healthcare
practices, and so on. But perhaps the greatest
and longest-lasting impact will be on education,
namely children’s schooling.
The United Nations (UN) estimates that more or less
all – all of the 1.6 billion schoolchildren in the
world – have suffered an average loss of 4.5 months of
formal education, mainly because of school closures
during the pandemic. Most may well catch up, but
for too many, especially among disadvantaged and
vulnerable children, that loss will be the most
damaging legacy of Covid-19 because it will never be
salvaged. That is indeed a sad end.