Happy New Year’s Eve!
Welcome to the last Covid diary entry for 2020. This is the 163rd article I’ve written in 2020 about the virus, a topic that none of us were even thinking about on New Year’s Eve a year back, but oh my, how it has dominated our lives this year, hasn’t it. Let’s hope that 2021 will not see another 163 articles!
On the topic of writing, a bit of exciting (at least, for me) news to start with. As a lovely way to end 2020, I received a copy of my book “The Covid Survival Guide” in the mail today. Sure, I’d of course ordered a Kindle version when that came out on Tuesday last week, but the book feels so much massively more “real” now that I’ve a print copy in my hands.
With the virus clearly still going to be with us for some time to come, and with cases and deaths at historic high levels, you really can benefit from the resources concentrated into this book’s four parts, 17 chapters, 69 figures and charts, 470 pages, 650 links, and 780 footnotes. The book has made #1 best seller in various Amazon categories on several days. The Kindle version remains at $4.95 for a few more days, and the print version is $19.95. The Kindle version will soon be adjusted to be in line with other similar eBooks (ie $8.95), the print version price will stay stable until the end of March, at which point, there’ll be a small increase due to increased printing prices coming out then.
I’ve another book coming out some time in January too (just as soon as I complete the cover design, a dismayingly extended process). But it is nothing to do with the virus at all. It is a fiction work, a lengthy “techno-thriller”, a genre made popular by Tom Clancy. It is now available for pre-order, at a lovely low price of $2.99. The print edition (not available for pre-order) will probably be $16.95 on Amazon, and $19.95 elsewhere. They say you should write about what you know, so this story is set variously on a submarine, in Seattle, and in St Petersburg (I am more familiar with two of these locations than I am the third!).
For people like me, almost obsessively focused on tracking the spread of the virus and understanding trends, it has been a very frustrating week. Much of the data during the Christmas period, and extending on through early next week, is unreliable. Has there really been a significant drop in new cases and deaths in the US (and other countries too) or is this due to lack of efficient reporting during this time? At other times, are sudden surges real, or are they the result of several days reporting all being grouped together?
Not to sound like an eager ambulance chaser, but we’re now at the point where any Christmas “bump” in new cases should start appearing and it would be helpful to know what the outcome is proving to be. The Christmas bump clearly hasn’t appeared at all, but is that due to effective control measures, or lack of reporting? This article suggests it can take up to two weeks for new Covid cases to be officially entered into the system. That is unacceptable. Why is it possible to buy anything on Amazon in less than two minutes, and often have it delivered within 24 hours, but it can take two weeks for a piece of computer data to travel from a doctor’s office or laboratory to the people and places who count cases?
Our colossal failure to manage the virus is made up not only of people refusing to wear masks, and defiantly eating/drinking in crowded bars and restaurants, but also by colossal incompetence across every facet of our public health system. We can sort of understand the idiots who ignore the safety guidelines, but what excuses can we make for people earning generous six figure salaries, but who can’t figure out how to get data from a doctor’s office to a central server in under two weeks, or who are taking similar periods of time to urgently air-courier vaccines from central depositories to dispensaries?
More incompetence can be found wherever we choose to look. For example, the eagerly awaited vaccines. While some people are desperate to be vaccinated, we have been struggling with the twin problems of central repositories of vaccines being slow to distribute them to the states, and when eventual dispensing locations receive the vaccines, they too are slow to actually then vaccinate the people who sometimes are literally camped outside their front door.
Here’s an article that tries to explain the inexplicable, under the headline “Here’s Why the ‘Last Mile’ of Vaccine Distribution Is Going So Slowly“. Unfortunately, excuses, although available in rich abundance, are useless against the virus.
It gets worse. In West Virginia, health officials accidentally gave 42 people an experimental monoclonal antibody treatment instead of a vaccine shot. The monoclonal antibody treatment is intended to be given via a drip, not via an injection, and while authorities say there shouldn’t be any harm to the 42 people given the wrong drug, we wonder if there’ll be an interaction now between the antibodies and the vaccine.
It gets still worse. In Wisconsin, a hospital employee deliberately destroyed 570 doses of the vaccine. We’re not told why.
But all of this pales into insignificance compared to the latest nonsense from public health authorities, first in Britain, and now being eagerly copied in the US, too.
Someone in Britain decided “We’re so short of vaccine that instead of giving as many people as we can the proper double shot of vaccine, let’s give twice as many people a single shot of vaccine.”
This created an initial stunned shock, before Pfizer responded (as quoted in a Guardian article that has subsequently been rewritten to remove this quote) :
Data from the phase 3 study demonstrated that, although partial protection from the vaccine appears to begin as early as 12 days after the first dose, two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95%. There are no data to demonstrate that protection after the first dose is sustained after 21 days.
Government officials then seemed to conjure out of thin air some “proof” that a single shot might be 50% or more effective. But they did not directly respond to Pfizer’s point that there is no evidence that the first weak level of created immunity, whatever it might be, lasts beyond 21 days.
This change in dosing is not a result of field trials and rigorous double blind testing. It is some administrator who came up with the idea, and clearly is most influenced by the concept of giving something, anything, to twice as many people.
The government then said “Well, never mind Pfizer, we know with “our own” Oxford vaccine (aka the AstraZeneca vaccine), there is plenty of evidence of long-lasting benefits, because to start with, for a while, AstraZeneca was testing a single dose rather than moving to a double dose subsequently. The response to that claim is to note the single dose data applies only to people under 55, and has so few data points as to again be only weakly persuasive, and to further note that the reason AstraZeneca switched from a single dose to a double dose is because the single-dose effectiveness was considered unacceptably low.
The government then put out an official statement trying to justify this astonishing move that flies in the face of all the vaccine manufacturers’ approved vaccination plans. It reads well on the surface, but statisticians will see enormous confidence intervals associated with the claims, showing how weak and statistically insignificant the claims are. The methodology to re-sort the data by these new parameters to try and generate a perception of extended benefit from a single dose is also very weak and full of assumptions and hopes.
The funniest line of all though is where the document says
Protective immunity from the first dose likely lasts for a duration of 12 weeks (unpublished data).
So, we have “likely lasts for” – hardly a positive guarantee, and then we’re told the data on which this already weak statement is being made is unpublished and unable to be shared. And let’s not drill down into what the opening pair of words “Protective immunity” actually is promising, because that’s a very unclear and unsupported number too.
Would you bet your life on that type of weak promise? That’s like being told “perhaps three times out of four, this rope is probably strong enough to hold you for a while before it breaks, but we can’t tell you how we tested it to determine its strength”, and then being asked to dangle at the end of the rope, 100 ft above a hard concrete surface, for an extended time.
Here’s a rather complicated commentary and explanation about what the UK government is doing and why, although the commentator repeatedly has to say “I’m unable to evaluate this statement because there isn’t enough data”. The thing that most clearly sticks out, to me, is how shambolic the entire AstraZeneca trial was, with changes from one to two doses, an accidental group getting a half dose then a full dose, and as a result of these different “sub-trials” an insufficiency of supporting data for any of the different variations, but rather an awkward amalgamation of data from very different sub-trials.
The US then said “Gosh, we’d love to be able to ‘vaccinate’ twice as many people too”, but as you can see from the earlier discussions, above, the problem in the US isn’t a shortage of vaccine, it is an inability to get the vaccine from the bulk storage and into people’s arms. Surely that would be a better problem to address and solve.
A NY Times article several weeks ago was headlined “Pfizer’s Vaccine Offers Strong Protection After First Dose”. That sounds wonderful, but when you read the article, you discover that the “strong protection” is actually 52% – and that is not something that should be described as “strong” by any reasonable measure.
People saying “Due to the accidental mistakes in the AstraZeneca testing, we know their vaccine works for months after a single shot, so therefore, obviously the Pfizer and Moderna vaccines do the same, even though they’ve not been tested that way” are totally wrong. The thing is, the AstraZeneca vaccine is totally different to the Pfizer and Moderna vaccines. It “teaches” immunity in a different manner, and there is no reasonable basis for saying “If the AstraZeneca vaccine has these characteristics, then of course, the different type of vaccines will have the same characteristics too”.
We also don’t know how effective a delayed second dose will be, either. It is intended to “refresh” the body’s memory and knowledge of how to respond to Covid, but if the body has largely forgotten, over an extended time, will a refresher dose be enough, or will some other dosing regimen be needed? No testing has been done about that, but it appears we’re now going to abandon the testing structure that was required to get a vaccine approved, on a specific basis and dosage, and now change it any way people wish, without any validation whatsoever.
I remain cautious about taking any vaccine. But when I do come around, after watching real world outcomes and hopefully validations for a few more months, and hold my arm out, I definitely want the double dose, properly spaced apart, not a single dose.
Lastly, in this unhappy rant to end 2021, while I’ve been very critical of our officials in the preceding comments, let’s not spare ourselves. I can understand how some people have different opinions about things like social distancing, mask wearing, and where to balance the conflicting interests of protecting people and protecting businesses (although in truth, and in the mid rather than very short term, protecting one protects the other, too). But what is distinctive, particularly in the US, is the aggressive and even violent expression of these different opinions, and sadly it seems the less mainstream and less supported-by-evidence the views, the more aggressive people become. We (collectively – of course, you and I are not like that!) are as much a problem as are our public health officials.
As I started off saying above, the current data is probably not as reliable as normal due to holiday schedules and backlogs. But here it is, anyway.
I have to feel a frisson of pride to see my home state of Washington now in fifth best position – no small accomplishment when you remember back to the early days when Washington was the very first “epicenter” of the virus in the US.
In the small country case list, Gibraltar has suddenly appeared, going straight to fifth place. In the large country case list, the Czech Republic extends its lead over the US, while third place Belgium falls further behind, and the UK appears again, going straight to ninth place. In the death list, the US drops from its briefly held sixth place, and is now back at seventh place.
US Best and Worst States
|A week ago||Now||A week ago||Now|
|1 Best||VT (10,867)||VT (11,878)||VT (192)||HI (203)|
|5||NH (28,610)||WA (32,329)||OR (335)||OR (350)|
|47||UT (81,283)||TN (85,926)||CT (1,624)||SD (1,682)|
|51 Worst||ND (119,345)||ND (121,375)||NJ (2,103)||NJ (2,161)|
Top Case Rates Minor Countries (cases per million)
|Rank||One Week Ago||Today|
|1||Andorra (99,567)||Andorra (104,090)|
|4||San Marino||San Marino|
|10||Panama (51,451)||Panama (55,824)|
Top Case Rates Major Countries (cases per million)
|Rank||One Week Ago||Today|
|1||Czech Republic (61,618)||Czech Republic (67,046)|
|2||USA (57,575)||USA (61,501)|
|3||Belgium (54,445)||Belgium (55,467)|
|12||Poland (32,781)||Italy (34,877)|
Top Death Rate Major Countries (deaths per million)
|Rank||One Week Ago||Today|
|1||Belgium (1,649)||Belgium (1,674)|
|5||UK (1,023)||Czech Rep (1,080)|
|6||USA (1,015)||UK (1,080)|
|7||Czech Republic (1,005)||USA (1,065)|
|10||Mexico (928)||Argentina (951)|
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Items below include details of the new “English” more infectious virus strain now appearing around the US, a new problem for long-case sufferers, a new problem for us all, hotels offering Covid tests to guests, more moves to curtail people’s freedoms if not vaccinated, France is vaccinating people at a rate 62 times slower than its birth rate, Russia confesses to under-reporting its deaths, by a huge factor, varying issues at movie theaters, Disney, and Costco, the FDA gets greedy, what type of people choose to stockpile toilet paper and other supplies, and the appalling situation where medical practitioners are refusing to dispense monoclonal antibody treatments to people with early virus cases, even though there are hundreds of thousands of doses available and the drugs have been FDA approved.
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Please stay happy and healthy; all going well, I’ll be back again on Sunday, next year. Sounds like a long time away, but it isn’t!
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1 thought on “Covid-19 Diary : Thursday 31 December, 2020”
Re monoclonal antibody treatments: The WaPo article you share cites what seem to me some fairly practical reasons for the slow uptake, including lack of dedicated hospital facilities segregating confirm Covid victims from the general hospital population. The CVS Health idea of in-home provision seems sensible.