Interesting shift in strategy. Instead of giving the second dose within a few weeks of the first they’re going to allow up to 12 weeks between doses. Allows them to get more widespread level of some protection with dose 1 before later boosting protection.
They are considering the same strategy in Belgium, but with even bigger gap. It seems that it’s the only way to achieve at least some herd immunity before summer.
I think the only reason they're considering this in Belgium right now is because they are unprepared in the extreme. They have frankly pissed away their time instead of actually preparing for the vaccine, the past nine months.
The current vaccination rollout plan leaves healthcare workers unvaccinated until march. HEALTHCARE WORKERS.
There's been some pretty severe backlash to that, and rightfully so (I don't know of any other country that isn't vaccinating its health workers in the very first phase alongside senior citizens). I ran some numbers the other day and if you're distributing the vaccines exclusively via the 40-ish Belgian hospitals that can store the Pfizer one (and only 6 in Brussels), then there is no way to achieve herd immunity before end of 2020. The only real solution to that is to allow for more widespread distribution via pharmacies. (Yes, medium-term storage is an issue, but AIUI the Pfizer vaccines can still move around after thawing for some time so short term redistribution is possible if you've prepared for it).
So they're trying whatever they can to compress the timeline. It's not necessarily a bad decision, but it's a workaround to a worse one.
This is happening in the US as well, and now they're acting shell shocked at receiving 2-3 million doses because that is actually indeed a lot of doses which means you need lots of trained people on how to handle them and inject them. This is gonna take a long time. Hopefully Biden will scramble more people and resources. Depending on corporations as the sole distributors is a bad, bad idea.
Yes, and all the parties from the beginning of summer till days before new lockdown. I don’t know how it goes in other countries, unfortunately common sense is anything but common.
Also I’ve read that “Belgium accounts for 25% of Europe’s biotech”. I wonder why there’s no domestic vaccine yet given such R&D capacity.
We tried the same thing, in Canada, with the yellow fever vaccine. There were shortages about 6? 7? years ago, and 1/5th dosage was consider a stop-gap, by conveying some immunity.
I had the yellow fever vaccine last year in America. I received an, otherwise identical, Europe-manufactured vaccine instead of an American one because the shortage is on-going.
Supposedly identical, yet the European one (French?) wasn't approved for use in Canada yet.
Your response made me think back to my research a few years back. Mostly, because I am surprised that there are STILL shortages! For more than half a decade?!
Sanofi Pasteur has YF-Vax multi-dose vials and single dose vials on back order and the company estimates product will be available in 2021.[1]
Sanofi Pasteur has worked with FDA to make another vaccine, Stamaril, available in the US under an investigational new drug program. Stamaril is yellow fever vaccine manufactured by Sanofi Pasteur in France. It is not licensed in the US.
This, I recall. I also recall some more research, which I cannot find now, in that there were different production methods between the two vaccines. Hence, the lack of quick approval. Yet Yellow Fever is crazy spreadable! And still the vaccine is not fully approved in the US/Canada?!
I recall reading a report, where one person with yellow fever was briefly in an airport lounge. 20 minutes later, a few people passed through, and most caught it! Just... it makes COVID look like a joke, yet here governments are dragging their heels over approvals due to production methods over the same strains?
And those production methods / that company has been making and administering that version for decades? To hundreds of millions?
It really makes you think a bit about COVID approvals. Talk about a change of heart.
Sweden tried this with catastrophic end results. It's practically impossible to shield the vulnerable population from a highly contagious disease that is rampant in the non-vulnerable population - someone after all needs to tend for the vulnerable.
Swedish health system basically collapsed under the weight and after an order of magnitude more deaths than in comparable neighboring countries they are now taking to restrictions as well.
I am sure no one takes joy in "destruction of civil liberties", but we have to balance here some fundamental rights, like the right to life, with other fundamental rights such as freedom of movement and economic rights.
Also, I have to point out a glaring cognitive dissonance here. You basically just said: "let's put vulnerable people into unused hotels so we can safeguard civil liberties". Did you mean: "let's put vulnerable people into unused hotels so we can safeguard civil liberties of young people"?
I don't know what you've read or what sources you have. I'm a swede and have been following the Corona situation relatively closely (looking at facts and not media hysteria too much). My parents are retired health care professionals. My sister-in-law works at FHM. I've been in contact with hospitals and health services quite a bit the last year (my wife's grandma died due to cancer, I had a child that was born at one of the largest hospitals in Sweden). At times, the situation has been hard for health workers, having to work more than normal (sadly, the personnel situation was a big problem even before COVID, it just tipped it across the border). But to say that the Swedish health system collapsed is a lie (or at least back it up with data/some facts/sources).
I do agree though it'll be interesting to see what the cause for the relatively high amount of excessive deaths was (not bigger than many other western countries, such as Belgium or the US), but still. I'm not saying the Swedish approach was the best one (or even a good one), but let's not spread misinformation. Sweden is so much misused in this debate (on both sides) and that scares the me the most.
On that note, several really bad/horrible incidents in the spring where health care workers did strict prioritizations was due to media and mass hysteria - NOT because of health system collapse... Misinformation is really dangerous - life and death dangerous...
I guess it all depends on your definition of "collapse". I would describe a situation where hospitals are overloaded to the point where they have to choose who gets to live and who has to die a collapse.
Sources in English are harder to come by about this, but for example in spring when Stockholm's ICU beds were at full capacity it is implicit that people with better prognosis had to be prioritized. Seniors with severe cases of corona were instead given morphine and sent to die in care homes:
Nothing like this happened in Sweden's neighboring countries with more cautious COVID approach because ICU beds so far never reached full capacity. In a modern Nordic welfare state denying a dying person of care that could save their life is not only a complete failure of the health care system but also a crisis of moral values. I am not sure the Swedish public is yet ready to even admit the latter crisis.
Your source doesn't say the same thing you do (unless I'm missing something). The article talks about the problems at care homes. Aside from a few hospitals, we never maxed our ICU beds (AFAIK anyway). The "implicit" makes it really hard to argue without any source. Most likely you're referring to what I specifically brought up in my original comment. Some were not treated properly and sent home because of hysteria - not because of a national health care "collapse".
Did care homes in Sweden (which are separately organized from the rest of the health care system) manage COVID well? Probably not.
Did some people panic and made they stupid decisions? Probably.
Did we dismantle some temporary ICUs without using them? Yes.
Did we reach max ICU bed capacity in any region (the Swedish health care system is organized by regions)? Not that I know.
Did we have a national health care collapse? Not as far as I can see. If we did, please provide sources.
Sure, you can say that ICU bed limit was never actually reached, because you prioritized.
From the very beginning of the epidemic it has been clear a person with serious case of corona would go to an ICU and put on a ventilator for the best treatment. Hospitals instead told care homes in Stockholm not to send seniors with severe corona in at all:
> Now, increasing numbers of workers are also coming forward to criticise regional healthcare authorities for protocols which they say discourage care home workers from sending residents into hospital [...]
> "They told us that we shouldn't send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in," says nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic.
> From the very beginning of the epidemic it has been clear a person with serious case of corona would go to an ICU and put on a ventilator for the best treatment.
At the beginning of the pandemic, people thought this. As I understand it, it is actually preferable to keep patients off of ventilators as much as possible.
It is certainly not the case that, if you show up at a hospital and the hospital has unlimited resources, then you should be put on a ventilator because it’s somehow good for you.
> The Health and Social Care Inspectorate has shown that there was a marked reduction in the number of referrals to hospitals from residential care facilities for the older people during February–June 2020. However, it is hard to establish whether this type of guidelines led to physicians failing to make individual assessments of care need
So I gather that even if the health care system was never overloaded, there might have been some confusion in the elderly care that led to mistakes.
But to the extent the elderly care system was “overloaded” this has been the case for decades. Not due due to the COVID response.
> We have found that elderly care was unprepared and ill-equipped when the pandemic struck and that this was founded in structural shortcomings that were known long before the outbreak of the virus. The ultimate responsibility for these shortcomings rests with the Government in power – and with the previous governments that also possessed this information
I'm not sure I should wade into this, because I think swedish authorities need a lot of scrutiny and they have mismanaged the response, and refuse to accept accountability for this. I would direct this scrutiny towards the health authority and the political administration.
Anyway:
> I guess it all depends on your definition of "collapse". I would describe a situation where hospitals are overloaded to the point where they have to choose who gets to live and who has to die a collapse.
Triaging patients and prioritizing them is every day in a hospital, corona or not.
If you talk with a Swedish doctor (I do, because that's the health service I use), they often think in terms of which medicines are cost-effective and for which group of patients they should be used (basically - what is the human basis for using this expensive medication on this particular patient). To make it concrete, maybe they will even tell you that you are a "priority" because you have a long working life ahead of you.
Medicine and care can be infinitely expensive and public health care is a finite resource. They always calibrate towards giving patients adequate care, not infinite care.
You're right, but there's a difference between "it's not worth spending millions on an operation to slightly improve an unimportant part of someone's little finger" and "I have two people who will die if I can't treat them, and due to limited staff/hospital space one of them isn't being sent for treatment".
So yes, it's not binary between normally being infinate and now not, but it's also a bit too reductive to make that point without also being clear that Covid has caused more and worse triaging than usual. (But someone needed to make your portion of that point and you did it much better than I could have, so thanks!)
I don't think semantic debates are very worthwhile, but in my mind a system that collapses is completely non-functional, not partially non-functional.
A system that is choosing which patients to treat is therefor not collapsed.
Similarly, a bridge that has collapsed transports zero traffic - not 50% of the traffic.
But again, venturing into these semantic debates isn't useful. People choose hyperbolic words in order to justify their preconceived conclusions. The hyperbolic adjectives themselves aren't the point of OP above.
I'm starting to feel exactly the way you are. I believe we're already at the point where most people don't care, the only thing keeping lockdowns going is the threat of arrest.
None of these sources are people arrested merely for breaking lockdown. In literally every case of arrest in these articles, people are arrested for violating some other law - including assaulting police officers.
Most people that promote lockdowns 9 months into this either already didn’t work, have made the same or more money during Covid at their current job, or don’t give a hoot about civil liberties and enjoy the fist of out of control government getting jammed up you know where.
They don’t understand that they have invited the fox into the henhouse. This model of crisis response is going to be broadly applied in other situations after Covid is over, and they’ve given the government all the ammunition they need to apply it and enforce it.
When the lockdown started, I moved out of London and back home into a relatively poor area. Most people were in favour of it then, but today I do not know a single pro-lockdown person here that isn't:
1) a student with guaranteed income from their loans
2) a white-collar worker, usually senior
3) is somebody who is retired or has a lot of money
I'm not somebody who advocates for breaking the lockdown, but I wish the people pushing for them need to realise there are real consequences beyond pure survival (like people being evicted or going hungry). Rishi Sunak seems to be the only person in government who seems to understand the economic devastation to follow and is openly worried about it.
Pro lockdown people I’ve known in my life typically were already retired, or have safe and comfortable jobs in a corporation doing the same or better during this situation. Many I’ve known are making even more money AND working from home, which has been a huge win, win for them. Any extension of this situation is a huge boost for them economically and lifestyle wise.
Most of my personal circle though is small business owners, and starting with the laughable PPP mess and joke loan offerings, and just screwed up situation economically and shifted consumer habits, many are looking for the exits and running for the hills.
Only a couple in my group are doing really well in all of this, but they cater to the luxury end of the scale and the rich have gotten significantly richer in all of this. One of them does very high end custom pools and he is booked into 2022 with jobs because of all the California money flowing into Arizona.
My main concern is we have green lit tyranny to the governments around the world. For a virus that is arguably no worse than anything else we’ve experienced in the last 60-80 years we have flipped human rights and liberties on it’s head and completely perverted it. We are now in the process of normalizing this situation and behavior long term. The consequences of this are going to be felt for years after this, if not decades. We likely won’t even remember the virus in 5-7 years, but we’ll still be living under the system it ushered in.
FWIW I'm definitely part of the group making far more money working from home (in a far cheaper area too), but I'd happily give that up for my freedom back. I've been in a state of existential dread since the first day of lockdown.
> The consequences of this are going to be felt for years after this, if not decades. We likely won’t even remember the virus in 5-7 years, but we’ll still be living under the system it ushered in.
Economically, for sure. From a human rights perspective I can't see us continuing for much longer without large scale riots, like we saw earlier this year but directly focused on the lockdown.
One chilling effect from all this is when something worse than Covid inevitably comes about, reasonable countermeasures are going to be completely ignored.
You would expect Sweden to do roughly as well as its Scandinavian neighbors, not to perform roughly an order of magnitude worse. I’d say ‘collapse’ describes it well.
I am curious about a thing I read about Sweden, and would be interesting to hear your thoughts on this as a Swede: is it true that nursing home inhabitants per default (and regardless of a pandemic) do not get ICU level care anyway?
In Germany, you typically get 100% care unless you have specified that you do not want it (or your relatives make this difficult call). So the triage threat has been described by doctors as something along the lines of "we would effectively no longer try to treat a 90 year old nursing home patient with severe dementia in our ICU"
> is it true that nursing home inhabitants per default (and regardless of a pandemic) do not get ICU level care anyway?
No
All Swedes have the right to the best possible care based on the individuals needs
In coordination with the patient and/or next of kind it’s possible to take decisions to exclude life preserving care if it is determined to be in the best interest for the individual
It is never up to the care giver to take such decisions
> is it true that nursing home inhabitants per default (and regardless of a pandemic) do not get ICU level care anyway?
That's the case here in Spain for at least some of the oldest patients. Anaesthetizing someone frail and putting a ventilator down their throat stresses the system a lot, so isn't worth the risk - according to a doctor I know who was on the front lines. It sounded like standard medical practice (and she has worked in other countries).
There's a bit of a difference though between "all nursing home patients" and "the exceedingly frail ones". This might vary between countries to, as people in some countries might get put in nursing homes sooner than others.
I'm not saying Belgium is doing pretty well, but it's a big factor to take into consideration.
If you want to compare with the US both that and population density have to be taken into account.
Not sure why I'm getting downvotes though. A lot of people don't know about this and saying this 5 months ago actually received upvotes because it informs people about it. I'm 100% sure the op didn't knew.
As a swede, I want to correct you. There has been a ton of outright mis-information about my country and how it handled the coronavirus so I don't blame anyone for not knowing. The poor journalism that has been conducted is to blame and the resulting mis-information.
Misinformation 1: Swedens healthcare system did not collapse on itself. Fact: In the region where most people got sick (Stockholm) the military was called in to set up an emergency hospital. This was never used because the hospitals in Stockholm managed without it.
Misinformation 2: Sweden imposed no lock-down. While technically-kinda correct that we did not lock people in their homes, quite quickly it became illegal with public events of 50 or more people. (mid-late March I think).
Misinformation 3: Sweden "remained largely the same after the virus". Goodness sake, no. Anyone that claims this hasn't talked to a single swede.
Misinformation 4: Swedens strategy was to achieve herd immunity. No. In spring this question was asked at almost every press conference with FHM (ministry of public health). The strategy from the beginning was to preserve the overall health of Swedes as good as possible. During the open questions with FHM they have repeatedly brought up and said that the goal was not to achieve herd immunity. This stuff is complex and poor journalists don't like complex answers. As far as I remember, the reason for this "milder" strategy focused on spreading accurate and correct information about the virus was because FHM (correctly) predicted that we would have to live with the virus for a very long time. They decided that the best way to protect people over a period of possibly several years was by arming them with
information on how to protect themselves and others (social distance, wash your hands, work from home if you can).
The real issues that caused Sweden to have such high rates of death compared to similar countries like Denmark and Norway are more complex and has to do with lack of information for those caring for the elderly, poor equipment (and especially reserves with unusable equipment), and other systemic failures when it comes to elderly care.
Those in care homes were especially vulnerable because they are both older and come into contect with a lot of people. I believe the Swedish healthcare system failed to protect these people, and that is a major contributor to the high death toll.
Disclaimer: I offer this in good faith, and I don't disagree with your broader points.
I had to visit Stockholm twice in September to go to an Embassy. I caught the train from Copenhagen, where it was mandatory to wear masks on public transport (though not outside this).
As the train crossed the bridge into Sweden an announcement came over the intercom saying that we could now take our masks off.
As an outsider, I have had the chance to compare the way that a bunch of countries and populations have handled the pandemic. Perhaps the most stark shocks were actually in Copenhagen where I watched people queuing to get into pubs and sitting at densely packed tables at restaurants (September).
I'm always hesitant to judge because there are such complex dynamics at play and there is such and opportunity for biases to creep into what you see. But walking past it, it was hard not to wonder if it would come back to haunt them.
While visiting Sweden it was pretty clear that, aside from the masks, there was absolutely a change in behaviour (social distancing, hand hygiene). Compared to pre-pandemic visits.
The Radisson Blu had packaged up it's buffet breakfast into little containers for safety (that was a truly surreal breakfast -- tiny little glass jars of cheese).
I'm not saying Sweden's approach is right or wrong. The rest of the world hasn't been in any way consistent in their approach(es). But Sweden has definitely taken a different path on several issues.
Hey, that was pretty cool to hear. Thanks for sharing that experience.
The one thing I have continuously relearned about this virus is that pandemics are incredibly complex. It makes sense the pandemic spreads into every context humans place themsleves in.
I feel like Sweden (the world?) wasn't well prepared for a pandemic. Hopefully we can prepare better for the next one.
Everyone has the benefit of hindsight now. Having read a little bit about Anders Tegnell, I believe he is making decisions in good faith, and you can't ask for more than that. Trying to apply his expertise to the problem.
The majority of countries out there have made slip ups. Australia, which has fared better than most, had several "The Ruby Princess" and a hotel quarantine breach. They're still managing to tear each other apart politically even though the total deaths for Australia (pop 25 mil) is 909.
In some ways I think we've gotten off lightly with this pandemic. It could have been Ebola, or with similar survival rates.
We've actually proved as a global society that we can all pull in the right direction -- vaccines, etc. Has it been perfect? Not even close. Has it been worse for minorities and lower socioeconomic groups? Absolutely.
We can only hope, and plan that some of these things are a catalyst for changes that protect us next time, and make the world a better place in general.
Regarding the "lack of information for those caring for the elderly", that sounds fairly implausible, because information about the epidemic has been abundant.
The proportion of old people among the dead is not much different in Sweden from other comparable countries; it seems to me that any strategy with "protect the elderly and let the younger people take the hit" is doomed to fail. The more infections there are in the general population, the more infections there will be among the old and weak. And of course even the young and fit will also have a proportion among them who get seriously ill.
Maybe I should make it clear I don't defend the strategy. I'm not an expert and honestly I don't know what the best national strategy for protecting against a pandemic is.
Regarding the lack of information for the elderly care tough, I know Anders Tegnell (who was the spokesperson for FHM during most press conferences) have said in several interviews that he regards that as a failure on FHMs part. They believed that stressing that the elderly were the most vulnerable would be enough, but says that this was probably a mistake.
The Swedes have been misleading so much on this whole issue it’s hilarious.
First, Tegnell refused to believe in asymptomatic transmission.
Then he lied that herd immunity was never considered but we have emails from him to the broader scandinavian health directors saying that they should consider herd immunity through natural infection.
Then they insist that the only reason Sweden looks so bad is because of care homes (which, btw, is greatly affected by the fact that Tegnell didn’t believe in asymptomatic transmission well after every health department was officially basing policy on it). Well, care homes amounted to about 50% of Swedish deaths. So even if you completely excused Swedish care home deaths, while doing no such thing for its neighbors, it still had a death rate that was 2.5x that of Denmark and even worse compared to its other neighbors. So if we count Danish care home and old people deaths, but don’t count Swedish care home deaths, Sweden is still 2.5x worse in terms of death rates.
Finally, for all of that, Sweden was also close to the worst performing economy among its neighbors. Final economic numbers will take some time to really settle in, but what is clear is that Sweden didn’t get any economic benefit for not declaring an official lockdown.
Finally, let’s not compare for a moment. Sweden failed on its own terms. Here are some of the things Tegnell said we’re gonna be the benefits of the strategy:
1) Close to herd immunity in major parts of Sweden especially Stockholm after the first wave. This was absolutely destroyed when it was discovered that the worst parts of Stockholm had about 10% infected at most. It was nowhere close to the minimum 20-25% they were predicting.
2) Much better second wave than neighbors. Besides a couple of weeks lag (I’m not entirely clear why this lag existed, but Swedes have a summer tradition apparently of retreating to nature etc, which likely played a role in the improvement over summer as well as delaying the spread), Sweden has once again become the worst affected of its neighbors.
3) Better 2nd wave than 1st. It’s not worked out that way. The 2nd wave is worse than the first.
It would be one thing if the Swedes were like “oh well, this is how we want to do it”. But Tegnell has relied on both Swedish exceptionalism “oh, we Swedes are better than everyone else and so don’t even need to declare lockdowns” and contradictorily has also criticized other governments any week things haven’t looke as bad in Sweden.
Tegnell was proven right according to the latest research:
"Previous studies have shown that asymptomatic individuals infected with SARS-CoV-2 virus were infectious3, and might subsequently become symptomatic4. Compared with symptomatic patients, asymptomatic infected persons generally have low quantity of viral loads and a short duration of viral shedding, which decrease the transmission risk of SARS-CoV-25. In the present study, virus culture was carried out on samples from asymptomatic positive cases, and found no viable SARS-CoV-2 virus. All close contacts of the asymptomatic positive cases tested negative, indicating that the asymptomatic positive cases detected in this study were unlikely to be infectious."
To me, this sounds like Tegnell (who is an expert and has studied viruses and pandemics) knows what he's talking about. If you've ever seen an interview with him it becomes quite apparent that he's got a real scientidic mindset.
That study is an extremely weak support to the claim that this virus can't spread asymptomatically - it's nearly useless for that purpose. They only studied a small number of people at the very tail end of the infection who showed that they had some evidence of virus in them. They did not look at whether those patients actually had an active infection - they could have simply been detecting remnants of dead virus in their systems. They certainly didn't look at all at people in the incubation stage pre-symptoms.
Nature is one of the two top journals in the world and their conclusions directly contradict what you're saying. This was a study of 10,000,000 people.
~10 million residents from Wuhan (almost same size as Swedish population) got screened for covid. In ~30k people who recovered from covid, 107 tested positive for covid a second time. Roughly ~1000 people were in contact with asymptomatic carriers, but none (as in 0) tested positive for covid.
I did some simple google searching as well, and while it seems possible to transmit the virus without symptoms it also seems that a small minority of cases are transmitted by asymptomatic carriers. The numbers I find are ~20%. Sure, that isn't negligible, but I can understand why experts would base a strategy on those with symptoms.
My understanding of the political system in Sweden is that the administration is unusually independent and not very political. That leads to way more rational decisions compared to if politicians made the decisions. Also the infections were distributed very unevenly in the population with immigrants (Somali in particular) being disproportionally affected https://apnews.com/article/1d7916cf6e48b7a231b894ef9cda1a19.
Yeah, that is my understanding as well. We have a word for politicians that try to use the ministeries to "get it their way". "Ministerstyre", very roughly translates to "rule through ministry". Ruling by "Ministerstyre" is a surefire way to never get any votes for you and maybe even for your party again.
Independence of administration
Art. 2. No public authority, including the Riksdag, or decision-making body of any local authority, may determine how an administrative authority shall decide in a particular case relating to the exercise of public authority vis-à-vis an individual or a local authority, or relating to the application of law.
In terms of COVID, what the Swedish system led to was over reliance on one person. Whose strategy, incidentally, was criticized by his predecessor from the beginning. So if this had happened a few years ago, or if the predecessor would have had a slightly longer term, the same “rational system” would have led to a 180 different response.
And the problem for that 1 person was that Tegnell dismissed asymptomatic transmission. Dismissing the possibility of asymptomatic transmission led to making a mockery of his plans.
Everything since then has been an attempt to save face, including coming up with nonsensical excuses about how Sweden cannot do some things because “free dumb” (which it has since proceeded to do anyways).
Ironically, the faceless bureaucratic nature of public health in most countries allowed them to change tacks when they were wrong. In Sweden, since Tegnell became so intimately connected with and responsible for the Swedish response (to the point that politicians would blindly accept what he was saying), it became difficult for him to accept where he was wrong and then change strategy accordingly.
The rest of the world had it easier. Politicians would blame the WHO and China, public health officials would anonymously blame the politicians, and vice versa.
Within all this blaming it was still possible, as various public agencies in the rest of the world have, to actually change and improve responses based on new information since no one individual was tied to the earlier plan.
Of course, in general, the Swedish system is a lot better. But the pandemic has exposed a flaw that it’s over reliant on a single source of expertise. They mah need to consider having a separate private source of expertise (for example, the UK has something called SAGE) that can step in if the original source is unable to make necessary adjustments.
The covid response did not depend on the opinion of a single person. The FHM is responsible, not Tegnell. This was clarified early during the pandemic (somewhere around May maybe?). The director of FHM essentially told everyone during the press conference that it was very shameful of "some people" to paint Tegnell as the sole responsible for "the failures of the swedish strategy". An example here disproving the "crazy scientist Tegnell myth" is that the messaging remained exactly the same even when Tegnell went on vacation during the summer.
Also, it's even more complicated since FHM don't have authority to tell other government institutions how to run their business. You could call them a governmental support function, if that helps.
Regarding that Swedish politicians are "free dumb" and "they can't do anything". We have laws that could impose lockdown in the event of war, but these laws do not apply to a pandemic/epidemic. My understanding is that Norway and Denmark have similar laws, just that they do apply to pandemics/epidemics. I don't think it is right for politicians to have the ability to lock up people when the law does not support it. We should have had a law that could be used during a pandemic but we didn't.
I also think that the asymptomatic carrier thing is more complex than you describe. I don't think a majority of the cases were from asymptomatic carriers and if you follow the recommendations (social distancing + wash your hands etc.) it wouldn't be a problem.
So Sweden banned gatherings of 50 or more people, while countries that banned order of magnitude smaller groups did an order of magnitude better. Allowing groups up to 50 isn't anything like a lockdown as understood in many other countries. Also I think it was never practically feasible to isolate vulnerable people as you describe. As far as I know, no country has successfully kept society open in this way yet also protected vulnerable people and it was reckless and irresponsible to try to do so.
So Sweden banned gatherings of 50 or more people, while countries that banned order of magnitude smaller groups did an order of magnitude better.
And Spain locked people in their homes to the point where there was a black market in borrowing other people's dogs in order to have a legal reason to go outside, and did worse. There is not an obvious relationship between severity of lockdowns and deaths or hospitalizations. You see this in the US too, where the media have been demonizing Florida for months for its relatively lax restrictions, while its death rate is right at the national average.
Also I think it was never practically feasible to isolate vulnerable people as you describe.
And it is practical to expect the entire population to put their lives on hold for a year because of a disease that is not a significant danger to most of them?
Locking people into their homes like Spain and France did might have other ill effects, like a depression epidemic. Or people getting fed up with stupid politically motivated approaches gathering en masse to protest, making matters worse. The problem in Southern Europe is that people like to party. That still doesn't warrant 1 km radius lockups which I hope would be deemed a violation of human rights in court. I understand that we're not allowed to gather in large groups, but restricting going out on a bike ride alone or with your partner or walking the dog is quite a different matter. Also the French curfew is exagerated, eleven o'clock would have worked equally well. I guess we shall see in a few years which approach was correct.
I just hope the vaccines achieve immunity and stop this pandemic. This is great news. Too bad it's not approved in the EU yet. Hopefully early next year.
I don't think that lockdown is an instant recipe for covid handling success. There are many countries that "performed poorly" despite going into lockdown.
Also, I think you are missing the point. The swedish strategy was based on people following the recommendations over a long period of time. Locking down is not a sustainable strategy, especially when you believe that the pandemic might last for several years.
This is incorrect, please refer to the press conferences held by FHM between march and june. I think every other one had a question about herd immunity (mostly from international media) and that herd immunity was not the strategy that sweden focused on.
What goal was Sweden pursuing by taking no real action in the beginning of the pandemic? The reasons might be unclear, but the lack of action has been properly documented.
I think this is actually incorrect. Again, there is so much misinformation about this that I don't blame anyone. I think there was quite a lot of things being done.
I believe the goal was to keep people informed about the dangers of the virus and how to protect themselves, the most important parts being to wash your hands and social distance. I think they also provide information tailored to different sectors (like healthcare) and advise them on how to fight the virus. It's then up to the different sectors how they handle their specific situation.
I think that Sweden is perceived to not take action when it did. I think this comes from the politicians stepping aside and "transferring the leadership" to FHM (doing the opposite would be political suicide in Sweden). In some other countries you have had politicians boasting how good their response is. I've even seen politicians claim that people of their race just handle the disease better. FHM doesn't have the same vested interest in looking good.
They most certainly did try to pursue herd immunity, but didn't message it publically. This can be seen from emails recently unveiled by a freedom of information request. In which, Anders Tegnell states “One point would be to keep schools open to reach herd immunity faster”. When a colleague stated that such measures might increase the elderly death rate, he replied “10% might be worth it?”.
A number of other emails were deleted by Tegnell because “I delete a lot of emails that I do not consider relevant in a way that needs to be recorded”. We can only speculate what Tegnell deemed unworthy of our consideration.
> They most certainly did try to pursue herd immunity, but didn't message it publically.
The email published by The Guardian don't support this. He is mainly discussing the impact of keeping school open balancing the potential death in the elderly population against the immunity boost.
The official message from Sweden has always been they were trying to keep the virus manageable while minimizing the impact on society. This seems to have resulted in more deaths that their direct neighbors (but less than other countries in Europe). History will be able to judge with the full data.
As an aside, The Guardian coverage on coronavirus is generally awful. They usually deeply misrepresent/misunderstand what's happening in France for example.
> The email published by The Guardian don't support this. He is mainly discussing the impact of keeping school open balancing the potential death in the elderly population against the immunity boost.
What is this "immunity boost" you speak of? It sounds like a less intellectually brave version of herd immunity to me. Tegnell, unlike some, did not mince words when he said “One point would be to keep schools open to reach herd immunity faster”. He obviously had that as an object in mind when making decisions.
Herd immunity (or 'immunity boosting') was a disastrous policy and the link below goes into some detail as to the basic conceit of the position.
> This is especially clear in Sweden, where the authorities publicly predicted 40% seroconversion in Stockholm by May 2020; the actual IgG seroprevalence was around 15%
Ever heard the term flatten the curve? That is the same as the "herd immunity strategy". There are only two ways of getting herd immunity, either through a vaccine or "naturally".
In march it became apparent that stopping covid would not be possible (at least in Sweden) and the time frame of a potential vaccine was unknown - possibly that it would arrive too late to be useful.
At that point in time there is only one strategy left, herd immunity. The ONLY choice you have is how you want to approach it. Full lock-down and wait for vaccine? - not practically enforceable nor desirable. No restrictions? - Would overrun the hospitals and lead to massive suffering even outside of corona victims (at least in countries with an old population, for countries with a very young population that could very well be the best hing you could do).
Flatten the curve is about curbing the spread so that the hospitals can keep up. Not about stopping the disease. Navigating that road is full of compromises. Taking more risk with children in schools - that have a lot to loose on a lock-down but has low chance of getting seriously ill shouldn't be that of a controversial statement. Even if it turns out that the assumptions made when making that decision was wrong.
There are of course infinite considerations to make but yes, of course he had that in mind when making decisions! As he should have.
Nope, that's what they kind of started saying after the herd immunity experiment failed. Back in May they were still happy to go on record to say that herd immunity was part of the Swedish strategy:
But by July antibody tests showed that herd immunity was still very far away. Tegnell has since claimed it was never their goal, which to me sounds like hand washing.
EDIT: As pointed, Swedish representatives later asked the article to state that herd immunity was not their goal after all - you could almost forgive the journalist for the confusion. Here is Tegnell instead strategizing in private about letting the virus spread in school children to hasten herd immunity:
But note the correction at the bottom of that page:
April 27, 2020
An earlier version of this story said the Swedish government is pursuing a strategy of "herd immunity." Swedish officials say their plan was to impose limited restrictions instead of a lockdown but have denied they were purposely pursuing a strategy of herd immunity.
Herd immunity is a potential side-effect of a virus hitting a population, it was never the strategy!
If you have a pandemic with a new virus it would be kind off incompetent of the epidemiologists to not try to calculate if the population will reach herd immunity or not. That does NOT mean that heard immunity is the goal.
So where is your source on herd immunity strategy? Or will you just keep on spreading lies?
EDIT: Off course Sweden, just as Finland admits, calculated and talked about herd immunity. But there is not a single shred of proof that they picked that as a strategy. Do you really think everyone at the FHM (health agency) colluded on doing this behind the backs of the population and then they all keep it a secret? Why? What would there motives be?
The Guardian article definitely gives the game away. I made a comment earlier featuring some of the more damning quotes from the architect of the Swedish strategy.
Another reason why herd immunity won't work is because natural Covid-19 immunity seems to have a pretty short duration based on my own experience.
Source: Had Covid in March 2020, then again in December 2020. Only the second time was confirmed by PCR test (tests were not readily available back in March), but the symptoms are exactly the same so I'm convinced I've had it twice now. Immunity doesn't last 9 months!
Covid shares a lot of symptoms with other diseases. It is impossible to reliably say you already had Covid back in March, it could be a lot different things.
Yes, I cannot prove anything with certainty. But the symptoms are very distinctive to me (quite different from a 'flu, for example), and like I said, I experienced virtually identical symptoms and progression both times. So, personally, I'm highly convinced I've had Covid twice.
> "Despite no other documented case of reinfection being published"
Here's one for your reference. This pretty much matches my experience/timeframe, except my symptoms were similar both times (not worse the second time), and I don't have any known comorbidities:
Confirmed Reinfection with SARS-CoV-2 Variant VOC-202012/01
All I'm suggesting is to not be complacent if you've already had the virus. Your immunity, like mine, may not be long-term persistent. Get the vaccine even if you've already had the virus.
Just dramatically worse than their comparable neighbors who, unlike the rest of Europe, share the same cultural/demographic/socio-economic factors. Nothing screams denialist more than people trying to hand-wave the Swedish failure away by ignoring neighbors and comparing them to some other, bigger, EU covid clusterfuck.
According to [0] Sweden has better deaths per capita than the US, UK, Spain and Italy. We still have no data about what the longer term effects of all these business closures will be, because the pandemic is ongoing. And at the time the decisions were made it was wishful thinking that a vaccine would be almost upon us by now.
This Swedish "failure" is not yet manifest. They are an apparently weak performer, but by no means outside the pack. And the better performers in the pack are suspect - India and China may as well be several different countries packed together by population. Their numbers are a bit unrealistic.
For the note, I don't think it is meaningful to compare these statistics between other countries than OECD members. For instance, the Wikipedia list you mentioned indicates currently 45,000 deaths for Russia, whereas the Russian deputy prime minister has now said that the figure would be 186,000.
To be honest it sounds pretty denialist to me when someone says you have to compare Denmark, Sweden and Norway, but adding other countries is "not comparable". To me it just sounds like cherry picking.
An example of a big difference between Denmark and Sweden is that Sweden has a much more lenient immigration policy (for better or worse). I have heard anectodes from (swedish) friends about how these groups fare worse. I can very much imagine that differences like this make the comparison between the nordic countries less valid, so to me it makes sense not to cherry pick those three countries.
It isn’t cherry-picking, it is a standard that existed long before covid. The Nordic countries have always compared themselves to each other and have been lumped into a group externally. They share many similar characteristics and few differences — the immigration straw you are grasping at is indeed weak sauce and not significant-enough to account for the scope and magnitude of Sweden’s covid failures.
I know these countries are often compared. My point is that it is not a very good comparison to make in all cases. And mind you, the original claim was that a comparison between Sweden, UK, Spain etc. was not valid "because you should compare Sweden to Denmark and Norway". Where should you draw this imaginary line of which countries can and cannot be compared? Sure Saudi Arabia and Sweden are pretty hard to compare, but why not include the baltic states? Germany? US?
It's also very strange to me when people compare the nordic countries they forget that there are real differences between them. The difference in immigration policy is one plausible factor for a different response to Covid. I'm not claiming that the high death toll is caused by immigrants, I'm claiming that the lenient Swedish immigration policy adversly affected the death toll, compared to a more strict one like Denmarks. Is that a straw man argument because it doesn't fit a specific version of reality?
Being German, I don't consider these countries part of Northern Europe. While the UN might put the UK there (but not Belgium), the way I got taught the terminology, the UK would belong to Nordwesteuropa as a sub-region of Westeuropa, whereas Nordeuropa consists of the Nordics (and maybe the Baltics).
Not sure what the 'tried with catastrophic end results' is because the post you replied to has been censored, but; Sweden have done massively better than France, UK, USA, in deaths per million, they have even done better than Switzerland, all the while not treating their citizens like criminals. While the west look to shining examples like North Korea and China as what we should be doing.
Switzerland is only slightly lower than the US in death rate. I'm not sure the "even" is appropriate here for a country with far more deaths per capita than Austria and Germany, especially considering it also experienced a second wave far more fatal than virtually any other country.
If you had to look at this comparison without knowing; you couldn't tell which country maintained civil liberties. And yes there are countries that fared better, and countries that fared worse.
Sweden's second wave seems dwarfed by both France and Switzerland in this comparison.. I mean if you have to squint and twist the stats to make Sweden look bad, then maybe we gave up all our rights unnecessarily.
Overall, they have the 25th worst deaths per million on earth, UK is 12th, USA is 14th and France is 16th worst. They didn't do badly. And most all countries that did worse, did so while stripping every right and liberty off their citizens.
It's actually sad how this whole thing has progressed. Just look at this thread, anything that goes even in the slightest against the current is downvoted into oblivion. It's so disappointing, you can't say anything any more. And it's just people bringing up mild counterpoints or examples, but it doesn't matter any more, science is a religion, everything is with us or against us, all common sense and proper dialogue is thrown away for this extreme radicalisation.
Anti-capitalism is usually held exactly from a position of more freedom. In a more free world, your livelihood would not be conditioned by obedience to a totalitarian institution such as a company.
Opposition to pure free speech is indeed problematic, though.
> It's practically impossible to shield the vulnerable population from a highly contagious disease that is rampant in the non-vulnerable population - someone after all needs to tend for the vulnerable.
"By way of example, nursing homes should use staff with acquired immunity and perform frequent testing of other staff and all visitors. Staff rotation should be minimized."
To be fair, their "catastrophic" results is still a lower death rate than the United States. I feel like there are a lot of Americans who willingly accept that level of catastrophe in exchange for freedom.
Why do you consider Sweden’s surrounding countries to be comparable? What specific metrics are you basing that on? To me it seems like this comparison is arbitrary and relies on uncritical readers accepting geographical proximity as an acceptable proxy for all the complexities involved.
Sweden’s strategy could well have worked if they committed to it. They didn’t actually go for “herd immunity” as you claim, and had a number of lockdown restrictions in place, although to a lesser degree than some other places. They unfortunately had some early blunders with nursing home protocols, and over half their deaths are from nursing homes specifically. But if you correct for that, they would be looking a lot better.
As for isolating the elderly or vulnerable - it’s not a cognitive dissonance. Two different parties both have a right to liberties, the ability to assess risk trade offs for themselves, and agency to make their own decisions. Those who are risk averse can quarantine themselves indefinitely, while those who aren’t can continue with their lives unimpeded. What exactly is the dissonance?
Sweden's neighbours share similar demographics, climate, legislation, administration, health care system and to a large extent also cultural traits.
Swedes do a bit more of greeting people by hugging and even cheek-kissing than Finns or Norwegians do, but they all are a far cry from Italy, France or Belgium in that respect.
Thus, with so much similarity in background variables, the policy differences towards the epidemic are highlighted.
Only with a not-yet in effect law, which has been months in the making, will measures even approaching a full lockdown be legal in Sweden. An actual full lockdown would require constitutional level changes which has to go through multiple administrations before coming into effect.
There literally hasn't been many possible measures to take beyond those taken.
The country is also more devolved into regional administration than the neighbors. So yes, there are major differences in legislation.
This is weirdly missing from the rah-rah coming from both sides - it's not even really a tactic, but the outcome of our laws.
Catastrophic? They are pretty average for Europe. Cherry picking countries to compare it to makes little sense, as there are numerous factors other than geographical location that affect the virus. > 50% of the deaths occurred in care homes, as Sweden (like many other countries) sent older patients to them. Which is pretty much the opposite of what was I was suggesting.
Here is the Swedish COVID death toll per million plotted against comparable countries in Northern Europe. Sweden is a clear outlier, and there is little debate that their lax strategy was the reason.
What are you suggesting exactly? That old people with medical issues are quarantined in empty hotels? So we can protect the civil liberties of those who are less vulnerable?
You absolutely cherry picked the countries in that list. If Estonia is there so should be Lithuania and Latvia (to which Estonia is much more comparable economically and to a large degree socially than to the Nordic countries). And if Germany is there so should be Austria and Switzerland (small, highly developed and not that much less densely populated than Sweden if you only look at the areas where most people live) and so should France & UK (smaller populations than Germany, similar level of economic development).
It would be interesting to determine the effects of things like population density and urbanisation on the death rate. Sweden is a pretty sparsely populated country I think, which presumably acts to reduce the rate of spreading?
As you can see, it's not easy to draw a trendline that would show that a higher population density would produce higher covid infection rate. Basically, the pattern is what you get from a shotgun.
Population density is a red herring on it's own. Spain has a relatively low population density, but the cities are probably some of the most dense in Europe. Likewise 1/3 of Swedes live in cities, while there are huge areas that are very sparsely populated in the north.
All of these countries are not the right baseline to compare against. Funny, how positive shutdown results are hand waved away with population density and so on, while Sweden never gets compared against the other Scandinavian countries Finland and Norway. I know Finland is not technically Scandinavia, but a better to compare Sweden against than Denmark.
Population density calculated is not really a meaningful measure if you want to figure out how "densely" most people in the country live and it's completely useless in this case.
Sweden has an urbanization rate of over 85% and if you only look at the density of the area where most of the population lives it's not that different from countries like Denmark or Austria and some degree to Germany.
On the other hand, currently the covid infection rates in Sweden are flaming red in the sparsely populated Gävleborg and Västernorrland counties which you can hardly describe as "urbanized". The counties in Finland (Österbotten and Sadakunda), across the Bothnian Gulf on the same latitudes, have higher population density, but have not had this high infection rates, at least so far.
But I agree with the point; urbanization rate in the sense of having lots of people using public transit might have significant bearance on the spreading of the epidemic, while population density in the sense of people/km² is utterly irrelevant.
Similar population density, similar climate, similar lifestyle. Denmark is to far south and to small for that. Denmark more closely resembles, say, Belgium or some northern states in Germany.
Finland, Sweden, Norway, Denmark and Iceland form an entity that has shared history, culture, legislation and many other traits that make them comparable. For decades, the legislation, regulation etc in the countries has been developed together (often with Sweden as the progressive model that others are following, though that has now turned around a bit).
Geographically it is not so important that there is a bit of sea between Sweden and Finland (Scandinavia vs. Fennoscandia); this sea used to be something that connects, not something that differentiates between the lands.
Because they claimed that elderly patients were sent to care homes. I guess you could argue this is "fact based" in that it's a distortion of the facts.
Because they argued that comparing Sweden to it's similar neighbour is "cherry picking", and yet cherry picked a much less suitable group - the whole of Europe - because it suited their argument.
Because they, without any facts, imply that Sweden's high death toll could be avoided by putting the elderly in hotels
You don't give a reason for why the whole of Europe is less suitable than it's immediate neighbours (geographic location is only a small part of the puzzle).
> Keep them away from vulnerable people (who could be put into some of the unused hotels for example)
Depending on how you define it, there's something like 15 million vulnerable people in the UK. There's fewer than 1 million hotel rooms.
What happens to school-age children of people who are vulnerable? Do they have to isolate in the hotel rooms too?
What happens to the carers of some of these vulnerable people? Do they have to isolate? What about their families?
People who are "vulnerable" need by the far the most medical care. How do you do that safely? We can't avoid people picking up infections in hospitals at the moment. Surely it would be far worse if we let the virus go wild?
Wouldn't having lots of vulnerable people who need lots of personal care packed into hotels be at high risk for the virus spreading between them? Isn't that the problem we currently have with care homes?
As soon as you start looking into this as a solution it looks far easier to try to suppress the virus across the entire population.
I know of a few young and healthy people who have ended up in hospital due to COVID and still have longer term lunge damage. This whole “it only affects the elderly” meme needs to die. They’re just in a greater risk category of death but there are so many variables at play, such as the viral load. And if you’re allowing a virus to run rampant in the hope of gaining herd immunity then there’s a real risk that people will take in larger viral loads.
Also, natural immunity is only estimated to last around 2 or 3 months and offers no protection against other strains (some of which appear (statistically speaking) to affect younger folk more severely than the original SARA-CoV-2 strain).
I've also heard conflicting data on the natural immunity duration - many sources claim at least 3 months of protection, but I can't quickly find any that suggest immunity lasts no more than 3 months. Indirect evidence suggests immunity lasts longer, namely the persistently low re-infection rate - since the first wave is so long ago, you'd assume there was more reinfection by now if immunity lasted just 3 months, right? But maybe I'm reading this wrong; do you have a citation to back this surprising estimate?
I think that this is absence of evidence being taken as evidence of absence. It's pretty hard to bang the table and insist that natural immunity lasts for years when there are no examples of anyone being immune to this for years (yet). I think that professionals would fight shy of asserting this because they are exposing themselves to professional opprobrium (potentially) and they have lots of other things to do now and they are probable concerned that the message will be hijacked to justify not wearing masks/hugging old people/ having big parties/collapsing the healthcare system and killing lots of people. After immunization and when the infection rate goes low again I expect that stronger claims will get made.
At the very least we shouldn't assume that immunity will last for a short period of time. It may be possible since we obviously cannot have the data on long-term immunity yet, but there's no evidence of any significant uptick in reinfection... yet, and for what it's worth, immunity against the previous SARS coronavirus was long-lasting, so some optimism is warranted.
Evidence is necessarily lacking, but at least there's no obvious cause for concern yet.
Even just in my lengthy career in IT I’ve learned that it is better to plan for the worst but hope for the best rather than assume the best and then get caught out. And that’s in an industry where people don’t die from my mistakes.
I think that's perhaps an irrelevant or tangential conclusion to draw here. You need to weigh the various options fairly. But from the perspective of mitigating the risks of "worst case" scenarios - which I think is a tricky perspective in the first place, we need to be clear which worst case perspectives are worth mitigating.
Vaccine immunity durability is not some kind of primary goal - it's several steps away from one. The risk we should be mitigating is the risk of continued pandemic spread, not the risk of short-lived immunity. That may seem like a pedantic point, but the thing is, it raises one very relevant question: how would our actions be different if we pessimistically assume vaccine-induced immunity only lasts (say) 6-9 months?
I'd argue it's likely that this makes very little difference to our actions at this point. At worst it means we'll need to scale vaccine production to a higher level, but even at that higher level the costs are trivial compared to the extra budgets already being spent to save the economy, which are themselves probably small fry compared to the actual economic damage; i.e. even in the "worst case" the costs are eminently doable; the US or EU acting alone could afford to finance vaccinating the entire world, and would even from an entirely selfish perspective probably be well served to do so - and of course, they don't need to, since other countries won't bother waiting for external help. (However, it perhaps does partially help explain Chinese vaccine diplomacy - not only is it truly helpful, it's also in their self-interest both epidemiological, and diplomatically).
But extreme pessimism isn't harmless; I think people start taking warnings less seriously when we cry wolf too frequently, and turn out to have been too cautious, i.e. wrong, in retrospect. There's little organizational benefit to assuming vaccine protection is short-lived, and it's a dishonest projection. We should be honest about the fact that we don't know how long immunity lasts, but certainly more than a few months, and potentially much longer; it could last for many years.
So sure; we shouldn't unnecessarily accept intolerable risks to society even when those are unlikely (but at least plausible) - but I don't think that's the case here.
Well it goes both ways, we can neither assume long term immunity nor lack of long term immunity.
But it's not even a binary: the most likely outcome (by far I think) is that strong immunity of the quality that keeps you even from becoming a symptom-less spreader for a few days won't be lasting, but infection will never again be as dangerous as it was the first time (or would have been the first time, without a vaccine). The immune system is a memory hierarchy.
> Also, natural immunity is only estimated to last around 2 or 3 months and offers no protection against other strains (some of which appear (statistically speaking) to affect younger folk more severely than the original SARA-CoV-2 strain).
This is plain wrong. Natural immunity for SARS-COV-1 was observed even 10 years after infection in some trials. Immunity against other coronaviruses also lasts longer than 2-3 months and actually there is strong indication that natural T-Cell immunity might last people much much longer and be sufficient on its own like it is also with other coronaviruses.
The only thing which is estimated to disappear after 3-6 months are antibodies in your bloodstream.
Bare in mind other coronaviruses are a guide and not firm proof that our immunity to SARS-CoV-2 would be the same.
Plus having an immunity to one coronavirus doesn’t automatically buy you an immunity to another strain of coronavirus. We are already seeing several new strains.
Also having COVID-19 doesn’t automatically mean your body even develops an immunity. All sorts of caveats might prevent that from happening such as the infection being too mild to begin with (eg viral load).
And lastly, while on the topic of viral load, if your reinfection it too severe then you can still die from a reinfection even if you do have a immunity (immunity gives your body the resistance to fight it, but that doesn’t mean you’re invulnerable to the decease).
So while your points are valid, that doesn’t mean anyone who’s caught COVID-19 and recovered should be thinking they’re bullet proof (metaphorically speaking). At best, they could still be carriers. At worst they could still find their body unable to fight off any new infections.
Most research suggests that the fatality rate for COVID increases exponentially with age. IMO the health risks for people below <50 years alone probably doesn't justify any restrictions. The stronger argument is that younger people are prime vectors for spreading the disease to people who are at greater risk.
In Germany that doesn’t add up. We’ve been in lockdown, the incidence in people under 79 is almost constant since Oct, or even going down. Incidence for 79+ is almost double and rising. We can’t just blame young people all the time, it’s not like the young are all going and having parties in care homes (where a majority of the deaths occur). There has been almost nothing done to protect the elderly, except a full blanket lockdown on the entire country, and while all age categories under 79 are constant or going down, the only one that keeps going up is 79+ (https://corona.stat.uni-muenchen.de/maps/). The fact that politicians took the easy way, didn’t come up with a single workable solution for schools or care homes, and then after the summer put the blame again on the entire population is quite a failed strategy.
Wowzers!!!! That’s the most insane idea I’ve heard in 2020. Let’s take a load of people from their homes and pen them all in together, removed from society whilst everyone else goes about their normal lives? You would have rioting on both sides, from those penned in and the relatives of those people on the outside.
for me the most sad part is that, at least in Germany, in my opinion, part of the Seniors are not really caring about masks (mask under the nose == no mask). Sad to go to the supermarket and see them really not respecting the necessary distance or using the mask wrongly just because they don't want to use it.
Here’s something that might enlighten you: many old people don’t want to be alone for a year to avoid a chance of dying. Many old people would take that risk.
I think you didn't read my comment. I'm not talking about social isolation, but to use the mask properly - covering mouth and nose (at the same time) - and keep the recommended 1.5 m distance while in the supermarket
Somehow related. Post-Brexit, many young liberal europeans I know suggested stripping older UK nationals of their voting rights. Just like that, you'd be amazed how far people can go with this.
To me that’s something that goes beyond brexit. It doesn’t make sense that we exclude teenagers from deciding on matters they will have to live with for 70+ years, while assuming somebody who will die soon (and was potentially exposed to decades of disinformation) has a lucid brain worth listening to.
You could also make the argument that old people have seen and lived through more, while young people are impressionable and more prone to following "fads". For example, look at how much support certain ideas had among young folks in Germany in the 1930s.
Anyway, both opposing points of view, while having some merit, are simplifications. Both old and young people should be allowed to vote, and you'll have to find a sensible cut-off at what age to start.
Of course, then it depends who actually turns out to vote, and I believe the younger folks could have been a bit more active on the day of the brexit referendum. (Of course there were also other reasons why "leave" won, including blatant misdirection and cheating by the leave campaign.)
Talking about disenfranchisement - what baffles me the most though is that UK expats living in Europe, who had a disproportionately high stake in the outcome of the referendum, were apparently not allowed to participate.
Without “apparently”, they were explicitly excluded. As we EU expats to UK were. It was a tribalistic survey that pandered to British racists for the sake of some special interests; and lo, we discovered that British racism is alive and well.
Demographics make conservative votes overwhelming. What do you propose ? We young people are excluded from decision-making for the grim future we'll have to live in. It is imo as unfair as what those young brits propose.
In an unconstrained high incidence situation you need much, much harder isolation to reach a level of individual safety comparable to that of a lockdown that barely achieves an R value of roughly one. More like a space station than like a hotel.
And that level of lockdown you'd need at some point anyways, because even adults well within working age require intensive care often enough when infected to overload any health system.
And yes, despite all this, if vaccines were decades out (if you expect to be unable to achieve China-grade suppression) instead of months a path like the one you advocate might be the least bad. But "vaccines decades out" a counterfactual.
Stop lying. I didn't say that at all. I said it warranted further investigation, as there were studies showing its effectiveness. And the study used to discredit it had been retracted.
Every country on earth is investigating. Here is what I wrote in response to your other dead comment. Look through the sources, it's being thoroughly investigated and getting back negative results, which even if successful, wouldn't address the need for immunity:
Quickly glossing over that paper, 8,000 participants is not more than 30,000 from AstraZeneca’s recent trial. So right there, your claim about it being a larger study is gone.
Then there’s the hazard ratio. There’s a small decrease in mortality but nothing overwhelming. Loads of other studies are out there showing increases in hospitalization time, higher likelihood of requiring intubation, no decrease in viral load and of course, increased mortality. Here is a good summary of those: https://www.covid19treatmentguidelines.nih.gov/antiviral-the...
Now I’m not saying we shouldn’t be trialing hydroxychloroquine…in fact we are! But you seem to be implying that we’re chasing after the wrong thing when in fact, we’re chasing after everything.
Long term side effects will be studied and in great detail. Unfortunately, we don’t have the luxury of time because we’re in the middle of a pandemic. Your solution requires hospitalization, ventilation and for people to continue getting infected, while infecting others because we have no immune defenses against the virus or its variants!
I’m not sure what else to say but you’re going to need a lot more than just one study to be retracted before anything you said starts to make sense.
He's saying lock them up until they can vaccinated.
I mean, they'd be locked up in a national lockdown - so the issue isn't really them being locked down or not locked down. The question is do we lock down everyone else at the same time?
We should have gone for Kamikaze nurses who bug-chase the virus early in the year and then protect the elderly. Of course with heavy compensation (basically all the stimulus that could be prevented). I think for e.g. 500k there would have been plenty of volunteers
It seems an eminently sensible suggestion to me. Invest heavily in shielding and treatment for the vulnerable and vaccine development, while allowing the non-vulnerable to live their lives and keep the economy afloat.
Sweden's economy was also hit hard. Like many young people I don't want to catch covid. I'm not "shielding", but even if there were no restrictions in place I'd still be working from home and contributing far less to the economy
I'm (only) 50 but have no intention of going inside a pub or restaurant or non-essential shop until vaccination is widespread.
The economy was going to take a hit whatever so pretending everything would be normal if we shipped all the old people off somewhere is just silly. In reality that strategy would have been as imperfectly implemented as the current one and the outcomes would have been similarly flawed.
The clue is the fact that no government on the planet has seriously considered it persuing it for any length of time. It does not withstand scrutiny above the level that random commentators on internet message boards can provide.
The problem is that it's not easy to determine who is vulnerable. I have a 39 yo former colleague who passed away due to the coronavirus, previously in peak athletic form with no known health problems. How would you know who to isolate?
Plus, it's not just about death, but life long life quality impairments due to tissue necrosis, especially the lungs. Sure, probably single digit percent of people will develop this, but why risk ?
Not to pile in on you, but the reality in the UK has been instead that tens of millions have had their lives impacted by hodgepodge restrictions. The economy has had trajectory altering damage. Our younger generations (aka our future and the people who will prop up our economy and nation as we get too old to and eventually leave this earth) suffer the most for something that doesn't really endanger them statistically.
We've essentially seen a year of this now. I think I would either rather pile all the money lost from protecting "democracy and freedom" into inventively locking up our vulnerable in comfort and safety (e.g. commandeering the Isle of Wight or Cornwall for all I care) OR failing that, go full authoritarian akin to China to eradicate the virus.
The UK is an island for crying out loud...
This halfway house is disastrous for everyone, and we will feel the effects of it for decades, long after most the vulnerable we're trying to protect will have passed away anyway. I'd love to believe we could pretend that we can behave like our civilised Scandinavian peers but the reality is that in the UK social trust is simply too low. During the summer and after, I knew more people breaking the rules than adhering to them. Very few people actually stick to contact tracing and even fewer places will bar you from entry for not tracing. What a joke. The UK govt has made their bed but the population are equally to blame when essentially compliance with most measures are so low.
Trillions have been spent in the US on bailouts. You could have paid for full time care for every single vulnerable person for a year at that cost, and left everyone else to live normally.
And how would this presumably completely non-disease-transmissible full time care manifest itself? With doctors and nurses that also have kids, and social lives, and thus a chance to transmit disease.
Presumably medical professionals would be tested frequently and would a much higher sterilization standards and training than the average person. They'd of course still use n95 masks and perhaps even full body suits when they are present.
We should gauge our society on how we treat our most vulnerable people, and if this is how people want to shape our society then stop the train and let me get off.
Locking up vulnerable people in quasi-concentration camps staffed by hazmat suit wearing doctors administering ‘care’ in the most basic and cruel manner is no way to treat any human being live, let alone a group of lab rats. I’d challenge anyone advocating this nonsense to lock themselves away for six months with only the most basic/essential of interactions and see how they get on. This lack of empathy or any sense of understanding of human nature and sociability is absolutely absurd.
I don’t really see what you’re objecting to. Locking up a part of the population is strictly better than locking up the whole population. You could even make it optional! “High-risk individuals welcome to go to protection centres”
You’re deriding this approach as “nonsense” but your reasoning seems illogical to me. And washing it with words like “empathy” and “sociability” doesn’t help, since it comes off as the worst kind of virtue signaling, employing shaming disguised as a moral superiority.
I agree being locked down would be tough. But that’s what we are asking EVERYONE to do right now. Why should the elderly or vulnerable not have to bear the burden of THEIR evaluation of the risks, by being quarantined, instead of subjecting the entire rest of the world to lockdowns just so they can have a better (sooner) path to normal for themselves? That just looks to me like a selfish imposition on everyone else.
I don’t understand what point you’re making about challenging people to lock themselves away for six months with only basic interactions. That’s the current situation we’re in. And yes it is especially bad for the young, who need socialization, education, play time, and even simply to see faces/emotions without a mask. We are sacrificing their well being and future to do what - give the elderly a faster path out of their own quarantine or a few more years towards the end of their life? It’s a bad trade off and is highly unjust towards the young.
Lastly, we should gauge a society based on how we treat people’s fundamental rights, especially in a difficult situation. A society that gives up those rights easily and advocates for coercive governmental controls is not a great society.
It's not just a question of paying for the care for vulnerable persons. But young people sometimes also want to see their parents at least a few times a year, even if they aren't vulnerable and can care for themselves.
Wouldn't having a nurse or some other full time trained person present be more effective than anything at helping keep "young people" from getting too close? And if these "young people" are out of control, how does lockdown help anyway?
people who are affected are not just 90yo that need a nurse, there's a ton of people in their 60s and 70s (>2% chance of death by covid) who live a normal life and don't want to be locked in a room and cut from everyone else.
The lockdown helps because it protects people who don't care too, by relying on those who do _just a bit_.
Sadly, the option of segregating all at-risk people is not reasonably feasible.
As for those who don’t want to be locked in a room - sounds like they want to have it both ways - just the right amount of risk reduction and a sooner path to living their lives freely. But why is their desire for a normal life more important than others’ desire? Why should others have to give up their freedoms and endure an extended lockdown to enable them, instead of living their lives freely now?
but I wrote "in their 60s and 70s", replacing people 50-59 with 70-79 will obviously give you different results.
I agree with you, people want to have it both ways and it's easy to get upset with them, but that's how the world is, and if the healthcare system gets overwhelmed because of people who don't care everyone else still suffers.
For polio, only 0.5 % of those who contracted polio had nervous system symptoms. Of this small minority that developed muscle weakness, about 2 to 5 percent of children and 15 to 30 percent of adults died.
Still, it was a frightening disease, until it was eradicated by vaccines (except where it wasn't: now that covid has brought the world's focus back to vaccines, we should do something about that, too.)
In Italy those are exactly the super-spreaders who caused a spike of death in most ISOLATED caring homes in which only they could enter.
For your plan to remotely work you would have to:
- totally isolate the people over an age limit that you want to keep out of society, assuming they don't are still working and/or have the money to stay isolated
- isolate with them any professional they need. Not only nurses and doctors, which I think you already won't find in numbers high enough to be useful, indeed in most states they are not even enough to cover normal hospitals functions in case of spikes, but also for example electricians/plumbers/gardeners/etc only for them, people who have to go shopping for them, etc
- isolate the whole family group of ALL these professional above
- create a sparse amount of covid hospitals with yet another group of medic professionals just for them so to avoid cross contamination in hospitals which is the main sanitary risk at the moment
There are already numerous documented examples of COVID-19 spreading in care homes. Nurses some times get sick. Then you have admin staff, deliveries and their drivers, visitors, other engineers brought on site like electricians or cable guys.
You only need one person to badly wash their hands or forget to wipe down their deliveries for the whole care home to become a petri dish.
For crying out loud, nobody likes being at home for more than a year, but how can you make such claims? As of now, there's no way of telling whether there're no long-term consequences for young people. We're completely in the dark and you're suggesting taking the chances.
It should be the other way around actually - unused hotels for people who might be infected, so they can stay away from their family and contacts before it's safe again to go near them.
Often there is nothing like this available and whole families get needlesly infected when individual family members get infected as they don't really have anywhere to go to effectively isolate themselves.
This assumes that old people live isolated. In many countries this is hardly the case. If you take Greece or Italy for example, the elder live with their kids, and in many cases their grandchildren all together.
Does a broader/faster spread increase the likelihood of significant mutations (I've seen this suggested, but I'm unclear if it was by a reliable source)? If so, this seems like it may be a risky strategy, as it may, for instance, challenge your assumptions (that it "barely effects" young healthy people) or nullify your vaccine progress.
Yeah give the virus the chance to mutate so that vaccines are ineffective or it starts killing young people. Most people in favour of keeping everything open ignore the fact the virus mutates so more people are infected the larger the chances of a deadlier strain or a virus against which the current vaccines are ineffective.
Not this nonsense again! The problem is young people can and do mix with older generations and infect them. It's why no country has pushed this strategy.
they always seem to find additional data supporting this or that. Idk, to me it seems like their reporting is literally all over the place, how did they confirm 95% effectiveness? what's the trial-size, is it also 30k participants like the others? What's the age-distribution of those that took part in this 3-months trial, there are a ton of unknowns with that vaccine, and neither Oxford nor AZ are particularly helpful with clearing those doubts atm.
They have in many ways been more rigorous and transparent than other vaccine trials (weekly swab testing of all subjects, publishing the paper first rather than in the media first, being honest about mistakes made). They don’t control the media reporting.
That said it seems the group who received smaller doses by mistake was only 1300, not sure where they got the data on 12 weeks but presumably it’s also a small number or they’d be going with that for everyone.
Things should become clearer over time and I hope they can shift to the smaller doses first as it’d give us double the number of initial vaccinations when supplies are limited.
the just tried to fit in numerous trials into a single trial, whereas Biontech/Pfizer and Moderna were super clear about their trial-architecture and data (same 2-dose regime, given 3 weeks apart), we seem to have a ton of small trials with different data for that Oxford/AZ vaccine. Those 1300 participants who got the half dose full dose vaccine also turned out to be significantly younger than the other group who got the two full-dose regime, making those two groups really difficult to compare (apart from the fact that they were also differing in size)
Now we have a new number out there, 90% if the two doses are given 3 months apart, does anyone here now what the trial-size was? the age distribution? The statistical significance for that finding?
Don't forget that the BioNTech/moderna trials weren't really comparable - they relied on self-reported symptoms to trigger checks for infection. That is likely to lead to a higher apparent efficacy at the same underlyng efficacy.
By now it's clear that for all three vaccines regardless of the exact efficacy of the vaccine, the chances of getting a severe case is greatly diminished. It's at least plausible that getting a vaccine reducings the severity of an infection in general; specifically that it might push what would otherwise have been a mild case into the asymptomatic (but infected) category. I don't know how large that group is, but given how many mild cases there are, it could be quite sizable. And those cases would not have been included in moderna and biontech/pfizer's efficacy numbers, but would have been included in the oxford/AZ trial's numbers.
So while I'm no expert in any of this, I think it's at least fair to say that it's not trivial to compare the efficacies reported from the two mRNA vaccines to that of the oxford/AZ vaccine, because of this difference in methodology. Including vs. mostly excluding asymptomatic cases will affect the numbers.
The point being? All of these trials have their limitations; the oxford/AZ trials may have had bumps (but nothing all that serious sounding), but they also have extra data in the form of asymptomatic cases. The comparison isn't straightforward.
From the news report it's 95%, not 90%. Presumably the data about sample size etc. will be available when they publish. You can't reasonably expect that level of detail from a news article reporting prior to publication.
I think early data showed that you still get ~60% protection with the first shot (or was that for the Moderna vaccine?) Still, you get some level of immunity, booster only makes it higher.
The two dose studies provide incomplete information about the single dose efficacy — administration of the second dose ends the data collection for the first dose alone.
The data collection also includes the period of time that the body spends responding to the vaccine (so if you get the shot and get infected that day, the shot gets counted as not being effective).
And then on the other side of it, they don't have data on how long immunity from a single dose would last.
But it's likely that the Moderna and Pfizer vaccines have quite high effectiveness after the initial immune response.
Sure, while it's not perfect, the data for those 3 weeks between the first and second shot still can provide a lower bound approximation for immunity, which I assume is where the 60% comes from.
The point about how long single dose immunity lasts is fair though.
Some will forget, some won’t realise they need it, some will get symptoms the first time and not want it. I don’t expect it will be widespread but humans will be human
Mutations happen all the time regardless of vaccines. The vaccine adds evolutionary pressure and will likely give an advantage to the bearers of particular mutations.
If the virus has a smaller base of infected people who grow it, there will be less mutations. From that point of view, the sooner all the world is vaccinated, the better. The risk of a new, more dangerous mutation decreases.
I can no longer edit this comment, but I was wrong. The reasoning behind the longer gap between doses is logistical, and attempt to get as many first doses in as short a time as possible. It is scientifically unfounded.
The whole thing is ludicrous. This strategy also applies to the Pfizer vaccine. By having the booster further apart, it lowers its efficacy from over 90% to around 80%. Given the mistakes the UK government has made along the way, this just fills me with further dread for the situation (I have family there).
I would agree if this was for the general population but consider the most vulnerable are being vaccinated first. They should be treated with great care and priority and I think it’s unethical for the UK to lower their chances, especially considering the huge numbers of vaccines they are going to have over the coming weeks.
Looks like they approved the two-dose 62% ~effective~ efficacy regiment.
There was a lot of hope for the one-dose given the supply constraints or a retrial for the more promising half+full dose for greater efficacy.
I wonder if people will ask which vaccine they're receiving. 62% is kinda underwhelming when there's two 95% ones (Pfizer/Moderna), a 92% one (Gamaleya), and a 79-86% one (Sinopharm). With the latter two also not needing subzero temps.
"""Unlike other vaccines being trialled, the Oxford team had been taking weekly swabs from all volunteers to check whether they were infected but showing no symptoms. If the vaccine could prevent silent transmission it could stop them from unwittingly passing on the virus. "That's a big deal. Because that means the virus could be stopped in its tracks," says Pollard.
Intriguingly, when the trial results came out, there were indications it may partly suppress transmission of the virus. But more evidence is needed."""
and
"""Crucially, no-one who got the vaccine was hospitalised or got seriously ill due to Covid. Whereas in the control group there were 10 serious cases and one death."""
Perhaps, regardless of immunity, it reduces symptoms to "not serious", and may reduce transmission, which the other vaccines do not? Which seems like a fair trade for high immunity percentages, and possibly better for the wider community.
Pfizer has the highest efficacy endpoint (95% at preventing symptomatic infection, which would theoretically also prevent spread and symptoms at higher percentages) with equal efficacy across age groups.
Moderna is 95% at preventing symptoms (100% for serious symptoms in their trial but insufficient sample size). They also reported slightly lower efficacy for the elderly.
AstraZeneca is 62% for preventing symptoms (unknown for infection and spread).
So it's not quite a trade-off of spread prevention vs symptom prevention, because Pfizer claims to do both significantly better.
edit: reading the data in more detail, all 3 don't have sufficiently significant data to claim anything other than symptoms. So preventing spread is just PR-hype.
> Pfizer has the highest efficacy endpoint (95% at preventing infection
Cite, please. Pfizer's primary outcome measure was symptomatic infection. Only Oxford/AZ in the UK carried out weekly PCR tests to check for asymptomatic infections.
Reading the journal paper from AstraZeneca[1]. I don't think AZ can claim anything about preventing asymptomatic infections. You're right in that they're the only ones with that data, but that data is practically identical between control (37/2760) and vaccinated (34/2751) groups.
Side note, the more I read about the AZ trials in detail, the more it becomes obvious how messy their trial was compared to the Pfizer/Moderna ones. They have so many more methodologies and outcomes and much smaller samples.
> Unlike other vaccines being trialled, the Oxford team had been taking weekly swabs from all volunteers to check whether they were infected but showing no symptoms.
FTR, this only happened for one of the trials (the AZ results are actually from several trials combined) in England and Wales. In Brazil, for example, this was not done.
Presumably they also counted the numbers of cases with symptoms in control and experiment? I assume the ratio there was also not as favourable as in the mRNA vaccines?
> no-one who got the vaccine was hospitalised or got seriously ill due to Covid. Whereas in the control group there were 10 serious cases and one death.
I can only imagine what it must be like for these researchers. You give some people a dummy and let them get seriously ill and one even dies.
No idea what else we could possibly do, this is probably just how this must be for the greater good, but wow must that feel horrible for everyone involved. You have to tell the family "Sorry, she was in the control group!" Peak 2020 moment for everyone involved right there.
We should have been doing challenge trials from the start. Hundreds of thousands of lives if not more could have been saved, and people of sound mind could have decided for themselves if they want to participate and accept the risk. I know I would have.
I wonder if more authoritarian governments like China or Russia would be willing to do challenge trials.
Outside of ethical concerns, it comes with other complications, like how to design infecting the challengers so that it would be representative of real world infection/viral load.
> Simulation experiments revealed that to prevent an epidemic (reduce the peak by >99%), the vaccine efficacy has to be at least 60% when vaccination coverage is 100% (reproduction number=2.5–3.5). This vaccine efficacy threshold rises to 70% when coverage drops to 75% and up to 80% when coverage drops to 60% when reproduction number is 2.5, rising to 80% when coverage drops to 75% when the reproduction number is 3.5.
Also, it prevents hospitalisations completely which is crucial.
I asked elsewhere but seems this thread is the busiest:
Also, does anyone know - supposedly the Oxford vaccine had swab tests for the virus every week to catch cases even if trial participants weren’t showing symptoms, whereas for the Pfizer/BioNTech vaccine they were only swabbing if someone showed symptoms. Would that not have a large effect on efficacy numbers?
> Using Microsoft Excel, version 16, with the Crystal Ball add-in, the team developed a computational transmission, clinical, and economics outcomes model
I did not expect the simulation model to be written in Excel. Never heard of "Crystal Ball" before. From Oracle's website:
> Use Monte Carlo simulation to automatically calculate and record the results of thousands of different what–if cases
It is well known in the Excel modelling world and a lot of people use Excel for modelling.
I’m not sure coding these things up is always a great idea. I’ve done various types of programming over the years but in Excel you get things like dependency tracing, error checking, UIs for every components, Excel does have advantages for a lot of work. The equivalent code these domain experts produce is usually pretty awful.
There‘s whole books on numerical simulation with Excel. Which is absolutely incomprehensible - if you are math-wise enough to do simulations, you should be computer-wise enough to use a real programming language.
I’ve done this type of numerical work in code and it’s much more difficult than it first appears. It’s not like web development this stuff is much more like real computer science.
Matlab, yes. Matlab code can be versioned, and opened in VIM for independent review. It can have unit and integration tests. It can also often be run in alternative implementations with few changes, such as Octave.
Excel? You'd be lucky if Excel N-2 can properly handle the file, much less an "alternative implementation" such as LibreOffice Calc.
You can have manual tests (automated through VBA if you wanted) and reviews. The review tools are lesser known features built into Excel. I know from my experience accounting firms will take your spreadsheets and code too and audit it. I’ve worked with bankers who would effectively run a suite of tests before using their updated spreadsheets. These concepts aren’t unique to programming.
I upvoted this. It's quite a lot more important than your elegant one-liner reveals. I think there's a gaping hole in many people's skills that need to be addressed. We're educating people in how certain models work, with lots of equations and diagrams, but we don't give most people access to the power of computation that would greatly help their studies.
> some participants routinely swabbed themselves for SARS-CoV-2 testing, even if they weren’t showing symptoms. Differences in infection rates between people who received the placebo and those who got the Oxford vaccine suggest the vaccine blocks transmission, says Ewer. (The Pfizer and Moderna trials tested only people who showed symptoms.)
the 62% efficacy rate was for symptomatic cases, which makes those numbers comparable to the Biontech/Pfizer one. I think it was around 50% effective in stopping asymptomatic cases, which is also pretty good. But that main number comes from symptomatic cases
One thing I have been wondering: Given that R has been near to 1 in many countries, wouldn't we need much lower immunity rates and/or vaccine efficiencies if we maintain the minimal impact measures such as public masks?
My understanding would be that 10% immunity for instance would push R down by 10%. Once we get it below 1.0, we effectively won.
Is this for a vaccine that confers sterilizing immunity (ie, prevents infection and therefore onward transmission, as well as preventing severe disease)?
I don't believe we yet have evidence that any covid vaccine provides this. I've only read that any vaccine prevents disease or hospitalization.
There are some indications in animal studies for Moderna and Pfizer, and some preliminary data given by Moderna at the FDA meeting about reduction of transmission, but it's nothing definitive.
60% is not good enough to be worth taking it for me, personally. I am sure it is good enough for society, but I want a vaccine that allows me to go back to normal life, and if I take the 60% it becomes a coin-flip, plus I will be at the end of the line for the effective vaccines.
I wouldn't call 2/3rds as "only", this is quite high.
In Poland we have only ~40% that want to be vaccinated (but maybe this a result of Germany having much older population).
I'm a bit reluctant to vaccinating until I see some more tests on wider population and we could test for long term complications (e.g. reduced fertility which couldn't be tested earlier) and I'm a person that vaccinated my children (and myself) for all kinds of diseases.
So I assume there are more people like me (aside from the usual "anti-vaccination" crowd).
The 2/3rds already include people who in principle want to get vaccinated but would like to wait a bit more, like you. Only 1/3rd wants to get vaccinated as quickly as possible.
I feel like we’re watching a medical ethics textbook unfold in real time. When the cold judgement of impartial history books come out, it will be interesting to read about. I also am wondering about the mindset of people getting a 60% vaccine. Maybe they will expand access to it to younger front line workers, who know they would have to wait really long for the mRNA version
Yes. The wacky back-seat epidemiology is new with the many vaccine candidates. Most people won't get an actual choice, they'll be offered what their healthcare provider offers and they can take it or leave it.
Well typically there isn't such a large gap in vaccine performance.
62% is about as bad as vaccines get, and in any other circumstance the manufacturer would retrial instead of seek approval. Even the WHO recommends a 70% minimum during pandemic times (with 50%+ being a measure of last resort, which I guess we're at now).
On the other hand, 95% is better than the best of the best.
Most important thing - no-one who was given the vaccine in the trial got seriously ill.
Even if that’s all the vaccine can do for me, here’s my arm.
Remember the biggest threat is health care systems being overwhelmed. That’s when people will die at much much higher rates because they don’t get respirators/oxygen.
A bit off topic, but as far as I understand (not a medicla expert), respirators are not as important as they were though to be back in the spring when countries were fighting for equipment deliveries
Yeah it seems so - but they are still needed and in much more limited supply than oxygen.
I listened to an ICU doctor on the radio this morning saying the problem is that ANY kind of illness with covid is problematic because even fairly mild cases often require some medical attention, even if it’s just a doctor to reassure you you’re OK, that’s fine a doctor could be spending doing something more life-saving.
Here in the UK with this nee strain, the NHS is running out of resources in hotspot areas so any kind of vaccine will help.
The announcement [0] says they are going to prioritize everyone in risk groups getting their first shot over some people getting two, and as a result might have up to 12 weeks between the two shots. That seems like a reasonable way of dealing with the supply constraints, without entirely throwing out the protocol established via testing.
Given the choice, yes but anything now is better than something in a few months, time, especially looking at current UK mortality rates. These are now rivalling the first wave, even with treatments learning in the last nine months and NHS fully geared up.
UK cases have surpassed the first wave (with obvious caveats about far more testing now).
The hospitalised patients per day is probably a more reliable measure - that has not surpassed the first wave yet on either patients per day or patients in hospital, but it does look like it might surpass it in January.
UK deaths are nowhere near the first wave yet, though it may approach it in the coming weeks, however at present deaths are trending down as stricter measures were finally put in place again in December and we may be starting to see the impact of that. We will then of course in a few weeks see the impact of the government attempt to 'Save Christmas' so things will probably get worse again in January.
The UK totals for patients in hospital on the 25th December hadn't passed the peak yet, though they are very close. Doesn't matter too much though, they will no doubt pass that total of 21.6k at some point in January if they haven't already, especially as fewer patients are dying this time round.
This link goes to "confirmed deaths" per million people, see also the "case fatality rate" setting. The former is about 6.8 now versus 13.8 at the peak in April; the latter is 3% versus 15% at the peak in April. There are half as many deaths and a fifth of the deaths per case. That's not even close to "rivaling it despite being geared up", at least from this data. Is this data wrong?
Cases can't really be compared with the first wave because of significantly higher testing (450k per day now vs 60k per day in May, or 20k per day in April at the peak of hospitalisations).
Note that the official data on deaths only includes those confirmed (through a positive test) to have COVID-19; this almost certainly understates the total number of deaths in the first wave due to lack of testing capacity.
If you look at the charts you’ll see a marked difference in outcomes after hospitalisation. Deaths are significantly lower this time, probably a combination of the most vulnerable dying in the first wave and better treatments.
I'm thinking more the other way around. All the vaccines practically prevent hospitalization/death. But the AZ one is coin flip odds for symptoms, however minor. But even minor symptoms from COVID can have medium term damage (loss of smell/taste/lung capacity) that may not be recoverable.
If you're part of the elderly high risk group, long term isn't that much longer anyway. It's the people with most of their life ahead of them that has to pick between the long term damage of COVID vs the unknown potential of long term effects from mRNA/adenovirus.
If it was like my experience, you're told which one it is before you get the vaccine. I was given a 2-page write up on the Pfizer vaccine as I waited to receive the shot.
Amazing news, and so happy to see a lot of good sense here from the UK.
They have distanced themselves from the US with the fastest approvals of Pfizer and Astrazeneca, the smartest targeting of the population (a focus on saving lives by targeting most vulnerable groups first), and the enormously helpful focus on getting some immunity first before worrying about second doses.
The UK is no longer constrained by manufactured doses or anything else. The faster they put that existing supply into people, the faster they are done. They could be done with the pandemic by the end of January.
> They could be done with the pandemic by the end of January.
There are only 500,000 doses available for the first week of Jan according to Hancock's statement in the commons a few minutes ago, so it will be a while before everyone gets their first dose.
My understanding was always that AZ had capacity to produce many billions of doses by year (2021) end, and already had a large supply ready to go: is it possible that “first week of January” is referring specifically to the number of doses that can be administered by then which is limited by more than supply? Distribution, appointments etc. And if so, could we see the second week of January jump substantially? Access to just 500k doses would be a significant shift from the expectations that have been shared so far.
In Johnson's press conference just now they said the number of vaccinations was entirely limited by the available supply, not the ability to administer it, nor the distribution of it. They were explicit about this.
“Where we stand today is we have four million doses available right now and we've got enough active that we think we will be able to make a further 15 million available to the UK by the end of this year. Subject to regulatory approval, it could actually be 19 million doses by the end of this year (to the UK)."
That seems like something has clearly gone wrong, if more than a month ago they were in that position and now we are so limited by available dosage.
That would be suprising, given the quantity already produced by their partners worldwide. Because of the more standard supply chain they have many manufacturing partners. But I'll look for sources. Astrazeneca was always supposed to be a high volume player vs the others.
I've just read we are expecing about 2M doses a week of the AZ vaccine, so I guess we won't be done by end of Jan but I would expect the numbers to be coming down swiftly by then.
The parent's info is out of date. There was a big fuss a week or so ago about how the CDC's draft recommendations for how states should distribute vaccines prioritized "essential workers" instead of the elderly, which would've increased the total number of deaths, but these ended up not being the final recommendation. A large number of uninformed people are still raging about it though.
An issue that I basically never see come up is - why not administer the vaccine earlier on (pre-approval) to the most vulnerable? if P(death|vaccine) < P(death|covid) then it seems really barbaric not to give it. Many dead people now could be alive had that been done (and mRNA candidates were apparently available extremely early on).
The Oxford vaccine is a more classical one so wasn't available quite as early, but apparently the mRNA ones were developed in a very short space of time (weeks - months) and future development could cut that even further (and preemptive vaccines for potential pandemic-causing viruses could be kept in stock) - perhaps introducing a Bayesian triage pre-approval could be an important strategy in fighting viruses in the future?
In any case this and the mRNA vaccines are really tremendous achievements and somewhat restores my faith in humanity after a terrible year...
[...] why not administer the vaccine earlier on (pre-approval) to the most vulnerable? if P(death|vaccine) < P(death|covid) then it seems really barbaric not to give it.
The full equation is: P(death+injury|vaccine) < P(death|covid)
Before widespread testing, you don't know the severity of a treatment's side effects, especially in vulnerable subpopulations like children and elderly. The risk of severe complications for a novel drug are especially of concern when the immune system is involved, since it's often unstable or senescent in early and late age groups, and overreaction (e.g. cytokine storms) may prove toxic.
You don't want the cure to be worse than the disease unless the untreated mortality rate is sky high and no other therapy is viable, as it is for many cancers. In the case of Covid, with a 2-10% death rate (depending on age and region), such desperate measures are hard to justify, especially in low risk groups, until risk of injury is better known.
If you had e.g. a 75% chance of death but the vaccine had a 0.01% chance of killing or seriously impairing you, even taking into account all the issues and the risk of actually catching it the risk seems worthwhile.
However this discussion does make me think that the candidate range is going to be pretty narrow, and of course all concerned would have to be able and willing to give informed consent many of whom presumably would not.
Isn't safety the result of phase II tests? Weren't those complete in June for those vaccines that are getting deployed now?
And, anyway, I'm sure getting safety data from a large scale trial, where every vaccinated person is a data point is much faster than getting effectivity data, where only the people exposed to the virus count.
Shouldn't vaccines made with proven technology carry a somewhat high prior of efficacy?
(And, anyway, with all those problems people are finding on the trials, we are still green lighting them. What's only fair, because it's very likely that the problems aren't important. But why can we make that calculation now, but couldn't in June?)
Safety is the primary purpose of P2, but the size of those trials is often still too small (often 100 to 500) to detect rarer toxicity events, especially in secondary groups often excluded (e.g. juveniles) in trials that initially target a different primary group (e.g. old folks) for approval.
Many drugs fail due to toxicity only during/after P3 when the number of subjects (often 1000 to 30,000) is sufficient to engage sufficient contraindication factors and power needed statistics to reveal detail in the edge cases.
What is a reasonable prior for the toxicity of an old tech vaccine (like viral vector, that is reasonably common for COVID) that passed P2? We have been making vaccines for a while, we should be able to answer that.
Also, how long do we need to wait on P3 before we get the toxicity result?
A really rigorous answer is that we need several years because some problems appear very slowly. Yet, we are not waiting those years. We are declaring definitive success with incomplete information. What is very reasonable, because it is very unlikely that those vaccines will have long term toxicity... but then, why are we using that prior, but refuse to use the P2 or early P3 results to make a temporary decision?
Why we decided that it was ok to try the vaccine on 10s of thousands in June, but couldn't expand that number to 100's of thousands on July, or millions by August? The decisions were taken by calgo culting regulations, and caused a lot unnecessary harm.
> why not administer the vaccine earlier on (pre-approval) to the most vulnerable?
The issue is less tangible and less quantative that that. It's about trust and public buy-in. If vaccine is rolled out despite not fully understanding its efficacy and safety and there are even minor side-effects, there will be fewer people who take the vaccine when they are asked to do so.
At the cost of how many lives? And if the vaccine is successful how would that harm buy-in? If not then it's a failed experiment (though obviously the PR impact could be rather negative!)
I think it's pretty clear from the past year that we need different tools and approaches to dealing with pandemics. One part is clearly faster vaccine development (mRNA seems very promising for this) and pre-emptive vaccine development, another might be permitting very much informed consent take up early on.
The cost of a dangerous vaccine could be one hundred years of lower uptake of ALL vaccines decimating the populations of nearly every country in the world. Not worth the risk if you ask me.
I'm not sure a small subset having a bad reaction to a known-untested vaccine they volunteered to have would have quite as bad an impact as you say, certainly not 100 years of lower uptake!
It would likely have some kind of an impact though, and give fuel to anti-vaxxer types (yuk) but I am not sure the impact would be quite so severe.
>if P(death|vaccine) < P(death|covid) then it seems really barbaric not to give it.
No, it would have to be P(death|vaccine) < P(death|covid) * P(covid) because not everyone would get covid during the pre-approval period. That's a far higher bar.
Also, let's not forget P(covid|vaccine). People would behave very differently once they had the vaccine and feel safe. So if the vaccine isn't effective, that could be catastrophic.
> An issue that I basically never see come up is - why not administer the vaccine earlier on (pre-approval) to the most vulnerable? if P(death|vaccine) < P(death|covid) then it seems really barbaric not to give it.
Not sure, but I would think it comes down to hospitals not being overrun in the case of a widescale negative response to the vaccine. But since the whole thing is a game of probabilities, I do share your view.
You could distribute it in limited batches to only the most vulnerable which should reduce any risk of that. I think the most vulnerable are in any case most likely to already be heavily using the health services anyway (and would be the ones engaging them the most if they caught the virus).
Because of ethics in drug development. And these rules are there for a reason. Not sure what could have been done better with Covid vaccines, we have three now roughly a year after the first cases. All of them work and are either certified or on the track to soon be. We even have four if you include the Russian one.
Summing up the ethics part: Studies include volunteers in a controlled environment. Just administering un approved stuff to people means using people as guinea pigs. I don't want that, and it is doubtful we would have gained anything. Because now it is "simple" distribution and production problem.
'Because of ethics' and 'these rules are there for a reason' are not arguments, they're 'shut up' encoded. Present arguments please.
The progress of the vaccine has been incredible compared to usual, but that doesn't mean more could have been done. Every death is a tragedy.
People are constantly used as guinea pigs... as long as there is informed consent as per the Nuremberg code it's fine. Not suggesting anybody would be forced or ill-informed.
So back to my argument - you can make a reasonable guess at estimating P(death|vaccine) vs. P(death|covid) and set a big margin, then offer people to VOLUNTARILY agree to take it who are most at risk of dying.
The average age of death in the UK is 82 mostly with co-morbidities. I am sure many of these dead would have been happy to take the chance.
And in the case of the mRNA vaccines this not some trivial difference - some were developed within weeks/months, but took nearly a year longer to pass all testing.
It's really obvious that pandemics need different handling than the 'lock down and loads of people die anyway, both from the virus and the consequences of lockdown while ruining the economy + wait 2yrs for a vaccine to be fully distributed' approach we've got.
I hope lessons are learned from covid (I'm actually optimistic they will be, in countries other than the one where the virus emerged anyway).
So you never asked anyone. The problem is, if you ignore ethics, which of course says a lot about your priorities, still two fold.
First, you have development. That was arguably the fastest vaccine development in history. Not sure what could have been done faster here.
Second, you have production and distribution. Ramping up these two doesn't make much sense before you know whether or not the vaccines work. Now they are ramped up really fast. Going "fast and breaking" things may have resulted in more people being vaccinated early on. But this small benefit would have caused tremendous issues in a couple of weeks / months. The goal is to get millions vaccinated, not just a few elderly so that some people can go out partying again without feeling bad.
>So you never asked anyone. The problem is, if you ignore ethics, which of course says a lot about your priorities, still two fold.
This is offensive and I suggest you re-read my post (as well as the HN comment guidelines). I am not ignoring ethics, I specifically mention informed consent. I also have no idea what you mean by 'so you never asked anyone' - this is a hypothetical??
>The goal is to get millions vaccinated, not just a few elderly so that some people can go out partying again without feeling bad.
You're also strawmanning me pretty hard here.
> But this small benefit would have caused tremendous issues in a couple of weeks / months.
Not even sure how you come to this conclusion (you seem 100% certain that distributing the now-proven safe mRNA vaccine early would have caused tremendous issues, somehow).
You seem to want to be aggressive to me and strawman me as somebody who doesn't care about covid victims (my grandmother is 85 and has serious comorbidity risks thank you very much) so I am not going to respond further but I suggest you focus on arguments, not insults and dismissive comments. You can go to reddit and much of the rest of the internet for that.
So we agree to disagree. No problem for me. Regarding distribution, I saw way to many rushed logistics and supply chain initiatives in my life to know how things turn out when people cut corners for some limited early successes. I am happy authorities seem not to do that right now.
60% effective but 100% effective at preventing severe illness. That's really what matters. It's not about making sure nobody gets the virus (none of the vaccines can offer that) it's about making sure we can live with this thing until it goes away.
I live in the UK and if they offer this, I'm taking it.
Super easy, they just have very, very few old people. Different population pyramids. Hence low fatality ratio. And low prevalence is just because vast majority of people are young and have it asymptomatically.
It may also play a role that asymptomatic carriers have lower chance of transmitting infection, so R0 in those countries is lower.
The key take-home about this vaccine is it is a more traditional approach using an adenovirus vector, which doesn't have the cold chain logistical constraints of the pfizer vaccine. This means it will be possible to vaccinate in the community away from the cold storage found in large teaching hospitals, and also means that this vaccine can be supplied to parts of the world where it wouldn't otherwise be possible. Apart from a non-selfish point of view that the world should be protected from this virus, I also wonder how important it will be to control the virus in a global scale to reduce the chance of further mutations that may cause another pandemic in the near future.
Does anyone have a good link for the current status of the Gamaleya (Sputnik V) vaccine? I’ve been hearing and reading a lot of FUD about it, but if you were to take the (self reported) stats in this BBC article at face value it looks like one of the best options.
But really, despite a lot of pejorative language in there -- “Once they have this relationship, they can extort whatever they want” -- it just sounds like the same strategy the UK has been attempting (both politically, and in terms of vaccine development and approval), except the Russian version sounds more successful so far.
Edit to add: apologies in advance for dragging politics into this! But it seems like politics and vaccines are unfortunately intertwined.
their website has a good explainer of the differences (uses 2 different adenoviruses, which are also different from the ones the AZ vaccine uses): https://sputnikvaccine.com/about-vaccine/
Their Phase 1/2 results were published in Lancet[1], which also printed an opinion about the politics of the vaccine[2]
They have reported their final data for their phase 3 study in a press releace which states they will be published in a journal soon [3].
Thanks for that second link especially, this is exactly what I was looking for!
It sounds like much of the communication and release of scientific data has been bad, but in general the approach is sound and it’s likely to work well.
The same criticism about miscommunication could be (and has been) levelled at AZ, over the full-dose/half-dose mix-up.
Well, yes! Substitute “zero profit” with “low cost” and it sounds like the same idea.
The key question would seem to be, who can produce and distribute those billions of doses first? Is the AstraZeneca vaccine being produced at a large enough scale already, and/or has the current capacity already been bought up by the EU and other rich countries?
"Big Pharma" needs to make a profit from somewhere to finance r&d. 9 in 10 drugs (warning, made up statistic alert) don't reach the market, or something like that. And then they need to spend money on manufacturing. Then of course you have 'generics' when the drug is out of patent and other companies can produce it without royalties.
From the BBC article(s) I believe the UK has ordered 100m doses. I have no idea who is producing those though, and how long it takes.
As far as I can tell the data on the Chinese Sinovac and Russian Sputnik (which are of the same type) are consistent with the data for Oxford/AstraZeneca.
The UK really needs to roll this out fast because the current sudden growth in hospitalisation rates is a disaster, NHS is near full capacity again. I suspect there will be a full lockdown in January too.
It's so odd that he would make these statements in an interview without the data or a press release published. I mean this should be information subject to mandatory publication with regards to their shareholders. Astra has been by far the least trustworthy of the major companies so far. I just hope their jab works anyway.
From how I see it T4 is already a full lockdown and iirc over half the country is in T4 already so I don't see how things can be much different in January.
I believe the UK has relatively few orders of the Moderna vaccine whereas they are highly reliant on the Oxford one. Makes sense for the regulatory to put all resources on Oxford once Biontech had been approved and then (I presume) look at Moderna next.
UK deliveries of the Moderna vaccine aren't until April or later (and only 5m doses total) AFAIK so the Government / MHRA have probably placed it on the backburner.
I do not understand why there is a strong sentiment in the comments here about how a 63% efficacy rate is dissapointing. First of all, this is for the 2 doses 4 weeks apart regime, there is already some evidence to suggest that a 1.5 dosing regime results in a higher efficacy, along with other evidence about a theoretical 3 month wait time between the two doses for a higher efficacy rate.
Secondly, this vaccine already prevents hospitalisation and severe illness! That's already a game-changer in and of itself. If you vaccinate the 20m or so who are the most vulnerable to COVID-19 and the most likely to require hospitalisation, then you immediately solve the hospitals-may-be-overflowing problem out of the pandemic (which is the only reason we go into lockdown in the first place). This will allow life to return to normal!
How long does it take to vaccinate the whole population?
I did not look for better sources, but I read in this [1] CNN post that in 2021: AZ is producing 3 billion doses, Pfizer 1.3B and Moderna less than 1B.
So in total we are going to have 5 billion doses in 2021. Each person requires two doses. So we end up vaccinating around one third of the world's population. It seems to me even at the end of 2021 our lives will be still far from "normal".
This is the type of vaccine that can end the pandemic. Cheap to produce, cheap to distribute, old well-understood technology.
Also many countries have the capacity to produce a similar vaccine. For example here is a feel good story from RT about Venezuela buying Russia's similar Sputnik vaccine:
10 m. doses to be delivered within 3 months. How long time would it have taken Venezuela to procure a similar amount of mRNA vaccines from Pzifer or Moderna?
While they have been tested in trials for long, all of the adenovirus-based vaccines are new. There is only 1 commercially approved adenovirus vaccine, for rabies in wild animals.
So because only the 2-full-dose trial had large enough N, that's the one that's approved, so people will be given what is most likely 60% protection even though it's possible, likely even, that if the person administering the vaccine simply doesn't inject the whole first dose - the protection will be higher? What will happen when the 0.5+1 dose trials are finished? Will the dosage recommendation simply be changed then?
Whilst Oxford had the (generic) basis of the vaccine ready to go, prior to the COVID outbreak, it was the removal of all bureaucracy in this, and other, vaccine trials, that has allowed them to go from r&d to approved in 10 months or so.
Which is apparently what researchers will tell you is the 'real' time it takes to develop a vaccine. No time writing proposals and rewriting them when they get rejected, no awaiting someone to approve the proposal, no applications and waiting for grant money, no time spent waiting for volunteers for clinical trial groups, and so on.
The biggest speedup factor was how easy it was to get people sick. A certain number of people had to get sick within the trial groups before results could be conclusive. With how widespread COVID is and how many people caught it, they hit that requirement significantly faster than they normally would.
Yes. Listened to one of the researchers talking about this. They said just that, this time difference here is almost all down to not waiting for funding or going through the usual grant process.
What was long about it? It only months instead of years, and for mRNA vaccines this whole time was spent on the validation and approval process while the vaccine design itself took only about ~2 days right after SARS-CoV-2 was sequenced.
> "Moderna’s mRNA-1273, which reported a 94.5 percent efficacy rate on November 16, had been designed by January 13. This was just two days after the genetic sequence had been made public"
I assume you are referring to the approval process. I've been thinking that too.
I don't want to be that person who thinks a really complicated thing should be trivial, so: Can anyone suggest why it would take weeks to approve these vaccines? What might the regulator actually be doing in this time?
They're clearly going to know that the request is urgent, and know when it's going to be arriving in their inbox; they could ask for anything apart from final data ahead of time to check everything is as they want it. I don't see why they can't have made sure they were happy with everything else ahead of receiving the final data.
Both Pfizer and Moderna were approved within a week of request. So it's not expected for the approval process to be slow.
If you compare the data between Pfizer[1] and AstraZeneca[2]. The AZ trials were significantly more complicated, with variations in methodology between phases and locale and much smaller sample sizes. It looks like they had to massage data and combine phases and explain differences, why they were doing it, and why it should still be considered safe.
Pfizer just submitted a giant sample size homogeneous trial result.
I would imagine it's way easier explaining and approving the one methodology/result with a giant sample size from Pfizer than the four methodologies/trials with small sample sizes and different doses within those trials given by mistake from AZ.
> From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death.
It has been developed at a pace that would have been unthinkable before the pandemic.
The new vaccine approval comes after Public Health England said the country was facing "unprecedented" levels of infections
This is a approval for all of the people who said to just allow Hydrochloriquine for everyone, because after all, its a pandemic, and how bad can it be? (turns out, it gave people heart attacks).
Not only have AZ lied about their test plans (claiming that the two differing dose was deliberate in the first press releases), lied about who was at fault with dosing errors (they insisted that the Italians where at fault), "pooled" results with different populations to try and make a argument they were not testing for (which critically didn't include people over 55) - they just managed to get the UK to approve a dosing strategy that they never even tested.
It's a pandemic - and the UK has invested a lot in both loves and national prestige in this vaccine. But the shortcuts here may come back to haunt. Or it may be what stops this disease in it's tracks.
Counterpoint, it's been proven safe based on all available data (which is more than for any other vaccine) and it reliably prevents serious illness even if it doesn't prevent all infections as reliably as the mRNA vaccines.
If we want the best possible vaccine, wait 6 months. If we want a safe vaccine that can end the pandemic as quickly as possible, this is the vaccine for the job.
Except none of that data is actually public yet - and a ton of work is going to have to go into bias-work because of the half-assed pooling work that AZ did.
The half + full dose regime appears to have greater efficacy but wasn't approved because of insufficient data. I hope more data comes in and permits this. Also:
"However, unpublished data suggests that leaving a longer gap between the first and second doses increases the overall effectiveness of the jab."
That may well help too. But at the end of the day, the world needs a lot of vaccine. It's better to have Pfizer/Moderna and the Oxford vaccine at our disposal, particularly when the latter is also much cheaper and easier to store (this will be crucial in developing countries and/or rural populations). What matters is having fewer people get sick or die, not ensuring everyone is given the vaccine with the greatest efficacy.
The world would have 2x the vaccine available if they can fast track approval of the lower first dose. Hopefully given the prevalence in the UK they can now quickly do that work.
2x the initial rate, assuming we are constrained by supply right now but not so later on. In a few months supplies in developed countries will probably be sufficient for other things like logistics to be a bigger constraint.
And they are ramping pretty fast right now. We are not talking about books shipped by Amazon here. I for my part am really satisfied with vaccine distribution right now, quite the opposite to mask distribution and sourcing.
It seems all vaccines currently approved so far prevent hospitalisations completely. It won’t stop the epidemic completely depending on coverage but it’s enough to stop killing people.
Exactly. I expect and assume everything with the highest standards and outstanding research and development with anything having the 'Oxford' name.
But when I see '<70%' effectiveness compared to 95% effectiveness with the Pfizer-BioNTech and Moderna vaccines, the Oxford-AstraZeneca vaccine looks very disappointing and far from the top standard I have expected.
That's such a naive way to look at it. It's not like we could've known beforehand which type of vaccine would be more effective. Some tried mRNA, other tried other techniques, and they all have to go through a lengthy phase 3 trial. This is a novel virus, and if everyone just did one kind of vaccine, and that kind failed, they we would've been fucked.
Hell, it's even more complex than that, because even given a type of vaccine, even subtle stuff such as dose size and time between the two doses seem to play a huge role, and this is again something that needs to be tweaked over time, using long phase 3 trials. I would attribute it much more to luck than actual skills here.
Where are you getting your source for Astrazeneca's sample size being larger? Everything I've read so far says this result was based off a sample size of ~11k people. Which would be significantly smaller than the ~40k of Pfizer and ~30k of Moderna.
> With Moderna one, some people are loosing antibodies with in weeks.
That's... how vaccines work? Your anti-bodies don't stick around forever, and they're not supposed to. The purpose of the vaccine is to prime your memory B/T cells so that when the actual virus is introduced to your body the antibodies are produced much more rapidly, enough to kill the virus before it can take hold.
I believe the 2 doses will be administered 3 months apart. This should help get people their first dose more quickly and there’s a suggestion that this approach also has higher effectiveness.
Do I understand it right that they approved it before the phase 3 trial has been completed? In Russia this strategy has led the trial to a failure because people who got placebo would just go and get the real vaccine.
If we put aside the protocol failure (accidentally giving half dose then full dose), and ignore the fact that they tried to not discuss this for some time until called out on it, of course, you can't stress-test (injection of virus to actually test for immunity) as it's not ethical.
So the summary metric is the Vaccine Efficacy, calculated as 1-relative risk, where relative risk is the incidence of infection in the vaccine group relative to the incidence of infection in the control group.
So with N = 75 the targeted number of post-dose infections, and V = # vaccinated out of the N, P = # placebo out of the N, are they saying that 100*(1-V/N) is the efficacy ? Then if it's 50%, it actually means you have no benefit over the placebo.
This is good news for the UK. However I lack any confidence that the british government will be able to roll this out at any sort of speed.
The government has had almost a year to plan for the rollout. Obviously there are some different logisitics for storing the various vaccines, however the last mile infra is exactly the same.
There is a plan to train 30k st johns ambulance volunteers, however if they want a smooth rollout, they should have been trained already. This hasn't happened yet.
Getting the jabs in the people is only part of the problem, the jab needs to be prescribed, but doctor time is rare (as they are all being hoovered up to provide 45% extra intensive care beds)
Not only that, after the jab, you need to watch the patient for anaphylactic shock. This requires nurses, again very much lacking in numbers.
Good point on the monitoring requirement but not sure why you think this would need a prescription?
Normal vaccinations you just go through some questions on risk factors before the nurse gives you the shot, usually on egg allergy, any past reactions and the like. No reason this would be any different.
In the UK, All vaccinations are prescribed. Any medicine that is not over the counter needs to be explicitly prescribed before it can be dispensed. (this is what my doctor friends tell me anyway)
> Normal vaccinations you just go through some questions on risk factors before the nurse gives you the shot
there are nurse prescribers, that have the power to prescribe a limited number of things. That aside, the prescription doesn't need to be done with the patient present. it can be pre-filled with the nurse/other arranging the dispensing.
this doesn't mean that the rules can't be changed. I suspect that in time there will be special dispensation given to allow non medical staff to prescribe, dispense and administer jabs. However until the first million or so have been done, they'll want to keep an eye on things and monitor the number of "yellow card" incidents that occur.
The whole article skips the question of the differences between the 60% and 90%. We still don't know the effectiveness on old people, but that seems to be the main differentiator. Not writing that in the article is dishonest.
So, there is no reason to force down our throats the dubious vaccine from Pfiser which requires -70 C storage facilities. Not to mention of course the its creator has not been vaccinated yet. He said he did not want to take someelse's place.. What a horseshit.
You mean the CEO of Pfizer? He’s faaaar from being the creator of this vaccine, that was created by scientists in Germany, who were unrelated to Pfizer at the time.
The vaccine was developed prior to the end of the transition agreement, and the UK already had protocols for approving vaccines before rest of the EU (see Pfizer).
I disagree. I don't think it's been "heavily" politicized, or even moderately, though I'm happy for you to point me to a clip or link of the Government taking claim for it?
> The reporting around it has always sounded a bit nationalistic.
The press have certainly reported that it's British developed, and why not? I'd say they equally reported that the Moderna vaccine was developed by Turkish Germans/German Turks.
Matt Hancock, secretary of state for department of health and social care: "It is absolutely clear that because we’ve left the EU I was able to change the law so that the UK alone could make this authorisation decision. So because we’ve left the EU, we’ve been able to move faster."
See also Jacob monumental fucking bellend Rees-Mogg and Nadine Dorries who made similar claims.
> And its chief executive, Dr June Raine, said on Wednesday that "we have been able to authorise the supply of this vaccine using provisions under European law, which exist until 1 January".
The full summary is below. But the short answer is the regulators who did the work are saying it makes no difference
