Coronavirus

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albedo
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Re: Coronavirus

Post by albedo »

I'm sure there will be a mix of locations, according to vaccinee category, but GP surgeries will figure prominently, just like they have done for flu. Think about the target groups, taking 3 obvious ones to start with:

1. Front-line NHS staff - presumably at their place of work;
2. Care-home residents and staff - presumably a visit by a vaccination team;
3. Other priority groups, especially the elderly and those with health conditions: Only their GP practice is likely to have easy access to these patient details and able quickly to arrange appointments. So I suspect that the surgery will be the prime place for such vaccinations.

It's likely to be eg Easter before vaccine will be readily available to say the under 50's, so plenty of time to make wider arrangements by then for more open access to vaccination.

Caribbean
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Re: Coronavirus

Post by Caribbean »

It'll depend on location. Larger urban areas will get mass innocultion centres with rural/ small towns relying on GP practices/ cottage hospitals. As the first rounds will be hospital staff and residential homes, I would think they will start out "in house" or through the GPs who currently look after the homes
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RichardIC
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Re: Coronavirus

Post by RichardIC »

albedo wrote:1. Front-line NHS staff - presumably at their place of work;
2. Care-home residents and staff - presumably a visit by a vaccination team;
3. Other priority groups, especially the elderly and those with health conditions: Only their GP practice is likely to have easy access to these patient details and able quickly to arrange appointments. So I suspect that the surgery will be the prime place for such vaccinations.
Pretty much.

But the care home population is huge. School vaccination teams could theoretically help but they have a massive backlog to catch up on because schools were shut for such a long period.

There is absolutely no way this can just be left to GP practices. GP practices will almost certainly be the initial point of contact for patients, but not where the vaccination takes place. My mum had her flu jab at her local cricket club. There will certainly be drive-thrus.

On the issue of patient records, one of the things that's actually happened at pace during the pandemic is record sharing. Integrated Care Records have been talked about for two decades, but they've just happened. A paramedic on a 999 call can know as much about you as your GP in a few minutes.

albedo
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Re: Coronavirus

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RichardIC wrote:School vaccination teams could theoretically help but they have a massive backlog to catch up on because schools were shut for such a long period.
Schools are unlikely to figure at all on 2 counts: First, serious COVID infection in school age children is very rare so it's not a priority from that perspective. (Given that the vaccine(s) will be in short supply for the foreseeable future, prioritisation will be key.)

And, second, very few children have as yet been included in the clinical trials so there is no evidence of either efficacy or safety in children, which is important given that children are obviously still growing and therefore potentially vulnerable to different side-effects from adults. There will need to be separate trials for children. (And similarly probably other groups too like pregnant women and others who have been excluded from the trials to date.)

On similar grounds, I'm curious as to what the MHRA/EMA/FDA will decide about how safe it is to administer the vaccine to elderly subjects, given that there is as yet little evidence on safety/efficacy in that patient group. A proportion of older people has been included in most trials, but there will not yet be good evidence on smaller subgroups in the trials such as the elderly. Indeed, the preliminary Pfizer press release says nothing about how effective the vaccine is at preventing serious COVID disease - the primary endpoint was mild disease. Or about how long immunity might last and many other aspects of the COVID. The interim endpoint is too underpowered to provide much guidance on these aspects, but they might all hopefully start to emerge once the trial completes in perhaps 2-3 months' time. But for now a steady, measured start to vaccination seems like a prudent approach until more information is available.

topman
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Re: Coronavirus

Post by topman »

I've no doubt they'll be plans to mobilise more personal to assist in the mass vacations.

It'll be a challenge no doubt, but we've done other things we didn't think possible over the past few months.

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RichardIC
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Re: Coronavirus

Post by RichardIC »

albedo wrote:Schools are unlikely to figure at all on 2 counts: First, serious COVID infection in school age children is very rare so it's not a priority from that perspective. (Given that the vaccine(s) will be in short supply for the foreseeable future, prioritisation will be key.)
Schools may not figure from a COVID perspective but there is still a massive backlog of immunisations for other things as a result of school closures - HPV, diphtheria, tetanus and polio, meningitis and septicaemia, MMR.

And there's going to be far more school children immunised against flu this year because the little bleeders are super-spreaders.

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RichardIC
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Re: Coronavirus

Post by RichardIC »

So it now looks like local vaccinations at local levels are mainly going to be the responsibility of Primary Care Networks (groups of GP practices, usually covering a population of about 50,000 people) and delivered in batches of 975 vaccines with a shelf-life of a week in the case of the Pfizer vaccine - if it gets licensed.

PCNs are being tasked with identifying suitable locations. They probably won't be practices. They are also being asked to staff the sites. That's going to be a big ask and will require extra recruitment (and funding). You've got to remember that staff at GP practices are as prone to contracting COVID as anyone, and then they're self-isolating for two weeks.

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

RichardIC wrote:PCNs are being tasked with identifying suitable locations. They probably won't be practices. They are also being asked to staff the sites. That's going to be a big ask
Makes perfect sense (GP surgeries are like fortresses these days... as for getting access).
- will the NHS (contract) dentists and assistants be called in again, it is a big & evenly spread 'medical sub-population' with suitable training.
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ArmChairCivvy
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Re: Coronavirus

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Well, the evidence base though well documented for incidence as in children falling ill is much thinner as for their role in spreading (and again more so, when you raise the question 'who are children' from the Covid angle).
- the physical separation (not talking about bubbles but on a bigger scale) in the education system is set at 11
- whereas evidence from some other countries would suggest that from the point of view of spreading Covid, the age of 15 would be more like a break point... not easy to implement any separation physically (except by more mask wearing)
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

Fairly ambitious, trying to show 3 factors on a map (without resorting to relief feature; should be doable):
https://www.ecdc.europa.eu/en/covid-19/ ... e-movement

Pretty dire, only half of Greece and the northern half of the Nordics slightly better than Europe in general.
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

Now I can swap 'in other countries' for other nations, as
"The Welsh government’s own Sage equivalent, the technical advisory group (TAG), reported today new evidence that schools being open is associated with higher rates of Covid infection in the wider population. If proven, that may prompt Johnson to agree to masks in classrooms and maybe even rota systems for sixth forms in England."
- so much for BJ saying in the Parliament that in Sweden schools are closed (he should have said secondary schools, which are working in remote mode) and here they are open
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

A key question as to what other policies should support the vaccination campaign:
"As Van-Tam, among others, has said, it’s not clear from the information released so far about the trial that the vaccine prevents infection by the Sars-CoV-2 virus or just symptoms of Covid-19. If the vaccine merely stops symptoms developing, it might be possible that someone could take the vaccine and still get Covid-19, though without any noticeable illness. Such an asymptomatic individual might still be able to spread the virus if they shed it in large enough quantities to infect another person.

If – and it remains an “if” – the vaccine does not prevent asymptomatic transmission, its value would be somewhat limited says Eleanor Riley, an immunologist at the University of Edinburgh: “We’re not going to get rid of the virus with a vaccine like that.” It would mean health services would still have to work hard to identify and protect vulnerable people and treat those who end up developing a severe case of Covid-19."

wired.co.uk/article/covid-coronavirus-pfizer-vaccine-questions? of 11 November lists other points, too, but of course this first success is not likely to be the end of the story with vaccines
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

albedo
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Re: Coronavirus

Post by albedo »

ArmChairCivvy wrote:If – and it remains an “if” – the vaccine does not prevent asymptomatic transmission, its value would be somewhat limited says Eleanor Riley, an immunologist at the University of Edinburgh: “We’re not going to get rid of the virus with a vaccine like that.” It would mean health services would still have to work hard to identify and protect vulnerable people and treat those who end up developing a severe case of Covid-19."
Hmm. There is no realistic prospect, at least for the foreseeable future, that COVID will be eradicated with a vaccine.

But even if asymptomatic transmission remains a possibility in those who have received the jab(s) - and we probably won't know the answer to that for another 6-12 months - then once the mass vaccination programme is well under way there should still be good protection from the more serious consequences of COVID for vaccinees with boosters as required. What's not to like about that? Of course, anyone not wanting the jab will have to take their chances - it might well end up being their funeral, literally. It's probable also that even if asymptomatic transmission remains possible in principle that the viral loads are suppressed and so infectivity could be much reduced.

In other news, the first interim analysis results of the Moderna Phase III trial should be imminent - I'm guessing there might be an announcement Monday morning before the US markets open but we'll see. After that then both AstraZeneca and J&J are in the frame, but probably with some weeks delay as yet. The AZ trial in the US (which is probably the larger and more important one) has been seriously delayed by the extended pause in that trial and is also probably not helped by the 2:1 vaccination:placebo trial design (hence fewer infections in the placebo group and so slower to reach the first interim analysis threshold).

The UK AZ trial is difficult to call. It was the first to started (AFAICS in June/July), but is relatively small (just 12390). Unlike the US trials, published info on the UK trials is quite limited and I can't even spot what number of infections are required for the first interim analysis, but guessing it might be 75 like the AZ US trial.There was also a short pause (2 weeks or so?) in the UK trial. Oxford are saying 'it's not a race' so I take from that no results are imminent, but who knows.

J&J started later and have also experienced a pause - results possibly in January.

albedo
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Re: Coronavirus

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albedo wrote:In other news, the first interim analysis results of the Moderna Phase III trial should be imminent - I'm guessing there might be an announcement Monday morning before the US markets open but we'll see.
And, here we go:

https://www.businesswire.com/news/home/ ... y-Efficacy

At a first glance, 94.5% efficacy (I don't like the decimal point) with distribution at -20°C and storage for up to 30 days in a refrigerator. Think the UK vaccine sourcers have been a lit blindsided by this one!

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

Good news, while remembering that
-while distribution will be easier
- there won't be enough for everybody
- and may be transport arrangements can be tiered, according to difficulty - that is assuming we buy/ get any

And the mln $ question: treats symptoms only or also effectively suppresses spreading?
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

albedo
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Re: Coronavirus

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ArmChairCivvy wrote: And the mln $ question: treats symptoms only or also effectively suppresses spreading?
That's a tricky question for a trial to answer - suspect it will be 6-12 months before we know that. But personally I don't see that as a big deal. If there's enough vaccine supply then anyone (in an eligible group) who wants to can get vaccinated and thereby be protected.

A more important question IMO (and the real crunch one) is whether the vaccine prevents severe COVID. In this Moderna trial (so far) there were 11 severe cases in the placebo group vs zero in the treatment group. This is the crucial info that we have all been waiting for. Small numbers as yet but v promising.

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

I agree with you as to what is the best that we can expect from a limited trial... and it has been confirmed as well.

But in the longer term, with all vaccines counted together
albedo wrote: If there's enough vaccine supply then anyone (in an eligible group) who wants to can get vaccinated and thereby be protected.
plus those folks that have anti-bodies plus those that have naturally resistant types of interferons
... all these counted together must equal 0.6 x (total population minus children that haven't yet - give or take - reached their teens). Of course all progress towards that will be a big relief, but thinking about the end game - and how long it will take to get there & how much it will cost.
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

The travels of traits B and C across the continents, both East to West and the other way have been well documented (of course with a delay), but the question of where did trait A come from and when did it arrive is not even raised in this story (about a research piece) picked up by SkyNews:

"Samples from four patients, dating back to the start of October 2019, were found to contain antibodies, according to findings published by Milan's National Cancer Institute (NCI).

The results mean they would have caught coronavirus in September - some five months before Italy recorded its first official COVID-19 patient on 21 February, in a town near Milan, in the northern region of Lombardy.

The study - published by NCI's scientific magazine Tumori Journal - found that 11.6% of blood samples from 959 healthy volunteers, who were enrolled in a lung cancer screening trial between September 2019 and March 2020, had developed antibodies well before February."
https://news.sky.com/story/covid-19-cir ... m-12133825

The fatalities were hardly noted (if there were any), and then Italy was the first (at least in Europe) to be hit with "C"
- something is still missing in the overall story
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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Re: Coronavirus

Post by Caribbean »

ArmChairCivvy wrote:The results mean they would have caught coronavirus in September - some five months before Italy recorded its first official COVID-19 patient on 21 February, in a town near Milan, in the northern region of Lombardy.
Back in June, it was reported that analysis of parking patterns at five out of six Wuhan hospitals, coupled with a significant regional rise in internet searches on Baidu for the symptoms of infectious disease (mainly bowel problems and coughs, both apparently typical early symptoms of the Wuhan outbreak - pneumonia is a later stage), showed that "something" was happening in Wuhan back in August 2019. Not proof, but indicative that the outbreak may have started earlier than thought and in a manner that might not have immediately alerted the Chinese authorities. The path to Italy via Chinese expat workers in the garment and leather industries is well known.
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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

I'm particularly interested in the early trait as I think I picked it up in Spain and was sick as parrot from the 1st week of Jan... for 7 weeks
... of course 'telephone doctors' at that point did not put 1 and 2 together, to get 3

Relating to symptoms, in Germany 22% of patients have diarrhoea-like symptoms, and hence it has been added to 'the tick box list'
- not here, though??
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

albedo
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Re: Coronavirus

Post by albedo »

I see Pfizer are submitting an EUA (Emergency Use Authorisation) to the US FDA today. This is the last step in the chain before mass vaccination can start, subject of course to the FDA approving the EUA, which will probably take days to 2-3 weeks for a decision.

This is for the US. There is no solid information on any such move in Europe or the UK, but both EMA and MHRA (UK) have the Pfizer vaccine under the 'rolling review' process and so approval could come reasonably quickly. But I'm unsighted as to whether any new formal application needs to be made by Pfizer in Europe/UK.

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ArmChairCivvy
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Re: Coronavirus

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The article makes a big play out of the efforts to deflect interest and investigations into the virus origins:
https://thediplomat.com/2020/11/china-s ... -tensions/
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

Our World in Data has some changes (as an aggregator, which is a tough job as your product can only be as good as the feeds going into it are):
"all data on confirmed cases and deaths will be sourced from the daily dataset provided by Johns Hopkins University.

We will not change the format (variable names and types) of our complete COVID-19 dataset. If you have any scripts or automated data processes, they will continue to work"
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

Don't know how the word 'probably' got into Sky's reporting
"The vaccine will take months to roll out. Scientists don't know if it stops transmission, and we are probably going to have to live with COVID forever"
and it is true that we don't know if the vaccine will stop spreading, or just the symptoms.
- 'the' vaccine is wrong as well as we will have half a dozen, or more,
- so that alone makes 'the probably' too speculative

As for the approvals (and don't get me wrong, I'm in full agreement with what has been done), everyone does it differently:
- the PM tells us we have Jujutsu
- Trump would like to remove the hyphen in ju-jitsu, to get to the same speed, but his scientists remind him that a process is a not a synomym to a 'rubber stamp'
- and the Continentals follow the longer form, jiu-Jitsu
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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ArmChairCivvy
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Re: Coronavirus

Post by ArmChairCivvy »

The Week reports how the 'armchair' folks are invading every walk of life:
" While armchair epidemiologists have focused their attention on Sweden’s distinctive response to the coronavirus pandemic, another Nordic nation has quietly found an effective way to protect lives and livelihoods from Covid-19.

“Finland has had 90% fewer coronavirus deaths per capita than Sweden and its economy contracted by less in the first half of 2020 as well,” the Financial Times reports."

Sweden is on par with the UK, despite v different approaches (until now).

Stats on the role of the newest mutations across Europe are sparse, but figure 1. in this https://www.medrxiv.org/content/10.1101 ... 1.full.pdf shows
- a new one only emerging in the summer having become dominant in Spain
- and both of the new ones (both only from the summer) when taken together accounting for a quarter or more in France, Switzerland and the UK.
Ever-lasting truths: Multi-year budgets/ planning by necessity have to address the painful questions; more often than not the Either-Or prevails over Both-And.
If everyone is thinking the same, then someone is not thinking (attributed to Patton)

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