Covid: making it stick

By Richard North - June 12, 2021

While we obsess about chilled sausages to Northern Ireland, with the saga by no means over, Covid-19 is refusing to release its grip on the body politic, with talk of restrictions not being removed for another four weeks.

What is spooking the experts (and the not-so-expert) is the Indian variant. The variant has been identified in more than 90 percent of cases, with the total number recorded at over 42,000.

It is believed to spread more easily than the so-called Kent variant, and is said to be more resistant to Covid vaccines, particularly after just one dose and, we are told, may be associated with a greater risk of hospitalisation.

Public Health England also says that cases are doubling between every 4.5 and 11.5 days, depending on the region of England, and that it has about a 60 percent increased risk of household transmission compared with the Kent variant.

Not all is quite as it seems though, as the steep jump in Indian variant reports is partly due to the use of a rapid technique for identifying variants in positive Covid samples. Previously, positive samples used to take five to ten days to identify. The delay is now reduced to 48 hours.

Statistics relating to the use of vaccines are interesting. Since the start of February to 7 June, there have been 33,206 cases of the Indian variant in England. Some 19,573 of the individuals affected were unvaccinated,; 1,785 were fully vaccinated and 7,559 had received one dose. The vaccination status of the remainder was unclear.

As regards hospital admissions, 383 people in England were admitted with the Indian variant, of whom 223 tested positive before turning up at A&E. Some 42 had had two doses of the vaccine, 86 had one dose and 251 were unvaccinated. Of the 42 Covid-associated deaths, 23 were in unvaccinated people, 12 were fully vaccinated and seven had had one dose.

Inevitably, though, information is not complete and there may be some complicating factors which render comparisons with the behaviour of earlier variants more difficult. In May, for instance, it was reported that second vaccine doses could be brought forward in the worst-affected areas. Shortly afterwards, the BMA was calling for the interval between first and second doses to be halved.

In theory, that might reduce the efficacy of the vaccines, and it could be that some of the deaths recorded in the “fully” vaccinated occurred in those who has been given their second doses on a shortened timescale. There is the additional issue, in that some may only have had their last dose recently before presenting with illness, and had not acquired full immunity.

Then, in the hotspot areas, there are high levels of people from the Indian subcontinent, with a significant number resident in large households. Some of these have been host to recent travellers from India, who have been allowed to self-quarantine without supervision, mixing with household contacts.

In the nature of viral transmission, where there are a number of infected contacts, susceptible people may be exposed to such high viral loads that it overwhelms the acquired immunity conferred by the vaccine. Such people may even have been exposed before they were given their final dose, which may have impacted of the performance of the vaccines.

There variables may or may not be significant, but they do not seem to be being discussed. But until we see the behaviour of the Indian variant in a comparable situation, it is difficult to make comparative judgements on the performance of the vaccine and the relevance of the vaccinated deaths.

In an environment where we have little cause to trust in the good faith of our master, much less their competence, we cannot take it for granted that all the uncertainties have been factored in.

On the other hand, there could be real factors here, which are changing the epidemiology of the virus, which could justify delay in lifting the restrictions. But it is important that the government is open about the factors influencing its decision, which has rarely been the case.

Not least, the government needs to be far more candid about the adverse impacts of vaccination, as reports such as these are seen in the press. This is a problem which does not see, to be being addressed honestly – concern about the overall safety of vaccines should not be equated with anti-vax sentiment.

In principle, a vaccination programme is primarily a public health measure, designed to protect the community as a whole. Individual protection is secondary. Inevitably, any programme involves risks, so a judgement is made as to whether the overall risk to the community (from people damaged by the vaccine) is greater or less than the risk of not vaccinating.

The problem here comes in that certain age cohorts have a low risk of illness, and a higher risk of vaccine damage. Taken in isolation, that the risk-benefit ratio for that cohort may militate against vaccination, even though the overall community risk-benefit ratio is still favourable. Therefore, the cohort “at risk” of vaccination is being asked to sacrifice itself “for the greater good”, gaining no direct benefit from the programme.

Such considerations are less of an issue when for instance, there is a child vaccination programme, and the targets are all in approximately the same age band. Then, within broad parameters, the risk is the same for everyone being vaccinated. Then, the deal is easily made – everybody within the target cohort takes the same risk, and shares the same benefits.

With the Covid vaccination programme, though, the risks and benefits are being unequally shared. Therefore, it is not reasonable to expect those at most risk to adverse vaccine reactions to accept the risks without having the issues fully explained. And this is certainly case with the programme being expanded to include children.

When it come to the lifting of restrictions, though, the Telegraph is asserting that 21 June will no longer herald a full return to normality, after Johnson “resigned himself to a delay of up to four weeks in lifting the remaining Covid restrictions”.

But, with the prevailing uncertainties and the history of the management of this epidemic, gone are the days when automatic compliance can be assured. A number of anti-lockdown demonstrations have already taken place and more reaction can be expected.

More to the point, it is getting to the point where the fragile compact is in danger of being broken. Johnson could be on the verge of presuming too much, in asking the population readily to accept further delays without unimpeachable evidence of need.

As always, though, mushroom management prevails, where we are supposed to fall in with the orders of our masters, without question. Those orders, it seems, are to be finalised after the Cabinet’s Covid Operations committee meets on Sunday evening.

If they decide to delay any easements, that decision will be rubber-stamped by the Cabinet on Monday morning and announced by Johnson later that day. That may be the easiest part of it. Making it stick is another matter.