What is UK's plan B if another more transmissible or severe or vaccine evading variant emerges at 100,000 cases a day? The UK by relaxing its restrictions even more at high cases per day encourages new variants including homegrown variants.

There is a light at the end of the tunnel. The marvelous new vaccines ensure that, with new 2nd and 3rd generation even more effective vaccines on their way.

. Light at the end of the tunnel - we will get out of this pandemic, how quickly we get there is up to us - case of “vaccines and” not “vaccines only”

But right now with so few vaccinated, much can happen and we seem headed for more trouble again similarly to what happened after summer 2020.

, WHO warn now is not the time to rush back to normal - very premature - not enough people vaccinated yet - new variants surging - need to turn it around and bring cases down - or headed for trouble yet again

Indeed as Adam Finn explained on BBC NewsNight, we have also created perfect conditions for a new variant that evades vaccines. Not likely to evade instantly, this is about variants gradually eroding more and more of the effectiveness of the current vaccines needing a booster to stop them.

What do we do if a new variant of concern spreads at the height of the fourth wave in the summer, when it may have already risen to 100,000 cases per day?

This SAGE report from early May 2021 but only just released, specifically warn about the situation of a new variant that’s more deadly for populations that previously were safe from COVID. .

Released July 6, seems to be written before delta VOC on May 7

What is UK's plan B for new COVID variant more deadly for previously safe populations at 100,000 cases per day?

SAGE to UK gov:

You can find the document here:

We will vaccinate our way out of this eventually. It's a case of releasing the restrictions too soon. By September we will have fully vaccinated all adults who want to be vaccinated. By the end of 2021 we can vaccinate right down to six months and we have gen 2 and 3 vaccines coming too.

Here is Dr Rachel Clarke, a palliative care doctor in Oxford asking the UK government to delay re-opening until more are vaccinated.

For more on this and summary of the letter see my

- Dr Rachel Clarke, palliative care doctor in Oxford calling on UK government to delay July 19 lifting all restrictions

SUMMARY BY DR CHRISTINE PAGEL OF INDEPENDENT SAGE

Here is Christine Pagel of Independent SAGE summarizes some of the main points in the highlighted passage in a tweet:

Low case numbers better cos:
1. Easier to squash outbreaks
2. Test & Trace more effective
3. Reduces risk of new homegrown variants or imported ones spreading
4. Reduces long covid
5. Reduces NHS pressure
6. Helps disadvantaged communities
7. Prevents future restrictions

She presents them in the order they are given in the passage.

I will focus on the issue of new variants first, then cover the other points

I’ll then look at the section of the document where they go into details of specific measures we can do to improve Test & Trace to make it work better than it is now and to improve isolation, for instance to help people to isolate away from their own households to protect them.

SAGE WARNING OF RISK OF MORE DEADLY VARIANT EMERGING AT HIGH CASES PER DAY

As usual I will rewrite in briefer format for mildly autistic readers.This is based on my personal experience of communicating with autistic people in my voluntary work to help them on Facebook. For the background, and on how autistic people tend to process language differently, see my:

. Are you an orang utan or a chimpanzee? Common misunderstandings when talking about doomsday fears with people who are autistic, Aspergers, or very empathic and imaginative

Quotes indented from the document here:

Lower transmission also reduces the in-country risk of the emergence of variants of concern as well as slowing spread of any VoCs (including imported VoCs).

  • Low cases per day reduces risk of new homegrown variants of concern in the UK
  • slows down spread of any variants of concern including imported ones

So, putting it the other way around

  • High cases per day mean a variant of concern is more likely to arise in UK
  • High cases per day mean a new variant or an imported variant spreads faster

There is significant risk in allowing prevalence to rise, even if hospitalizations and deaths are kept low by vaccination. If it were necessary to reduce prevalence to low levels again (e.g., VoC become more pathogenic for others previously less affected), then restrictive measures would be required for much longer.

So it’s saying that

  • If a new variant of concern arises that is more deadly in populations previously not affected, THEN
  • starting from high cases per day
  • Restrictions such as another lockdown need to continue for far longer to control it

Although it doesn’t go into more detail that could include

  • a new variant more deadly for younger people, or
  • a new variant with significant vaccine escape, attacking elderly people who were previously safe

WHAT IS UK’s PLAN B FOR A MORE A NEW VARIANT OF CONCERN AT HIGH PREVALENCE?

Of course we very much hope this doesn’t happen. But the WHO warned that we are going to see new variants at some point. The WHO say we have made a very premature rush back to normality and we need to turn this around or we are headed for trouble yet again.

WHO MAKES SAME WARNING THAT NEW VARIANTS OF CONCERN ARE BOUND TO CONTINUE TO ARISE WITH HIGH TRANSMISSION

Dr Mike Ryan is **Executive Director of the WHO Health Emergencies Programme** (WHO Headquarters Leadership Team)

Dr Maria van Kerkhove is the WHO COVID-19 technical lead (Maria Van Kerkhove (@mvankerkhove))

(click to watch on Youtube)

Maria van Kerkhove put it like this:

I do want to mention one other thing with these variants. It's the delta variant that everyone is concerned about right now. But there are four variants circulating.

The delta variant is more transmissible than the alpha variant which was the most transmissible before the delta variant arose.

The virus is still evolving. There will be more variants. And variants mutate. And they will become more transmissible because that is what they do. They are not alive, they don't have a brain, they are not thinking about this, but they are evolving.

The delta variant is more transmissible than alpha

Alpha was the most transmissible before delta

There will be more variants.

The new variants will be more transmissible.

This is what viruses do, they become more transmissible as they evolve.

Viruses don’t have a brain.

Viruses are not thinking about this.

But viruses are evolving.

And so we are expecting to see more variants come. That is not to strike fear, it's a reality. More increased transmissible variants without the vaccine coverage is a dangerous situation. So let's course correct right now and see if we can turn a corner and make sure that those trajectories going up start coming back down.

We expect more variants.

This is not to strike fear. This is reality.

Variants that are more transmissible without vaccines to stop them is a dangerous situation.

So - let’s see if we can course correct right now.

Let’s turn a corner and get these cases per day going down again.

Full transcript of that section here:

. WHO warn now is not the time to rush back to normal - very premature - not enough people vaccinated yet - new variants surging - need to turn it around and bring cases down - or headed for trouble yet again

THAT’S WHAT VIRUSES DO - MORE TRANSMISSION = MORE VARIANTS, LESS TRANSMISSION = LESS VARIANTS

This is from an earlier press briefing

(click to watch on Youtube)

"That’s what viruses do, they evolve, but we can prevent the emergence of variants by preventing transmission. It’s quite simple. More transmission, more variants. Less transmission, less variants."

My blog post about it at Science20.

. WHO: To Prevent New Variants, Suppress COVID Globally : More Transmission = More Variants : Less Transmission = Less Variants

UK CREATING PERFECT CONDITIONS FOR A VARIANT TO EVOLVE THAT EVADES VACCINE IMMUNITY

This is Adam Finn, pediatrician and member of the Joint Committee on Vaccination and Immunization in the UK

The slightly dangerous situation that we are entering now is that the variants we have seen emerging so far in the last year, their selective advantage is that they are more transmissible, and they have simply been able to outcompete the other viruses because they can infect more people.

The variants that emerged last year spread because they were more transmissible

The variants so far were able to outcompete viruses because they infect more people

What we have got in the UK at the moment is a population that is much more immune than any of the populations where variants have emerged before.

The UK has a population with many more immune people than any population where variants emerged before

So the selection pressure on the virus now will be to evade that immunity. So the risk of having a large epidemic in the context of a relatively highly immune population is that we see variants emerge that can escape that immunity.

So the selection pressure is to evade that immunity.

A large epidemic in a relatively highly immune population can lead to new variants that can escape that immunity

I have not seen even one scientist in any of the Twitter threads of scientists talking to each other support the UK's decision.

This is Dr Sammie, a Scottish immunologist post doc researching in the US, commenting that what we have done is exactly how she would design an experiment to try to evolve a vaccine resistant strain of the virus

MORE ABOUT SAGE DOCUMENT WARNING THAT A NEW VARIANT OF CONCERN WILL BE HARDER TO CONTROL AT HIGH CASES PER DAY

As we saw, the document warns that it will take far longer to control it and get back to low levels of cases if we start from high prevalence.

Given how long it took to get down to the early May levels from January, how long would it take to get down from 100,000 cases per day with a more transmissible new variant than delta with significant vaccine escape, or one that is more deadly for groups that were previously safe such as young people?

It took 18 days to halve the number of cases in January. It will likely take longer in this new situation with a more transmissible variant - and a new VOC would be even more transmissible than delta

What is UK’s plan B if we have to do this again?

18 days to halve cases per day from Jan 9, 2021. Likely slower with new variant

FAST DOUBLING MAKES RESPONSE HARDER

Right now cases are doubling every 9 days in the UK. It’s at 26,224 cases.

If we were to notice a new variant of concern today and realize action is urgent, given a couple of days to react and a week to notice the effect, we’d be at 50,000 cases per day before the restrictions do anything.

If we notice a new variant of concern at 50,000 cases per day, it will peak at 100,000 and so on. That’s assuming the new measures are strong enough to stop it,

NO SCIENTIFIC REASON FOR THIS DELAY IN PUBLICATION

There is no scientific reason to delay such important advice so long - it was clearly written before step 3 on 17 May and before the delta variant was identified on 7th May.

This is a clear example of how the UK government is acting as a gate keeper for the best advice of our scientists.

The UK government didn’t discuss this in their announcement about a plan to release nearly all remaining restrictions on July 19 including requirement for masks in public transport and only published the document the day after that decision.

But the document they release devotes an paragraph to it - and this is written before delta was identified. What advice is SAGE giving them now that they won’t publish until weeks later?

IMHO governments shouldn’t be in charge of the release dates of important scientific reports like this.

I will rewrite parts of this SAGE briefing in more direct language suitable for mildly autistic people and also with an easier vocabulary with less use of academic language.

Importance of keeping case numbers low

First, here is Prof. Christine Pagel’s summary again:

Summary of recently released SAGE document

Released 6th July seems to be written before delta
Prof Christine Pagel of Independent Sage in a tweet:

Low case numbers better cos:
1. Easier to squash outbreaks
2. Test & Trace more effective
3. Reduces risk of new homegrown variants or imported ones spreading
4. Reduces long covid
5. Reduces NHS pressure
6. Helps disadvantaged communities
7. Prevents future restrictions

In more detail the passage says:

Vaccination will reduce the proportion of cases that lead to hospitalization and death. However there are many advantages in keeping R < 1 and cases per day low.

  • Easier to prevent rapid growth in pandemic which could lead to NHS overwhelmed.
  • More time to react to increases from a low baseline
  • Easier to spot outbreaks in advance.
  • Test Trace Isolate more effective at low numbers of cases per day - as shown in countries with low prevalence which can stop outbreaks quickly
  • Reduce impact of post COVID syndromes
  • Allow more NHS capacity for routine care
  • Increasing health inequalities in COVID related illness and death, because a rise in cases will impact most on groups with minority ethnic backgrounds or economically disadvantaged as they tend to be less vaccinated,

It then has a long section on measures to keep numbers low.

IMPORTANCE OF #DOITALL INCLUDING FACE COVERINGS AND OF ONGOING MEASURES EVEN AT LOW PREVALENCE

It talks about the importance of face coverings amongst other measures. In all this it is advising the government in exactly the same way as Independent SAGE in its regular Friday presentations. This is especially relevant given the government’s decision to drop mandate for face coverings e.g. . in shops or public transport

Even beyond the point when all adults have been offered the vaccine, keeping some level of measures in place both through summer and beyond would significantly decrease ongoing transmission. It is notable that countries (e.g. New Zealand) that have near-zero Covid-19 have decided to retain some baseline measures (e.g. wearing of masks on public transport) to reduce the impact of occasional outbreaks.

Keeping some level of measures through the summer and beyond would significantly decrease transmission.

Countries with near zero COVID like New Zealand retain baseline measures like masks on public transport to reduce impact of occasional outbreaks.

[So given SAGE recommended masks even with low cases per day I don’t see how they can possibly be recommending removing the masks mandate now]

MODELING SUGGESTS POSSIBLE HOSPITAL WAVE AS LARGE AS IN JANUARY - THIS IS WRITTEN BEFORE DELTA

SPI-M modelling shows it is highly likely that there will be a resurgence in infections with a peak at some point after steps 3 and 4 have been taken because not everyone will have been vaccinated, vaccines are not 100% effective, and the virus will continue to circulate1 2. The size and timing of a wave depends on what happens between now and then (vaccine rollout, waning immunity if any, behavioural response to the release of measures, new variants, etc.), as well as on the baseline measures in place.

It’s highly likely that cases surge at some point after steps 3 and 4, the size depending on many factors such as behavioural response, waning immunity, behavioural response, new variants etc

[we now know of course that there was a new variant, the delta]

Another wave would be expected to occur even if the assumed baseline measures reduce transmission by 25%; however, it would be much higher without these3. Sensitivity analysis from one model considered by SPI-M shows that if the reduction achieved by baseline measures is only modest (rather than the 25% central scenario), hospital occupancy could reach levels comparable to previous peaks

Even if the remaining baseline measures reduce transmission by 25% there will be a new wave in the summer. If the reduction relative to no measures is modest, then the peak in hospitalization could be similar to previous peaks.

ADVICE FOR POLICY MAKERS

There are some measures where there appears to be scope to have significantly more impact on transmission than is currently being achieved. This includes improving adherence to isolation (including a culture change so that people are less likely to attend workplaces when unwell), improved ventilation, and continued working from home where possible.

  • Improving isolation
  • Culture change so less likely to go to work when unwell
  • improved ventilation
  • continue working from home where possible.

It gives many more specific recommendations for policy makers.

They warn that the vaccine roll out may lead people to think the risk is low and if some measures are lifted, people are likely to think other ones don’t matter also.

Also a small change in the level of risk at an individual level can make big changes at the society level by allowing the virus to spread faster.

They warn that risks may be concentrated in some groups of people. They say such groups may need more intensive support.

IMPORTANCE OF ISOLATING FROM OTHER MEMBERS OF THE HOUSEHOLD

The document says

Self-isolation is critical. It needs to become routine and normative that people with symptoms do all they can to self-isolate. Engagement with testing is also needed, but only isolation prevents transmission. If all individuals were able to fully isolate upon symptom onset (so that they caused no further onward transmission) R could be reduced by around 50%8. Some transmission would remain due to asymptomatic and pre-symptomatic transmission. This drops to 39% with a one-day delay before isolation and 25% with a two-day 9delay. This highlights the importance of enabling isolation from the onset of symptoms, not just from the receipt of a positive test result.

If everyone who gets COVID symptoms was to immediately self isolate the R would be reduced by 50%.

With a one day delay before isolation R is reduced 39% - the 1.5 reduces to 0.915.

With a two day delay it’s reduced by 25%,

This highlights importance of isolation from onset of symptoms, not just receipt of a positive test result.

[to give an example, R of 1.4 would reduce to 0.7 if they immediately isolate, to 0.854 with a one day delay and 1.05 with a two day delay]

It should be noted that such full isolation would require no onward transmission even within the household and that there are major disincentives preventing many people from isolating this way.

This would need isolation even within the household (The WHO often make this point, typically 80% of transmission is to others in the same household).

While rates of self-reported isolation among people who have already received a positive test result are high, among the wider population many people with a cough, fever, or loss of sense of taste or smell, report neither requesting a test nor self-isolating.

Many people with symptoms of COVID don’t get tested, though many do isolate after they test positive.

The majority of those self-isolating after a test report being unable to keep themselves completely separate from other household members, particularly those with dependent children12, which may also reduce effectiveness. Data on adherence is limited, with much based on self-reporting, and options to improve this data should be considered

Most people who self isolate are not able to isolate from other household members

See also Mike Ryan’s golden wish for us to control our outbreaks.

. Mike Ryan for WHO - if one golden wish to control US / Europe COVID19 - each case that tests positive to isolate properly and all contacts to quarantine properly - isolated from anyone else - not to imprison but to break chains of contact.

REPORT RELEASE DELAYED BY TWO MONTHS

This report was released on 6th July, the day after the UK announced it will relax all restrictions on July 19. This timing can’t be coincidence.

This new SAGE report shows that two months ago, the UK‘s science advisors, SAGE, already advised the UK government about this risk and gave many other reasons to keep cases low and R < 1 for the same reasons other experts like Independent SAGE have given and the WHO give.

I don't think there is any hidden agenda here. Just populist politicians that don't pay much attention to the science and delayed the release because their gut feeling told them it is okay to open up and the report contradicted their gut feelings.

It can't be because of scientific advice. Remarkably not one of the many experts I follow on COVID on Twitter says this is good advice. There isn't even any debate on the topic amongst scientists that I can see.

The UK's decision can't be for economic reasons. Wearing masks has no negative economic impact and it prevents long COVID which does have a negative economic impact. The stress on the NHS will also have negative economic impact.

It is just an unscientific populist government going by gut feeling and things they think the public will like.

NOT A HIDDEN AGENDA JUST A NON SCIENTIFIC POPULIST GOVERNMENT

IMHO I don't think there is any hidden agenda here, just a non scientific populist government.

It has repeatedly ignored predictions of scientists, and then when the things they predicted happen, says nobody could have known, so it never learns from its mistakes. I.e. just a populist government that doesn't base its decisions on the science and delays the science reports so that it doesn't need to explain why it's ignoring them.

They seem to just make up their own rules and ignore the scientific advice. Gut feeling I think, not science.

We could make a big difference if scientists controlled release of scientific information, rather than the government, and if we allowed press briefings by SAGE as for Independent SAGE.

This could go a long way towards dealing with issues of a non scientific populist government that ignores its science advisors.

More on this here:

. Why is the UK government lifting the few remaining protective restrictions for COVID with rapidly rising cases per day? - no economic reason - just populist and non scientific

VACCINATIONS DO NOT DECOUPLE THE HOSPITALIZATIONS FROM THE CASES 3% OF A LARGE NUMBER OF CASES IS A LARGE NUMBER OF HOSPITALIZATIONS

Politicians say this over and over and many are coming to believe it from repetition. The idea you get is that because of vaccination cases can rise and rise and it will have almost no effect on hospitalizations.

This is just not true. If cases per day are rising, hospitalizations will rise. Cases are currently doubling every 9 days in the UK.

Hospitalization is increasing

Right now admissions are doubling every 11 days by one estimate. That will be 1,600 admissions a day by the end of the month if it continues.

But there is no way this can continue like that. Hospitalizations will double at the same rate as the cases a week or two later.

We can’t vaccinate fast enough so that vaccination %s are significantly changed on the timescale of 9 days, the doubling time. So with almost the same % vaccinated at the end of the week as at the start, then other things being equal the % of hospitalizations should be the same.

Take the example of 1000 cases doubling to 2000 in 9 days and a hospitalization rate of 3%, so, 30 hospital cases for every 1000 COVID+ cases.

If the 1000 cases lead to 30 hospitalizations two weeks later, then the 2000 cases will lead to 60 hospitalizations, so the hospitalizations have the same doubling time as the cases but offset by a couple of weeks.

If cases are doubling every 9 days, then a week or two later, hospitalizations will double on the same timescale.

At present hospitalizations are running at about 3% to 4%. That means that the 100,000 per day cases Sajid Javid predicted for 19th July will mean 3000 to 4000 hospitalizations a couple of weeks later. That’s similar to the peak in January.

But that 100,000 isn't a prediction of a peak. It's likely still rising.

There are 25 million unvaccinated people in the UK, it would reach 20 million new cases before they approach natural herd immunity thresholds assuming it's 80%, It's 10 million total new cases to get half way to herd immunity.

You've probably seen the drawings of epicurves for uncontrolled transmission - the peak comes when half of those who will eventually be infected get the disease (the total infected = the area under the curve). The half way point is when you expect the peak in cases per day to occur if you have uncontrolled transmission without enough vaccination fast enough to replace the natural immunity with vaccine induced immunity.

EXPECT LARGE NUMBERS OF HOSPITALIZATIONS AMONGST FULLY VACCINATED - ABOUT EQUAL TO NUMBERS NOT VACCINATED

To take an example. The risk of hospitalization is reduced about 20-fold with Pfizer double dose vaccinated.

With a high risk group (e.g 80+), if 95 out of 100 are fully vaccinated, they will have the same number of hospitalizations as the 5 out of 100 who are not vaccinated. E.g. if unvaccinated risk is 20% you expect 2 hospitalizations out of 100, 1 vaccinated, 1 not.

So that means instead of 20 out of 100 you get 2 out of 100 (say) hospitalized but the cases will still rise. And even in the high risk well vaccinated groups you can expect half of those will be in the fully vaccinated, which may seem counterintuitive but this explains why.

If even more than 95% are vaccinated then the percentage that are vaccinated is even higher. The more successful your vaccination program, the higher percentage of hospitalizations you see in the vaccinated people. If you have everyone vaccinated, then 100% of hospitalization is amongst the vaccinated. But hugely reduced over if you have nobody vaccinated.

WHO RESPONDING TO QUESTIONS ABOUT UK'S MOVE IN PRESS CONFERENCE ON 7TH JULY

(click to watch on Youtube)

Question from the BBC: I will ask Dr Ryan another question about the UK change of policy, because I think it is watched around the world. Part of the Government's reasoning they say is that if they have an exit wave now, in August, it is better than having one later in September, so they are gambling on cases going up sharply and then falling back down pretty sharply. Could you just explain to me a bit more about whether you think that's too hopeful or whether there is some good grounds to believe that would work.

BBC: UK government say if they have an exit wave now in August it is better than one in September, is there good grounds to think it would work?

Answer from Dr Mike Ryan. I'm not aware that that's the logic driving our colleagues in the United Kingdom. I suspect it is not. I would like to verify that it is not.

But the logic of more people being infected is better, is I think logic that has proven its moral emptiness and its epidemiological stupidity previously.

Dr Mike Ryan: I would like to verify it is not the logic driving our colleagues in the UK.

The logic of more people being infected is better has proven its moral emptiness and its epidemiological stupidity previously.

From the press briefing here

(click to watch on Youtube)

Dr Mike Ryan explains at the end of the press briefing that he honestly thinks that deliberately permitting infection is not the aim of the UK government.

(click to watch on Youtube)

https://youtu.be/JThz6cjtqLI?t=2532

He says he is sure the excellent scientists that advise the UK health system, will open up very cautiously and be ready to adjust that opening up according to the epidemiology.

WHO: Should UK drop all restrictions at a time of high and increasing transmission?

(click to watch on Youtube)

Question and Dr Maria van Kerkhove's answer: at start.

2:29

Dr Mike Ryan's answer:

They both say we need extreme care at this time.

I will add a taanscript later once YouTube does the auto transcript or the WHO publish their one on the press briefings page.

WHERE DO WE GO FOR GOOD ADVICE?

I recommend following the WHO above all. Especially their social media Q/As.

This is their most recent one

And an earlier one:

. Yes fully vaccinated people can still end up in hospital - very effective against severe disease, hospitalization and death, but no vaccine is 100% effective - continue to #DOITALL to protect yourself and stop transmission

Also Independent SAGE - I would of course link to SAGE if they did press briefings, but they don’t.

. Independent SAGE (@IndependentSage) | Twitter

Some individual members of SAGE to post to Twitter. But they post about their own views and can’t answer questions about SAGE reports.

And do continue to wear masks - the government is just not giving us the same advice their scientist give to them.

There is light at the end of the tunnel. Long term we will get over this, the WHO are sure of that.

. Light at the end of the tunnel - we will get out of this pandemic, how quickly we get there is up to us - case of “vaccines and” not “vaccines only”

WE CAN DO A LOT AT AN INDIVIDUAL LEVEL - DON’T FEEL POWERLESS - BY YOUR DECISIONS TODAY YOU CAN HELP SAVE MANY PEOPLE FROM COVID

It is right to be worried about this. But it's not apocalyptic. It's a realistic worry about potential for something similar to what happened in January in the UK.

We can do a LOT individually to protect the others around us by #DOITALL to stop transmission, knowing that this is what the scientists advise.

If you stop just one chain of transmission, potentially this could stop a superspreader event, with maybe dozens and eventually hundreds of cases.

You may be saving many from long COVID and even death, without even knowing it. That’s not nothing. We aren’t powerless, at an individual level we can do a lot and even more collectively.

DELTA SPREADING RAPIDLY IN UK DUE TO HIGH RISK ACTIVITIES

​⁠The fast spread in the UK is happening mainly in age groups 15 to 25, amongst people who take no precautions - you see them on TV - hugging each other, shouting, singing, no physical distancing. It's no wonder it spreads with a doubling time of 9 days.

​⁠If you don't do those high risk activities your chance of getting it is much lower.

DOUBLY VACCINATED PEOPLE CAN STILL INFECT OTHERS

The WHO to advise everyone to wear masks wherever possible even if doubly vaccinated. This is from a recent Q/A.

. Yes fully vaccinated people can still end up in hospital - very effective against severe disease, hospitalization and death, but no vaccine is 100% effective - continue to #DOITALL to protect yourself and stop transmission

This is an easy way to reduce your risk further and to reduce transmission.

From the Times of Israel,

  • A vaccinated person returned to Israel from London
  • They gave the virus to another vaccinated person
  • who then gave it to a school child
  • who then infected 75 other high school pupils at an end of term party.
  • Those could then infect many more
  • out of 75 you can expect 5 or 6 to get long COVID, sick for months, possibly longer.

. Officials to weigh reimposing some virus restrictions as Delta variant spreads

Also your risk of hospitalization or death is reduced if double dose vaccinated but not zero.

The way I think about it, I’m 66, and double dose vaccinated. This reduces my risk of hospitalization ten-fold, but it is still likely ten times higher than the risk of hospitalization of someone in their 20s. It’s not zero. Risk of death is likely reduced by a similar amount.

If you get a vaccine then once you are double dose vaccinated your risk of hospitalization is much lower and your risk of long COVID is likely reduced too.

WHAT ABOUT MASKS AT HOME?

​⁠There is some evidence here from China in spring 2020 - the ones who did that had less transmission within the household.

In a study of 124 Beijing households with > 1 laboratory-confirmed case of SARS-CoV-2 infection, mask use by the index patient and family contacts before the index patient developed symptoms reduced secondary transmission within the households by 79%

⁠Coronavirus Disease 2019 (COVID-19)

​
⁠That's a nearly 5-fold reduction. Especially with delta where there are many cases of everyone in a household getting it, many more than for previous variants, wearing fabric masks at home during periods of very high community transmission seems a wise move.

This is not saying to mandate masks at home. Not seen anyone suggest that. However, for people at home who want more protection, it's something you could do.

MASKS ESPECIALLY IMPORTANT WITH DELTA VARIANT

⁠Delta can transmit in 10 to 15 seconds.

This must be rare as otherwise it would have an R0 far higher than 5 to 8.. In that shopping mall in Australia only a few of the many people the index case passed actually got COVID.

However it does happen. Masks likely reduce the risk a lot.

Masks may be almost as good as a vaccination. Both at once is even better, and physical distancing as well and ventilation all brings it down while still continuing ordinary life otherwise.

THIS IS NOT FLU - SUMMER IS NOT A GOOD TIME TO EASE UP

We are in mid summer, with cases rising fast. The government is telling us, in the middle of a rapidly rising cases per day, that this is the best time to ease on measures, It's rather unconvincing.

It's true that winter has the additional pressure of the flu season. But flu never surges in summer like this.

It is clear from the way COVID is behaving in the UK right now that, unlike flu, the "COVID season" is year-round.

The evidence for seasonality is weak. WHO don't see it.

Dr Maria van Kerkhove:

(click to watch on Youtube)

There is no inevitable next step here. There is no inevitable aspect to this pandemic. It's what we make it.

The next step is not inevitable.

I think so many people want SARS-CoV2, COVID to have this predictability. Like flu. Like there will be a season. Like we can just get through the summer in the northern hemisphere then we will prepare for the winter. Or if we can just get through the summer in the southern hemisphere ...

People want COVID to be predictable.

They want it to have seasons.

This virus is not behaving this way. Maybe we will get to a point where there is a seasonality, or there will be some seasonal patterns, maybe that will happen, but right now, we are not seeing that.

The virus is not behaving in a seasonal way

Maybe in the future the virus will have some seasonal patterns

But right now we don't see seasonality

What we are seeing is that we are allowing this virus to spread between people through this combination of factors.

And this idea of having to prepare for a surge, to me it shows how much we have failed in our ability to express the need to be ready, to be vigilant and to invest in those systems now.

This idea that we have to prepare for a surge shows how much we (the WHO) have failed in our ability to explain.

We need to be

  • ready
  • vigilant
  • invest in those systems right now

 

SO WHEN DO WE EASE UP? WHEN EVERYONE HAS HAD A CHANCE TO BE FULLY VACCINATED?!

Mathematical Biologist Kit Yates:

We have vaccines coming along that are tweaked to the variants. We have vaccines already being tested down to age 6 months by Pfizer. We have 2nd and 3rd generation vaccines on their way that will be easier to make, more stable, easier to store and produce a stronger immune response.

There will be a time when we can open up fully and won't even need masks any more. But we can get there faster if we stop transmission now.

I go into all that here:

. Light at the end of the tunnel - we will get out of this pandemic, how quickly we get there is up to us - case of “vaccines and” not “vaccines only”

The pandemic will end eventually.

If the existing vaccines control it then we will have everyone in the UK vaccinated by the end of the year who wants to be right down to 6 months old, it will surely end then. There I'm assuming that the Pfizer trials down to six months are successful.

Probably well before.

If it has vaccine escape, then it depends on new vaccines that target the new variants. The lead time for those is about 3 months. So, if we found a new variant, say, next month in August then we would have new vaccines tailored to it by November.

However we also need to stop variants worldwide, as, even if we are back to "normal" with everyone vaccinated in the UK, a new variant could arise anywhere else. They are running at about one variant every 25 million cases. So for instance, if 20% of Africans got COVID, that's 200 million people, could lead to many new variants just from Africa alone.

This is why even just for self interest it is so important for the developed world to support rapid vaccination roll out in the weaker economies. It's not charity.

My blog post about it at Science20.

. WHO: To Prevent New Variants, Suppress COVID Globally : More Transmission = More Variants : Less Transmission = Less Variants

SHARE HIGH QUALITY INFORMATION TO HELP PROTECT YOUR COMMUNITY - IN REAL LIFE OR ONLINE

​⁠You can share the high quality information from the WHO with others in your community - this can help your community to prepare better and hopefully it spreads and more of them take more care.

​⁠A community that takes more care will be better protected as a community. If your household takes more care than others, you are better protected as a household. If your local community takes more care then a hot spot is less likely to arise there.

It’s the same online, if you share good information online, then it helps others in widely spread areas of the world to help their local communities too.

YOU CAN DONATE TO WHO

The WHO have had major shortfalls in funding this year. In the last social media Q/A they mention that out of their $1.9 billion funding, currently they have only $50 million in discretionary funding that they can mobilize anywhere in an emergency. That's not a lot given the large numbers of countries they respond to. They talk about this 28 minutes into this Q/A and also later on

Last year for the first time they started to receive donations from the public. They have received a quarter of a billion dollars of funding for the COVID rel

You can also donate to COVAX - I did. Whenever you get vaccinated in a wealthy country, if you can easily afford it, consider donating the cost of a vaccine dose to COVAX in their GoGiveOne campaign.

You can access all their fund raising campaigns here.

https://www.who.foundation/en

INDIVIDUAL ACTIONS TAKE A WHILE TO CHANGE THE COURSE OF GOVERNMENTS - BUT RIGHT NOW WE CAN SAVE THE HEALTH AND EVEN THE LIVES OF OTHERS - WITHOUT EVEN KNOWING IT

​⁠There is little we can do individually about cases rising in the country as a whole or in the world.

It is hard to influence governments that have set their mind on a particular path. It takes time. There is a huge response from experts trying to get our government in the UK to change direction. But it’s like trying to change the path of a supertanker. It’s got huge momentum, inertia. Just gut feeling and force of habit I think, but it takes a whiel tochange that.

We can add our voice to that, but there isn’t much we can do directly.

However we can immediately do a lot for our own tiny corner of the world.

The world is so interconnected, transmission that you stop here today could be cases in Africa or Brazil or the US or Indonesia or India or almost anywhere in the world prevented a few weeks from now.

By your individual actions, without knowing it, you could save hundreds of people from COVID weeks down the road in distant parts of the globe.

A child in the US, or Africa or Brazil or India may be spared from long COVID.

A vulnerable adult may be saved from death.

Just because you took a bit more care today with mask wearing, phsyical distancing, ventilation, avoding crowds etc

If you look at this positively there is much that every single one of us can do every day to help protect the lives and the health of others in the world.

Then collectively we can also begin to help turn the trajectory of this pandemic downwards as Dr Maria van Kerkhove put it in the social media Q/A on Monday

And so we are expecting to see more variants come. That is not to strike fear, it's a reality. More increased transmissible variants without the vaccine coverage is a dangerous situation. So let's course correct right now and see if we can turn a corner and make sure that those trajectories going up start coming back down.

WHO TO FOLLOW ON TWITTER ON COVID

Twitter is a great place for expert information on COVID, but you need to follow experts.

You can take a look at the list of people I follow. Here are some of the top experts I find especially helpful. Often tweet useful information, with their most recent tweets:

. Maria Van Kerkhove (@mvankerkhove) (COVID 19 technical lead for WHO)

This is her most recent tweet thread on the current situation

. Aleksandra Kuzmanovic (@KuzmanovicA) Social media manager at WHO - often retweets important COVID information, media articles about WHO and tweets about the social media Q/As for the WHO that she is the interviewer for

. Tedros Adhanom Ghebreyesus (@DrTedros) (Director of WHO)

Global response to COVID

. Independent SAGE (@IndependentSage) Often critical of the UK government plans. Get another insight different from the official message you see so often on TV.

. Prof. Christina Pagel - of Independent SAGE - she has been saying all along what SAGE also said but talks directly to the public

She retweets many interesting high quality tweets on topics related to COVID every day, including the latest academic reasearch findings.

This is one she retweeted today on vaccine escape.

She also does regular long thread type summaries on the current situation in the UK, most recent one here.

And posts about gaps and issues in the UK government’s health response as for Independent SAGE.

. Rachel Clarke (@doctor_oxford) - Palliative care doctor from Oxford who was called in to assist with people dying of COVID in the first wave and has been working on the frontline ever since and written a book about it.

Also

These people often retweet other experts. When they retweet someone who says something especially useful and helpful I often then follow the person they retweeted too.

WHERE TO FOLLOW ME

You can follow me at my blog on quora

. Debunking Doomsday

and on Twitter

. Robert Walker BSc, science blogger & fact checker

OUR DOOMSDAY DEBUNKED GROUP - VOLUNTARY FACT CHECKERS TO HELP SCARED PEOPLE

I help run a group of voluntary fact checkers to help people who are scared, often suicidal, by theses stories with realistic advice.

The aim is not positive spin, or sugar coating, but to help them access the best information available, fact check the infodemic, and fake news, and for genuine situations of concern such as COVID, global warming, or biodiversity loss, we use positive framing.

Positive framing means that you present true positive stories, not to counteract the negatives but to put them in context. Psychologists recommend that to motivate peole to action you need three positive framings to each negative framing. That includes stories of people who are doing things thta help and work.

This helps the scared people, and it also actually is more likely to lead to action than the extreme negative framing and even negative spin used by almost all activists today.

See my

. How to motivate your self, and others to act on climate change, biodiversity or anything else - tips from psychology

WELCOME FACT CHECKERS AND SCARED PEOPLE

We welcome fact checkers - if you are expert - or if you are good at reliable sourcing, and checking things, you are especially welcome.

Please check the rules before commenting and posting.

Clear rules are especially important since many of our members are autistic. It’s running at perhaps one in four of those scared of stories is autistic, far higher than the prevalence generally. They are particularly vulnerable to click bait headlines, for instance, as many autistic people are not easily able to parse hyperbole, or exaggerations.

So it is also very useful if you are used to talking to autistic people, also people who can help with reassuring people who are scared, just to be there and talk to them.

The group is also bipolar friendly. Those seem to be the groups of people mosst vulnerable to getting terrified by these stories.

However please don’t go away thinking it is only for you if you are autistic or bipolar. Most members are neither of those. Anyone who is scared of the click bait scary stories is welcome.