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Vaccine Roundup, Late December

There’s been a lot of news, so it’s time to survey the vaccine landscape. For this post, I’m only going to cover the big players that are either deep into human trials or have actually been rolling out vaccines to the general population – another post to come will go further down the list. But that still leaves us with plenty to talk about. The situation is. . .well, I’m going with “chaotic”, overused though it is.

I don’t have separate categories for the Pfizer/BioNTech and Moderna vaccines this time, since they’re already under EUA here in the US and people are being vaccinated as we speak. That rollout is worth a longer discussion, but it’s as much politics as it is medicine. Vice President Pence’s statement earlier this month of having 20 million people vaccinated by the end of the year is totally out of reach, though, and I believe that he has now altered that to having 20 million doses shipped (and I’m not even sure about that). The CDC says that vaccinated numbers should start rising steeply, and I certainly hope that’s the case.

Oxford/AstraZeneca: As the world knows, this adenovirus vector vaccine has been a messy one. I think that both partners need to take responsibility for some real mistakes in the trial execution and further mistakes in their announcements since the data became available. But I haven’t seen any sign of that (although I would be even happier than usual to be corrected on that point).

Last night, the UK authorities approved this vaccine for distribution there. Of special interest is the intent to give as many people as possible a first shot, without holding back supplies for the second round. I think that this is simultaneously the correct decision for them to make and also very bad news. It appears that the coronavirus variant first reported there is indeed more contagious: Trevor Bedford is convinced, and we have early data that would seem to only make sense if the R for this form is indeed higher. One mechanism for that may be higher viral load developing in patients more quickly, making them presumably more infectious (via shedding more viral particles). That said, it also appears (so far) that the course of disease with this variant is not actually worse than the other strains, but it’s not any better, either. And with higher transmission, that’s bad enough. (Note that the WHO believes that the South Africa variant is spreading quickly as well).

That situation in the UK appears to be one of the biggest factors driving the approval and rollout, and I see their point: this vaccine is indeed better than nothing, one shot for more people is likely to be better than two-shots-for-some, and it looks like they’re going to need all the help they can get. But “better than nothing” is a rough place to be. So what do we know about the efficacy of a single shot of the Oxford/AZ vaccine, and about the effect of waiting for a second one?

All I can say is that attempts to answer those questions land you immediately in a confusing mess. It’s a mess made worse by AstraZeneca, whose CEO has made statements about the vaccine’s efficacy that are not (so far) backed up by actual numbers. If you’d like me to name a major drug company that’s going to come out of this pandemic looking worse, it’s them. Anyway, as you’ll recall, initially there was a hint that a lower first dose followed by a standard second dose might be more protective overall (although I don’t think the evidence for that is very strong at all, considering the statistical spread in the data). But now there’s a report that increased efficacy might be driven by an even longer wait between the two doses. I don’t find that evidence very compelling, either (we’re getting into some pretty small subgroups by this point, and that is always a dangerous area to draw conclusions from). And if you’re going to leave people walking around with a half dose at first, or a full dose but with a longer wait for the second one, it makes the question above even more crucial: how protective is one dose?

We do not know. We don’t know for this vaccine, nor for the Pfizer/BioNTech one, nor for Moderna’s. No studies have been designed to find that out, so all we can do is guess based on what we’ve seen with the interval between doses in the two-dose studies. That’s been encouraging with the two mRNA vaccines, but remember: we don’t know how they are over a longer period, because no one was left without a second dose for that long. It’s certainly possible that without the second booster that the protection seen after one shot starts to wane. We do not know. And we know even less about the Oxford/AZ vaccine’s behavior under these conditions. Giving as many people in the UK as possible a single dose of that vaccine with a longer wait until the booster is a gamble, and you wouldn’t want to do it that way if the alternatives weren’t even worse. It’s the right move, unfortunately, and it’s a damned shame it’s come to this. Update: the UK is now planning to try this with the Pfizer/BioNTech vaccine as well – thoughts here.

The US trial of this vaccine was paused for weeks, of course, while adverse events were investigated. It’s basically fully enrolled now, and the data will include many more elderly patients than have been investigated to date. I would assume that our current terrible infection rates will allow this trial to move along rather quickly, but I have no estimate of when we might see it report.

J&J: data on the one-dose clinical trial of this adenovirus vector candidate should be coming very soon indeed. It’s going to be of great interest, given the results from the Oxford/AZ effort, and given the deliberate one-dose protocol. The company has a two-dose trial underway as well, but we won’t be seeing data on that one until later.

CanSino: this adenovirus vector vaccine (Ad5) is said to be submitting data to Mexico shortly, presumably for regulatory approval. Trials have been underway there, as well as in Pakistan, Chile, and other countries. No efficacy or safety data have been reported publicly, however.

Gamaleya Research Institute: this two-adenovirus-vector two-dose vaccine has made some news as well. Earlier this month, a press release from the GRI said that the vaccine was 91% effective, based on a trial with over 17,000 vaccinated patients and over 5600 controls. The release also says that a full paper is in the works, to be published in a leading journal, and I very much look forward to that. It appears that the vaccine is now being shipped to Belarus, Argentina and Hungary, but Reuters reports that the Argentina shipment is for only the first dose, which is the easier of the two different adenovirus vectors to manufacture. Nothing on the other countries as yet, but the Hungarian shipment was quite small (6,000 doses), which tells you that it’s more in press-release territory anyway. It’s unclear what’s going on – Reuters had a source saying that the Argentine shipment was excess production from the manufacture of the first shot, and that they’re still catching up on the second. I have seen no reliable figures on the protection offered by just that first shot – the director of the GRI has said, though, that immunity from the first shot lasts only 3 to 4 months.

Meanwhile, the earlier reported collaboration between GRI and AstraZeneca seems to be real – a clinical trial has been registered. I’m quite curious to see how this is going to go, and whether it will produce results in time to make any sort of impact.

Sinovac: Word has just come in the last couple of days from a trial in Turkey of this inactivated virus vaccine. Turkish officials said that it was 91% effective, but we have no numbers to back that up yet. What we do know is that this was based on a rather small trial (752 people vaccinated, 570 in the control group), so the confidence interval on that number is surely going to be large. Sinovac, for its part, seems to have said nothing yet. I’m glad to see that this vaccine seems to be working, but you would really want to see a lot more data on both efficacy and safety.

SinoPharm/Beijing Institute: this inactivated-virus vaccine candidate has just reported data in The Lancet from its Phase 1/2 trials (safety and immunogenicity). And they have now announced that interim analysis of Phase 3 data show 79% efficacy, but with no actual numbers yet. Note that this is the same one that UAE officials announced an 86% efficacy for, but (as far as I can see) SinoPharm has still made no comment on that. Everyone would very much like to have a more complete look at the data, but there is no word on when that will be forthcoming. We don’t know how many people were in these trials, the inclusion or diagnostic criteria used, nor do we have any safety data at all. So this could be encouraging, but I myself would rather stay home and wait for something with more numbers behind it, rather than take a vaccine on this basis. More on this as more data appear.

Novavax: this should be the next trial we hear about after J&J reports, and a lot of people are waiting to see how this recombinant-protein candidate works out. These will be results from a trial in the UK – a US Phase 3 just launched this week. This one has much less rigorous storage requirements and is generally easier to manufacture, and it could be a big contributor if things work out.

182 comments on “Vaccine Roundup, Late December”

  1. Matthew says:

    This chatter about only giving one dose of a prime/boost vaccine is foolishness.
    I hope no one takes that idea seriously.
    Additionally, vaccine administration is happening much too slowly at this point. Are local health officials in touch with their health facilities to track rates of administration to identify the bottlenecks and WHY things are moving so slowly?

    1. Smokerr says:

      I disagree.

      Perfect is the enemy of good enough.

      With the huge ramp up of cases, deaths and hospital capacity to zero in some states, let alone specific locations, something now is better than dead .

      If we can slow it down at all, that is a huge benefit.

      When you screw up the early stages the grim reaper strikes

      Holding doses back when the needs is critial is wrong.

      We can learn if a second dose works latter and we can then repeat the whole dose set as supplies allow.

      Perfect no, but we gave that up when an incompetent was elected.

      1. Mandark says:

        Smokerr, I don’t know why you assume that giving more people partial protection (with a single dose) would save more lives than giving fewer people full protection (with two doses). It’s not at all clear how the outcomes would compare.

        1. Chris Phillips says:

          Strictly we don’t have data to indicate an answer either way, do we?

          But I would say that the evidence points towards the first dose giving well over half the protection of two doses, in the short term.

          I think we are talking about short term expedients. The UK approach of not abandoning the second dose, but delaying it so that people can have the first dose sooner, seems sensible to me.

          1. Not-an-epidemiologist says:

            Agreed. But this should have been the policy weeks ago. The risk of inaction so massively outweighs the risk of action in the UK that it beggars belief they’ve waited so long.

            Re. Derek’s comments on AZ – yes, it was messy. But the company is stuck between a rock and a hard place – any admission of issues will be misinterpreted horribly by the general public, and right now the AZ vaccine is too big to fail. It’s the only (current) hope most countries have for population-level vaccination.

          2. Adrian says:

            “any admission of issues will be misinterpreted horribly by the general public”

            The University of Oxford and AstraZeneca have displayed a high level of incompetence.
            There is not much to misinterpret on that.
            Let’s pray the actual vaccine is not as botched as its creators.

            “It’s the only (current) hope most countries have for population-level vaccination.”

            Only if “most” is “India and the UK”.
            Sputnik V and the Chinese vaccines are the most popular vaccines in countries outside the EU and US.

          3. Smokerr says:

            Soviet and Chinese are a propaganda move and there is no data with them so its a full on crap shoot. That is truly a coin flip for undeveloped countries and not an enviable position to be in.

            As for effiecays of a 2nd shot and when, some of the writing says it was a compromise in getting people back for the second one.

            This is all new, they had no idea how long the first worked for let alone what the best timing for the second one is. So timing for the 2nd shot is a op aspect not best practices and tested (just like a partial Oxford dose for the first one and a full for the second one per UK)

            So yes, first get one now and two seconds latter is a possibility as well.

            As time will reveal more, get one or a partial one and then figure out where to go from there.

          4. Adrian says:

            News flash: The Soviet Union ceased existing 30 years ago.

            It is not true that “this is all new”, there are plenty of vaccines on the market for years where two shots are needed and it is well understood why.

    2. anon says:

      Well, as Derek said, J&J has a trial with one dose and a trial with two doses (which I am in!).

      One dose of a cheap and stable adenovirus-based vaccine, if effective, would be a great addition. Indeed, two doses might be better (and likely will be), but if it is a hair-splitting difference (say, 90% effective vs, 95% effective), one dose might win out

    3. Michael says:

      Matthew, what do you think of the current 55% dose reserve in the US? I agree purposely giving only one dose is not smart, but reserving so much supply to guarantee a second dose for everyone in the event of a complete supply disruption seems silly to me.

      If we weren’t holding those doses back, we could begin some of phase 1b now… Which could operate in parallel with the pharmacy driven LTCF program and the innoculations in hospitals. My county has plans to operate massive high capacity drive through clinics that could be triggered and begin ramping.

      1. Matthew says:

        Michael,
        The vaccine supplies in the individual states now is just the “first dose”.
        The second Pfizer doses are to be shipped imminently.
        No state has yet administered anywhere close to all of their allotted “first dose”. So it doesn’t matter if you flood the states with vaccines or if you increase the Prime vaccinations and delay the Boost vaccinations.
        The States aren’t able or willing to increase the rate of vaccinations.
        Hopefully this changes. But still no reason to dispense with or indefinitely delay the Boost dose.

        1. Michael says:

          Matthew–

          I think it does matter if you flood the states with it. There are some localities that have expended their whole dose. And my locality would be in phase 1B and would have other venues open for vaccination beyond the hospitals and LTCF’s, which would increase throughput.

          I’m not saying to reserve 0; just something more like 33% instead of 55%. Even if Pfizer stalled completely you’d still get most of the people their second dose.

        2. Michael says:

          Just for clarity, I’m not saying to dispense with or delay the second dose. I’m merely saying to not reserve fully for it, and to take a very small -risk- of delayed second doses if a worst-case production breakdown happens.

        3. Catinthehat says:

          It does matter not because of supply but because of vaccine administration constraints
          Starting Jan 1 The vaccinators will have to spend time vaccinating second dose recipients instead of first dose recipients.
          That’s the bottleneck right now the slow pace of the vaccinators. It will make this slow pace twice as slow.

          1. Michael says:

            Catinthehat– Again, if my locality had more of the reserved doses, there would be additional -parallel- vaccination efforts launched to reach essential workers. This could be expected to increase throughput.

    4. Charles Beck says:

      You are overlooking Vaxart candidate VXA-CoV2-1 which is the only oral vaccine in clinical trials. P1 readout in days. Possibly an important role in combatting the new variant by providing mucosal immunity. https://clinicaltrials.gov/ct2/show/NCT04563702?term=vaxart&draw=2&rank=1

    5. P Thompson says:

      What is a “recombinant protein” vaccine? TY

      1. sgcox says:

        Recombinant Spike protein (with some modifications to improve stability as I understand) plus adjuvant.

    6. Philip says:

      Matthew, I disagree with your statement: “This chatter about only giving one dose of a prime/boost vaccine is foolishness.”

      We know for the Moderna vaccine that one dose does give very good protection. From “Vaccines and Related Biological Products Advisory Committee December 17, 2020 Meeting Briefing Document – FDA (https://www.fda.gov/media/144434/download), table 15 shows a VE of 92.1% (95% CI: 68.8%, 99.1%) for just one dose. That is very close to the VE of 94.5% (95% CI: 86.5%, 97.8%) shown in table 9 for after the second dose plus two weeks.

      We don’t know how long it lasts or how much a delay in the second dose hurts protection, but we are in desperate times. Desperate times call for some calculated risk taking.

      The states need to go through as many people as they can following their priority list for three months with just one dose of one of the mRNA vaccines. After three months people who have had one dose go back on the priority list, near the top. No hold back of vaccines, get it into arms ASAP. The risk is worth it.

      1. DataWatcher says:

        At the very least, I could see administering one shot to people who have already contracted COVID-19 and recovered, holding off the second dose for at least six months (or whenever there are sufficient vaccines generally available). People who’ve had COVID have at least some immunity, so the single vaccine could act as a “booster” for them. Then, at the appropriate time, they could complete their regimen. I’m a little surprised this hasn’t been suggested; it could be a reasonable compromise.

        1. Adrian says:

          This is not “a reasonable compromise”, using a vaccine as a booster for people who already had an infection is uncharted territory and I am not aware of any data for that.

          The US and the UK currently have “trials” with multi-million people each enrolled that will show whether there are any safety issues doing that, but when it comes to protection the result is as unknown as they are for mixing shots of different vaccines.

          1. Michael says:

            I agree this is unreasonable.

            I just don’t understand why we’re holding back so many doses. 55% is a very large reserve.

            Even if Pfizer lost half of their production, you could still get everyone their second dose if you only held back 25%. In a worst case scenario where Pfizer completely stopped producing, 10M doses in flight, you’d get 5M people 1 dose and 2.5M people 2 doses, vs. 5M people 2 doses. You’d not want to do this in purpose, but this doesn’t seem like such a catastrophic difference for Pfizer stall. Even this scenario (2.5M fully vaxed, 5M people stuck with their second dose late) *probably* saves more lives than the alternative (5M people fully vaxed), though I admit it’s poorly understood.

            And throughput of administration would increase if there were more doses around– my county would be in phase 1B, and would have activated drive-through vaccination clinics at major COVID test sites.

          2. exGlaxoid says:

            The shingles vaccine is a booster for people that had chickpox originally, and it works great.

            There is some data comig from the trials on people who already had covid, not sure how much is out yet, but I believe that safety has already been shown.

        2. Boy, that makes great logical sense but hopefully it translates to immunological sense too.

  2. Ole says:

    Does anyone know if there are planned trials to determine if/to what degree vaccinated persons can transmit the disease? Seems important info,

    1. myst_05 says:

      This would be impossible to truly confirm without a vaccine challenge trial. If the UK follows up on their challenge trial plans, we would probably know the answer by the end of 2021…

    2. Mandark says:

      As myst_95 said, it’s impossible to test this directly, but the closest one could get was in the Oxford/AZ vaccine trial in the UK, where they tested for all infections (not just symptomatic ones) with regular PCR tests. Clearly, without an infection one cannot transmit (someone please correct me if I’m mistaken). But as this blog post says, the results of their studies are overall very messy.

  3. David W says:

    If the Novavax UK trial produces good results, what does that mean in terms of approval? Would the FDA approve based on UK data, or would they wait until the US trial also finishes?

    1. Patrick says:

      The FDA doesn’t require that trials be in the US, but it does seem to have higher quality standards than some other regulators, and it’s probably a little easier with US trials. But if the UK trial is robust in both size and design, then it could work for submission.

      1. luysii says:

        Patrick: That’s a welcome switch. Back in the mid to late 60s neurologists would read papers from Europe about the magical effects of L-DOPA for Parkinsonism and drool. The FDA didn’t accept any of this and required a US trial. It was finally approved in September 1970. You have to know how lousy the therapy for Parkinsonism was prior to L-DOPA. I actually saw a few people get out of wheelchairs once they got it.

        1. Michael says:

          The other thing is, the FDA is pretty skeptical when the demographics exposed to a trial do not map well to the demographics that would receive a drug in the US.

          A Japanese trial of a drug that would be mostly given to old white guys in the US may be no-go.

          1. luysii says:

            Michael:True enough, but European demographics in the 60s were much closer to those of the USA than they are now. Of all nonUSA cohorts they were the closest.

          2. Smokerr says:

            Never forget that there was Thalidomide as well.

            The carnage to avoid a bit of normal morning sickness was tragic.

            There is a balance invovled in all of this.

  4. Jonathan says:

    I think the Oxford/AstraZeneca always had a 4-12 week range in their protocol between first and second doses (someone please correct me if I am wrong). So going for one vaccination now on the basis there will be supplies for a booster in 3 months time is not entirely stupid.

    With the Pfizer vaccine the data (graph included on this website) indicated there was protection against symptomatic disease after only 11-12 days from the first date, but of course without knowing how long it lasted without the booster. I haven’t seen the equivalent graph for AstraZeneca.

    It is frustrating that more data is not yet public. AstraZeneca had an arm of their trial where subjects had PCR tests once a week, as well as reporting symptoms in line with the rest of the trial. They should know whether there is any evidence (although numbers will be limited) for the vaccine blocking transmission as well as symptoms.

    It is possible (I don’t know) that the long pause in AstraZeneca trials in the US will create a “natural experiment” on the efficacy of different intervals between doses.

    The other thing is that in the UK, with two vaccines now approved, there are reportedly academic groups proposing clinical trials exploring the efficacy of using different vaccines for primer and booster. However that will obviously take a while to report.

    1. Chris Phillips says:

      “AstraZeneca had an arm of their trial where subjects had PCR tests once a week, as well as reporting symptoms in line with the rest of the trial. They should know whether there is any evidence (although numbers will be limited) for the vaccine blocking transmission as well as symptoms.”

      That was in the Lancet publication a few weeks ago, wasn’t it? Significantly less efficacy for asymptomatic than for symptomatic infection.

    2. Tony M says:

      More data on AstraZeneca vaccine here:

      https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazeneca/information-for-healthcare-professionals-on-covid-19-vaccine-astrazeneca

      “The level of protection gained from a single dose of COVID-19 Vaccine AstraZeneca was assessed in an exploratory analysis that included participants who had received one dose. . Participants were censored from the analysis at the earliest time point of when they received a second dose or at 12 weeks post dose 1. In this population, vaccine efficacy from 22 days post dose 1 was 73.00%. COVID-19 Vaccine AstraZeneca 12/7,998 vs control 44/7,982.”

      “Exploratory analyses showed that increased immunogenicity was associated with a longer dose interval (see Immunogenicity Table 3)” Need to refer to the table in the link. Measured Immune response in those who received the booster greater than 12 weeks ( as measured by 28 days after 2nd dose) was nearly 3 times greater than those who received booster leas than 6 weeks.

      Regards

      1. Roland says:

        “median follow-up time post-dose 1 and post-dose 2 was 132 days and 63 days, respectively.”

        This suggests approx median 10 weeks between doses, and..

        “the interval between dose 1 and dose 2 ranged from 4 to 26 weeks”

        The >=4 week dosing is (at least primarily) because a large single-dose cohort was converted to two-dose protocol 7 weeks after the trial began, which hopefully is the explanation for such a haphazard spread of intervals (inviting people who’ve gone on their holidays back for a second dose at their leisure etc). The later cohorts were planned as 4 week intervals and seem to have hit <6 weeks because there's lots of data bunched in that range.

        The immunogenicity table hints that waiting even longer than 12 weeks is optimal. Seeing that I'm less surprised the MHRA allowed the longer interval. On admittedly limited data it looks win-win, and it's certainly a much more convincing hypothesis than 'maybe giving a lower dose first boosted immunity somehow'.

        1. achemist says:

          I really dont understand how they botched the trials so throughly.

          Its a big company that should know how to run drug trials by now. I get that everything was in a hurry – but so were all other companies. Either the other companies are better at keeping stuff under wraps or this is a giant fuckup.
          No idea if AZ or the Oxford team is to blame

          1. Smokerr says:

            In the US, State of West Virginia, somehow they manged to give doses of the Anti Body mix instead of Covd vaccine.

            Never underestimate the power of human stupidity. Not the same bottles, not the same supplier, not the same logistics path.

      2. Tony M says:

        I think it worth pointing out that in table – COVID-19 Vaccine AstraZeneca efficacy against COVID-19,
        it shows that for “any dose received” (for 10,014 in the vaccinated group and 10,000 in the control group) there was only 2 Hospitalisations out of 108 Covid-19 cases in the vaccine group and 16 Hospitalisations out of 227 cases in the control group. However, “Two cases of hospitalisation occurred on Days 1 and 10 post vaccination”. Consequently, no hospitalisations occurred after day 11 in the vaccinated group, which means that the vaccine is probably more effective at reducing hospitalisations than just Covid-19 infections.

        Regards

  5. Jason P says:

    Thanks Derek. I suspect going forward the focus is going to be on the manufacturing of these vaccines- why is it taking so long? As far as distribution goes, I thought the US Military with its logistical experience was running the show. I am sure that is a great strawman for politicians, but I suspect the snafu will be in manufacturing or the preparedness of locals administering the vaccines.

    1. John M says:

      Derek, this would be a great topic for a future post: what does it look like to manufacture a vaccine, especially an mRNA vaccine. I’ve heard in a variety of settings, “Why doesn’t the government just force Moderna to give us the recipe and then 1000 factories could start making it.” As though it’s literally a recipe for Oreos.

      You have touched on it many times, and some of your process chemist and pharmaceutical manufacturing commenters have described it here and there but a dedicated post to what it takes to 1) build and bring online a drug “factory”, 2) the extra challenges of manufacturing something completely new (mRNA in lipid nanoparticles), and 3) the specialized supply chain for the raw materials would be educational for all of us.

      1. Forgotten Wilbury says:

        Agreed, this would make a great post to point others to (and learn something from myself)! I’m sure one of the main points missed by most people is that GMP is a thing, and those facilities don’t spring from the ground fully formed.

      2. Derek Lowe says:

        That would indeed be a good post! I’m going to have to talk to more people who’ve actually had to do that sort of thing before I write it, though – my career has never taken me there, and it is certainly a different world.

        1. Mammalian scale-up person says:

          Derek, does the comment form that takes email addresses report them back to you?

  6. Else says:

    Any idea when we will know if the Pfizer/Moderna vaccines effective against the SouthAfrica/UK Variants? tnx

  7. Daniel Neely says:

    Is Astrazenica running multiple trials in the US? Someone I know was unblinded from a trial for that vax about a week ago. The impression I was given was that it was because the trial itself was over. If there was only one running, I’m wondering if she was unblinded because she’d been given the placebo; but was otherwise in the first group of staff her employer was vaccinating.

    1. exGlaxoid says:

      I’m in thew AZ trial.. With the second shot, they gave me a sheet with FAQs about possible senerios, like being offered the Pfizer/Moderna vaccine at work , needing to know your vaccination status for work, and many other issues. They asked people to contact the study people if offered any other vaccine, before getting it, and said that they could unblind you if you needed to know your status. They suggested gettingan approved vaccine if in the placebo arm, but not if in the AZ real vaccine arm, as that has not been studied, but again asked people to let them know their choice, so they can keep track of any issues of mixing vaccines. It will happen eventually, so better to look for any issues on the trial members.

      Both the first and second shots had no effect, not even a sore spot, so I might be saline, or the shot is the mildest vaccine ever. So if I get to the point I can get an approved vaccine, I might ask. Also, they said that once the trial has enough data to get approval, theyy will ask the FDA to allow them to give real vaccine to all placebo recipients.

      The study I am in is doing weekly covid symptom checks, but there will be blood tests and maybe nasel swaps several times after the second shot. I am convinced that the AZ vaccine does one major thing well, it appears to keep people from getting serious illness, which will help keep hospitals from being overwhelmed and prevent deaths. Since 40% of all deaths are from the 2-3 million people in nursing homes, once they are vaccinated for 2-3 weeks, there should be a dramtic drop in deaths and hospitalizations at least from that group, which should help hospitals better handle the rest of the patients.

      I agree with the UK idea of one shot first and then go back and do second shots ASAP, bassed on the evidense I have seen, it makes sense. Holding back so much vaccine in the US seems overly cautious in the light of 1000’s dying a day. The manufacturing process should only get faster and better over time, so holding backa little should be enough.

    2. John K says:

      I don’t think so. I’m in the AZD1222 trial. What I’ve been told is that they will unblind you if you have the opportunity to get one of the other vaccines or ask to be unblinded. They also said they will start unblinding people in the placebo group one they submit or have enough data for the EUA. They estimated that to be sometime in January.

  8. Mike S says:

    There is some lmportant news from Moderna. I am participating in the phase 3 trail. I just got an email saying that they are unblinding and will be giving the vaccine to those who received the placebo.

    1. Anon2 says:

      If Moderna is starting to see data that their vaccine does not have lasting efficacy (as hinted at when comparing t-cell activity during phase 1/2), dosing placebo patients now will cut off new data and keep their stock price from falling.

      1. Smokerr says:

        Or we have enough information to keep people out of the hospital and form dying?

        Of wait until we have data?

        I could care less how much money they make nor the PR end, and worry about the long term affects down the road when we can, get another dose!

        And how about those yearly flu shots. I am sure its all a plot so they have a revenue stream.

      2. Adrian says:

        For the other 4 human coronaviruses immunity lasts for less than a year, lasting immunity was always unlikely for COVID-19 vaccines.

        People in that age group already get a fresh shot of the influenza vaccine every year (although that is due to changing virus), it would not be a shocking surprise if people over 60 would need a COVID-19 shot every 3 months for the rest of their lives.

        1. Barry says:

          The closest relatives of SARSCoV2 are the coronaviruses causing SARS and MERS, not the four coldviruses. We have evidence from these two that immunity (Memory T-cells, not Memory B-cells) lasts for years. The author stresses that a focus on circulating IgG in plasma–although it’s the easiest measurement to make–correlates poorly with clinical outcome. IgA and T-cell responses are more important.

          https://www.cell.com/immunity/pdf/S1074-7613(20)30312-5.pdf

    2. Bill says:

      Surprised no one mentioned the schedule to approve US use of AZ perhaps in April.

      Of course I guess there’s no rush, so why be concerned with being four months behind UK and others? Clearly they don’t know what they’re doing — and we do.

  9. Masher says:

    Regarding efficacy against the new variants of the virus, in an interview on the BBC today a leading figure from the Oxford/AstraZeneca trial – Professor John Bell if I recall correctly – sounded confident that the UK variant would be susceptible to the vaccine because only one “shoulder” of the spike protein has a significant change (as he put it, attempting to explain it to laymen like me). However, he made worrying comments that the South Africa variant presents a far greater challenge because it has mutations on both “shoulders”.

    I believe that flu vaccines are tweaked each year to reflect the strains in circulation. Can anyone enlighten me as to whether that will also be possible against this new enemy? As the virus mutates, will it just be a case of redesigning/adjusting the vaccines to match and rolling them out, or will there need to be another 9 months of clinical trials for every new variant, which would be a nightmare?

    1. Marko says:

      My guess is that the mRNA vaccines will be directly comparable to flu vaccines in terms of updating. Once the “platform” is approved, a new paint job will be considered inconsequential in terms of safety.

      1. Anon2 says:

        This is not true. You don’t want promiscuous RNA in your system, who knows what damage it can cause. An attenuated virus like the influenza vaccines are an entirely different mechanism.

        1. Smokerr says:

          Maybe we can have a wedding and settle down them thar promiscuous RNA’s?

          1. Marko says:

            No vaccine, of any kind, could make my RNA more promiscuous than it is already.

        2. Patrick says:

          This is an essentially nonsensical statement. Promiscuous RNA? What, like in the vaccines already?

          Yeah, no, it should be relatively easy to input updated versions of the spike protein and run relatively simple and short immunogenicity and basic safety testing. This part of the promise of mRNA vaccines.

        3. DataWatcher says:

          Obviously, with all this promiscuous RNA running around, a prophylactic vaccine will be of utmost importance.

    2. Patrick says:

      I’m not an expert myself, but I have repeatedly read experts stating that the mRNA vaccine are highly tweakable and will have no issues in this regard. We may have to do it in times to come, but at least the mRNA vaccines are well prepared for it.

    3. rondi says:

      a little OT–Masher. you have some of the last name correct–> Campbell.
      He has a YT channel & has a 20 to 30min almost every night. Loaded with data–mostly from US & UK.

    4. Chris Phillips says:

      I suppose even if there had to be new trials to demonstrate safety alone, that could be done a lot more quickly than demonstrating efficacy again.

  10. Adrian says:

    “But now there’s a report that increased efficacy might be driven by an even longer wait between the two doses.”

    The Oxford vaccine has the design flaw of using the same vector twice, fading immune response against the vector would be a plausible explanation why waiting longer might be better for that specific vaccine.

    1. Chris Phillips says:

      That’s what I was thinking. Is this to do with the time course of an immune reaction to the vector?

      And is there any reason not to do some trials in the UK right now, alongside the mass vaccination programme, to investigate the timing issue (comparing different timings with one another rather than with a placebo, obviously)?

      If viral vector vaccines are going to be used in the future, isn’t this the ideal opportunity to clarify this issue?

      1. Adrian says:

        Using the same vector twice is a design flaw of the Oxford vaccine only, the Gamaleya/Sputnik V vaccine got that right by using two different vectors.

        Your “investigate the timing issue” suggestion to work around this Oxford vaccine problem has to some extent already been done (see the link from Derek), reliable data from new studies would obviously not be available before autumn.

        Derek mentions in his post the upcoming trial of giving one shot of the Oxford vaccine and one shot of one of the Sputnik V doses as attempt to workaround this flaw of the Oxford vaccine. Accelerating that trial would make more sense, since using one of the Sputnik V doses as booster shot for the Oxford vaccine would avoid the problems caused by using the same vector twice – one would assume this might elevate the protection to the same level as two doses of Sputnik V.

    2. Daniel says:

      J&J’s adenovirus vaccine already has 57 days between doses so they obviously think this is the case.

  11. Smokerr says:

    As Grant found out at Shiloh, win the battle now and worry about the war latter.

  12. DataWatcher says:

    “Additionally, vaccine administration is happening much too slowly at this point. Are local health officials in touch with their health facilities to track rates of administration to identify the bottlenecks and WHY things are moving so slowly?”

    Blame it on the chaotic, obsessively decentralized and privatized U.S. healthcare “non-system”. We have no coordinated public health infrastructure.

    I predict that vaccine rollouts and actual vaccinations will go much more smoothly, and begin to have a positive effect on COVID death rates and eventually infection rates more rapidly, in virtually all other developed nations than in the U.S. for quite some time. It’s likely that under a Biden administration, increased federal funding will allow us to ramp up vaccine production and distribution considerably; but the states will continue to be egregiously underfunded, infrastructure-poor, and short of necessary personnel. The state-by-state implementation of actual vaccination programs that we’re saddled with under our “system” will be an Achilles heel for a long time.

    1. DH says:

      ‘Blame it on the chaotic, obsessively decentralized and privatized U.S. healthcare “non-system”.’

      Yet somehow our chaotic, obsessively decentralized and privatized U.S. grocery “non-system” manages to get ice cream to every place it’s needed. How is this possible without nationalized food service? It’s astounding!

      1. sgcox says:

        May be because ice cream is something people really want and proactively looking for.
        No one is going to dentist or do intravenous doxorubicin for fun unless no choice.
        Or inject Pfizer vaccine for that matter.
        Completely different market system.

        1. Ken says:

          As Kenneth Arrow pointed out over 50 years ago.

      2. Daniel Barkalow says:

        It’s okay to waste some ice cream. If too much ice cream gets delivered to some small town by mistake, the manufacturer writes it off as a smaller cost than making sure it never happens would be. If a couple of cases of ice cream end up at a landscaping company instead of the grocery store they were intended for, they just send more to the right place. By spending a bit more money, you can make an extra 10% of the demand for ice cream, and make up for it in time and money by not having to make sure it doesn’t get wasted. It’s easy for a decentralized system to get something everywhere it’s needed and some places it’s not; it’s much harder for a decentralized system to get a limited and insufficient supply delivered only to places it’s needed, and fairly distributed among those.

      3. Wallace Grommet says:

        Who is shilling for Big Ice Cream when lactose intolerance is wreaking havoc?

      4. DataWatcher says:

        I’m afraid the “ice cream” analogy is faulty. The logistics of distribution, storage, and “administration” are totally different. A longstanding commercial product like ice cream has distribution routes and modalities well in place. No equivalent infrastructure exists in the U.S. for public health. Furthermore, ice cream is stored relatively easily, and is available at outlets ranging from chain supermarkets to corner stores, the vast majority of which are accessible to most people. It can be sold by any clerk or store employee (whereas a vaccine needs a trained medical professional to administer it). And if a frail senior citizen with limited mobility wants some ice cream, she can have one of her grandkids run to the corner store and pick some up. None of that is remotely true for a vaccine, which is difficult to store and is available at limited locations, many of which are NOT easily accessible to the people who need it most.

      5. Adrian says:

        It’s simple: Market economy works badly for healthcare.

        Market economy is based on the assumption of an informed customer who then chooses the best option.

        With ice cream it works – there are multiple manufacturer and multiple shops, and you choose the best offer.

        If you are unconsciousness after an accident, are you comparing what ambulance provider has the best offer?
        And then do a price comparison between hospitals?

        Also no insurance company would voluntarily accept customers wth pre-existing conditions whose treatment would cost more than the insurance premiums.

  13. tannebil says:

    The Tass piece quoting the director at GRI talked about a “light” vaccine that would be 85% effective but with immunity that only lasts 3-4 months.

    1. Is that just talking about some kind of efficacy decay curve where efficacy would drop below some defined level of effectiveness? How would that work in the antibody system? Does it mean that the vaccine just didn’t stimulate the production of the long-term memory antibodies?

    2. The placement of the Tass reference creates an association that implies the first dose of the Sputnik 5 is this light vaccine but the Tass article doesn’t make an explicit connection that the GRI director is referring to it. Is there anything more explicit? Does that leave the countries like Argentina that are already administering the first dose swinging in the breeze if GRI can’t deliver the second?

    1. tannebil says:

      Found something else from Tass clarifying that in the comments a week earlier that the “light” vaccine is the first shot in the Sputnik V two-shot series and that the usage would be if a country needed to act fast and cheap. Seems odd unless it is a round-about way of saying that they can produce a lot more of shot 1 than shot 2 so they are trying to create a “shot 1 only” market. I wonder if a production imbalance is the motivation for the GRI/AstraZeneca work as well. Details seem scarce on that effort.

      https://tass.com/russia/1239597

      1. Adrian says:

        “The main goal of this preparation is to decrease the number of deaths caused by the coronavirus in countries with very high death tolls.”

        With only one shot the price would be half, and distribution is a lot easier.
        The latter might not be a problem in countries like Russia or Cuba that have a functioning healthcare system, but in many other countries administering two shots with a fixed interval between them can be a huge challenge.

        1. Mariner says:

          I’m pretty sure I read an article somewhere that mentioned that the Russians were having problems with the production of the Ad26 vaccine for the second dose. Pushing the one they aren’t encountering manufacturing problems with is also good business as well as perhaps being able to save lives.

  14. Matt says:

    Isn’t there a risk that a single shot approach, while protecting the individual, would risk fixing evasive mutations more effectively than a two shot approach? Any opinions?

    1. Adrian says:

      As of today we do not even have data whether the approved vaccines actually reduce infections and transmissions, or whether they only reduce symptoms.

      In a monkey trial for the Oxford vaccine the monkeys were still infected, but they were protected from serious COVID-19 like in the human vaccine trials.

      If vaccines do not reduce infections, the vaccines might in any case already encourage evasive mutations in the virus.

      1. DataWatcher says:

        “In a monkey trial for the Oxford vaccine the monkeys were still infected, but they were protected from serious COVID-19 like in the human vaccine trials.”

        My memory tells me that the results were similar for the J&J single-dose vaccine — encouraging efficacy in terms of symptomatic disease, but infection still evident in the nasal passages.

    2. DataWatcher says:

      Matt, this has been suggested. I don’t remember where, now, but not long after the initial EUA was granted for the Pfizer/BioNTech vaccine, I saw an article where it suggested that people who took only one shot and neglected to take the second one would heighten the risk of exactly what you suggest. I don’t know whether that’s still considered a potential problem, but I haven’t seen it mentioned in the context of the UK policy.

  15. mallam says:

    What about the Sanofi/GSK using the latter’s super duper adjuvent?

  16. Jonathan says:

    I think we need an update on vaccine reactions. In Canada, the rate of serious reactions seem close to 1 in 5,000, which is high and there is evidence it is dissuading people to take it. One such young 27 year old needed CPR: https://www.cbc.ca/news/canada/hamilton/covid-19-vaccine-allergic-reaction-1.5856827

    Is there anything really being done about this? I suggest if it doesn’t get identified and fixed soon without as effective alternatives coming to market, it WILL complicate the end of the pandemic because many people will not take it. 60% of Canadians (normally a passive population) are concerned about its side effects: https://www.businesswire.com/news/home/20201230005039/en/Optimity-2020-COVID-19-Vaccine-Survey-Finds-That-59-of-Canadians-are-Concerned-About-Side-Effects-from-the-Vaccine

    I am concerned that it’s not enough to say people who have allergies should stay away, since many people have allergies and will be afraid to get the shots.

  17. Charles Coe says:

    https://www.nature.com/articles/s41467-020-19818-2

    This is a month old, but contact tracing of the “new” strain of COVID in GB did not seem to show significant increased transmission. Has something changed since?

    1. DataWatcher says:

      Unless I’m missing something — and please pardon me if I am — the general consensus is that this new strain (as well as the new one found in South Africa) is, indeed, more transmissible, but exactly how *much* more has yet to be determined. I think we’ve seen a lot of scare headlines and panicked reactions, and perhaps they’re justified (better to err on the side of caution), but the fact is that we still really don’t know. These new strains apparently arose during a time when there was an overall very significant uptick in new cases, so it may be difficult to tease out how much of the increase in transmission is actually due to the mutation, and how much will turn out to be revealed as another case of “Post hoc ergo propter hoc.”

    2. Chris Phillips says:

      Yes – contact tracing has shown secondary infection of about 15% of contacts for the new variant compared with 10% for others. Consistent with estimates of 50% increased transmissibility from the speed with which the new variant is supplanting others in south-east England.

    1. DataWatcher says:

      Any idea why France, of all places, seems to be such a hotbed of anti-vax sentiment?

      1. achmist says:

        They have a basically pathological aversion of authority.

        Applied to kings, applies to presidents and unfortunately also applies to science.

    2. sgcox says:

      Looks like we will soon learn the effect of mass vaccination in Israel.
      They are on the way to get 25% population vaccinated by the end of January.
      Now, that is the efficiency !

  18. Marko says:

    So refreshing to see clear arguments used to support policies designed to prevent carnage, rather than promote it :

    https://app.box.com/s/uwwn2dv4o2d0ena726gf4403f3p2acnu

    This will mark the turning point where we go from the US and the UK both managing the pandemic dreadfully, to the UK leaving that category, leaving the US to wallow in that swill alone.

    1. DataWatcher says:

      Marko, this does look good. I admit I hadn’t been aware of data that showed increased efficacy associated with a longer waiting time between doses in the Moderna and Pfizer/BioNTech vaccines I remain skeptical about a “one-shot only” policy, but from the looks of this, a longer waiting time could be a win-win situation: more vaccines immediately available, AND higher efficacy overall. If this is the case, what are the odds that a policy such as this might be adopted in the U.S., perhaps after Jan. 20 when the scientists are once again back in charge? (Alternately, it could at least be “highly recommended” that people wait longer, which might work better for Americans loath to feel as if they’re being asked to “obey” anything for their own good!)

      Of course, if everyone is waiting for over two months, instead of one, to get their second dose, it will probably take longer for our initial rollout to be completed, meaning that a full reopening of the economy could be delayed for at least an additional several months. Do you think that would meet significant resistance in the U.S.?

      1. Marko says:

        “…meaning that a full reopening of the economy could be delayed for at least an additional several months. Do you think that would meet significant resistance in the U.S.? ”

        We don’t even know yet if the vaccines will prevent transmission. We do know that they will prevent severe disease and deaths, and the falloff in deaths will be directly related to how many at-risk people get a timely shot. I predict we’ll be able to see the difference in the US vs UK death data within a few months.

        Yes, in the US, the economy is all. That’s what we’re hyper-focused on, not on preventing deaths.

        1. Marko says:

          I’m assuming, of course, that the UK regulators follow through with those recommendations. I have no reason to think that they’re any less constipated than those in the US, I just hope they are.

      2. Adrian says:

        Reopening before the virus is defeated only brings more carnage and the next lockdown.

        Just a few weeks ago the major of London was promoting carnage by begging people to go shopping instead of telling people to maintain social distancing, and now more people are dying due to this masked mass murderer.

        If the goal was a full reopening of the economy as fast as possible, then the only option would be to ignore vaccines and do suppression instead.

        A hard lockdown for 3 months, and COVID-19 is gone.
        The carnage will already be over earlier.

        That’s the solution countries like China or New Zealand have chosen, and it would still be faster and economically cheaper if done today.

        What are the current estimates in how many months the whole population in the US or the UK might be vaccinated?

        1. Marko says:

          ” What are the current estimates in how many months the whole population in the US or the UK might be vaccinated? ”

          The way things are going in the US, I’d guess 5-10 years.

        2. Carl says:

          A long time, they where protecting a third of the UK population by april, but that was before they made the one shot decision.

          The real issue in the UK is that different pieces of the government have been fighting themselves. It was obvious at the end of November that the PM and his cabinet wanted a full lock-down over Christmas but parliament wouldn’t have.

          1. Scepticalscientist says:

            No. It was the prime minister who was set on allowing as ‘normal’ a Christmas as possible. He dithers on almost every decision leading to the sorry mess the UK is now in.

  19. Dave's brother. says:

    Given the probability of higher viral loads in the new strain and the apparently unchanged mortality rate, it is safe to assume at this point that the immune response is where it’s at. I ask because the thought occurs, god forbid, that should another variant come along capable of evading current vaccines (won’t there be selective forces in this direction) that the smart money would be to redirect R&D in this direction. Seems it’s a direction that offers benefits beyond the coronavirus.

    1. Adrian says:

      All we know about the new variant is statistical analysis that it had higher R in the lockdown conditions that were already present when it appeared in England a few months ago.

      Reasons could for example be:
      – higher viral load
      – lower viral load required for infection
      – the virus survives longer outside the human body
      – better at avoiding the immune response, infected people are longer infectious
      – more asymptomatic infections
      – …

      Some plausible explanations are less likely than others, but so far we simply don’t have data to decide what the actual reason is.

      1. DataWatcher says:

        If England is at all like the U.S., a good number of individuals and businesses were probably violating the “lockdown” restrictions (e.g., having large private gatherings, being lax in enforcing masking and “distancing” requirements) increasingly as the autumn season wore on. Might this be at least a contributing factor?

        1. sgcox says:

          That would imply that people in Kent and South London are particularly naughty which is not the case. The new variant was specifically identified as the alarm was raised by a statistical anomaly. In all other parts of the country under similar conditions, including Scotland and Wales the infection rates were going down as expected but in South East was accelerating like no measures have been taken.
          There is no questions that it is indeed more transmissible, question is only by how much.

  20. Marko says:

    Tulsi rightfully calling out her thoughtless colleagues :

    https://twitter.com/TulsiGabbard/status/1344806404062814208

  21. Duncan says:

    On the UK dosing issue.

    Part of the controversy here is that people who have had dose 1 and who had appointments booked for dose 2 are having those appointments cancelled and rebooked at short notice. That includes my 86 year old Auntie. It will also include a large number of very frail and elderly people. It will also soak up administration time that surely would be better used at least taking appointments that were already booked.

    On the science, instinctively my feeling is that we should be following what Pfizer, AZ, Moderna et al say. BUT… in defence of the UK government (something I have not said much recently) it does look like the idea of a longer time between the two doses is not at all a fringe idea. It seems that there are a number of very credible scientists who are mainstream and who are hardly tainted by electoral politics or the culture wars who are saying that the longer gap is the right strategy, at least in the circumstances.

    https://www.sciencemediacentre.org/expert-reaction-to-the-oxford-astrazeneca-covid-19-vaccine-being-approved-for-use-in-the-uk-by-the-mhra/

    As a layman it is hard for me to judge, however there does seem to be a genuine divide of expert scientific opinion on this question. Whilst I am quite certain that no scientist is acting in bad faith I do question the wisdom of playing this out on social media platforms.

    For the UK it looks like 4th January is showtime and we find out what mass vaccination looks like. I, of course, hope that all parts of the world have a very successful rollout with successful vaccines and we learn best practices that will be with us for decades.

  22. Chris Phillips says:

    Preprint from Imperial College on transmission of the new UK variant:
    “There is a consensus among all analyses that the VOC has a substantial transmission advantage, with the estimated difference in reproduction numbers between VOC and non-VOC ranging between 0.4 and 0.7, and the ratio of reproduction numbers varying between 1.4 and 1.8. We note that these estimates of transmission advantage apply to a period where high levels of social distancing were in place in England; extrapolation to other transmission contexts therefore requires caution.”
    https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-12-31-COVID19-Report-42-Preprint-VOC.pdf

    1. Marko says:

      One thing I find curious is the extent to which the increase in cases of the UK variant is concentrated in the <19 age group. Given that that's the same group you might expect to have higher levels of antibody to common cold coronaviruses (ccc ), it makes me wonder if they're missing an "immune escape" component of the higher transmissibility they've seen.

      They rule out immune escape by looking at reinfection rates and by testing mutations vs. convalescent plasma, etc., but that's all CoV-2 specific. I'd like to see someone test vs. ccc convalescent plasmas.

      Admittedly, it's never been proven that ccc immunity protects against CoV-2 infection, but the possibility hasn't been ruled out, either. It seems to me that it should be one of the mechanisms that would be investigated in trying to sort out the higher transmissibility of variants.

      1. Chris Phillips says:

        The preprint from Imperial College suggests as a possible reason that schools remained open during the November lockdown in the UK, so that children of school age would have been mixing more than adults. Though the preprint also leaves open the possibility that transmissibility among young people is intrinsically higher.

        1. Adrian says:

          Transmission among children might have been reduced for the old variant.
          Note that children always meant < 10 year, the 10-19 age group is more like adults.

          In a study in schools in Austria, the 7-day incidence was something like 300/100k that was not different from the situation among adults.

          In autumn the professions with the highest risk of infection in Germany were not nurses or people working in a supermarket or any other assumed risk group – the professions with the highest risk of infection were school teachers and kindergarten teachers.

          If you force 25 children in the age group 10-19 into the same room every workday with no protection except cloth masks, they are at a higher risk of infection than many working adults.

          1. Mariner says:

            Just to note, in the UK the children (and staff) must wear masks in the corridors, but they do not wear them during the lessons themselves. The teachers are supposed to stay at the front of the class to a degree, but this isn’t possible if a child requires assistance.

            My wife is a secondary school teacher and is understandably concerned that she works in rooms with a couple of hundred unmasked teenagers over the course of each week. With the apparent increase in transmissibility of the new variant, I’d imagine she would be more at risk of infection. And from there, myself, our young children and my septuagenarian parents who help with childcare when we’re both working.

            We’ll have to see whether or not the authorities take the schools into account enough given the spread of the new variant. I’m of the opinion that we’ll probably have a heavy national lockdown before too long, no doubt too late to help many people.

          2. Adrian says:

            If your wife is worried about “unmasked teenagers”, then tell her that cloth masks wouldn’t make much difference.

            Germany does the cloth mask circus also in the class rooms.
            In a school in Hamburg for teenage children a genetic analysis of an outbreak in September was done.
            The result was that most likely one person brought the infection into the school, where it spread to at least 30 teachers and pupils.

            The sane action for the British government would be to announce now that schools will stay closed until Easter.
            It is not realistic that current lockdown restrictions in the UK can be relaxed earlier.

          3. Uncle Steve says:

            In the UK, does it not look increasingly like an epidemic of test results rather than disease?

            It’s happened before with PCR:
            https://www.nytimes.com/2007/01/22/health/22whoop.html

            At the very least, surely positive PCR tests should be double-checked and/or followed up with lateral flow/antibody testing? Why isn’t this standard practice?

          4. Adrian says:

            No, it does not look like a problem with test results only in the UK.

            False positives in testing are easy to prove or disprove by looking at hospital utilisation and number of daily deaths 1-2 weeks later.

            https://www.theguardian.com/world/2021/jan/02/london-hospital-nurse-patient-safety-covid-cases-whittington
            “It’s not having enough nurses to care for patients – patient safety is being affected,” the nurse told PA Media. “Some are in corridors, being looked after in makeshift areas, makeshift wards have been created for Covid patients, and ICUs are running out of space.

          5. WST says:

            In UK, 10% of randomly selected PCR swabs are sent for full analysis, and the virus RNA is sequenced , it’s an independent confirmation of the tests findings.
            In Denmark, 10-20% of the swabs are sequenced.
            In several clinical testes PCR tests were used in parallel with sequencing and viral culture.
            Other EU countries also regularly sequence samples .

            With so much parallel independent verifications going on , it’s obvious that any claims of “false epidemic” are of the “earth is flat” quality.

    2. JRRT the Younger says:

      For alternative take on latest pre-print from Imperial College, please see…

      https://blogs.sciencemag.org/pipeline/archives/2020/12/22/the-new-mutations#comment-335688

      Scroll down to penultimate comment out of 202 (up to now):

      1 January, 2021 at 9:38 am

      1. Chris Phillips says:

        Really? “Reclyne in ye armchayr in ye laboratorium”? What a lot of crap.

        If there were any serious point to be made, I’d be only to happy to hear it, but this kind of drivel is just offensive, given the number of people dying right now.

        1. JRRT the Younger says:

          Thank you for feedback, much appreciated, although citing one line out of context bit of an old debating trick. If nowt else, know one reader has read to the end. Wonder what the Data Baron would make of it? Rest assured, that’s not you, nor any other hospital staff. Utmost respect for all of you, as said already elsewhere.

          Assume that like scribes, data barons not allowed to set foot in almshouses these days. Near as can be got to underlying truth will out in the end. I may be right, I may be wrong, or maybe somewhere in between. Reasonable to think same goes for all protagonists in what’s becoming a bit of a scientific, philosophical and political civil war of reason and emotion. Plenty in these comments from the majority side, so here’s a link to a minority platform…

          https://lockdownsceptics.org/

          As for the hospital wards, all the very best to the best of the best with that.

  23. Aki says:

    There is now a contest on making algorithm for optimizing the covid vaccine structure. See https://berthub.eu/articles/posts/part-2-reverse-engineering-source-code-of-the-biontech-pfizer-vaccine/

  24. Lane Simonian says:

    This CDC recommendations on vaccines seems like a bit of a mish-mash:

    https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

    The following in particular seems problematical:

    “While there is otherwise no recommended minimum interval between infection and vaccination, current evidence suggests that reinfection is uncommon in the 90 days after initial infection. Thus, persons with documented acute SARS-CoV-2 infection in the preceding 90 days may delay vaccination until near the end of this period, if desired.”

    I am not sure how they came by the 90 day number, but if reinfections are quite rare then it seem like the last group that needs a vaccination are those who have already been infected by the virus, especially given distribution problems.

    There are scattered reports that those who have already been infected by this novel coronavirus are also more likely to experience adverse side effects. That is also somehting that should be nailed down one way or another before too much passage of time.

    1. Michael says:

      Not vaccinating people with documented cases only moves the needle a little bit. Yes, it’s better to avoid if possible, but it’s not going to massively stretch supply– only around 6% at best. And some of those people are false positives or people who didn’t build sterilizing immunity.

      I agree it’s worth watching the side effect profile carefully in this population.

      90 days seems like a sane compromise; enough to clear the worst part of the supply hurdles and still small in comparison of time of natural immunity. There’s no perfect justification for any number. It means that we’ll probably be vaccinating phase 1C and healthcare workers who delayed for this reason at the same time, which seems reasonable.

      1. DataWatcher says:

        I’m wondering if healthcare workers who choose to “delay” their first vaccinations will be a problem. Data so far seem to show significant resistance among nurses, aides, and other front-line providers; in my own experience, a good friend is staffing coordinator in a major urban hospital — it’s her job to sign people up to get vaccinated — and she reports that at least 70% of the nurses and other front-line workers she’s tried to sign up have said, “No, I’m not sure if it’s safe yet; I’ll wait awhile to see.” If they decide that “awhile” has run its course in a few months, when others are in line to get vaccinated, we could see some pretty dicey bottlenecks arising. Who gets first dibs — someone who was eligible in December or January but decided to “wait awhile,” or someone who is *now” eligible in April or May? And in the meantime, how much risk did those unvaccinated providers continue to pose for their patients and colleagues? (And, for that matter, will the vaccines earmarked for those folks who decided to “wait” go to waste, or can they be reallocated to someone else immediately, even if that person isn’t technically in the “eligible” cohort right now?)

        1. Bill says:

          I get a little concerned when so many critical Covid care workers think the vaccines might not be safe. But then I get to thinking how terribly overworked and emotionally battered they are. I doubt they have the time to track the science. Plus are living in a constant state of fear — who knows how that affects your decisions? Hats off to them. I expect they’ll come around eventually.

          1. DataWatcher says:

            Bill, I agree 100% — I know quite a few front-line healthcare workers, from nurses to medical assistants and aides, and their daily life is akin to working in a M.A.S.H. unit in the middle of a firefight. And, of course, many are African-American, and even though they’re now part of “the system,” they have very good, historical reasons for still distrusting it. I don’t “blame” them at all. Nonetheless their reluctance is unfortunate, both in immunological terms and in terms of the “example” they’re setting for laypeople, who desperately need the reassuring voices of medical professionals to help assuage their own doubts.

        2. Adrian says:

          “And in the meantime, how much risk did those unvaccinated providers continue to pose for their patients and colleagues?”

          If vaccinations only turn symptomatic infections into asymptomatic infections, then vaccinated providers increase the risk for their patients and colleagues.

          1. Some idiot says:

            For what it’s worth, here in Denmark, nursing home residents are being vaccinated at the same time as the personnel in that nursing home. Which sort of would address that question. But we really need the answer to that question…

          2. Adrian says:

            For nursing homes this is an option, but not for health care workers in a hospital.

          3. Wallace Grommet says:

            Present your data. It will be rigorously scrutinized

        3. Wallace Grommet says:

          Not the case here in Washington State. Most general practitioners are eager to be immunized, including my ARNP partner. My hospital-based radiologist sister has already been inoculated and reports no side effects.

    2. Adrian says:

      Based on the experience with other human coronaviruses, immunity against COVID-19 is only temporary.

      The 90 day number seems reasonable based on what is currently known about immunity, it would be optimistic to assume that the majority of people who had COVID-19 back in spring last year would still be immune today.

      Derek quotes in his post that the first shot of Sputnik V only gives 3-4 months immunity, this also matches the 90 days.

      1. aviators99 says:

        Clearly for this coronavirus it’s much longer than 90 days. We didn’t see any proven reinfections in the first 90 days, and 12 months later the number of reinfections is statistically insignificant.

        1. Adrian says:

          “We didn’t see any proven reinfections in the first 90 days”

          This is fake news, see for example
          https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30764-7/fulltext

  25. Sc says:

    Apparently the UK’s recently updated vaccination green book says that if a second dose of the vaccine you got isn’t available, or if you don’t know which you got, you can just take whatever is available. While I think it’s likely a combination will work this seems like one heck of a way to find out…

    1. Chris Phillips says:

      Surely they shouldn’t be relying on members of the public to remember which vaccine they got?

      Not that I can’t believe it – medical workers routinely relied on my father to tell them whether he had allergies, despite the fact they knew he had dementia.

      1. Smokerr says:

        Yep, I finally asked the Nurse assistant one day, why do we keep repeating all this stuff each time I come here, you write it down, put it the computer and then you want a list of what I am taking again.

        Every so many months I fill out your sheet.

        Does anyone read this stuff?

        1. Jason P says:

          Perhaps it is because you could have stopped taking some medications or started taking additional medications? Would you want to be treat with something that is deletarious to you because you didn’t disclose something?

          Also, I have to wonder if the interview process isn’t diagnostic in its self. Memory, speech patterns, etc perhaps add additional information?

  26. DataWatcher says:

    Apparently there’s a lot of state-by-state leeway on this. Here’s the guideline from the Mississippi State Dept. of Health:

    “You can be vaccinated if you have tested positive for COVID-19 if you wait until your isolation period is over and your symptoms have significantly improved.”

  27. Julia says:

    Slaoui says oxford/AZ vaccine cannot be approved yet because there isn’t enough data on elderly people. Can anybody explain why it can’t be approved now for other ages?

    1. Bill says:

      Seems to me most everything they do is based on following staid traditional policies and not at all focused on saving lives in the immediate future. The US is going to have half a million deaths before this is over and the nearly all of them will be traceable to incomprehensible public health response and populace non-cooperation. A serious indictment of our values and competence as a country.

      1. Marko says:

        “A serious indictment of our values and competence as a country.”

        Exactly. But , to be honest , it’s only the most recent of such indictments in a long-running list.

  28. Paul says:

    Is there any suggestion that the different dosing rules imposed by the UK goverment will be used to actually gather usefull info on that approach, i.e by designing and conducting a controlled trial ? Given Pfizer’s statements it seems they’re not involved in such a study, and the MHRA haven’t stated they’re collecting it. The rollout of the vaccine itself is chaotic, but it would seem a good time to try to gather the data that might answer some of our questions, any indications if anyone is collecting that data and if so, who ?

  29. Marko says:

    It looks like the SARS-CoV-2 TaqPath S dropouts (SGTF) may not yet be a good proxy for the UK variant in the US. Only 4 of 31 such dropouts that were sequenced turned out to be the UK variant , while in the UK, the vast majority are:

    https://twitter.com/dmaccannell/status/1345081019225894912

    1. Duncan says:

      Certainly it is far from the ideal, albeit my reading is that ‘mixing and matching’ would happen only in an extremely low number of cases.

      My suspicion is that the UK is simply the first to bump up against issues that other countries will bump up against soon.

      I understand that some parts of Canada have already gone down the route of prioritising first doses. It has been reported that Ireland is at least considering the UK’s approach – https://www.irishtimes.com/news/ireland/irish-news/prolonging-interval-between-covid-vaccine-shots-to-aid-rollout-speed-examined-1.4448401. It it likely that others are doing the same.

      Indeed I see that Fauci said that whilst he expected the US to continue following the shorter gap I did not see his comments as explicitly ruling out longer gaps forever.

      The other factor in all of this is whether or not J&J’s one dose formula works with one dose. That would be a true game changer and I’m very surprised that the media have not talked more about that.

    2. Chris Phillips says:

      Apparently the editor of the BMJ has written to the NYT asking them to correct their report, which she says is misleading.

      I don’t think it is (and I don’t think the MSN version is, either). But this is meant to happen only in exceptional circumstances if the person concerned is considered to be at high risk or is not considered likely to attend again.

      1. Duncan says:

        There is though a broader issue here that I’m starting to get increasingly concerned about. I have been concerned about so-called ‘science by press release.’ However we are now really starting to see ‘science by twitter brawl.’

        Over the past few days some people (including some I have worked with) who I thought of as level-headed and thoughtful seem to have lost their heads completely.

        What we are seeing with the UK’s approach is, it seems, a genuine scientific disagreement – no doubt seriously held. But the way this has turned into a social media brawl is something that should make a lot of people reflect. Granted: as the pandemic has gone on many people from many walks of life perhaps should have stepped away from social media. But what has happened in the past few days across scientific communities has gone to another level.

        Of course there has always been scientific disagreement, what we see now is what in the past happened on the pages of journals and in seminar rooms being played out on social media. Anyone that thinks there is such a thing as ‘the science’ asks to be deceived.

        I’ve spent 20 years working for scientific professional institutions and what I’m seeing now would have been regarded with horror in 1999. It’s time to take a step back, it’s time to rethink science and social media and it’s time to realise that science does not happen on twitter – however eminent the people at the keyboard are.

        1. Jason P says:

          Amen Bro!

          1. RHB says:

            Spot on.

  30. Smokerr says:

    There is a huge factor of the so called Essential Workers wanting to be first in line.

    First that was arbitrary. In Alaska, Sea Food workers were deemed essential.. That is not society essential, that is industry essential and political clout.

    So now they want to be in front of the line.

    Vulnerable and impact vs essential are are not remotely the same. Prisoners are not essential, but they are disproportional rates and they spread to the community and it was not part of the sentencing to do that to them.

    Older people that get sick and take up hospital beds need to be done first so hospitals are free to treat as needed no have to go to death panels.

    Most people can protect themselves with masks and distancing , stop travel and not socializing but don’t want to. So they make it worse.

    A grocery store worker is important, but there are many of those and they tend younger.

    Its arbitrary and its political and those should not be the drivers.

  31. Chris Phillips says:

    Apparently the Indian regulator has approved the AstraZeneca vaccine and also a vaccine called Covax developed by Bharat Biotech in collaboration with the Indian Council of Medical Research and National Institute of Virology. The latter apparently on the basis of Phase 1 and 2 results, as Phase 3 is still in progress.

    I’m afraid I’ve never heard of Covax. It’s an inactivated vaccine, and some more information is available here:
    https://www.hindustantimes.com/india-news/bharat-biotech-s-vaccine-gets-primary-clearance-all-you-need-to-know-about-covaxin-s-efficacy-price/story-oMQlTg6bvaDoLyyRQou5cO.html

    Any thoughts?

    1. Adrian says:

      It is named Covaxin, not Coxav.

      Inactivated virus is the low-tech proven technology approach also used by the Chinese vaccines. In general this approach works as expected. Protection of this approach compared to other vaccines is yet to be shown, based on the data available so far I am optimistic that these vaccines offer better protection at least compared to the Oxford vaccine.

      India and the UK are in a pretty desperate situation right now, that’s why they are doing premature approvals of vaccines.

      Approval of a non-working or even unsafe vaccine would prove beyond any doubt that approved vaccines cannot be trusted.

      1. Chris Phillips says:

        Thank you for pointing out my error regarding the name of that vaccine.

        But I was hoping someone had some pertinent comments about that one in particular, rather than generalities about inactivated vaccines and vaccine approval policies.

        1. Adrian says:

          A preprint of interim phase 1 data on 375 participants between the age of 18 and 55 was published less than 3 weeks ago.
          No phase 2 data has been published.
          The phase 3 trial had not even finished enrollment.

          What pertinent comments did you expect with that little data?

          1. Chris Phillips says:

            Something like what you’ve just posted, for which thanks (though politeness costs nothing 🙂 ).

    2. Chris Phillips says:

      The BBC reports that the approval of the Covaxin vaccine without published efficacy data has aroused a lot of controversy in India:
      https://www.bbc.com/news/world-asia-india-55526123

  32. JRRT the Younger says:

    For alternative take on latest pre-print from Imperial College, alluded to several times above, please see…

    https://blogs.sciencemag.org/pipeline/archives/2020/12/22/the-new-mutations#comment-335688

    Scroll down to penultimate comment out of 202 (up to now):

    1 January, 2021 at 9:38 am

  33. Tommie Fairfax says:

    Re: “The sane action for the British government would be to announce now that schools will stay closed until Easter. It is not realistic that current lockdown restrictions in the UK can be relaxed earlier,” and similar sentiment from other commenters.

    Once upon a time around the year 1968, when I was around age 15, I had a grandad who was around 70. Used to go round their house some Saturdays for my tea and a natter, especially in winter. Football, his greenhouse, cricket, his life’s work, school, his son my Uncle, learning to drive, his war to end all wars and land fit for heroes to live in, my difficult subject. Wikipedia now tells ‘twas also the winter of the 1968 Hong Kong flu epidemic.

    Retired by then, he was. Steel worker, he’d been. Prone to bad bronchitis, nowadays generalised as a respiratory illness, then called a bad chest. The Trenches, those ciggies handed out by officers to calm men’s nerves that became a lifetime’s habit until stopped after a shock from the doc, that Second War steel works loading shed with blackout curtains left in place all day, that kept all the steam train smoke in, smoke for the men to gasp in and cough out again, while doing the work of loading steel girders onto railway wagons.

    Looking back, must have been many a time I went round with a sniffle or a snuffle, a sore throat and a runny nose, maybe a slight temperature, even a mild case of flu. All most likely picked up at the skill, thought and germ incubator called school. Something serious enough to be off school with, I wouldn’t have gone to his house. Now I’m thinking… as the UK’s current Health Minister could no doubt advise, I could’ve killed my Grandad any number of Saturday evenings. Who knows, I could even’ve been “asymptomatic” any number of times…

    Oh dear. A murderer I‘d’ve been. Called up before judge and jury, I‘ll conduct my own defence retrospectively – not just me who did it, Your Honour. What about The Lord Kitchener who’d called him up, Field Marshal Haig who sent him off, Prime Minister Lloyd George, the Kaiser, Luddendorf and Hindenburg, that Gabriel Prinzip who assassinated The Archduke in the first place and kicked the whole Great War caboodle off? Never mind the Second War British Government who ordered the steel works blacked out. So that’s Sir Winston and Mr Attlee well and truly implicated, and come to think about it, Goring’s Luftwaffe too, even if the bombs they did drop once, and only once, mostly missed the steel works.

    No need to worry, if Grandad’d known I’d be up before the Beak he’d have absolved with a little note hand scrawled to hand over in his grandson’s defence. ‘Cos, what was the alternative? From when I first went to school aged 5, and he was around 60, never to see each other again? Would’ve diminished us both, big time.

    By around the year 1968, was the time of Grosvenor Square, student protest blowin’ across the Atlantic on Bob Dylan’s wind, les evenements importing across the channel from Paris, which even fifteen year olds stuck growin’ up in no man’s land and every man’s place couldn’t but help notice. Not up for Saturday evening discussion. Firing squads and All That. March, march, march. Dig, dig, dig. Real treat of a lift down the line on Motors.

    As for shutting schools to protect the likes of him, he’d’ve been appalled, ‘cos it might ‘a meant he later never got to do that trip to that upmarket university his grandson got into, to see that nice room his grandson had overlooking the river, at same age as when Privates were getting handed ciggies by Officers. And on long drive back home in car to say to daughter and son in law… Maybe being in that MADNESS in the Trenches did make some sort of sense after all.

    All ended mid to late January the following winter. Picked up a cold or undiagnosed flu, that took a turn for the worse. Had happened numerous times in numerous other winters before and now wasn’t going to happen ever again. Not there myself. First job 200 miles away. Might have last seen him that new year. I might even have had a sniffle or a snuffle, a bit of a cold, not even thought much of at the time.

    Am told the Doctor said he’d suffered enough and offered to help him on his way. Gasping terribly at the end. Offer greatfully accepted. Read in the papers such assistance not as readily proferred now. Progress means change, but change does not always mean progress.

    So don’t get me started on shutting UK schools, to add another 575 million lost UK schooldays to the 835 million lost already. Understand masterplan in place to vaccinate the over 65s by Easter (that’s me, btw). Maybe invite teachers to that cohort too, might make sense? All looks like an achievable par 4 lined up to be holed, providing approach shots and putt played right, except even the best golfers sometimes go over par or get bogeys or worse, especially on a course never played before.

    So before we know where we are, summer term’s down the pan too, ‘cos there’ll also be all those untreated conditions from the last year builded up, ended up, piled up in hospital admissions and overcrowding, interpreted as spread still not stopped, virus still not controlled.

    Something will still just have to be done, to address the continuing crisis and manage the life and death problem, delay the latest peak, shift the latest “sombrero”, stop the “vector of disease” and “quantum of illness” in its tracks. And so the whole self perpetuating cycle will go on, under cover of The Science and the ever emergent scientific evidence.

    As regards school closures, for what it’s worth, the 80something nana and the 90something granny have been against those all along, as have several of their elderly neighbours, and of course the late 60something father too. Just saying

    1. Adrian says:

      Peak death is 3-4 weeks after effective measures that brought R below 1.

      If the Tier 4 extension at the turn of the year turns out to be what brought R below 1, we will see the highest numbers of ICU usage and daily deaths in late January.
      ICU usage and daily deaths would be back down at the current lower levels at some point in February/March.

      If reopening schools brings R back over 1, ICU usage and daily deaths will still be increasing through February.

      Vaccinations in January will have little effect on the infections in January that will be the ICU patients and deaths in February.

      The NHS is already short of nurses today and the ones they have are burnt out, reopening schools might trigger a collapse of the British healthcare system. Just saying.

        1. Adrian says:

          Apologies for feeding the Tommie Fairfax troll.

          1. RHB says:

            Oh I see, “Adrian,” another debating point. “Tommie” is a troll. In fact, written by a serious scientist, 6 years retired from formal science, but with 40+ serious scientific publications (25 as lead author), 40+ granted patents and a serious contribution to discovery of a seriously safe and effective anticancer drug, to show for a 30+ year past career at a leading UK R&D healthcare site, whose digital face now nowadays is this…

            https://www.alderleypark.co.uk/

            Tommie (and many other true life Tommies) are making some very serious points (albeit in my own case in a somewhat scientifically unconventional way). If you can’t see those points, “Adrian,” then I humbly submit that is for you to think about (whosoever you are) and for any other interested parties to reflect upon.

            For I am trying to see the problems you highlight, “Adrian,” but despite Professor Ferguson et al’s latest paper, I cannot seriously see how taking 9 million kids out of school for the next 3 months is going to make that much difference to all the problems besetting the NHS…

            …But I can sure see how that will affect the 9 million kids and their families, and, from knowledge at first hand, how that will affect one of those nine million in particular. The sort of cost-benefit-uncertainty analysis I’d like to think the British Government is this very weekend weighing up very carefully on behalf of all the nation’s citizens.

          2. Marko says:

            You were actually feeding the RHB troll, the one with multiple alternate personalities and invisible friends, who craves attention desperately, using every troll trick in the book to get a rise. Ignore the drivel, whatever handle it’s underand maybe he’ll seek out suckers in some other forum.

        2. RHB Tro*** says:

          True to form, man duly gone for, not ball. So predictable. Reminded of “most brutal game in English football history”, which a modern day ref thinks nowadays would have earned 11 players red cards…

          https://www.bbc.co.uk/sport/football/52416192

          Out of interest, done some bloggeromics on comments on this and some other recent Pipeline postings. Preceding commenter has 12 posts on this thread, and two online commenter mates who regularly post alongside, and on occasion converse with the preceding commenter, have between them posted 43 times. So the trio have made 55 posts in total (out of thread’s 174 in real time).

          Whereas RHB and alter egos have now posted 8 times on this thread, albeit 4 posts quite lengthy. Too tedious to enumerate, but plausibly trio’s and RHB’s word counts comparable. On another recent Pipeline posting, preceding commenter singlehandedly posted 51 comments (out of 203), mates 15. RHB and aliases 17, albeit this time 7 pretty wordy. Personal best (or worst).

          So just who is trolling who here? Going back further in recent time, RHB can recall 4 Pipeline postings where RHB or alter egos commented. That takes us back to 16 scientific Pipelines ago (mid-November), of which RHB and aliases have thus commented in earnest on 6 in total.

          Whereas a quick scroll up and down the postings clearly tells preceding commenter comments copiously pretty much every time and two online mates chip in pretty frequently too. As alluded to before, often perform as a duo, and on occasion a trio. So must be comment content, not frequency, trio so miffed about, otherwise a case of “do as I say not as I do.”

          Comment content. Succinctly summarised as… Trio “Pro-Lockdowners,” RHB and alter egos “Anti-Lockdowners.” And get impression that 3 to 1 ratio (or higher) plausibly reflects wider set of Pro’s and Anti’s relative populating of Pipeline comments.

          Ditto for mainstream science. So to end with a plug for three scientific and two civil Anti sites, hosts of which RHB knows in person only one (although much cheered up personally and scientifically to come across all 5 sites around 3 months ago):

          https://www.cebm.net/
          https://lockdownsceptics.org/
          https://twitter.com/michaelyeadon3?lang=en
          https://twitter.com/JuliaHB1?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp
          https://twitter.com/JohnWhelo

          As for seeking out “suckers in another forum” for “witless malice,” “utter nonsense” and “crap,” I don’t do social media or much in way of commenting elsewhere. Just hang out here, as per last decade or so, mostly commenting once in a while, until “The Pandemic” came along, and only last two months in any volume, once some thoughts about “The Pandemic” started to crystallise out.

          If I’m a nuisance, Dr Denominator, Enumerator & Moderator, please do boot me off. Just the usual two email addresses to block. Won’t take offence and will still visit. Best site by a country mile for keeping an OAP scientifically alive and kicking. Set an old buffer off thinking about PPE too.

          Real time: UK “national lockdown” imminent, schools to close again. Trio 3-1 RHB. BBC reports Parliament to “vote retrospectively on Wednesday.” Interesting democratic concept, that…

  34. Bill says:

    ” I cannot seriously see how taking 9 million kids out of school for the next 3 months is going to make that much difference to all the problems besetting the NHS…”

    It seems beyond likely to me that children away from direct supervision every minute can follow safety protocols.

    I’ve seen it claimed kids don’t readily infect one another. I’ve seen it claimed that they don’t readily infect their households.

    But I’ve also seen it claimed that they typically get as big a viral load as adults and logically should be spreaders. And that household spread is the very largest source for infection.

    What I haven’t seen is scholarly work on the subject that isn’t serving a political ideal. Are there scholarly treatments of how much spread is apparently caused by kids and school?

    1. Adrian says:

      There is little data from before the fall since schools were closed in spring.

      There are studies ongoing (especially a large one in Austria), but overviews tend to be available only in less scientific forms like
      https://www.spiegel.de/international/world/new-on-the-covid-19-front-lines-children-may-be-driving-the-pandemic-after-all-a-95e4c0e7-2ea0-479b-ac27-d17f07d147a5

      It seems now that claims in summer/autumn that children and schools would not play any role in COVID-19 transmissions were wrong.

        1. Adrian says:

          One thing to keep in mind when discussing this is that there are different definitions of “children”.

          Many studies on COVID-19 infections in children are defining children as “under the age of 10”.
          Results from studies based on this definition have been used to justify reopening schools for children of all ages, despite pupils of age 18 being more like college students than children under the age of 10.

  35. RHB says:

    Been thinking about this on and off into this evening. In response to stand alone question, seems reasonable to think vast majority of UK’s estimated 12 million parents of UK’s estimated 9 million kids would want their kids to have the best possible education.

    Likewise the UK’s 9 million kids’ estimated 16 million surviving grandparents would also, on the whole, want their grandkids educated as well as possible, although during the ongoing SARS 2 epidemic grandparents’ feelings in some cases understandably conflicted by concerns for own health and wellbeing. Throw in a guesstimated 2 million great grandparents and that’s 30 million parents, grandparents and great grandparents with more than a passing interest in seeing their offspring and direct descendents educated…

    …Further compounded for the same 30 milllon UK citizens by nephews, nieces, great nephews, great nieces, etcetera, and any other relationships that come about from being half or step relatives, etcetera.

    Also seems reasonable to think that, despite introduction of online learning that inevitably varies from school to school and teacher to teacher, and whichever way looked at inherently can’t match up to the real deal, the 30 million parents, grandparents and great grandparents are still concerned by that compromised summer 2020 term, and, depending on the luck of the draw, just as concerned by kids sent home last term to self isolate after being deemed close contacts of a “tested positive.” I know we were, by early November concerned to the total of 17-days-out-of-45.

    So, having children, grandchildren or great grandchildren, that’s 30 million out of the UK’s 52 million adult population accounted for. Plausibly, say, another 10 million adults who could become parents in fullness of time. Let’s say 7 million eventually will. Inevitably pretty much all under age 40 now. Reasonable to think they’d all want an education for their children as yet unborn, and would empathise with existing parents.

    So we’ve now reached an estimated 37 million out of 52 million, almost three quarters of the UK adult population. The first “Key Message” of the European Centre for Disease Control latest Technical Report…

    “COVID-19 in children and the role of school settings in transmission – first update,”

    That commenter Adrian kindly linked, says…

    “There is a general consensus that the decision to close schools to control the COVID-19 pandemic should be used as a last resort. The negative physical, mental health and educational impact of proactive school closures on children, as well as the economic impact on society more broadly, would likely outweigh the benefits.”

    While Professor Ferguson et al’s Report Number 42, entitled…

    “Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data”

    And kindly linked by commenter Chris Phillips, concludes…

    “The substantial transmission advantage we have estimated the VOC to have over prior viral lineages poses major challenges for ongoing control of COVID-19 in the UK and elsewhere in the coming months. Social distancing measures will need to be more stringent than they would have otherwise. A particular concern is whether it will be possible to maintain control over transmission while allowing schools to reopen in January 2021.”

    To which commenter Bill points out, “It seems beyond likely to me that children away from direct supervision every minute can follow safety protocols.” In other words, kids will be kids (Here, Here!), and where’s the scholarly study on effect on viral transmission of kids being off school. Good luck with modelling that one, Prof et al.

    So to cut to the chase, seems all comes down to values. Any number of numerical values any number of numerate scientists and modellers can come up with – Report Number 42, Table S2, 95% CI across 8 models is 16-67% effect???

    And the values of 37 million UK current and future parents, grandparents and great grandparents. So here’s a thought question to you all. What do you want to happen this term – Schools In or Skool’s Out?

    By way of context, you’ll by now know full well what Skool’s Out means for your kids, grandkids and great grandkids. Might go some way to helping SAVE LIVES and PROTECT THE NHS. Might Not.

    Governmental Hippocratic Oath to weigh up on your behalf the cost-benefit-uncertainty of In or Out. Your oath too, calling out the answer you want to call out, not the answer you feel you ought to give.

  36. debinski says:

    Any thoughts on the recent suggestion from Slaoui that the US should use half doses of the Moderna vaccine to make more vaccine available sooner?

    “We know it induces identical immune response” to the full dose, he added.
    https://in.reuters.com/article/us-health-coronavirus-usa-moderna-idUSKBN2980NW

  37. Masher says:

    A few days ago, after reading about doubts which had been expressed by Prof. John Bell of the Oxford vaccine group, I asked on here about the efficacy of vaccines against the new variants, and got some helpful replies.

    A new article in the Daily Telegraph (UK) reiterates Prof. Bell’s thinking on this:-
    https://www.telegraph.co.uk/news/2021/01/03/south-african-variant-could-resistant-vaccine-expert-suggests/

    The article is behind a paywall, but key points are … his “gut feeling” is that the vaccines already on stream will be effective against the new UK strain, but there is a big question mark against the South Africa one, as its mutations are substantial changes in the structure of the protein. He goes on to say that it’s unlikely that these mutations will entirely evade the vaccines, which will still have a “residual effect”. He also said it should only take a month or 6 weeks to make new vaccines in response, and that we are likely to have to respond to further variants as time goes on.

    btw my “layman” status is confirmed by the fact that I had to check the maths for the CAPTCHA question on my calculator 🙂

  38. Marjorie says:

    Given the high reactogenicity of mRNA vaccines (particularly Moderna’s); in case of some spectacularly severe systemic reactions (even if not statistically significant), there would be a risk of loss of confidence in this technology by a section of the population, for example mildly allergic subjects.

    Hopefully not, but I believe that this risk should be anticipated by having an option on some inactivated virus vaccines, perhaps less effective but better tolerated and known as “classical vaccines” by the population.

    A few tens of millions of doses might be enough to plug that hole.

  39. David T says:

    Since the Moderna vaccine is a much bigger molecule than the Pfizer one (three times as big I believe) I wonder if it would be more likely to be effective against a resistant strain. Presumably it encodes for a larger part of the spike protein. The same might apply to the inactivated whole virus vaccines from China.

    one

  40. Chris says:

    https://www.bbc.co.uk/news/world-latin-america-55642648

    A coronavirus vaccine developed by China’s Sinovac has been found to be 50.4% effective in Brazilian clinical trials, according to the latest results released by researchers.

  41. Martin says:

    Concerning 1 vs 2 shots, there was also an argument that a partial immunity might promote mutations, what is the opinin of the forum?
    Sorry if this Q has been posted previously, was not able to read through the 180+

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