The place are we within the pandemic?
The underside line right here is that anybody making the assertion ‘popping out of the Covid atmosphere’ has not stored up with the information, which show the next:
1. Transmission is ~ 98% by way of airborne aerosols, identified since March 2020 and firmly established by preliminary guidelines on masking and areas the place that is maintained.
2. The pandemic is unabated. Circumstances stay excessive, with a number of waves a 12 months. This to the extent that hospital beds replenish each wave, world-wide well being care employees are burning out as a consequence of overwork and ready lists are getting so lengthy that the most suitable choice is turning into the avoidance of unwell well being.
3. Deaths are decrease as a consequence of vaccines, however SARS-CoV-2 is an adept immune escapologist
4. Lengthy Covid is a rising socio-economic downside, a consequence is the lack of members of an organisation’s workforce.
5. Viral persistence is measurable 15 months after restoration, and among the many targets is bone marrow and the immune system.
6. There isn’t any treatment and no efficacious remedy, and that is true for acute an infection (when you’ve gotten overt signs for ~ 10 days), viral persistence (months/years, see beneath) and LongCovid (see beneath). That is in distinction to HIV.
The implications of the above are that organisations must:
A. Explicitly state that masks are anticipated to protect the well being of your self and of your co-workers and supply masks to the workforce.
B. Explicitly present particulars on air flow of rooms occupied by the workforce and/or set up HEPA filters in all such rooms.
C. Count on these with even partial signs have a transparent LFTs earlier than returning to work.
D. Present updates on the standing of present variants, how a lot we don’t know and the extent to which Public Well being surveillance is dependable.
Anything is a gross dereliction of responsibility on the a part of an organisation’s administration.
Under I take every of the above statements and supply the proof, together with hyperlinks. If any reader from my office, the College of Liverpool can provide you with an argument based mostly on proof why we must always not take all potential measures towards transmission, then I’ll settle for that the College doesn’t must take such measures. Till then, not doing so stays a gross dereliction of responsibility.
Transmission
Transmission is ~98% by airborne aerosols. Aerosols DO NOT drop to the bottom, they continue to be airborne, and the one safety is to cut back their focus. That is achieved by two complementary routes:
Masks to cut back the quantity of aerosols put into the air by an contaminated individual;
Air flow and filtration to make sure fast dilution.
Some assets and feedback on these
A pleasant article in PNAS on how secondary bodily measures work, which ought to be on the desk of each organisations’ Well being and Security Workplace.
A quite simple message from JAMA in an article on this topic
“As a result of no single method is 100% efficient in stopping COVID-19, prevention measures work finest when layered, together with vaccination and nonpharmacologic interventions that scale back inhalation of infectious particles.”
The identical article makes additional wonderful factors. One on the long-term implications for constructing design
“Lowering contaminants in shared air by bettering air dealing with techniques in buildings is a horny, broadly efficient structural measure that doesn’t require repeated particular person actions.”
There’s a good Sci-Comm piece right here.
The proof on the efficacy of the completely different layers of is that you’re safer in a small room with an unvaccinated individual, each sporting a FFP2/N95 masks, than in the identical room, each vaccinated however with out masks.
We must always after all so far as potential have all measures in place.
Pandemic is unabated
Information acquisition is being dismantled, so it’s important to make use of essential colleges. The testing programme is now not useful, since you can’t report the outcomes of assessments bought privately. Furthermore, the superb ONS survey will quickly be restricted, so we can have even much less info on the quantity contaminated later within the 12 months, and the one proxy will then be NHS information on admissions and mattress occupancy.
For the document the ONS survey information are right here and for the week ending 29 June 2022 for England the estimated variety of folks testing constructive for COVID-19 was 2,154,000 (95% credible interval: 2,062,600 to 2,247,100), equating to three.95% of the inhabitants, or round 1 in 25 folks.
There are very helpful analyses of those information, which I like to recommend, e.g., @TravellingTabby on Twitter who maintains a wonderful information internet web page from the ONS information
The concept the virus is attenuating is WRONG. As normally small numbers, giant impact sizes, once we go to a good sized examine (130 okay sufferers) there isn’t a proof that Omicron is milder
Deaths are decrease
The estimate from WHO is that vaccines have prevented 20 M deaths. Nonetheless, extra deaths over historic common nonetheless substantial. The issue is that the efficacy of the vaccines is nice, however not almost adequate. That is compounded by giving the virus a free reign in order that pure choice can function at extraordinarily excessive throughput. The result’s a virus that was already good at immune escape is now a grasp. Some information within the hyperlinks beneath.
The Tweetorial from Deepti Gurdasani covers a latest Science paper that demonstrates immune escape and that T-cell immunity to Omicron is poor at finest
The paper is right here.
Long Covid
This happens in a big variety of folks after they get well from acute an infection. The chance solely diminished just a little by vaccination in line with this giant examine of 33 okay folks contaminated after vaccination with over 13 M controls!
A key take dwelling message from this paper is:
“Altogether, the findings counsel that vaccination earlier than an infection confers solely partial safety within the post-acute section of the illness; therefore, reliance on it as a sole mitigation technique might not optimally scale back long-term well being penalties of SARS-CoV-2 an infection. The findings emphasize the necessity for continued optimization of methods for main prevention of BTI and can information growth of post-acute care pathways for folks with BTI.
Importantly, the chance of LongCovid will increase with every an infection.
The ONS (UK) information type early April 2022 point out 1.7 million folks with LongCovid within the UK (2.7% of the inhabitants), and it additionally impacts the younger…:
“40,000 aged 2-11 (confidence intervals 32K-48K) 59,000 aged 12-16 (confidence intervals 52K-66K) That’s a complete of 99,000 youngsters “
For these aged 17-24, that’s 89,000 (CI 77K-102K)
For these with an sickness period of at the least A YEAR: 14,000 aged 2-11 (confidence intervals 9K-19K) 17,000 aged 12-16 (confidence intervals 13K-20K) That’s a complete of 31,000 youngsters. For these aged 17-24, that’s 45,000 (CI 36K-54K).
Sadly, these affected can’t pursue their typical lives and work, research, hobbies, and so forth., are largely or utterly suspended.
There may be good proof that micro clots are a part of the issue and it appears seemingly that viral persistence in our organs might also contribute.
Viral persistence
Information from autopsies show viral persistence in organs in even average circumstances (so no hospitalisation) as much as 15 months publish an infection. These information are prone to worsen, slightly than higher as we progress into the pandemic and we purchase extra time-dependent information.
Tright here is not any treatment and vaccines are an help, however not an answer
The medicine we have now are merely re-purposing present ones, and their efficacy is modest, at finest. It will likely be a while, 5 to 10 years maybe, earlier than we have now medicine that particularly goal SARS-CoV-2 capabilities equivalent to its polyprotein protease. There may be good proof for microclots taking part in a task in LongCovid, however we haven’t but bought a medical trial working with preregistered outcomes and so forth. – thus far we have now case studies solely.
Present vaccines are shedding efficacy towards variants more proficient at immune escape, a wholly predictable final result given close to zero measures to cut back transmission, so the virus has had an evolutionary area day exploring host-pathogen interactions, to our detriment after all.
The long run with out measures past vaccination
Attrition of the workforce, most pronounced in these uncovered to giant numbers of people in small areas, equivalent to healthcare and training.
Attrition of the scholar inhabitants in a position to undertake research.
The result is that society just isn’t sustainable, in the identical approach that Medieval societies weren’t sustainable within the face of inhabitants loss as a result of Plague. One solely has to think about the complicated chain of abilities that underpin fundamental on a regular basis features of life:
The cell phone, wants leading edge sills in supplies, chips, telecommunications networks, GPS satellites, electrical energy manufacturing, and naturally software program in all components of the chain.
Take out 10% of the workforce and we battle. Presently over 2.7 % of the inhabitants are affected, ~0.9 % to the extent they can not work, and this after simply 2.5 years of the pandemic. What can we face up to? 5%, 10 %? I don’t know, however I can’t see a legitimate argument for testing the speculation that society can face up to X% of LongCovid. When you have one, let me know.
The Future
Future A We proceed to disregard the proof, and see whether or not our society can face up to the influence of a big % of its inhabitants with LongCovid requiring care and being unable to work. This can be a plan of action taken by an ideologue, and isn’t potential for a scientist to behave on this approach, since in science we critically consider proof.
Future B We apply mitigation measures in order to cut back the frequency of transmission, scale back infections and so the quantity with LongCovid, till such time because the pandemic is over and/or we have now medicine that actually work. That is the plan of action of any organisation that has the effectively being of its workers (and college students) as a core worth, it’s evidence- and knowledge-driven, and goals to be sustainable, that’s to exist in a recognisable type in 10-50 years time.