Day: 22 May 2021

Stop Worrying About Fat Shaming. We Need to Talk About Obesity

A GP has emailed Lockdown Sceptics with a short piece about obesity, which she calls the elephant in the room. Given its links to susceptibility to COVID-19, we have to start talking about it.

Forgive me if this offends you. For the past 16 months we have an elephant in the (COVID-19) room that we seem to refuse to talk about. As a clinician working in a very large London GP practice, I’ve been wondering if and when patients might spot the elephant and take some action. It hasn’t happened yet.

So what is the elephant you ask? It’s the undeniable fact that a healthy weight and lifestyle which includes regular exercise will (almost definitely) reduce your risk of dying with an infection such as Covid by an enormous amount. To name it and shame it, the elephant’s name is specifically obesity. Yes there are genetics, yes there is age, yes there are the random unlucky ones. But for the vast majority who become seriously ill with COVID-19, obesity is a significant contributory factor. The vast majority of patients who end up in ITU with Covid have a BMI of >25 and it often does’t end well for them.

Now you might think that’s not relevant to you as you have checked out the infection fatality risk in your age group (and hopefully the Covid ship has sailed anyway…) and you know it’s ridiculously low. However, is that really a good excuse? So you might get Covid and not die (I certainly hope you don’t), but what about the increased risks of developing diabetes, cancer, heart disease, strokes, infertility, difficult labours, long Covid (the list goes on and on)?

So, I’ve spent 16 months talking to my patients about this. (Contrary to public perception we have been doing something!) Have they listened? Well, yes, I would say most of them hear me out. However, what has struck me is that a few of them (a generally well educated, affluent bunch) were genuinely surprised by what they heard. They had no idea there was such a strong correlation between obesity and increased risk of dying or being very unwell with Covid. But sadly in the majority of cases I fear I’ve wasted my breath.

So, who’s to blame? SAGE wouldn’t deny it, Boris has mentioned it, the BBC have whispered about it… But the mystery remains as to WHY WE AREN’T SHOUTING ABOUT THIS FROM THE ROOFTOPS?!? Is it because the media and the rest of the band wagon are afraid of fat shaming? Or would a massive increase in health promotion distract from all the fear mongering and vaccine obsession? Boris has the perfect platform to mention this every time he does one of his irritating lectures to the nation.

I’m not writing this piece to rant. I’m writing it because maybe this is the forum to speak out and start to create a change that will not only reduce people’s risk of dying from diseases like Covid, but, more importantly, will reduce the risk of them getting innumerable diseases. Maybe what is needed is to separate statement of fact (obesity carries significant health risk) from subjective judgement (it’s your fault you’re obese). If we remove the subjective element, then perhaps we’d be able to talk about it in a more objective and calm way? It would allow us to state plainly the health risks, and (more importantly) facilitate weight loss for those who want to attempt it. It is very sensitive subject and until we stop worrying about causing offence we won’t be able to have a proper grown up discussion.

Update: Gary Johnson, the Managing Director of Inpharmation, has emailed us to correct the impression, given by the author of this piece, that obesity is a more important risk factor than age when it comes to susceptibility to COVID-19.

I know from reading your site regularly that you will be well aware that the risk of increasing age spans several order of magnitude. Whereas the risks from obesity are a fraction of an order of magnitude.

The best data I know of for the demographics and outcomes for patients on critical care is the INARC report on COVID-19 in critical care.

While it is true that around four fifths of the COVID critical care population have a BMI of over 25, this misleads. Firstly, the cut off for obesity is 30 and not 25. Secondly, as we age, we put on weight and the average age for critical care COVID patients is around 60. So we need to compare the critical care COVID population with the sex and age matched general population. You can see this on page 65 of the INARC report. The COVID critical care population is a just a little more overweight/obese than the general population. In earlier INARC reports, the proportions have actually been quite similar.

And, while it is true that it often does not end well for overweight COVID patients on ITU, it is no more true for them than for other COVID patients who end up on ITU. On page 65 of the report you will see that, surprisingly, a lower percentage of obese patients in critical care die (34.6%) than of non-obese patients. The worst outcome is for those patients with a BMI of <25, with 42.2% of those in critical care dying.

Please don’t get me wrong, I am not advocating obesity – just fact checking.

Keep up the great work.

Cummings Claims That Government’s Original Plan Was ‘Herd Immunity by September’

In early March of 2020, there was rising public concern that the UK was taking an altogether different approach to its neighbours, leading some people to joke that Britain was the world’s “control group”. To allay public fears, the health Secretary Matt Hancock wrote an op-ed in The Telegraph on March 15th claiming that “herd immunity” was not part of the government’s plan. Here’s the full quote:

We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy. Our goal is to protect life from this virus, our strategy is to protect the most vulnerable and protect the NHS through contain, delay, research and mitigate.

Now Dominic Cummings – the former chief advisor to Boris Johnson, who left No. 10 “with immediate effect” in mid November – has claimed that the government did intend to pursue a “herd immunity” strategy. At 3:38 this afternoon, Cummings tweeted:

Media generally abysmal on covid but even I’ve been surprised by 1 thing: how many hacks have parroted Hancock’s line that ‘herd immunity wasn’t the plan’ when ‘herd immunity by Sep’ was *literally the official plan in all docs/graphs/meetings* until it was ditched

In a subsequent tweet, Cummings elaborated on why the government’s original plan was “ditched”. He writes:

In week of 9/3, No10 was made aware by various people that the official plan wd lead to catastrophe. It was then replaced by Plan B. But how ‘herd immunity by Sep’ cd have been the plan until that week is a fundamental issue in the whole disaster

What Cummings says is of course broadly consistent with the statements Chris Whitty and Patrick Vallance had made up until the date of Hancock’s article, as well as with the infamous ‘UK Influenza Pandemic Preparedness Strategy 2011’. In a hearing of the Health and Social Care Committee on March 5th, Whitty said, “what we’re very keen to do is not intervene until the point we absolutely have to, so as to minimise economic and social disruption.”

Opinions obviously differ about whether the original plan would “lead to catastrophe”, but it’s interesting to have an insider’s perspective on the Government’s early planning.

Stop Press: In a further tweet, Cummings has accused the Government of lying. He writes:

No10 decided to lie: ‘herd immunity has never been… part of our coronavirus strategy’. V foolish, & appalling ethics, to lie about it. The right line wd have been what PM knows is true: our original plan was wrong & we changed when we realised

More Than 50 Million Covid Vaccine Doses Administered in England

England’s Covid vaccine rollout has reached another milestone with more than 50 million doses having been given, Health Secretary Matt Hancock announced.

Sky News has more.

The landmark figure, reached on Saturday, showed that 31,546,846 first doses have been given, alongside 18,699,556 second jabs…

NHS England’s Lead for the NHS Covid Vaccination Programme, Dr Emily Lawson, said: “Today the biggest NHS vaccination programme in history hit another outstanding milestone, with more than 50 million life-saving jabs being administered across the country in six months, and the roll out continuing at pace with tens of thousands of 34 and 35 year-olds quick to act on their invites this week, ahead of the next age groups able to book today.

“This success is the result of the tireless efforts of NHS teams, alongside local partners and volunteers, who are determined to protect their patients, families and communities.

“Despite this we must take nothing for granted so you are invited please book your appointment – and along with millions of others get vital protection against coronavirus.”…

The rollout has accelerated this week, with different age groups able to book every day since Monday, when it was announced 37 year-olds could book their jabs.

Given that so many vaccine doses have now been administered, including to the most vulnerable, why are we still discussing the possibility of lockdown being extended beyond June 21st, and the idea of healthy children being vaccinated?

The Sky News report is worth reading in full.

Teenagers in Manchester to be Offered Covid Vaccines

Mancunian children as young as 16 are to be offered Covid vaccines produced by Pfizer and Moderna – though, notably, not by AstraZeneca – as local authorities launch a “preventive vaccine plan” due to fears about the Indian variant. This decision has been made in spite of the advice given by Professor Adam Finn, a member of the Government’s Joint Committee on Vaccination and Immunisation, that children shouldn’t be vaccinated because of the “side effects”. The Sun has the story.

David Regan, Manchester’s Director of Public Health, said the city was in a “race against time” to tackle the new variant – which is more transmissible than other strains. [Is it? Note that the article later acknowledges there is no evidence for this.]

Pfizer and Moderna vaccines will be offered to people aged 18 and over in target wards, while 17 and 16 year-olds from eligible households will also get the jab call.

The wards involved in the accelerated vaccine rollout are Ardwick, Crumpsall, Cheetham, Moss Side, Levenshulme, Longsight, Rusholme, and Whalley Range.

These areas have populations of more than half black, Asian, and minority-ethnic residents, with many people living in multi-generational households.

Across the rest of England, people aged 32 and 33 can now book their vaccine appointment as the age limit dropped once more…

A total of 49 cases of the new strain have been identified – but there is no evidence to show that it is more transmissible or resistant to vaccines, health chiefs said…

Extra testing and tracing is being carried out while the “strange combination of mutations” continues to be probed.

Downing Street said yesterday that the variant is being monitored and stressed “we won’t hesitate to put in measures that we think are necessary to try and tackle the transmission of any variants”.

Worth reading in full.

How Did a Disease With no Symptoms Take Over the World?

We’re publishing an original essay today by a senior research scientist at a pharmaceutical company asking how managing an ‘asymptomatic disease’ became the main focus of Government policy in the U.K. and around the world, when the very concept of an ‘asymptomatic disease’ is nonsensical. Here’s an extract in which he tries to flesh out exactly why the concept makes so little sense.

First, let’s see why defining having a disease based purely on the presence of a pathogen is a flawed concept. This is best illustrated by reference to another virus, Epstein-Barr Virus or EBV. You’ll be forgiven if you’ve never heard of this virus, but it could be argued to be one of the most successful human pathogens because almost everyone is infected by it. Most people are infected early in life and if this happens then EBV takes up residence in your B-cells (the cells in your immune system responsible for making antibodies) where it quietly persists throughout your life. Every now and then the virus goes into active replication and makes copies of itself which get shed into your mouth, a process that you are blissfully unaware is happening. The problems with EBV generally occur if you don’t get infected early in life but avoid infection until you’re much older. Now when you get infected with EBV, you can develop a disease called infectious mononucleosis or, more commonly, glandular fever. This often happens in young adults when they become interested in close physical contact with members of the opposite (or same) sex… which is why glandular fever is sometimes referred to as “the kissing disease”.

Now let’s apply the new asymptomatic COVID-19 orthodoxy to EBV where we define having a disease purely through the presence of a viral genome. So, according to this definition, almost everyone in the U.K. (and the world) is suffering from a new disease, asymptomatic glandular fever, and if we were to do a large-scale mass screening campaign we’d discover that there were millions of ‘cases’ of asymptomatic glandular fever in the U.K. alone!

Of course, this is complete nonsense. We aren’t all ‘suffering’ from asymptomatic glandular fever. Glandular fever requires infection by EBV, but EBV infection does not necessarily lead to glandular fever. The same is true of COVID-19 and SARS-CoV-2 and so the concept of asymptomatic COVID-19 as a disease is as ridiculous as that of asymptomatic glandular fever.

Worth reading in full.

Vulnerable People Continuing to Shield Despite No Longer Needing to, According to New Data

The four million people in England and Wales who have been advised to shield were told they no longer needed to in April. In England, most clinically extremely vulnerable (CEV) people are aware of this change in guidance and most have been fully vaccinated against Covid. But half have decided to continue shielding anyway. The Evening Standard has the story.

The Office for National Statistics (ONS) said that 50% of CEV people said they were continuing to shield when asked between April 26th and May 1st.

But an ONS analysis, published on Friday, found that 84% reported being aware that Government advice to shield had been paused and that two-thirds (67%) had received two doses of coronavirus vaccine.

Tim Gibbs, Head of the Public Services Analysis team at the ONS, said: “Since April 1st, 2021, CEV people have been advised that they no longer need to shield to protect themselves from Covid.

“Our results today show that although Government advice to shield has paused, half of those identified as CEV reported continuing to shield.

“We’ve recently seen lockdown restrictions ease significantly, this is great to see, however, it’s critical that we continue to monitor the impact of these changes on groups such as the clinically extremely vulnerable.”

The ONS added that approximately 420,000 of CEV people (11%) were estimated to have not left the house in the last seven days.

There are a total of 3.7 million people in England identified as being clinically extremely vulnerable to severe impact from COVID-19, the ONS said.

Worth reading in full.

Current Covid Vaccines Unlikely to Protect against New Variants in Future, Says SAGE

SAGE has laid the seedbed for more lockdowns in the future, warning that current Covid vaccines are unlikely to protect against new variants of the ever-evolving virus, the eradication of which is “extremely unlikely”. Sky News has the story.

[In a paper published on Friday, SAGE scientists] warn that eventually it is likely “current vaccines will fail to protect against transmission, infection, or even against disease caused by newer variants”.

The document, which considers the long-term plan for Covid jabs, says that “loss of vaccine effectiveness will result in further economic and social costs” and “a solution is to update vaccines to keep pace with virus evolution”.

The scientists add that “we should also consider whether future vaccination policy will aim to immunise the whole population or only those at risk from severe disease”.

The document, which was produced by SAGE’s vaccines update subgroup on May 4th, says current Covid jabs are based on the “Wuhan-like virus” that emerged in China in 2019.

Further doses of those vaccines might maintain protection into the winter of 2021/22 “but potentially less so for individuals with a less robust immune response”, it states.

The scientists say “worryingly” there is increasing evidence that Covid vaccines are less effective at protecting against infections and mild disease caused by the South African variant of the virus, compared to the Kent variant.

Several manufacturers have already started to produce updated vaccines for trials based on the South African variant instead of the virus originally identified in Wuhan, according to SAGE.

“If another variant (e.g. B.1.617 from India) predominated or co-circulated with B.1.1.7 (Kent variant) in the U.K., it is not obvious at the moment which variant based vaccine would most effectively cross protect,” SAGE said.

In February, some of the advisors on SAGE said that Britain could be trapped in lockdown cycles for “several years” because of the emergence of new Covid variants. SAGE member Professor Sir Ian Boyd believes that we could be stuck in a pattern of “control and release for a long time to come”.

The Sky News report is worth reading in full.

Stop Press: Data published by Public Health England suggests that two doses of the AstraZeneca or Pfizer vaccines are 80% effective in preventing infection from the Indian variant, seemingly contradicting the warning issued by SAGE. That’s only 7% less effective than the vaccines are against the Kent variant. The Telegraph has more.

PHE Study Showing Vaccines “90% Effective” is Plagued With Problems – and the Post-Vaccination Infection Spike is There Again

New data from Public Health England (PHE) suggests that the vaccines (both AstraZeneca and Pfizer) are up to 90% effective in preventing symptomatic infection in the over-65s when fully vaccinated.

This is a remarkable result and was widely reported in the media. It is notably much better than the trial data for AstraZeneca, which suggested only 70% efficacy for all ages.

So much better, in fact, that one wonders if something has gone wrong with one or the other study. How can a vaccine be 70% effective for all ages in a controlled trial then 90% effective in the over-65s in the real world? The authors of the PHE study did not compare their results to the AstraZeneca trial or attempt an explanation so we are none the wiser.

The new findings come from the second instalment of a weekly vaccine surveillance report from PHE. The first coincided last week with a peer-reviewed article in the BMJ which set out the study design and method in full. I’ve gone through this study and discussed it at length with others who are medically qualified and we’ve identified a number of issues that are worth flagging up as they call into question the reliability of the results.

What have the authors done? They’ve looked at all the Pillar 2 testing data for England (in the community, so not hospitals) and narrowed it down to “156,930 adults aged 70 years and older who reported symptoms of COVID-19 between December 8th 2020 and February 19th 2021 and were successfully linked to vaccination data in the National Immunisation Management System”. They excluded various test results, including when there are more than three negative follow-ups for the same person and anyone who had tested positive prior to the study.

They have then used this data to compare symptomatic infection rates between those who are vaccinated and unvaccinated, breaking it down by age, vaccine type, and days since vaccination.

Here’s the table of the people in their study.

The first thing to note is the huge difference in the positivity rate between vaccinated and unvaccinated groups. It is 24% in the vaccinated (32,832/(32,832+106,037)) and 65% in the unvaccinated (11,758/(11,758+6,303)). This wide disparity and very high positivity rate (the high rate presumably being due in part to everyone in the study, including those who test negative, having symptoms) cast doubt on the extent to which these can be considered representative groups that can fairly be compared or the results generalised to the population.

The next strange thing about the study is the authors split it into two, giving results separately for people vaccinated before January 4th and after January 4th. They explain this stratification as follows:

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