Day: 2 June 2021

Postcard From Toronto

We’re publishing a new postcard today, our first in a while. This one is a postcard from Toronto, which has been in lockdown in one form or another since last November. The Ontario Premier Doug Ford hit the “emergency brake” in April, ramping up restrictions, and it hasn’t been released yet. Our correspondent, Catherine Brennan, is more than a little fed up. In the following extract, she writes about attending her first anti-lockdown protest a couple of weeks ago:

I have to admit, I felt somewhat nervous about going to the rally. Would I be arrested? What would these protesters be like? An unruly mob, frothing at the mouth with questionable personal hygiene? One left-leaning politician (and in Canada we’re all rather left-leaning – so this guy is practically falling over), warned that these rallies were full of white supremacists. While I am white, and no amount of self-tan can disguise my Irish legs, I struggled to find anyone to fit that description so cruelly slurred by the noticeably absent MP. How did he know who attended when he himself wasn’t there? So I asked my friend, she of Russian-Jewish parents who fled the pogroms living in barns for two years – was she secretly a white supremacist? I asked the lovely black couple who, very sensibly, set up lawn chairs to enjoy the convivial atmosphere. Why are you here, I asked. They answered, like so many other people I spoke with, that they were worried for their kids, whose lives have been on hold. They too had called their local politicians only to hear canned responses. Like me, they wondered whether a better balance might be struck between absolute risk and relative risk. They were disturbed by the political deafness on how lockdowns have affected kids’ welfare. These were not anti-maskers, anti-vaxxers or any other of the ad hominem name-calling around dissent these days. They were there to show support in a time of great isolation.

Worth reading in full.

How Far Should We Take Civil Disobedience to the Public Health Police State?

We’re publishing another original essay today by Donald S. Siegel and Robert M. Sauer, two professors of social science, about what ordinary people can do to push back against what they call “the public health police state”. They believe a good role model is Artur Pawlowsky, the Polish-Canadian minister who saw off the police when they tried to shut down his Calgary church on Good Friday. Here is an extract:

Unfortunately, resistance to the Branch Covidians has been too passive. We are reminded of the famous scene from the Godfather, involving Johnny Fontane and Don Vito Corleone. Johnny Fontane was the godson of Don Vito Corleone and a famous singer.

In the scene, the whimpering Fontane is complaining to the Godfather about the studio head who will not give him a movie part that is ideally suited to him and will launch his film career. He whines to Don Corleone, stating: “Oh, Godfather, I don’t know what to do.” The exasperated Godfather takes him by the neck and screams the following: “You can act like a man!”

An example of such a real man is Artur Pawlowski, a Polish-Canadian minister based in Calgary, who has bravely defied the Government’s COVID-19 public health orders. In Calgary, as in other parts of Canada, the severity of coronavirus restrictions is matched only by the paucity of the virus. Artur became a YouTube sensation when he openly defied the police and the public health inspector when they interrupted his religious service on Good Friday, referring to them as “Nazis” and “Gestapo” and belligerently demanded that they leave the church. He was ultimately arrested by the authorities.

In our view, Pastor Pawlowski is the modern-day equivalent of Cardinal József Mindszenty, leader of the Catholic Church in Hungary, who came to represent uncompromising opposition to fascism and communism in Hungary. After WWII, Cardinal Mindszenty was jailed and tortured by the Communists and given a life sentence in a 1949 show trial that was widely condemned in the West. Midszenty was ultimately freed and remains a potent symbol of opposition to Communism and a great example of resistance to the totalitarian repression of religious freedom. We need more religious leaders like Pawlowski and Midszenty to stand up to the public health police state. We also deeply admire the courage of the ultra-orthodox Jewish leadership in the U.S. and Israel for their enlightened opposition and vigorous civil disobedience.

Worth reading in full.

Almost 40% Of Recent Covid Victims Died Primarily of Other Conditions

Reported Covid deaths have been low in recent weeks but the real number of people for whom the virus was a major cause of death is lower still, according to the latest figures which show that almost 40% of recently registered Covid deaths in England and Wales were people who died primarily from another condition. The Telegraph has the story.

Out of 107 Covid deaths registered in the week ending May 21st, just 66 had the virus recorded as the underlying cause of death – 61.7%. 

For the rest of the cases, although coronavirus was mentioned on the death certificate it was not a major cause.

It is the lowest number of deaths with Covid as the underlying cause since the week ending March 13th, 2020 – the first week that deaths involving Covid were registered in England and Wales, when just five registrations were listed.

The ONS continues to include those who did not primarily die of Covid in its official statistics, even though the World Health Organisation has issued guidance warning they should not be classified as Covid deaths in official figures.

The data lends support to claims that although cases have been rising in Britain in recent weeks, due largely to the Indian [“Delta”] variant, that is not so far translating into a significant increase in deaths.

On Tuesday, the Government announced the first day without any Covid deaths since before the first lockdown in March last year…

The weekly ONS data show that Covid is now mentioned in only around one in 90 death registrations in England and Wales – the equivalent of just 1.1% of all deaths registered in the week.

It is the lowest proportion since the week ending September 11th, when the figure was 1.0%. At the peak of the second wave, in the week ending January 29th, the figure stood at 45.7%. 

The number of Covid deaths registered in England and Wales in the most recent week, to May 21st, is also the lowest since the week to September 11th.

Worth reading in full.

Did Care Homes Achieve Focused Protection in the Second Wave?

Contrary to popular understanding, Britain’s second wave of COVID-19 was less deadly than the first: although there were more deaths within 28 days of a positive test, age-adjusted excess mortality was lower. 

One possible explanation is that fewer people were infected in the second wave (even though the infection fatality rate remained constant). However, data from the Coronavirus Infection Survey suggests that roughly the same number of people were infected in the two waves. About 7% of people had antibodies at the end of the first wave, and about 14% had antibodies toward the end of the second wave (before the vaccination program had gotten fully underway). 

Incidentally, some people may have been infected without developing antibodies. I’m using the number who developed antibodies as a proxy for the total number who were infected in each wave.

Another possible explanation is that we became better at treating the illness. Evidence suggests that thousands of lives were saved by corticosteroids like dexamethasone, but these may not have been widely used in the first wave. Yet another explanation is simply that there were fewer frail elderly people alive at the beginning of the second wave, meaning that the average elderly person who became infected was less likely to die from the disease. 

However, there’s possibly a fourth reason why the second wave was less deadly than the first, namely that care homes achieved a degree of focused protection.

In the first wave, a disproportionate number of those who died were care home residents. This is partly because elderly patients who’d caught the virus in hospital were discharged to care homes when they were still infectious, resulting in deadly outbreaks. Hence more effort was made to shield care home residents in the second wave. 

According to the ONS, there were 27,079 excess deaths in care homes during the first wave, but only 1,335 during the second wave:

This finding is supported by two recent academic studies. One study, published in Environmental Research, found that the percentage of COVID-19 deaths among care home residents was lower in the second wave in eight out of 11 countries with available data, including the UK. 

Another, unpublished study observed a major spike in excess mortality among care home residents last spring, but no increase during the final weeks of 2020.

While it’s too early to say exactly which factors explain the reduction in mortality between the two waves, the evidence presented here suggests that effective shielding of care home residents may have been a major contributor. Though it should be noted that care home occupancy was lower in the autumn and winter, which probably accounts for some of the disparity in excess deaths.

Perhaps if more attention had been paid to shielding in the first wave, Britain would have come through the pandemic with a lower death toll. 

This post has been updated.

Time to “Move on” with Ending Lockdown, Says Government Adviser Sir John Bell

Sir John Bell says it is time to “move on” with ending lockdown, given that the numbers are no longer “too intimidating”. The Regius Professor of Medicine at Oxford and member of the expert advisory group to the Vaccine Taskforce added that it would be wrong to “scamper down a rabbit hole” every time a new variant emerges because Covid “is here to stay probably forever“. The MailOnline has more.

Hitting back at members of SAGE calling for a longer lockdown, Sir John Bell said ministers must instead focus on hospitalisations and deaths [rather than on variants and cases], which have remained flat nationally but there are signs of admissions increasing.  

The Oxford University medical expert, who has advised the Government on Covid tests and vaccines, suggested the country must take a leap of faith and put trust in its world-beating vaccination rollout…

Sir John becomes the highest-profile adviser to call for ministers to stick with the roadmap and bring an end to social distancing laws on June 21st’s “Freedom Day”.

His comments come as pressure mounts on Boris Johnson to push the date back to buy time to roll out jabs to millions more people to defend against the Indian variant.

New Covid cases have now been above 3,000 for seven consecutive days in the U.K. but the country yesterday reported zero new deaths for the first time since July 2020, bolstering calls for Number 10 to push ahead with plans to get back to normal…

Sir [John] told BBC Radio 4’s Today programme: “I think we do need to keep our eye on hospitalisations, serious disease and deaths, which is really what we are trying to manage.

“If we scamper down a rabbit hole every time we see a new variant we are going to spend a long time huddled away – so I think we need to get a bit of balance into the discussion and keep our eyes on the serious disease we are trying to prevent.”

The Oxford expert also urged ministers to back rolling out the vaccine in other nations, to get outbreaks under control and reduce the risk of vaccine-busting variants emerging. 

Sir John’s intervention comes as Boris Johnson faces mounting pressure to delay England’s June 21st Freedom Day, with some scientists warning rising cases could spark “Covid volcanoes” in hospitals.

Worth reading in full.

Stop Press: The Prime Minister says there is still “nothing in the data at the moment that means we cannot go ahead with Step Four” of the roadmap out of lockdown, but believes the “data is still ambiguous“.

U.K. Rights Watchdog Endorses Mandatory Covid Vaccination for Care Home Staff

The U.K.’s human rights watchdog admits that forcing care home staff to get vaccinated against Covid would be a “significant departure from current public health policy”, but has endorsed the move anyway. Support of the idea from the Equality and Human Rights Commission (EHRC) could tip the balance away from the likes of Health Minister Nadine Dorries who oppose the “no jab, no job” policy, towards the view – held by both the Prime Minister and the Health Secretary – that legislation on this matter is necessary “to reach a position of much greater safety for care recipients”. The Guardian has more.

Ministers are considering changing the law to make vaccination a condition of deployment for people in some professions that come into regular close contact with elderly and vulnerable people at high risk from the coronavirus.

In a report to the Government seen by the Guardian, the EHRC admitted that making vaccines compulsory for care home staff would be a “significant departure from current public health policy”.

But they judged that ministers were “right to prioritise protection of the right to life for residents and staff” and said it would be reasonable for care home workers to need a jab “in order to work directly with older and disabled people, subject to some important safeguards”.

The Guardian adds that the EHRC is likely to make a similar recommendation about healthcare workers. Vaccines Minister Nadhim Zahawi has suggested that NHS staff could also face mandatory vaccination, though the idea has received firm opposition from both the Royal College of Nursing, which has a membership of 450,000 registered nurses, and the Royal College of General Practitioners, representing over 50,000 British GPs.

Zahawi said no decisions had been made yet, and stressed there was a precedent: surgeons were required to be vaccinated against hepatitis B. He added: “It would be incumbent on any responsible Government to have the debate, to do the thinking about how we go about protecting the most vulnerable by making sure that those who look after them are vaccinated.”

A Government source said: “We think it would save lives.”

There is nervousness in Whitehall about making moves to force anyone to have a coronavirus injection, given the fear that this could make people who are already vaccine hesitant even more resistant.

[Whitehall is right to be nervous on this point: research suggests that health and social care workers who feel greater pressure from their employers to receive Covid vaccination are more likely to decline it.]

However, now that care workers had been eligible for vaccines for months due to their high position on the priority list, the EHRC said some demographic groups that were less likely to get vaccinated were “disproportionately represented in the adult social care sector workforce”.

The EHRC said mandatory vaccination could risk further excluding these groups “from access to employment”, so a proportionate approach with important safeguards was needed.

Worth reading in full.

A Quarter of Britain’s Pubs and Restaurants Have Yet to Reopen

Despite the recent easing of restrictions for both outdoor and indoor hospitality, new research shows that almost a quarter of Britain’s licensed premises have yet to reopen. The partial reopening of the sector has been largely hampered by the continuation of social distancing guidelines. Nearly 7.5% of Britain’s pre-lockdown total of pubs and restaurants have already closed for good. The Caterer has more.

23.7% of Britain’s… licensed premises have yet to reopen despite the return of inside service, new Market Recovery Monitor research from CGA and AlixPartners reveals.

The snapshot data found just under 25,000 venues are still shut, with similar trading numbers in England (76.6%) and Scotland (77.4%), but a notably slower return in Wales (69.6%).

The Market Recovery Monitor showed slightly more pubs have reopened than restaurants. Around nine in 10 high street pubs (92.9%), food pubs (91.8%) and community pubs (89.6%) are back trading, alongside 89.2% of casual dining and other restaurants.

However, social distancing and restrictions in place still make it unviable for swathes of venues to open, and 45.2% of Britain’s sports and social clubs remain closed, alongside 50.9% of large venues and 27% of bars. 

More than 8,500 premises… have already closed for good.

Karl Chessell, CGA’s Director for Hospitality Operators and Food, EMEA, said: “The return of large parts of hospitality for indoor service was a landmark moment for consumers and businesses alike, but it is alarming to see that so many venues have still not been able to welcome guests. Many will have decided that restrictions and space constraints make opening unviable, while some sectors like late-night bars and nightclubs are still completely off limits.

“It will be an anxious wait to see how many of the venues that are holding on until the final easing of restrictions will be able to make it through. Sustained support is clearly going to be needed to save thousands of vulnerable businesses and jobs.”

The continued presence of a fear of Covid (“Covid Anxiety Syndrome“, as it has been labelled) means many people have struggled with returning to normal life. This will no doubt have created further difficulties for publicans and restaurateur hoping to maximise sales after many months of forced closure. Recent polling from Ipsos MORI shows that 14% of British adults aren’t looking forward to having dinner in a restaurant with friends and 18% aren’t looking forward to going to the pub.

The Caterer report is worth reading in full.

News Round-Up

PHE Quietly Revises Down Effectiveness of AstraZeneca Vaccine

The latest Public Health England (PHE) weekly vaccine surveillance report appeared on Thursday (another one is due tomorrow).

I wasn’t holding out high hopes for this instalment, after digging down into the method used the previous week and finding it didn’t control adequately for background incidence (so confounded vaccine effectiveness with natural decline) and applied such brutal adjustments it could turn a 4% effectiveness into a 73% one. It lived down to expectations.

The authors appear still to be working out what exactly their reports are for as each of the three to date presents different information in a slightly different way. While the first was largely a summary of evidence published elsewhere, the second served more as a showcase for PHE’s latest study and focused on effectiveness against symptomatic disease in the over-65s (90%, supposedly). This week, the over-65s are gone and the focus is on effectiveness against the Indian variant. This makes reading the reports quite confusing, as each doesn’t feel so much like an update to the previous one as a stand-alone report on a separate topic.

In between Report 2 (for week 20) and Report 3, a separate PHE study was published on the Indian Delta variant which found the effectiveness of full vaccination against symptomatic Covid reduced from 93% to 88% with Pfizer and 66% to 60% with AstraZeneca when the Indian Delta variant was involved versus the British Alpha variant.

As I noted last week, this 66% effectiveness of AstraZeneca (against the British Alpha variant) was a long way below the 90% in the over-65s claimed in Report 2. It’s probably a sign of how low my opinion is of PHE vaccine studies that I was pleasantly surprised to see this discrepancy actually make an impact on the data presented in Report 3, and you can see below in the AstraZeneca two-doses box (top right) week 20’s “85-90%” has become “65% to 90%” in week 21. There is still no explanation from PHE, however, as to why one of their studies finds AstraZeneca 90% effective against symptomatic infection in the over-65s while another finds it is just 66% effective in all ages. Is this not the kind of discrepancy that should occasion comment from the authors?