Month: June 2021

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?

Zero Daily Deaths Announced In the Whole Of the U.K. for First Time

The U.K. has reported zero deaths within 28 days of a positive Covid test for the first time since March 2020 amid calls from Government advisors for lockdown to be extended past June 21st. Sky News has more.

The UK has reported zero daily coronavirus-related deaths for the first time since the pandemic began, but the Health Secretary has warned “we haven’t beaten this virus yet”.

According to the latest government data, 3,165 new COVID-19 cases were also recorded in the latest 24-hour period.

Matt Hancock tweeted that although the “whole country will be so glad there were no COVID-related deaths recorded yesterday… we know we haven’t beaten this virus yet”.

The latest figures come after a bank holiday weekend when the number of deaths and cases can be lower due to reporting lags.

Yet the suffering caused by the lockdowns continues.

Worth reading in full.

Stop Press: A reader has compiled a table showing the total daily tests, the number of cases, the percentage of tests that are positive and the number of Covid deaths recorded in each month dating back to March 2020. As you can see, there’s been a steady decline in the number of deaths since their peak in January 2021.

Scotland Delays the Lifting of Lockdown Restrictions – Will England Follow Suit?

The lifting of lockdown restrictions has been halted in much of the central belt of Scotland, with Nicola Sturgeon pinning the blame on the spread of the Indian Delta Covid variant. Sky News has the story.

Giving a Covid update to the Scottish Parliament, [the First Minister] said there was hope the rollout of vaccinations was “opening the path to a less restrictive way” of dealing with the virus.

But, with not all adults having yet received two doses of a vaccine, [Sturgeon] told MSPs: “We are not quite there yet.”

She added: “As we make this transition – just to compound the challenge – we are also dealing with a new, faster spreading variant.

“This is, of course, a new development that has arisen since we set out our indicative route map back in March.

“All of this means that at this critical stage – to avoid being knocked off course completely – we must still err on the side of caution.”

Edinburgh and Midlothian, Dundee, East Dunbartonshire, Renfrewshire, East Renfrewshire, North, South and East Ayrshire, North and South Lanarkshire, Clackmannanshire and Stirling have not yet met the criteria to see restrictions ease, Ms Sturgeon said.

As a result, those areas will remain under Level Two restrictions [meaning limits will remain on social mixing and on leisure and entertainment businesses].

However, Glasgow will move down from Level Three to Level Two from Saturday.

And another 18 local authorities will see restrictions ease from Saturday to move down to Level One measures.

Worth reading in full.

Despite calls from various Government advisors for the end of England’s lockdown to be pushed back, the Prime Minister says there’s no evidence to suggest that the country’s reopening should be delayed. The Guardian has the story.

Boris Johnson stands by his comments that there is nothing in the data to suggest a deviation from England’s reopening on June 21st, Downing Street has said, as scientists said the U.K. was facing a perilous moment.

The Business Minister Paul Scully also said on Tuesday there was “cautious optimism” that the date for the final lifting of restrictions could go ahead as planned. He told Times Radio the Government did not want to have to roll back restrictions again.

“One thing that we saw last year, before Christmas, was the stop-start nature just didn’t work for businesses and cost them more. So we’ve got to get it absolutely right. People’s jobs and livelihoods depend on it.” …

Asked about the Prime Minister’s view on the latest data, a Number 10 spokesman said: “I was going to point to what the PM said on Thursday. The Prime Minister has said on a number of occasions that we haven’t seen anything in the data but we will continue to look at the data, we will continue to look at the latest scientific evidence as we move through June towards June 21st.”

A announcement on the final step of the roadmap out of lockdown is expected on June 14th.

Also worth reading in full.

Restrictions Resulted in “a Consistent Global Drop In Access to Cancer Care”, According to New Review of 69 Studies

A review of 69 studies from across the world has found that there was “a consistent global drop in access to cancer care” – both for adults and for children – during the first wave of Covid due to the restrictive measures introduced by governments. The review, led by Carl Heneghan, Jon Brassey, and Tom Jefferson for Collateral Global, highlights that late-stage cancer presentations (which are linked to decreased survival rates for certain cancers) increased because of delays to screenings, diagnoses, waiting lists and treatments during lockdowns, as well as after restrictions were lifted.

In an editorial based on their review, Carl Heneghan (Professor of Evidence-Based Medicine at Oxford) and Tom Jefferson (an epidemiologist and expert on respiratory diseases) present the findings from various studies on changes to cancer services due to government-imposed restrictions.

From mid-March until the end of April 2020, a cervical cancer screening unit in Cameroon saw screening numbers drop by nearly 80%. This is troubling because late-stage presentations are linked to decreased cervical cancer survival. The five-year survival rate for U.S. women diagnosed with advanced cervical cancer is 15% compared with 93% for those presenting much earlier with localised disease. A similar outcome is seen in low-income countries. In India, for example, the five-year survival is 9% for advanced disease compared with 78% when the cancer is diagnosed at stage one when it is localised to the cervix.

Several studies in our review reported that when routine services resumed after restrictions were lifted, there was still a shift to later-stage disease presentations, even in countries that were relatively unaffected by the pandemic.

In a Japanese regional treatment centre, no significant changes were seen in the number of patients undergoing surgery. However, the number of patients undergoing surgery with advanced disease increased compared with before the emergency. In three university-affiliated hospitals in Korea, the number of cancers diagnosed remained the same; however, the proportion of patients with stage three-four non-small-cell lung cancer (NSCLC) increased to 75% compared to an average of 63% in the three previous years.

Not all cancers have the same prognosis but presenting late with lung cancer is bad news. In those with early disease, more than 55 out of 100 people will survive for five years or more after diagnosis. But in later stage four disease – which has spread beyond the lungs – only five out of 100 survive for five years or more.

In low resource settings, delays had lethal effects. Among Indian patients presenting to a tertiary care hospital with oral cancers, 39% were deemed inoperable in the early three months of the Covid pandemic – double the number compared with the pre-Covid era.

These delays in care were not restricted to adults as children were affected in a variety of countries. In Turkey, a major Paediatric Oncology Department reported reductions in children undergoing chemotherapy, radiotherapy, surgery, and imaging studies during the Covid period. In Italy, presentations to the National Pediatric Oncology Unit in Milan during the lockdown phase were half of what would normally be expected. And in a U.S. tertiary referral centre, 75% of new leukaemia/lymphoma diagnoses required intensive care in April 2020 compared with a monthly average of 12% in 2018–2019.

Patients with cancer often delay seeking medical advice. The early phase of the COVID-19 pandemic substantially exacerbated these delays. The true extent of the impact of these delays may never be known. However, a substantial body of evidence reports that delays lead to later-stage cancer, which translates into more severe disease and subsequently reduces life expectancy. Low and middle-income countries are disproportionately affected by cancer, where more than two-thirds of all global deaths occur.

Worth reading in full.

The full review can be found here.

No Reason to Delay the End of Lockdown, Says Professor Robert Dingwall

Despite all the doom and gloom about the impact of the Indian Delta Covid variant, Robert Dingwall, Professor of Sociology at Nottingham Trent University and member of Government advisory group NERVTAG, says there is no reason to delay the end of lockdown. Professor Dingwall told Times Radio (as quoted in the Guardian) that “we have to push on” with unlocking because Covid no longer poses a great threat to society, whereas the “collateral damage” of lockdown does.

Personally, I don’t see any case for delay… from a societal point of view, I think it’s really important that we go ahead on June 21st, and I’ve not really seen anything in the data that would lead me to doubt that as a proposition on the evidence to date.

I think we need to recognise the way in which levels of fear and anxiety in the population have been amplified over the last 15 months or so.

We’ve got to look at the collateral damage in terms of untreated cancers, untreated heart conditions, all of the other things that people suffer from.

We’ve got to think about the impact of economic damage that would be caused by further periods of delay and uncertainty…

He added that because of the successful vaccine rollout, a slight increase in cases (due to the Indian variant) does not warrant the continuation of strict lockdown restrictions.

By the time we get to June 21st, everybody who is in the nine priority groups or the highest risk will have had both jabs, and would have had a period of time to consolidate the immunity.

What are we going on with is really running into younger age groups who are intrinsically much lower risk. Many of the scientists who’ve been talking over the weekend simply haven’t adjusted their expectations to understand that – (for these people) Covid is a mild illness in the community.

As the Director of Public Health Bolton was saying last week, the people who are going into hospital… it’s not like January, these are not desperately ill people.

They’re people who need a little bit of extra support with oxygen, they need access to the dexamethasone treatment, which is very effective.

They go in, stay in hospital for three or four days and they go out again. There is no realistic prospect of the NHS facing the sorts of pressures that it faced in January and February. And that’s why I think we have to push on with this.

Appearing on Lucy Johnston’s “Sketch Notes On A Pandemic” podcast on Sunday, Professor Dingwall also said (as flagged in today’s News Round-Up) there has been a “preference… throughout the pandemic to believe in the evidence of modelling rather than the evidence of the world”.

School Day Could Be Extended under £15 Billion Scheme to Help Pupils Make Up for Lost Time

The Department for Education (DfE), which was last week accused of being “surprisingly resistant” to investigating the shortfalls in its Covid response, is now reportedly backing “sweeping reform” to help make up for the disruption caused to education by lockdown – and to avoid the £1.5 trillion cost of doing nothing. This could include extending the school day by half an hour under a £15 billion “Covid [that is, lockdown] rescue plan”. The Times has the story.

A leaked presentation of a report by Sir Kevan Collins, the Government’s Education Recovery Commissioner, calls for all children to receive an extra 100 hours of schooling each year from 2022, with a minimum 35-hour week.

The ambitious plan for England proposes extra tutoring for five million pupils and additional training for 500,000 teachers. It also hints that an extra year of sixth-form should be considered if teenagers cannot complete A-level courses in time.

The report warns that the cost to the country of inaction could be £1.5 trillion, 100 times the cost of the three-year package, but the Treasury is thought to be offering only £1.5 billion, a tenth of what is said to be needed to help pupils to bounce back from the pandemic.

A 56-page presentation based on the report, dated April 15th, is described as a draft that is 90% complete. One Whitehall source said that nothing had “changed fundamentally” since then.

At the heart of the document are the “three Ts” – extra time, teaching and tutoring. It says that all three combined are essential to catch up. This means lengthening the school day, improving teaching through more training, and providing tutoring on top of lessons.

Schools are likely to have a degree of freedom over how they choose to extend the day. Adding the 100 hours evenly each day would roughly add up to half an hour of extra schooling. Teachers would be paid more for the work.

Boris Johnson has been briefed on the findings, and in meetings with Collins has indicated support for the plan…

The DfE is also backing sweeping reform. However, Rishi Sunak, the Chancellor, has balked at the cost of the package, which is equivalent to about £700 per pupil over three years. One insider described the £1.5 billion offered by the Treasury as “ridiculous”.

The news comes as the Times Education Commission embarks on a year-long inquiry that will lead to recommendations for reform…

Children have missed almost half a year of in-person schooling, with about 23 weeks of school closures during the pandemic. According to the report, the U.K. had the longest closures of schools and universities combined in Europe.

Worth reading in full.

Should Britain Have Tried to Contain the Virus Using Border Controls?

In his testimony to the Health and Science select committees, Dominic Cummings heavily criticised the Government’s handling of the pandemic. One of the biggest mistakes, he argued, was the failure to impose border controls:

Obviously, we should have shut the borders in January. We should have done exactly what Taiwan did… Yes, that has some disruption, but the kind of cost-benefit ratio is massively, massively out of whack, and at least it is worth a try, like lots of things. At least you try it … If it doesn’t work, you still have the whole nightmare to deal with, anyway. 

However, Cummings somewhat absolved the Government of blame on this score – at least with the respect to the period before April – insofar as all the scientists were advising against border controls:

He was told, and we were all told repeatedly, that the advice is not to close the borders, because essentially it would have no effect… you cannot blame the Prime Minister directly. That was the official advice. The official advice was, categorically, that closing the borders will have no effect.

Cummings’ testimony is consistent with the evidence from SAGE meetings in January and February of last year. For example, the minutes of a meeting on January 22nd record that “NERVTAG does not advise port of entry screening”.

Another factor Cummings mentioned, as to why the Government didn’t impose border controls, is political correctness:

At this time, another group-think thing was that it was basically racist to call for closing the borders and blaming China, the whole Chinese new year thing and everything else. In retrospect, I think that was just obviously completely wrong.

What should we make of Cummings’ argument that border controls were at least “worth a try” in January? On the face of it, the argument seems very reasonable. In the best-case scenario, we could have achieved the same outcomes as New Zealand – zero excess mortality and just a small decline in GDP. And in the worst-case scenario, we’d have been in the same situation as otherwise. 

However, the latter outcome – being no worse-off – isn’t necessarily the worst-case scenario. A potentially even worse scenario is if we’d contained the virus until the autumn, and then experienced a major epidemic at the same time as the NHS came under its normal winter pressures. 

This was in fact one of the reasons why scientists were initially advising against both border controls and lockdowns. Cummings was apparently told:

Even if we therefore suppress it completely, all that you are going to do is get a second peak in the winter when the NHS is already, every year, under pressure … If you try and flatten it now, the second peak comes up in the wintertime and that is even worse than the summer.

This argument should not be dismissed out of hand. Several of the European countries with the highest death tolls – Poland, Bulgaria, Czechia – are ones that escaped the first wave, only to get clobbered in the second. (Of course, there may be several reasons for the high death tolls in these countries; I’m not suggesting the epidemic’s timing is the only one.)

Deciding whether to impose border controls therefore represents a trade-off between the benefits of buying time and/or achieving containment versus the risks of postponing the epidemic until the winter. 

News Round-Up

Do SAGE Members Calling for Lockdown to be Extended Beyond June 21st Not Believe the Vaccines Work?

So do the vaccines not work then? That’s certainly the impression you’d get from the way various members of SAGE are carrying on, warning of new waves and new variants and the need to delay the end of lockdown even further (completely ignoring the fact that half of America is now open without any problems so far).

As Sherelle Jacobs asks in the Telegraph, why is the debate continuing as though nothing has changed despite half the country – the most vulnerable half – being vaccinated?

Instead of discussing how quickly vaccines could spell the end of restrictions, the commentariat fixates on the risk of another wave as if absolutely nothing has changed. Somehow, despite low deaths, the Indian variant rather than the vaccine has become the game changer.

We have become wearily used to these media interventions from SAGE members in the build-up to key decisions around lockdowns, usually pushing some skewed version of the scientific evidence to frighten the public and pile pressure on the Government to tighten or maintain restrictions. This was bad enough in the autumn before the vaccines were on the scene, but now it leaves you wondering if they know something we don’t about how well the vaccines prevent death and serious disease.

The Government has been continually putting out new research showing how effective the vaccines are, including against the Indian variant, and while I have written on a number of occasions about the shortcomings of these studies, I had been assuming that the vaccines do work, or at least that the Government and its scientists believe they work. With all this talk of third waves and extending lockdown, you have to wonder.

The latest line to justify extending the lockdown is from NERVTAG member Professor Ravi Gupta, who argues for just a few more weeks to let more people get vaccinated, saying there are signs an “explosive” third wave is on the horizon.

Yet according to the latest figures, 51.3% of the adult population has now had one vaccine dose and 31.4% has had two. Over 90% of the over-70s are now fully vaccinated.