Seasonal Flu

Now They’re Redefining ‘Endemic’ to Keep the Pandemic Going On and On

Uh-oh, now they’re trying to redefine the word ‘endemic’ in a way that moves the end of the emergency even further away.

Paul Nuki, of the Telegraph‘s Gates-funded Global Health Security team, has written a piece pushing this agenda (though to be fair to Bill Gates himself, last week he said Covid is now becoming like flu, an endemic disease). Here are some excerpts, with my comments interpolated in boldface.

Christina Pagel, a Professor of Operational Research at University College London, notes that “a virus isn’t endemic just because a Government minister says it is and just because people want it to be”. [Note that Prof. Pagel is a mathematician with no medical training.]

“The current pattern of waning vaccination, new immune evasive variants, and minimal public health response seem set to doom us to massive surges once or twice a year”, she tweeted last week. [A seasonal respiratory virus then.]

Dr Helen Salisbury, a senior GP and Oxford academic, added that people may regret talking about Covid becoming endemic as a good thing. “TB and smallpox were once endemic in the UK – it doesn’t mean mild, it just means widespread”, she warned. [But Covid, and particularly Omicron, is mild.]

So what does it really mean for a disease to become endemic and where do we stand as regards SARS-CoV-2?

Francois Balloux, a professor of computational biology at University College London, was one of the first to talk about Covid becoming an endemic disease and says, “in retrospect, we epidemiologists should have come up with a tighter definition”.

He says the common dictionary definition of the word – a disease regularly found among people in a particular area – is misleading. For epidemiologists, the term is more technical and relates to a virus’s reproduction value settling at around one.

“Essentially it means that things are kept in check up to a point by the immunity in the population”, says Prof Balloux. “There is a stability and a predictability to an endemic pathogen but the complication is that they can still go up and down”. [So is it stable and predictable or not?]

Influenza is a good example. Its seasonal waves are largely predictable and kept in check through a mixture of natural immunity, vaccines and behaviour change. [Flu being endemic and ‘kept in check’ has nothing to do with vaccines or behaviour change. Vaccines probably reduce the death toll but it was endemic and ‘kept in check’ before vaccines came along. And what has behaviour change got to do with anything – when did anyone change their behaviour during a winter flu wave, besides possibly staying at home when unwell?]. There are good years in which it kills very few and bad years where it can dangerously stretch health services. …

Adam Kucharski, an Associate Professor at the London School of Hygiene and Tropical Medicine, thinks it may take longer for things to become predictable.

He notes the evolution of SARS-CoV-2 may not yet have settled into a gentle foreseeable drift, where each new variant comes from a known lineage. Omicron didn’t emerge from the Delta lineage and Delta didn’t emerge from the Alpha, Beta or Gamma lines, he says.

“I suspect we’ve still got a period of uncertainty before we can predict the coming years with any confidence”, he told the Telegraph. “Covid evolution might pause in an Omicron-shaped corner for a while, or Omicron might give rise to another variant, much like we’d see for seasonal coronaviruses and flu, or we could see another evolutionary surprise”. [When did evolutionary predictability become a condition of being endemic? Flu is not predictable, which is one reason the vaccines are hit and miss. Indeed, Dr. Kucharski admits the endemic coronaviruses and flu virus themselves give rise to new variants, so why should this exclude SARS-CoV-2 from being endemic?]

For now, Omicron cases appear to be plateauing in parts of the U.K. On Saturday, Dr Susan Hopkins, the UK Health Security Agency chief medical adviser, said the number of infections were flat in London and the South East and rising only slowly now in the North. [Plateauing? Rising? Plummeting more like, including in the North. This is a flat-out inaccurate description of the current state of the outbreak.]

“All of that means we are seeing a slowdown in the number of admissions to hospital but they are slowing down rather than reversing”, she said. [The number of Covid patients in hospital and ICU has been declining for some days now – anyone can see this on the Government Covid dashboard.]

With hospitalisations still running at over 2,000 a day and most regular NHS business still on hold, Dr Hopkins will be hoping SARS-CoV-2 becomes endemic in the UK at a somewhat lower level than it is today. [We’re at the peak of the winter wave of a seasonal respiratory virus, what a ridiculous thing to say; of course it will not remain endemic at this level.]

Otherwise, as the US Centers for Disease Control suggests, we may be needing yet another new word. “Hyperendemic refers to persistent, high levels of disease occurrence”, it notes. [Well yes, if a virus was to persist at its winter peak level throughout the year that could be a problem. But it doesn’t, so we don’t need a new scary-sounding term to refer to it, thank you very much.]

There’s no need to over-complicate this. Flu is endemic. By endemic we mean like flu, so we can go back to normal. Covid is now like flu. Next topic.

Not worth reading in full.

Infections Falling in England, Data Shows – The Same Time as Last Year Despite No Lockdown

The latest data from the ONS infection survey confirms that coronavirus prevalence has been falling in London since the end of last month. This is occurring at the same time as last year, despite no lockdown being imposed this time and the emergence of the Omicron variant.

The data also shows that in the last week of 2021, an estimated 6% of the population of England or one in 15 people would test positive for COVID-19. This compares to a peak prevalence last winter of around 2%, so around three times higher.

The breakdown by age shows high prevalence in all age groups and particularly those under 50. Most age groups appeared to be peaking at the end of December, though in the over-50s infections were rising albeit from a lower level.

Sadiq Khan Calls for Mandatory Face Masks on Public Transport

Mayor of London Sadiq Khan has called on the Government to re-impose mandatory face masks on public transport and has recommended that members of the public wear them voluntarily in the meantime. Khan has also called on Londoners to protect the NHS this winter by receiving a Covid booster vaccine when it becomes available, as well as to book a place for the annual flu jab. The MailOnline has the story.

The Government has been resistant to bringing in ‘Plan B’ measures, which would see the reintroduction of mandatory facemasks indoors and guidance to work from home and the use of Covid passports.

Mr Khan called for Londoners to get vaccinated against Covid and the flu to protect the NHS this winter.

It comes as official data shows more and more adults in their 30s and 40s are choosing to wear face masks on buses and trains amid spiralling Covid cases.

An Office for National Statistics poll found 33% of middle-aged adults wore coverings while on public transport at the start of September.

But just a month later this had ticked upwards to almost 40%, despite no change in official guidance.

The London Mayor said in a statement that the “deadly virus has not gone away and this winter we’re facing both flu and Covid”.

He added: “The worst thing we can do is to lower our guard, be complacent and underestimate the risk these viruses pose to all of us.

“The situation with Covid in London is so finely balanced that it needs all of us to act together to protect ourselves, our loved ones, the things we enjoy and our NHS this winter.

“That’s why I’m urging all eligible Londoners to have the booster vaccine and flu jab as soon as you are offered it, continue to wear a mask where you can and I’m calling on the Government to put simple and effective steps, such as mandatory face coverings on public transport, in place to halt the spread of the virus now.”

The Mayor’s comments came after a leading scientist suggested measures in ‘Plan B’ may not be needed if data continues to show a decline in cases.

Worth reading in full.

Brits Suffering from ‘Super Colds’ Due to Weakened Flu Immunity Following Lockdowns

The decline in flu immunity during lockdowns has resulted in Brits complaining of suffering from ‘super colds’, with extra disruption to life likely to be caused by some health experts advising those with symptoms to isolate before ruling out Covid through testing. The Mirror has the story.

Social media is seeing users increasingly talking about having caught a “Super Cold” as Covid tests come back negative. …

[Professor Neil Mabbott says:] “As [lockdown] measures are eased and people start mixing more indoors and travelling on public transport we can expect to see a significant rise in colds and other respiratory diseases.”

Professor Alex Richter, of Birmingham University, said: “It is impossible to tell the difference between a cold and Covid clinically.

“They present so similarly that only PCR testing can differentiate between the two. Lateral flow testing can help with screening, but if someone has symptoms then they should go for a PCR swab test.”

“It is unlikely we are seeing the circulation of a ‘Super Cold’,” Professor Mabbott added.

“Rather our immune systems have had limited exposure to colds over the past 18 months, so our immunity to these diseases will have waned during this period and will be less effective against colds than would be expected normally.” …

Professor Alan McNally is Professor of Microbial Evolutionary Genomics at the University of Birmingham and was Infectious Disease lead at the Milton Keynes Lighthouse Lab.

He said: “If you have any symptoms of respiratory infection you should stay at home to prevent transmission and get a test done for Covid to rule in or out.

“Trying to self-diagnose is a sure-fire way to send Covid case rates soaring again.”

Worth reading in full.

Stop Press: The Telegraph has some advice for those suffering from the ‘super cold’.

Covid Infections Begin to Rise in Northern Europe as Winter ‘Flu Season’ Gets Underway

Has the winter ‘flu season’ begun in northern Europe, with signs of upticks in Covid positive tests in the U.K., Denmark, Finland, the Netherlands and also Russia?

There’s no new variant driving these – it appears to be purely seasonal, with Delta still dominating. There’s also a lot more herd immunity around now (and high vaccination rates, if that has any effect on infection and transmission). What will a winter Covid surge look like under these conditions? We may be about to find out.

Denmark recently ended all restrictions, including abolishing vaccine passports, declaring Covid no longer a “socially critical disease”. Let’s hope it holds its nerve as winter hits, and that we, too, will resist introducing any draconian new measures as we face whatever the coming season may throw at us.

Covid May No Longer Be “The Most Significant” Threat to Health, Says Head of U.K. Health Security Agency

With talk ramping up about the danger posed by seasonal influenza this winter – especially given the impact lockdowns and social distancing are likely to have had on immunity – the Chief Executive of the U.K. Health Security Agency has acknowledged that Covid is no longer the “most significant” threat to health. The Sunday Telegraph has the story.

[Dr. Jenny Harries] said today that Covid was possibly no more dangerous than flu, as she warned that there would be a lower immunity to the illness this year.

She said: “It is important to remember that for an average flu season it’s about 11,000 deaths a year, it’s somewhere between four (thousand) to 22,000 over the last four to five years.

“So we are starting to move to a situation where, perhaps Covid is not the most significant element, and many of those individuals affected will of course have other comorbidities, which will make them vulnerable to serious illness but other reasons as well.”

It comes as the NHS launched its biggest ever flu vaccination drive amid fears flu deaths could be the worst for 50 years because of lockdowns and social distancing.

More than 35 million people will be offered flu jabs this winter, amid concern that prolonged restrictions on social contact have left Britain with little immunity.

Officials fear that this winter could see up to 60,000 flu deaths – the worst figure in Britain since the 1968 Hong Kong Flu pandemic – without strong uptake of vaccines.

There is also concern about the effectiveness of this year’s jabs, because the lack of flu last year made it harder for scientists to sample the virus and predict the dominant strains.

Meanwhile Dr. Harries added that the dominance of the Delta variant globally has seen other coronavirus variants “become extinct”, but warned we still need to “stay alert”.

“With the dominance of Delta, it does look as though many of the other variants which have been detected are becoming extinct, and a number of variants under investigation have risen slightly, we’ve seen cases, and they’ve become extinct,” she told The Andrew Marr Show.

However she cautioned that it was imperative to “stay alert”, as she said it was “still very early days of a new virus”.

Worth reading in full.

Decline in Flu Immunity Due to Clampdown on Socialising Has Led to ‘Worst Colds Ever’

Some Brits say they are suffering from their “worst cold ever” as scientists warn that the decline in flu immunity during continued lockdowns could lead to a difficult winter. The Independent has the story.

For Rebecca London, 24, from Bournemouth, a usual cold would mean “a runny nose, sneezing, a bit of a sore throat and feeling a bit rundown”.

“Nothing like this,” she told the BBC, saying she could barely sleep during her illness, which numerous lateral flow tests confirmed was not Covid.

Others have spoken of being “floored” by their colds, some of which lasted for more than a month.

Dr. Philippa Kaye, a GP in London, told the broadcaster: “We’ve actually been seeing a rise in the number of coughs and colds and viral infections.

“We are mixing in a way that we haven’t been mixing over the past 18 months.

“During those first lockdowns, we saw numbers of other [non-Covid] infections fall. We think that that was primarily due to the restrictions on meeting up.”

In more positive news, the World Health Organisation’s latest influenza update suggested that global cases were “at lower levels” than predicted for this time of year, despite fears of mass outbreaks.

However, with winter approaching, the situation could get worse, as Professor Anthony Harnden, the Deputy Chair of the Joint Committee on Vaccination and Immunisation, has warned. He said that low flu immunity “could be potentially a bigger problem this winter than Covid”.

Worth reading in full.

English Patients Could Get Routine Annual Covid Jabs at Same Time as They Get Flu Vaccinations, Says Nadhim Zahawi

The media focus is currently centred on the booster jabs that will be given this year – starting with the over-50s and care workers – but the Government is already looking to the booster vaccine roll-outs of the future. Vaccines Minister Nadhim Zahawi says that English patients could get routine annual Covid jabs at the same time as they get their flu vaccinations. The Guardian has the story.

Scientists have warned that the NHS is likely to be under significant pressure from other seasonal illnesses as well as Covid infections.

Zahawi said he hoped the booster programme would be the “last piece of the jigsaw” to allow society to continue through the winter without lockdowns.

Speaking to BBC Radio 4’s Today programme he said: “Where possible we will try and co-administer – with one caveat – with flu. GPs and pharmacies, which are the backbone of the vaccination programme, can rapidly vaccinate lots of people.

“This is probably the last piece of the jigsaw to allow us to transition this virus from pandemic to endemic and I hope by next year we will be in a position to deal with this virus with an annual inoculation programme as we do flu.” …

Boris Johnson is on Tuesday to confirm the start of a booster jabs programme for the over-50s, a day after Government scientists finally approved vaccinations for older schoolchildren. [Why finally? Why were they supposed to give the green light?]

Worth reading in full.

Total Focus On Covid Could Mean Flu Vaccines Less Effective This Year

Medical experts are concerned that flu vaccines may be less effective this winter as resources have been focused on Covid over the past year and there has been a significant drop in the number of global shipments of influenza surveillance samples. MailOnline has the story.

Every year a new influenza vaccine is developed to protect against several strains of the virus that have been circulating around the world.

But over the past year, surveillance of flu strains dropped to a fraction of normal levels as medical resources were turned over to monitoring Covid.

There has also been a lack of flu infections because of lockdowns worldwide, which has also reduced surveillance.

The effectiveness of flu vaccines varies from one season to the next but it is estimated at between 30 and 60%.

It comes amid fears of a bad bout of influenza this year due to a lack of natural immunity caused by lockdowns.

Last September – five months before experts decide which strain to protect against – global genetic sequencing of flu had dropped by 94%, according to jab makers.

And global shipments of influenza surveillance samples have dropped by 62% compared to before the pandemic.

Dr. Beverly Taylor, Head of Influenza and Scientific Affairs at Seqirus, which provides Britain with seasonal flu jabs, said: “We could have reduced the opportunity to identify viruses as they emerge.

“We certainly have reduced the opportunity to look at which viruses would give the best overall protection and the best coverage of all the circulating viruses.”

There are concerns the NHS could be overwhelmed this winter by a triple-whammy of surging flu and Covid admissions, and backlog patients needing treatment.

Experts also fear immunity to flu has waned over the year-and-a-half since the pandemic began because so few people have caught the virus.

Worth reading in full.

Britain Set to Carry Out Largest Flu Vaccine Roll-Out in Its History This Winter

Encouraged by its large Covid vaccine programme, Britain will carry out the largest flu vaccine roll-out in its history this winter, with all secondary school pupils and children aged two and three set to be offered vaccines. Officials expect that, altogether, 35 million people could be vaccinated against seasonal flu this year and that Covid and flu vaccines will continue to be given for “years to come”. MailOnline has the story.

NHS England and Improvement, and Public Health England have issued the 2021-2022 annual flu letter to providers, outlining their plans for this year’s expanded programme.

From September, 35 million people including all secondary school students up to Year 11, children aged two and three on August 31st, all primary school children, people aged 50 and over, pregnant women, unpaid carers, and frontline health and adult social care staff will be eligible for the free jab.

The drive will build on last year’s expanded flu programme, which saw a record 19 million jabs being administered.

[Health Secretary Sajid] Javid encouraged all those eligible to get their flu jab when they are called.

“Flu can be a serious illness and we want to build a wall of protection by immunising a record number of people,” he said. 

“With the nation getting closer to normal life, we must learn to live with Covid alongside other viruses and we’re offering the free flu jab to millions more people to help keep them safe this winter.

“The phenomenal scale of the Covid vaccination programme is a clear demonstration of the positive impact vaccination can make and I encourage all those eligible to get their flu jab when called forward.”

Public Health England medical director Dr Yvonne Doyle said the upcoming flu season will be “highly unpredictable” combined with “the likelihood that Covid will still be circulating”.

The flu programme is expected to be delivered alongside any booster programme for Covid vaccinations.  

The Joint Committee on Vaccination and Immunisation is expected to publish its final advice on the Covid booster jab programme later this summer. …

In a letter sent to senior leaders, GPs and hospital bosses earlier this month, NHS England said health systems should be preparing to deliver booster doses of the coronavirus vaccination between September 6th and December 17th. 

NHS Providers Chief Executive Chris Hopson said people will [need] to be vaccinated for flu and coronavirus for “years to come”.     

“Rolling out a flu programme of this scale alongside a Covid booster campaign will take a huge amount of planning, collaboration and commitment, particularly from primary care,” he said.  

“It is incredibly ambitious in its scale and complexity, and while we have no doubt the NHS can meet this challenge, we do need to think about how we enable NHS staff to carry out this programme while meeting the other pressures they face.

“We’ll be vaccinating against flu and Covid for years to come so let’s put our approach on a sustainable footing as soon as possible.”

Worth reading in full.