COVID: The New Normal - When and How ?

[marinyork]

C) even with the above, there WILL be new variants, just like there is with flu, so, a degree of risk will always be present.

There will be new variants. Trying to vaccinate as near to everyone as you can possibly get and keeping cases low before the new variants emerge and take over is the strategy. The alternative is we don't even get through that much of the population before it starts all over again.

The E484K mutation has appeared multiple places on earth independently on timescales of a year/months (uncertainty). It's only 7 months to September. We do have to be quite careful on this one.

 

[BoldonLad]

It's not that at all.

I have friends in different positions. The ones who don't have young children screaming, refusing to do homework, saved wads of cash on commutes, reasonable sized house, happy with family life (things are never a breeze), sufficient contact with friends and family are all doing all right. The case with some who are going to day jobs which is what they want and it's quiet but not too quiet if you know what I mean. They cannot see the other world the single ones, no family, friend contact fallen off a cliff and uncertain work and financials are deeply unhappy and find it hard to see that things will ever change. Or other ones stuck in very cramped conditions with a very precarious and grim family life.

It's not really anything to do with glass half empty, glass half full.

It was you who made the pessimistic (in my view) comment, that you saw "no future", not me. I agree 100% that many groups are finding lockdown much more difficult than others, I have some such people in my family circle. Surely, this means we have to find a solution which gives the most benefit to most people, rather than one which concentrates the benefit in a limited number of groups. Inevitably, that will mean compromise, and, inevitably, that will involve risk. All in my humble opinion, of course.

 

[BoldonLad]

There will be new variants. Trying to vaccinate as near to everyone as you can possibly get and keeping cases low before the new variants emerge and take over is the strategy. The alternative is we don't even get through that much of the population before it starts all over again.

The E484K mutation has appeared multiple places on earth independently on timescales of a year/months (uncertainty). It's only 7 months to September. We do have to be quite careful on this one.

I don't dispute we have to be careful, but, being careful is not the same as standing frozen to the spot. It is necessary to make moves, but, there will be risks.

 

[McWobble]

View attachment 573878
View: https://twitter.com/Mark_J_Harper/status/1360713436179673099


Back to normal by Easter.

I think he's mad. I think the 63 MPs signing that are mad. Or am I wrong?

Oh good grief.

Even if restrictions were to be removed by the end of April, most people won't have had their first dose - and as MY pointed out, those who aren't are most likely to be at the highest risk of exposure. Many, probably most, of those vaccinated will not yet have received their second shot, so will not be fully protected. In short, the UK will still have a vulnerable population in which rapidly growing exponential transmission can take place.

Worse, the B117 variant has evolved the E488K mutation twice in separate cases. As as the Brazilian P1 variant and the SA variant. E488K is associated with increased probability of reinfection and diminished vaccine effectiveness. This action would create conditions that would select for this mutation. My suspicion is that B117 would rapidly - within a couple of months - be replaced by the SA variant (as it's already established in the UK). It would then propagate throughout the high risk population as, even though they will have been vaccinated, it's less effective against this variant. In any case, I would expect variants with E488K to become dominant in this scenario.

This is not the worst potential outcome. As the coevolution of E488K shows, CV is clearly evolving towards antigen escape - where it produces a strain that is not recognised by antibodies that were produced by previous infection or vaccination. Peopled who've been vaccinated or had previous CV infections would be just as vulnerable to such as strain as those yet to encounter it. Allowing unconstrained growth in a population where a significant fraction have partial protection due to incomplete vaccination is the perfect breeding grounds for variants with antigen escape to evolve. I therefore think it likely that we'd see further variants appear which are even better at infecting those who already have antibodies to previous variants.

I cannot emphasise strongly enough how appallingly bad this idea is.

 

[marinyork]

And thems just the places that does a lot of genomic testing so picked up the independent mutations of E484K over what are in reality small patches of the globe where the virus is out of control (not everywhere). There are likely more mutations of E484K out there or other completely different strains, or will be before autumn.

 

[Ajax Bay]

I said: "as the UK population approaches herd immunity (end June)."

Not quite sure we will achieve herd immunity by June. I thought it would take a couple of years?

Rehashing a previous post to do the maths again for 'approaching' herd immunity.
If we take 75% as the percentage of the population which need to be immune before that's achieved. With a UK population (over 4 years old) of 64M that's 47M. Currently about 15M have received the first dose and the daily rate is 435.310pd.
Once we've vaccinated 47M (first or both doses), we'll be over the 75%.
Edit (with better maths and rate of vaccination estimate) if the UK programme continues on plan/past performance: assumes 450,000 a day from now on but NB from 14 March an increasing proportion will be second doses.
14 Mar = 27M (first dose)
2 Apr = 34M (first dose; number in JCVI Gps 1-9 is 32M btw, government suggestion/target = end April)
1 May = 37M, then all doses go on second dose till:
9 Jun = 37M
30 Jun = 38M
31 Jul = 45M
Edit: So estimate 6 Aug to hit 47M and approaching (effective) herd immunity (14 days later).
Caveats: Depends on
= vaccination programme continues at pace (450,000 daily from 14 Mar and maintained, 7-day averages)
= how effective the vaccines are (we hope 90%)
= how infectious the viral strain is (come May) - factors into 'R' and NB it's going to be a lovely May (well last year it was )
= restriction measures reducing R - these measures will have been progressively revised across the UK by then and
assumes vaccines minimises transmitting (as well as getting infected with symptoms) - emerging data suggest this is a reasonable assumption.

* A factor which would bring herd immunity forward is the number of non-vaccinated under 30s (about 20M all up) who have previously 'had' COVID-19, a good proportion asymptomatic and/or not tested, who still have sufficient antibodies to resist infection. Every million of those brings forward herd immunity 5 days.
* This ignores the cut-off continent and further afield, but only because this post is too long already.

One of the [benefits of] herd immunity is to keep vulnerable groups who cannot get vaccinated (e.g. due to health conditions like allergic reactions to the vaccine) safe[r] by making it less likely that they'll catch the disease.
Another is to minimise the opportunity for the virus to mutate and produce a variant either more transmissible, or more lethal or resistant to the immunising effect of the current set of vaccines.

 

[marinyork]

Deeply sceptical . I've not heard anyone say herd immunity is around 75% for ages. With B.1.1.7 and B.1.351 and other variants that are more transmissable it may be more like 90%, or some even think it's impossible and certainly without some restrictions.

We may have slow downs, we may have a very nice 2nd half of the summer and cases low, herd immunity by end of June sounds as realistic to me as Boris promising a good Christmas last year.

That was the whole point of my post going on about the schools and why we had to be careful.

This whole scenario sounds like more like dealing with the earlier variants wish lashings of optimism and current vaccine progress we may have got to herd immunity eventually.

I'm sceptical especially due to the city of Manaus in Brazil and we can see what happens in Israel when they get up to 75% of the population vaccinated. Let's hope it does.

 

[midlife]

I said: "as the UK population approaches herd immunity (end June)."

Rehashing a previous post to do the maths again for 'approaching' herd immunity.
If we take 75% as the percentage of the population which need to be immune before that's achieved. With a UK population (over 4 years old) of 64M that's 47M. Currently about 15M have received the first dose and the daily rate is 435.310pd.
Once we've vaccinated 47M (first or both doses), we'll be over the 75%.
If the UK programme continues on plan/past performance: assumes 400,000 a day from now on, and from 14 March split half and half (1st/2nd dose)).
14 Mar = 26M
14 Apr = 32M (roughly the number in JCVI Gps 1-9 btw, government suggestion/target = end April)
14 May = 38M
So estimate 27 Jun to hit 47M and approaching (effective) herd immunity (14 days later).
Caveats: Depends on
= vaccination programme continues at pace (400,000 daily and maintained, 7-day averages, less than current to allow for supply reduction and general pessimism bias)
= how effective the vaccines are (we hope 90%)
= how infectious the viral strain is (come May) - factors into 'R' and NB it's going to be a lovely May (well last year it was )
= restriction measures reducing R - these measures will have been progressively revised across the UK by then and
assumes vaccines minimises transmitting (as well as getting infected with symptoms) - emerging data suggest this is a reasonable assumption.

* A factor which would bring herd immunity forward is the number of non-vaccinated under 30s (about 20M all up) who have previously 'had' COVID-19, a good proportion asymptomatic and/or not tested, who still have sufficient antibodies to resist infection. Every million of those brings forward herd immunity 5 days.
* This ignores the cut-off continent and further afield, but only because this post is too long already.

One of the [benefits of] herd immunity is to keep vulnerable groups who cannot get vaccinated (e.g. due to health conditions like allergic reactions to the vaccine) safe[r] by making it less likely that they'll catch the disease.
Another is to minimise the opportunity for the virus to mutate and produce a variant either more transmissible, or more lethal or resistant to the immunising effect of the current set of vaccines.

Some think that it might be difficult given the variants about at the moment, plus getting the second dose to circa 80% adults might stretch the June target in your figures. Maybe I'm just pessimistic....

https://www.uea.ac.uk/news/-/articl...t-be-achievable-even-with-high-vaccine-uptake

 

[All uphill]

My view (guess) is that there will be a significant section of the public who resume their 2019 lifestyle as soon as possible, including restaurants, pubs and holidays abroad; there will be another group (including me) who will make only slight changes from now, and a majority who will be somewhere in between.

We may have a summer with low infection rates and deaths, but I foresee another wave in the autumn.

Disclaimer: in the past it's been pretty safe to bet against anything I am confident about

 

[Ajax Bay]

Some think that it might be difficult given the variants about at the moment, plus getting the second dose to circa 80% adults might stretch the June target in your figures. Maybe I'm just pessimistic....

Agree ref variants - see caveats. Likewise relies on effectiveness of all three vaccines (Moderna from next month)
Yes, Edit: see revisions. Some protection (?80%) 14 days after vaccination.
Note take-up levels in the various cohorts doesn't matter (for this aspect) provided the programme just rolls on to vaccinate in numbers.
Think you're perfectly realistic. The UEA paper makes several overlaid pessimistic calculations and assumptions.
Edit: This CDC article: COVID-19 Vaccines and Herd Immunity gives an excellent insight into the various factors which will affect achieving herd immunity, if ever.
At 200,000 first doses a day in the summer, every additional percentage point needed for herd immunity represents about 3 additional days of vaccinations.

 

[MrGrumpy]

Seriously how can anyone see much change in restrictions this year. A total cluster f last year and the reluctance to unwrap too quick is due to lessons learned you hope . Staycation possible in the summer . Crowds of people piled into Pubs no way want happen this year , maybe just maybe next year . Virus will need to mutate into something less viral fingers crossed !

 

[Blue Hills]

Seriously how can anyone see much change in restrictions this year.

I fear you are being extremely negative.
I think we are well on the home straight.

 

[Ajax Bay]

Seriously,

How can't anyone see that reduction in restrictions this year is certain.
Staycation boom in the summer. Crowds of people piled into pubs, perhaps with a little more restraint,
Oh, but absolutely no kissing, especially not if you haven't been vaccinated (eg under 25 till August). And no sex with anyone you aren't living with.
Yeah, right.

 

[johnblack]

How can't anyone see that reduction in restrictions this year is certain.
Staycation boom in the summer. Crowds of people piled into pubs, perhaps with a little more restraint,
Oh, but absolutely no kissing, especially not if you haven't been vaccinated (eg under 25 till August). And no sex with anyone you aren't living with.
Yeah, right.

I'd rather stay in lockdown than have a holiday in this country

 

[marinyork]

Oh, but absolutely no kissing, especially not if you haven't been vaccinated (eg under 25 till August). And no sex with anyone you aren't living with.
Yeah, right.

This is true for many of us. Different sides of it including the other side covered in this article:

https://www.theguardian.com/lifeand...tact-the-people-breaking-lockdown-to-have-sex