Coronavirus – Part 9 (July 2021)

Dr John Ling continues to provide us with a monthly review of all things Covid. This, his latest offering, was published earlier today on his personal website, which is well worth a look for many other resources and information. Thank you John!

The Covid-19 numbers

It is almost impossible to review and summarise the unprecedented fluctuations of the Covid-19 pandemic during July.  They defy logic and order.  That virus is a desperado.

Remember during most of May, new cases were down to only 2,500 or so each day.  But by the end of June and the beginning of July, the UK was suffering an upward trend of new cases at around 27,000 per day.  By mid-July, that number had almost doubled to 50,000 yet by the end of July it had settled back to about 30,000 per day.  What volatility!  The third wave was here, but somewhat waveringly.  So, do these decreasing numbers in the last days of July represent a turning point in the pandemic?  Are you an optimist or a pessimist?

The numbers of hospitalisations, people on ventilators and deaths have been less erratic, but decidedly upward.  They began July at 400, 300 and 30 per day respectively and ended the month at 950 and 850 and 80.  None of these trends is welcome or comforting.

Overall, the total numbers of Covid-19 cases and deaths in the UK have now reached approximately 5.8 million and 129,000 respectively.

The vaccination data are somewhat more heartening.  After eight months of the UK roll-out, a total of 84.7 million doses have been administered, consisting of 46.8 million first doses and 37.9 million second doses.  Overall, 70% of the UK’s adult population has now been single jabbed.  Analysis by Public Health England (PHE) reckons that the coronavirus vaccines have prevented 22 million new infections and 60,000 Covid-related deaths.

The global picture is, as ever, more assorted.  There have now been totals of 196.6 million Covid-19 cases and 4.2 million deaths worldwide.  Currently, the USA is the most infected country (91,000 new cases per day) followed by Brazil, India, Indonesia, Iran and then the UK in sixth place (30,000).  Countries reporting the most deaths are the USA (a total of 607,000) followed by Brazil, India, Mexico, Peru, Russia and the UK (129,000).  In terms of deaths per million population, Peru tops the table (5,949) with the UK ranked at number 18 (1,909).

The outlook

In mid-July, the UK’s Scientific Advisory Group for Emergencies (SAGE) released its assessment of the likely impact of the lifting of restrictions post-19 July.  It reckoned that, at its peak, around 100,000 new cases per day could occur leading to more than 1,000 people a day being hospitalised and more than 100 a day dying.  Cases are not expected to peak until mid-August at the earliest.

SAGE is not alone.  There are several other organisations’ estimates, typically less severe, from which to choose.  Such computer modelling is at best sophisticated guesswork, relying on past trends, weighted statistics and human hunches.  Are their facts and figures any more accurate than those of your average TV pundit?  We shall see.

Looking further ahead into the year, there are additional predicted Covid-related setbacks.  For instance, the Academy of Medical Sciences has recently forecast that outbreaks of respiratory syncytial virus (RSV, the common virus that causes mild, cold-like symptoms) during this coming autumn plus flu in the winter could be around twice the magnitude of a normal year.  And they may overlap with yet another peak of Covid-19 infections.  The most probable outcome will be added pressure on the National Health Service (NHS).

Finally, what is even more confusing and unpredictable is the outlook for holiday travel with its vaccine passports, changeable quarantine regulations, designation of amber-plus countries, vaccination regulations, and so on.  There will be no attempt in this article to rationalise and comment on that mess.

And the general outlook?  As ever, we will be learning to live with the virus.  And as ever, this Covid-19 pandemic is far from over.

‘Freedom Day’ and its curious aftermath

Monday 19 July was that long-awaited day when the UK government relaxed almost all those Covid-19 restrictions, at least, in England.  Of course, it was a divisive strategy.  A YouGov poll had revealed that the government was out of step with the public on its decision to reopen, with just 31% in favour compared with 55% against.

Some politicians, restaurateurs, night clubbers, sports fans and the like could hardly wait.  Others, including healthcare leaders, raised significant concerns, calling the action ‘foolish’ and ‘unethical’ at a time when new cases were continuing to rise to over 50,000 a day and when hospital admissions were also on the upturn.

The libertarians responded by asking, ‘If not now, when?’  Summer was here, schools were out, holidays were round the corner, so less personal contacts and less risky outdoor activities were more likely.  Besides, should the population wait until the autumn to reopen amid the start of the additionally dangerous cold and flu seasons?  In its defence the government said it had already planned to vaccinate 35 million people against flu this year.  Yet this move has reportedly left GP practices facing a ‘planning nightmare’ that could leave many healthcare staff unable to opt in to deliver the proposed Covid-19 booster jabs.

Then despite Professor Neil Ferguson, the erstwhile government coronavirus advisor, warning that the UK may have 200,000 new coronavirus cases a day by mid-August, Boris Johnson on the night before ‘Freedom Day’, urged the public to, ‘please, please be cautious.’  The upshot was that Monday 19 July came and went.  And nothing drastic occurred – at least, not yet.  The expectation was that if cases of Covid-19 were to flourish, as a result of more mass gatherings, less social distancing, less face coverings, and so on, it would take a week or two before the wretched bug was seen to be taking a hold.

Nevertheless, here is the unexpected oddity.  From 1 July, new cases in the UK started to increase slowly to around 27,000 and then they took off to peak at around 50,000 by 15 July.  Was this the beginning of the dreaded exponential growth of a devastating third wave?  Seemingly, not so.  Contrary to expectation, the numbers actually began to fall so that by the end of July they were about 30,000.

And no-one can convincingly explain why these fluctuations occurred.  Questions arise.  For example, have school holidays meant less contact among parents at the school gate, but also among pupils, who, though not usually seriously ill with Covid-19, have become more important spreaders as more adults are protected by vaccinations?  Or was the rise in cases caused by the Euros football tournament with especially men watching indoors, in close-knit groups, but as the competition ended, so did the fall in Covid-19 infections?  Or has there been less testing because those with booked holidays are less inclined to get tested with the prospect of enforced isolation?  Or now with about 90% of UK adults displaying antibodies from either vaccination or natural infection, does the virus have less opportunity to spread than in the first and second waves?  Or has summer sun and the recent heatwaves meant more open windows, better ventilation, less opportunity for the virus?

The truth is no-one knows the causes of these new case fluctuations.  Other pertinent questions remain, such as, will the fall continue, or is this a false dawn?  How long will people retain immunity?  What lies ahead this winter?  Will the NHS cope?  Will the estimated two million people believed to have already developed long Covid be joined by others?  Is there room for optimism yet?

Have you been ‘pinged’?

Apparently the NHS Test and Trace (NHST&T) service has been working overtime as judged by the boom in the numbers of people who have been ‘pinged’ and told to self-isolate after coming into contact with someone with Covid-19.  For example, between 1 and 7 July, a total of 520,194 people in England had received an alert.  A further 9,932 people received the same alert in Wales.  The data from the following week were up by 17% and reached almost 690,000 in the week ending 21 July.

This has created a so-called ‘pingdemic’.  Such self-isolation has resulted in massive staff absenteeism across all business sectors of the UK.  For instance, several supermarkets, including Tesco and Sainsbury’s, apologised as shortages of delivery drivers strained supply chains and a lack of shop staff caused empty shelves.

Meanwhile, workforce shortages meant that some businesses, such as fuel provider BP temporarily closed ‘a handful of sites’.  And dozens of councils were forced to suspend bin collections.  Most temporarily stopped garden waste pick-ups, but some recycling collections were also hit.

Complaints from businesses pressured the government to act.  Already employers with fully-vaccinated key workers can request an exemption from isolation for named employees in industries such as energy, food production and supply, waste treatment, essential chemicals, medicines and emergency services.  And by 16 August, self-isolation for all fully-vaccinated people ‘pinged’ by the app is due to be scrapped.  In the meantime, if you are contacted by NHST&T you are legally obliged to self-isolate until 10 days have passed since your contact with an infected person.

Questions about the effectiveness of the NHST&T service persist.  Have you seen the government guidance entitled, ‘NHS Test and Trace: what to do if you are contacted’?  There are a full 15 pages of it!  Furthermore, it is reported that because of the inconvenience of the ‘pingdemic’ some 20% of those registered have already deleted the app.  And of those ‘pinged’ not all will always self-isolate.  This approved procedure was not encouraged by the announcement at 08:00 on ‘Freedom Day’ by Boris Johnson and Rishi Sunak that they were exempt from self-isolating after coming into contact with the Covid-19-positive health secretary, Sajid Javid, because they were taking part in the pilot scheme involving daily testing.  Less than three hours later, at 10:38, Downing Street announced a U-turn following a ‘furious backlash’ from the general public – both senior politicians subsequently self-isolated.

For a service that has been costed at an eye-watering £37 billion, there will need to be robust and searching questions asked when the Covid-19 public inquiry is convened.

Sputnik V is safe?

Russia’s Covid-19 vaccine, Sputnik V (what else?), has long been eyed with suspicion.  For a start, the Russian ministry of health approved its use on 11 August 2020, more than a month before its Phase 1 and 2 human clinical trial results were published, and before its Phase 3 trial had even started.  Moreover, doubts remained about the incidence and reporting of its possible rare side effects.  But, based on evidence from Russia and several other countries, it has now been widely declared to be both safe and effective.

Although Sputnik V, also known as Gam-COVID-Vac, was the first Covid-19 vaccine to be registered for use in any country, it has since been approved by 67 countries, including Brazil, Hungary, India and the Philippines.  But the vaccine, and its one-dose sibling Sputnik Light, has yet to receive approval for emergency use from either the European Medicines Agency (EMA), or the World Health Organization (WHO).  Approval by the WHO is crucial for global distribution through the COVAX initiative, which provides Covid-19 vaccines for lower-income nations.

This dubious route for the development of Sputnik V by scientists at the Gamaleya National Center of Epidemiology and Microbiology in Moscow, is more reminiscent of Russian roulette rather than orthodox vaccine production.  In this case, the upshot proved to be apparently beneficial rather than fatal.

The Lambda variant

All viruses change over time, though most such mutations have little or no impact on a virus’ properties.  However, since January 2020, the World Health Organization (WHO) has been tracking the genetic modifications and geographical movements of potentially-hazardous Covid-19 variants (more strictly known as SARS-CoV-2 variants).  The WHO has classified them as either Variants of Interest (VOIs) or Variants of Concern (VOCs) depending on their perceived risk to global public health.  The current dangerous VOCs have been named as Alpha, Beta, Gamma and Delta, but several less harmful and less widespread VOIs have already been identified, including Eta, Iota, Kappa and Lambda.

The concern is that these VOIs may develop into VOCs.  The tale of the VOI Lambda is therefore instructive.  On 14 June 2021, a variant, assigned to Pango lineage C.37, GISAID clade GR/452Q.V1, NextStrain clade 20D, was designated as a global VOI by the WHO and labelled as ‘Lambda’.  It contains several notable mutations, including L452Q and F490S.

This variant, now known as Lambda, was first detected in Peru in August 2020 and has spread to 29 countries, mainly in Latin America.  Since 20 January 2021, 668 Lambda infections have been reported in the United States.  In Peru, Lambda is now responsible for more than 90% of new Covid-19 cases, a rise from less than 0.5% in December 2020.  The country has already suffered the world’s worst mortality rate (currently 5,949 deaths per million population) due to Covid-19.

In neighbouring Chile, where the primary vaccine is China’s Sinovac (also known as CoronaVac), the Lambda variant has accounted for 31% of cases during the last two months.  These are despite the relatively high proportion of 59% of Chile’s population having been doubly vaccinated, though with this vaccine with a poor efficacy of 56%.

So far only eight cases of Lambda have been confirmed in the UK, most of which have been linked to overseas travel.  There is currently no evidence that Lambda is more transmissible, or that it causes more severe disease, or renders the vaccines currently used in the UK any less effective.  As yet, no-one knows for certain, so Lambda remains as a VOI.  Groups like the WHO and Public Health England (PHE) are monitoring the situation.

Needle, nose or mouth?

Will the vaccinating needle become redundant?  Two additional systems for delivering vaccines are on the horizon – maybe.

First, there is news of a spritz coronavirus vaccine being developed by Rokote Laboratories Finland Ltd.  The company has recently secured funding of 9 million euros to create the treatment to be administered as a nasal spray, known as FINCoVac.  The new funding will also underwrite Phase 1 and Phase 2 human clinical trials.

The vaccine is based on novel gene-transfer technology, which has already been successfully used in several clinical trials using gene therapy to treat cardiovascular diseases and cancers.  According to Seppo Ylä-Herttuala, from the University of Eastern Finland, one of the lead scientists behind the project, ‘The vaccine uses a safe adenovirus carrier that contains a cloned DNA strand of the SARS-Cov-2 virus’s S protein.  This can be used to program nasopharyngeal cells to produce the surface protein of the SARS-CoV-2 virus which, in turn, produces a response to the vaccine.  There are no other parts of the virus in the vaccine.’  It is envisaged that in the future such a vaccine could serve as an easy-to-administer booster for those who have already received traditional vaccines.

Second, there is a Covid-19 vaccine as a pill.  A human clinical trial of a prospective oral pill is set to start in Israel.  Oramed Pharmaceuticals, based in Jerusalem, has created a single-dose oral version of a vaccine being developed by the Indian company, Premas Biotech.  In March 2021, the Israeli company announced that doses of the pill had resulted in the successful generation of Covid-19 antibodies in pigs.

If effective in human clinical trials this oral medication will not need to be stored at low temperatures, it will eliminate the need for administration by professional healthcare workers, and it will help vaccinate populations in countries with limited financial resources and infrastructure.  In other words, such a pill could be a ‘game-changer’ for many.

Should children be vaccinated?

This has been a recurring question, but as the adult population becomes largely vaccinated, it has inevitably shifted up to the vaccine policy frontline.

It is already known that severe Covid-19 illness, deaths and even long Covid are rare among healthy youngsters.  Yet children, and particularly adolescents, can play a significant part in coronavirus transmission and there are additional concerns as new variants emerge.  Moreover, only a few vaccines have been tested in young people over the age of 12, including the mRNA vaccines made by Moderna and Pfizer–BioNTech, and the two Chinese vaccines made by Sinovac and Sinopharm.  So far, these appear to be safe in adolescents, yet rare adverse reactions have occurred, for example, with an association between the Pfizer–BioNTech vaccine and heart inflammation disorders known as myocarditis and pericarditis.  And there is that thorny question, is it ethical to vaccinate ‘low-risk’ children when ‘high-risk’ adults, including key healthcare workers, in other countries remain unvaccinated?  So, on balance, should children be vaccinated, do they even need to be vaccinated?

On 19 July, the UK’s Joint Committee on Vaccination and Immunisation (JCVI) issued guidelines and the vaccines minister, Nadhim Zahawi, confirmed that children over 12, who are at higher risk of getting ill if they catch Covid-19, namely those with severe neurodisabilities, or at risk of immunosuppression, are to be offered Pfizer-BioNTech vaccinations.  In addition, some healthy children over 12, who live with vulnerable people, can also have vaccines, as well as those on the cusp of turning 18.  This means that overall, around 370,000 children will be eligible.  However, the vast majority of children in the UK, who are low risk, will not be offered any vaccines, at least, not for now.  This puts the UK in marked contrast with numerous other countries, such as the USA, Canada, Israel, Singapore and Japan, which already have implemented policies for mass vaccinating their children aged 12 and over.

Abuse during vaccinations

Just what is happening here?  This is deeply shocking.  A survey published at the end of June revealed that over half (52%) of GP practice staff have received threats of physical abuse while working on the Covid-19 vaccination programme.

The poll of 222 GP practice staff by the Medical Protection Society (MPS) also found that over half (53%) of staff said that their surgery or vaccination centres had been defaced by anti-vaccination material.  The survey included GPs, nurses and practice managers at surgeries in the UK.

And it is apparently getting worse.  By mid-July, Covid-19 vaccinators were reporting abuse, threats and aggression from people demanding their second jab early, that is, before the recommended eight weeks, so they can go on holiday this summer.  Police have had to be called to some incidents and other GP-led vaccination centres have had to hire security guards to protect themselves.

Two thirds of respondents (60%) said that abuse and complaints relating to the Covid-19 vaccination programme had impacted on their own or their team’s mental well-being.  A spokesman for the MPS said, ‘Well-being support must be provided to all GP surgery staff who are feeling overwhelmed and demoralised, and a zero tolerance policy of abuse must be enforced across the NHS so healthcare workers feel their safety is a priority.’  Come on, these people are trying to help you – ‘Let your gentleness be evident to all’ [Philippians 4:5].

Dr Joseph Mercola

No, me neither.  But The New York Times (24 July) called 67-year-old Joseph Mercola, ‘the most influential spreader of coronavirus misinformation online.’  He is an osteopathic physician and a proponent of alternative medicine, from Cape Coral, Florida, who has become rich and famous by selling natural health products and by making misleading claims about Covid-19 vaccines.

Since the pandemic started, Mercola has posted more than 600 articles on Facebook spreading doubts about vaccines.  He employs dozens of staff to create fake news and spread it to millions of Facebook and additional social platform users.  In other words, he has become an arch-manipulator of both facts and people.

For example, one of his articles, published online on 9 February, declared that coronavirus vaccines were ‘a medical fraud’ and that they did not prevent infections, provide immunity, or stop transmission of Covid-19.  The article further claimed that the vaccines, ‘alter your genetic coding, turning you into a viral protein factory that has no off-switch.’

In mid-July, President Biden referred to a claim that 65% of anti-vaccine messaging on social media could be traced to 12 people – the so-called ‘Disinformation Dozen’, of which Mercola is a key figure.  Biden further stated that such bogus messaging is one of the chief obstacles to improving vaccination rates as new cases, hospitalisations and deaths from Covid-19 increase across the US.

By mid-July, every US state was reporting increased cases and 30 states had yet to reach 50% vaccine coverage.  As Anthony Fauci, the chief medical adviser to the President, said vaccine reluctance had put the US in an ‘unnecessary predicament’ and that, ‘We’re going in the wrong direction.’  Anti-vaxxers, charlatans and conspiracy theorists like Joseph Mercola are largely to blame.

Eat your way to immunity?

Natto beans are one of Japan’s most traditional, distinctive, pungent and sticky, not to mention, weird, culinary delights made from soybeans fermented with Bacillus subtilis var. natto.  Recently a team from the Tokyo University of Agriculture and Technology (TUAT) reported that extracts from natto can breakdown spike proteins on the coronavirus’s surface, preventing it from infecting other cells.

The study was published as, ‘Natto extract, a Japanese fermented soybean food, directly inhibits viral infections including SARS-CoV-2in vitro’ by Mami Obi et al., in Biochemical and Biophysical Research Communications (2021, 570: 21-25).

The Japanese researchers believe that more than one of natto’s enzymes may be involved in this antiviral property.  These preliminary results were obtained with in vitro natto components rather than in vivoingestion of the fermented beans.  So in the future, could you eat your way to immunity?  A fascinating concept, but one on which the jury is still out.

[On a personal note: for several weeks in 1989, to the consternation, yet admiration, of my Japanese hosts at the University of Miyazaki, I found natto beans surprisingly appetising.]