Coronavirus update – Part 13

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

The Covid-19 numbers

One year, one month, one day, there will be declining numbers of Covid-19 cases to celebrate.  But that time is not yet.  Instead, the UK daily cases are creeping up inexorably.  During the second half of November there were about 45,000 cases each day, that is, 10,000 more than in the first half of the month.  Towards the end of November, even 50,000 was reached, a number not seen since July.  Some 8 months ago, the UK cases hardly reached 3,000 on any day.  At the moment, there is no evidence of a sustained decline.  Indeed, a momentous milestone has recently been passed.  On 25 November, the UK total of confirmed cases exceeded 10 million.

Daily Covid-19 deaths in the UK remain broadly flat at about 150.  They are flat because many elderly have already died, treatment of Covid-19 patients has improved and because the vast majority of old people have now been double or triple vaccinated.  Yet there are still some 7,500 Covid-19 patients hospitalised with 900 on ventilators.  Hospitals have yet to be tested in the impending, potentially overwhelming, winter season.

Of course, vaccination numbers continue to rise.  Now 75% of the UK population have had at least one jab, that is, 51 million with a first jab and 46 million with a second.  Moreover, a total of 18 million third booster doses have been administered.

Worldwide the picture is worsening.  Total cases have now exceeded 260 million with well over 5 million deaths.  The USA still tops the daily infection table with an average of 100,000 cases per day, followed by newcomer Germany with 50,000, the UK with 45,000 per day and then France and Russia.  The USA also still dominates the total death table at 775,000 trailed by Brazil and India with the UK in seventh place at 145,000.

The biggest numerical surge this month has occurred in Europe.  It has suddenly become the Covid-19 epicentre.  The UK data are changing but less drastically.  However, those epidemiologists who say that the UK, of all the European countries, is closest to the end of the pandemic seem like optimists, or utopians, or idealists, or romantics.  As ever, this wretched Covid-19 virus has not yet finished with us.

Europe’s fourth wave

Many of Europe’s countries are beginning to experience a fourth wave of Covid-19 infections, hospitalisations and restrictions.  According to the World Health Organization (WHO), in mid-November, weekly infections rose by 7% across the continent and deaths by 10%.  The WHO is ‘very worried’ about the spread of Covid-19 within Europe.  Some experts have predicted that Europe could witness between 300,000 and 500,000 more Covid-19 deaths by Spring 2022.  It’s getting bad out there.

For example, the German chancellor, Angela Merkel, has admitted that her country is in the grip of a ‘dramatic’ fourth Covid-19 wave.  Daily cases have recently risen to record levels of over 79,000, overtaking the UK rate for the first time.  Only those Germans who are fully vaccinated are now allowed in restaurants, cinemas, museums and concert venues.  Similarly across Belgium, a new series of restrictions has been announced in an attempt to avoid a further lockdown.  Belgians must now work from home for four days a week and masks must be worn in bars, cafés, hotels and restaurants.  Likewise, amid record confirmed Covid-19 cases and deaths, the Netherlands has implemented Covid-19 passports for access to certain venues as well as a general curfew from 20.00.

So far, the Austrian government has taken the toughest European measures.  First, in mid-November, it imposed a lockdown on its two million unvaccinated citizens.  Second, a few days later, it announced a full national Covid-19 lockdown from 22 November for 10 days.  Third, it became the first European country to make Covid-19 vaccination a mandatory requirement, with the law due to take effect from 1 February 2022.  About 65% of Austria’s population is fully vaccinated, one of the lowest rates in Western Europe.  Perhaps unsurprisingly, the country’s daily vaccination rate has risen sharply during late November.

These, and other newly-enforced, restrictions have been met with civil protest.  Many Europeans object to mandatory lockdowns, compulsory vaccinations, infringement of rights and privacy, especially by the usual culprits of antivaxxers, conspiracy theorists, Uncle Tom Cobley and all.  These recent demands have prompted peaceful demonstrations as well as dangerous riots in several countries, notably the Netherlands, Belgium and Austria.  So what should governments do in the face of surging cases?  Let the pandemic run freely?

The Omicron variant

This update is not a spoiler alert – it is the inevitable – a new Covid-19 variant has been announced.  South African authorities raised the alarm at 14.00 on Tuesday 23 November.  It was apparently first identified in Botswana and then turned up in travellers to Hong Kong from South Africa.  This new variant is officially named as B.1.1.529, registered by the World Health Organization (WHO) as a variant of concern (VOC) and colloquially known as Omicron, the fifteenth letter of the Greek alphabet.  What about 13 and 14, Nu and Xi?  For a few hours it was actually called Nu, but then someone realised that the phrase ‘the new variant is Nu’ was somewhat foolish.  Xi was also rejected because of possible offence to China’s president, Xi Jinping.  So Omicron it is.

The UK Health Security Agency believes that the Omicron variant is the most worrying it has seen, and could be of greater concern than Delta.  Sajid Javid, the UK’s Secretary of State for Health and Social Care, warned the House of Commons that Omicron is, ‘of huge international concern’ and that it ‘may pose substantial risk to public health.’  Soumya Swaminathan, chief scientist of the WHO, said the new variant has ‘a number of worrying mutations in the spike protein.’  In fact, there are overall about 50 mutations including 32 on the spike protein and 15 on the receptor-binding domains (RBDs), which are the targets of most vaccines to stop the virus entering the body’s cells.  In other words, the shape of the Omicron variant’s spike protein now looks very different and therefore the current vaccines may not ‘fit’ sufficiently well rendering them less effective, a property known as vaccine escape.

The world responded rapidly to Omicron.  The UK government moved swiftly and on 26 November banned travel flights from South Africa and five other southern African countries in an attempt to prevent the arrival of Omicron in Britain.  The USA, EU countries and Switzerland also halted flights promptly.  However, such embargoes are ultimately unlikely to reduce the spread of Omicron, or any other variants, but such a strategy could buy a little time to understand the variant better and prepare to tackle it more effectively.  The UK government’s current threefold plan is first, limit Omicron’s entry into the UK – all UK arrivals must now take a PCR test.  Second, limit Omicron’s spread within the UK – any person in contact with a suspected case of Omicron must now isolate for 10 days.  And third, bolster the UK defences – increase access to vaccinations and drugs, such as antivirals, plus booster jabs for all over 18-year-olds by the end of January to be administered in descending age order.  In addition, there is a return to compulsory mask wearing in shops and public transport, and some other bits and pieces of protective legislation.  And everything comes with Sajid Javid’s subtext – ‘so we can all continue to enjoy Christmas with our families.’

Omicron’s arrival prompted other rapid responses on 26 November – Black Friday indeed.  For example, the global stock markets suffered widespread negative trading, plummeting by as much as 4%.  On the plus side, several vaccine manufacturers confirmed that they were ready to reconfigure their products if necessary.  For instance, BioNTech reckoned it could tweak its mRNA vaccine within six weeks with batches ready for shipping and jabbing within 100 days.

The obvious questions have already been raised.  How many cases have been reported?  Is Omicron more transmissible than other variants?  How susceptible is Omicron to current Covid-19 vaccines and drugs?  Is Omicron more virulent?  Will Omicron replace Delta as the principal cause of Covid-19 around the world?

The answer to the first question is that the number of Omicron cases has been increasing in almost all provinces of South Africa.  It has also been identified in Botswana, Hong Kong and Israel.  And Omicron has now arrived in Europe, with the first case confirmed in Belgium on 26 November.  Laboratories at Leuven University reported a case of the B.1.1.529 strain after an unvaccinated young woman tested positive on 22 November.  On 27 November, the first cases of Omicron were detected in the UK – one in Brentwood and one in Nottingham, though the infected people were known to each other.  These are but the first cases.  The Omicron variant has already spread around the globe.  It is now a waiting game to see if case numbers can be contained rather than spiral.

As yet, there is little hard scientific fact or real-world information about the Omicron variant.  Will its increasing presence lead to further restrictions?  Will the public accept another round of restraints, even severe lockdown curbs?  How widespread might a community’s ‘pandemic fatigue’ be?  What about a straightforward return to hands, face, space?  These and other questions will be topics of concern and conversation in the coming weeks.

The first antiviral drug – Lagevrio (molnupiravir)

On 4 November, the Medicines and Healthcare products Regulatory Agency (MHRA) authorised the UK to become the first country to approve the use of molnupiravir, an oral antiviral drug.  Developed by the US companies Merck Sharp & Dohme (MSD) and Ridgeback Biotherapeutics, in trials, it was shown to halve the risk of hospitalisation for Covid-19 patients.  It is now set to be marketed as Lagevrio.

The MHRA has authorised Lagevrio for people who have mild to moderate Covid-19 plus at least one risk factor, such as obesity, older age (>60 years), diabetes mellitus, or heart disease, from developing severe Covid-19.  And based on the clinical trial data, Lagevrio is most effective when taken during the early stages of infection.  So the MHRA recommends it is used as soon as possible following diagnosis by a positive Covid-19 test and within five days of symptom onset.

The UK’s Secretary of State for Health and Social Care, Sajid Javid, commented, ‘Today is a historic day for our country, as the UK is now the first country in the world to approve an antiviral that can be taken at home for Covid-19.  This will be a game changer for the most vulnerable and the immunosuppressed, who will soon be able to receive the ground-breaking treatment.’

On 19 November, some two weeks later, the European Medicines Agency (EMA) informed EU member states that they too could use Lagevrio to treat Covid-19 in emergency cases.

The second antiviral drug – Paxlovid (PF-07321332 and ritonavir)

On 5 November, the very next day after the Lagevrio announcement, the US-based pharmaceutical giant, Pfizer, announced that its own oral antiviral drug, a combination of PF-07321332 and ritonavir and trademarked as Paxlovid, reduced the risk of Covid-19 hospitalisations or death by 89% for those at high risk of severe illness.  In this Phase 2/3 clinical trial, 1,219 adults were enrolled, with half receiving Paxlovid and the other half receiving a placebo orally every 12 hours for five days.  Preliminary analysis showed that only three patients who received Paxlovid within three days of Covid-19 symptom onset were hospitalised with no deaths reported.  This is compared with 27 in hospital and seven deaths in patients who received a placebo.

Similar figures were seen in people treated within five days of symptom onset.  That is, there were six patients admitted to hospital in the Paxlovid group with no deaths, but in the placebo group it was 41 hospitalised with 10 deaths.  Besides drug efficacy the trial also examined drug safety.  With 1,881 participants, there were similar proportions who experienced adverse effects, mostly of a mild intensity – 19% in the Paxlovid group and 21% in the placebo group.

The UK government has so far purchased 250,000 courses of Paxlovid alongside 480,000 courses of Lagevrio, though the former has yet to receive MHRA approval.  The UK’s Secretary of State for Health and Social Care, Sajid Javid, commented, ‘If approved, this could be another significant weapon in our armoury to fight the virus alongside our vaccines and other treatments, including molnupiravir [Lagevrio], which the UK was the first country in the world to approve.’

Pfizer has since applied to the US Food and Drug Administration (FDA) for emergency authorisation of Paxlovid.  However, the move has resulted in considerable unrest, especially among bioethicists, because the application includes the use of Paxlovid for unvaccinated people.  It is alleged this could undermine the US vaccination programme by rewarding people who have ignored public health advice and by penalising those who have heeded it.

By mid-November, Pfizer reported on a deal that will allow 95 developing countries to manufacture and sell generic versions of its Paxlovid pill.  The agreement with the Medicines Patent Pool will give 53% of the world’s population access to Paxlovid.  However, the agreement excludes some countries, such as Brazil, which already have massive, and largely uncontrolled, outbreaks of Covid-19.

Update on monoclonal antibody AZD7442 – Evusheld

Not to be left out of the rush to tame the Covid-19 virus, AstraZeneca has continued to trial its monoclonal antibody treatment known as AZD7442.  This non-vaccine treatment is a combination of two long-acting antibodies (LAABs), tixagevimab (AZD8895) and cilgavimab (AZD1061).  Both are derived from components of the immune system known as B-lymphocytes and donated by patients who have recovered from Covid-19 infections.  These antibodies were initially isolated by scientists at Vanderbilt University Medical Center in Nashville, Tennessee, and subsequently licensed to AstraZeneca in June 2020.  The treatment is now commonly known as Evusheld.

Evusheld is not a vaccine.  Instead it provides antibodies directly to the body via intra-muscular injections.  These bind to distinct sites on the spike protein of the virus stopping it from entering the body’s cells and therefore preventing a Covid-19 infection.

Evusheld has been undergoing two separate trials.  In the Phase 3 human trial, known as the PROVENT trial, two-thirds of the 5,197 participants were given a single 300 mg intra-muscular dose of Evusheld in two separate, sequential injections.  It reduced the risk of developing symptomatic Covid-19 infection by 77%.  There were no cases of severe Covid-19 or related deaths in those given Evusheld, whereas in the placebo group, there were three cases of severe Covid-19, which included two deaths.

Data from the latest six-month assessment trial of Evusheld, known as the TACKLE trial, were based on 4,991 participants.  This cohort consisted of a wider age range of participants who suffered from more comorbidities making them more susceptible to Covid-19.  Taken as a preventive measure, that is, as a prophylactic, a 300 mg dose of Evusheld reduced the risk of symptomatic Covid-19 by 83%.  When taken three days after symptom onset, a 600 mg dose cut the risk of severe illness or death by 88%.  There were no cases of severe Covid-19 or Covid-19-related deaths in either the Phase 3 primary or the six-month analyses.  In the placebo arm of the trial there were five cases of severe Covid-19 and two Covid-19-related deaths.  In addition, doses of the antibody cocktail were generally well tolerated, with no new safety issues identified.

During mid-November, Bahrain became the first country to authorise the emergency use of Evusheld.  AstraZeneca has agreed to supply the US government with 700,000 doses, if the treatment is granted emergency use authorisation by the US Food and Drug Administration (FDA).  The UK had initially planned to purchase one million Evusheld doses, but a deal has yet to be signed.

Antibody therapy versus vaccination and antivirals

Which is best, antibody treatment or vaccination?  They are fundamentally different therapies.  A monoclonal antibody drug, like Evusheld, delivers laboratory-made versions of the body’s natural antibodies to fight infection.  On the other hand, a vaccine stimulates the body to make its own antibodies and build its own immunity.  Are antibody treatments potential alternatives to vaccines?  Yes and no.  Antibody drugs cost significantly more, which may limit their use to particularly high-risk groups.  Antibody doses typically cost above $1,000 each, whereas a Covid-19 vaccine shot costs on average between $3 and $30 per dose.

Evusheld also takes more time to administer, needs to be given by a trained doctor or nurse, and patients may require longer monitoring afterwards than the 15 minutes following a vaccine.  In other words, it is not something that can be quickly given in a pharmacy or health hub, so it is not ideal for widespread, fast roll-out.  Moreover, basic data from ongoing antibody trials are still needed, whereas the efficacy and safety of the approved vaccines are now fairly well understood.  AstraZeneca has maintained that Evusheld’s ‘real advantage’ is as a preventative shot and little is known about its long-term efficacy, pattern of waning, need for boosters and so on.

Furthermore, the distinct roles of monoclonal antibodies, such as Evusheld, versus oral antiviral agents, such as Lagevrio and Paxlovid, is not yet clear.  Obviously delivery by mouth is easier than by injection.  And antivirals can be taken at home.  Yet their therapeutic windows (before, at, or soon after Covid-19 onset) and their target populations (the elderly, immunosuppressed, those who do not respond well to vaccines, cancer patients and so on) are likely to overlap.

There is plenty yet to be discovered and applied in this fight against Covid-19.  Big pharma companies around the world are, even this very day, creating and trialling new products.  The need is great.  Billions have yet to be vaccinated by dint of hesitancy or by lack of supply.  Thousands upon thosands of suitable patients have yet to be offered antiviral or antibody therapies.

PHSMs, NPIs and BESSIs

Besides vaccines and drugs, such as antivirals and antibodies, there are other Covid-19 treatments.  They are known as public health and social measures (PHSMs), or non-pharmaceutical interventions (NPIs), or even behavioural, environmental, social, and systems interventions (BESSIs).  But just how effective are they?  It is difficult to know because so little relevant, high-quality research has been completed.

A recent review, a meta-analysis study, of PHSMs examined a total of 72 appropriate studies.  These findings by Stella Talic et al., were reported as ‘Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis’ in The British Medical Journal (2021, 375: e068302, 18 November).  Overall, the relative reductions in symptomatic Covid-19 infections were found to be 53% for mask wearing, 53% for handwashing and 25% for physical distancing.

But these figures are open to severe criticism.  For example, the three reported PHSMs were not independently assessed – those who wash their hands probably also wear masks and avoid crowds.  And what sort of masks were worn?  Simple cloth or medical grade?  Moreover, what about other PHSMs?  As Talic and her colleagues stated, ‘Meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces.’  Nor was the effect of increased ventilation mentioned, though socialising indoors in places with poor ventilation is reckoned to increase the risk of infection.  Therefore opening windows and doors to ventilate a room where people are meeting is another PHSM.

Assessing the effectiveness of PHSMs is undoubtedly problematic.  It would be nice to have a quantitative value of each PHSM, but that is not possible – the variables in the real world are simply too great.  Instead, only a more qualitative assessment, driven by common sense, is available – since the virus is spread primarily by respiratory droplets, it makes sense to block or filter that transmission route with a face covering.

After nearly two years of Covid-19, there is a paucity of good research into PHSMs.  Contrast that with the billions poured into vaccine research and production.  Therefore the pragmatic approach is to bundle the PHSMs and accept the lot.  Remember the government’s PHSM mantra from 2020 – hands (frequent washing hygiene), face (wearing well-fitting masks), space (physical distancing) and some others too, including improving ventilation of indoor spaces, avoiding crowded places, and getting vaccinated.  Simple and cheap, but effective.

The gift of the jab – Covid-19 and flu vaccinations

Winter is imminent.  So are weakened immune systems along with influenza and other contagious seasonal respiratory illnesses.  In a bad flu year as many as 30,000 people in the UK are reported to die from flu and pneumonia.  Taking the last 12 months in the UK, a total of 40,000 people have died from Covid-19.  So, are deaths from flu and Covid-19 numerically similar?  Herein lies a statistical anomaly because UK flu deaths are often reported to be about only 1,500 each year.  But when pneumonia deaths are included, as they often are reported together, the total death toll typically becomes approximately 20,000.  And there is yet another caveat.  Deaths are officially reported either as ‘involving influenza and pneumonia’ or as ‘due to influenza and pneumonia’.  The relevant UK data for 2020 were 112,000 and 20,500 respectively.  Statistics can be confusing!

These two main streams of influenza and Covid-19 infections have similarities.  They are both viral.  On the other hand, pneumonia can be viral, bacterial or fungal.  Moreover, influenza and Covid-19 are both spread by close contact via touching, or by respiratory droplets released during talking, sneezing, or coughing.  The signs and symptoms of both diseases are also similar.  They both include fevers, coughs, sore throats, headaches and so on.  Serious complications for both can be pneumonia, organ failure, heart attacks, strokes and so on.  People with mild symptoms of either can rest and recover at home – those with severe symptoms of either need to be hospitalised.

Currently (late November), cases of the two diseases are numerically dissimilar.  Influenza activity across the UK is very low.  By contrast, Covid-19 cases are slowly increasing and are now consistently above 40,000 per day, some 10,000 more than at the beginning of the month.

Yet both Covid-19 and flu can be significantly prevented by vaccination.  And that is why the UK, and many other countries, are making vaccines their primary defences against both diseases.  The race is on to get the greater proportion of the UK population vaccinated.  Primary, secondary and booster doses for Covid-19 plus flu jabs are now being made more widely available.  True, there is also a vaccine against pneumonia, known as pneumococcal polysaccharide vaccine (PPV).  But it is a one-off jab, typically given to the over-65s to protect them from the most common cause of pneumonia, the bacterium, Streptococcus pneumoniae. 

A booster dose of Covid-19 vaccine helps prolong protection in the double-jabbed, particularly in older age groups.  According to UK Health Security Agency data, having three doses offers a 93% protection against symptomatic disease.  UK government ministers have been urging millions of Britons to get their Covid-19 booster jab by 11 December to ensure they have ‘very high protection against Covid by Christmas Day.’

From 22 November, people across the UK have been (or soon will be depending on their country of residence) able to book their booster dose of a Covid-19 vaccine.  That includes more than a million 40 to 49-year-olds immediately, and a further eligible 1.5 million will be sent invitations in the coming weeks.  In addition, booster jabs are available to those who are aged 16 or over with a health condition that puts them at high risk from Covid-19, or a front-line health or social care worker, or an adult who lives with an immunosuppressed person.  And from 30 November, spurred on by the arrival of the Omicron variant, the UK’s policy has been expanded to offer all over-18s a booster jab by the end of January, as well as a second jab for 12 to 15-year-olds.  Variously, you can wait to be invited, book online, call 119, or attend an NHS walk-in centre.  Ts & Cs apply!

By contrast, flu vaccinations have been offered annually for many years by the NHS and now (in the autumn) is the best time to get jabbed.  2021 and 2022 may yet be dire years for flu as fewer people have built up natural flu immunity because of the precautions taken during the Covid-19 pandemic.  Moreover, if people contract flu and Covid-19 at the same time, they are more likely to become seriously ill.  Taken separately or together, the flu and Covid-19 vaccines are considered to be generally both safe and effective.

Yet a tricky problem with flu vaccines exists.  Each year they have to be formulated to counteract several, typically three or four, major mutated strains of influenza.  In other words, to allow for manufacturing time, the components of the latest vaccines are based on predictions of the likely strains to appear well ahead in any particular year.  Put another way, the formula of the vaccine is a guess, but an educated guess.  Yet such a guess affects a vaccine’s effectiveness.  Between 2015 and 2020, across all age groups, flu vaccination in the UK prevented 15 to 52% of cases.  Those may seem ineffective prescriptions, but any protection to limit the contraction, consequences and spread of flu, especially among vulnerable older adults, is welcome.

To help shield the population during the flu season, the NHS is keen this year to offer free flu jabs to those aged 50 and over, plus a range of other people with certain health conditions.  The NHS has a target of 85% uptake among the over 65s and 75% among the eligible under 65s.  Again, Ts & Cs apply.

The foolish Dr Foley

Christopher M Foley, MD, ABIM, was a 71-year-old doctor in Minnesota.  He was also a master of spreading Covid-19 misinformation.  On 15 October, he also ironically died of Covid-19.

After working for 22 years as a doctor in the Minnesota health system, Foley retired and in 2001 he founded Minnesota Natural Medicine (MNM), a private medical practice that he described as an ‘innovative crossroads between conventional and so-called “alternative medicine” with chiropractic, naturopathy, massage, acupuncture, and herbal medicine all under one roof.’  He had his admirers.

From the earliest days of the Covid-19 pandemic, he used his MNM website to broadcast his views on what he called the ‘Wuhan virus’.  In March 2020, he stated that the virus was ‘likely a bioweapon’ and he contended that homoeopathy could be ‘one of the better weapons’ for fighting it.  He also became a prominent voice in Minnesota’s anti-mask and anti-lockdown movement.  In October 2020, he wrote, ‘It is time to stop the lockdowns, take a careful look at the damage that will continue if they remain, and re-examine some of the rules regarding personal protection equipment.’

Foley called Covid-19 vaccination a ‘human experiment’, and proposed high doses of vitamins A, C and D as alternatives.  He also recommended ivermectin as a prophylactic and hydroxychloroquine as a treatment.  He described masks as ‘downright dangerous to the individual (especially children) if worn for extensive periods of time’, and called mask mandates for children ‘abusive and negligent’.  He even reposted content from Robert F Kennedy Jr, one of the USA’s most prolific anti-vaccine advocates, who had been banned from social media platforms for spreading Covid-19 misinformation.

Christopher Foley’s obituary reported that he died ‘after an unexpected illness’.  At his funeral service, his eldest son, Logan, confirmed, ‘He died of complications from Covid.  Was he vaccinated?  No, he wasn’t.  If only he’d been vaccinated, wouldn’t he still be here?  Obviously, we’ll never know.’  So was Christopher Foley foolish?  You answer that.

Word of the year 2021

As a measure of how much the Covid-19 pandemic has entered human lives, consider this facet.  The lexicographers at the Oxford English Dictionary have chosen as their word of the year for 2021, ‘vax’ or ‘vaxx’.  The OED drolly declared that this shorthand for vaccine had ‘injected itself into the bloodstream of the English language.’  Moreover, its usage had broadened to vax cards, fully-vaxxed and so on.

It all started back on 8 December 2020, when Margaret Keenan became the first person in the world to receive the Pfizer-BioNTech Covid-19 vaccine.  Since then, more than 100 million doses have been administered across the UK, not to mention the billions delivered worldwide.  Yes, 2021 has seen a lot of vax.  It is a deserved prize-winning word.

But I still feel sorry for ‘jab’.