Wednesday 2 December 2020

COVID UK Data Briefing and vaccine news 2nd December 2020

 COVID UK Data Briefing and vaccine news 2nd December 2020
There's sooooo much COVID news today that tomorrow's report would be the size of a cow, so I've done an extra today covering the vaccine news...

The huge news today is that the UK MHRA have approved the Pfizer / BioNTech vaccine for use in the UK. We are the first Western country to approve a vaccine, and deliveries are expected next week. 

"The UK was the first country to sign a deal with Pfizer/BioNTech - now we will be the first to deploy their vaccine.
To everyone involved in this breakthrough: thank you.
In years to come, we will remember this moment as the day the UK led humanity’s charge against this disease."
Alok Sharma, UK Business Secretary. 
Don't let the irony pass you by. We are on the very brink of leaving the EU, and our urgent emergency vaccine supplies have been developed in the USA /Germany by a Turkish-led company and manufactured in Belgium. We actually won't even be able to complete this sort of transaction as swiftly in 4 weeks time. 
And then take a moment to consider that Trump attempted to force the hand of manufacturers and regulators in order that a vaccine was ready before the US election a whole month ago, and yet miraculously his urgency has now gone, and the UK have approved it before the USA... 

First vaccine approved Pfizer BioNTech image of bottle and text

There was a UK Coronavirus data briefing this morning with Dr June Raine of the MHRA (Medicines and Healthcare products Regulatory Agency), Prof Sir Munir Pirmohamed from the Commission on Human Medicine Expert Working Group, and Prof Wei Shen Lim, from the Joint Committee on Vaccination and Immunisation. 

I like Dr June. She talks incredibly slowly and deliberately, she's really easy to type up. 
This briefing has been called because the MHRA has approved the use of the Pfizer / BioNTech vaccine. The UK Government has accepted that advice, and will deploy the vaccine. 
It is ONLY currently approved for Adults aged 16+. 
June has slides showing how trials have been expedited. Usually a vaccine takes about 10 years, but as I've said before, most of that time is spent in board meetings trying to convince University heads and financial backers that it's worthwhile, and then recruiting volunteers. All of that hasn't needed to happen. Trial phases had all the money they needed and volunteers are queuing up, so as soon as it was safe and looked positive, they began the next stage of trials to run at the same time. None of the actual 'testing' has been completed any more quickly than usual. 
Prof Sir Munir says that the data shows this vaccine to be 95% effective, and effective across all age groups. It needs to be stored at ultra-low temperatures, so logistics are a bit more complicated than just boxing it up and shipping it out. There are no problems with people who have already had COVID being vaccinated, and a test is not necessary beforehand. 
Prof Wei says the UK already have one of the best immunisation programmes in the world. We are good at this. 
Vaccine priority in this first round is for those most at risk of dying, and to protect health & social care. By immunising our health and social care workers, we not only protect their vulnerable patients and residents, we also keep them at work, rather than self-isolating or ill, meaning that services can continue, and lives will be protected. 
Age is by far the most important risk factor. (It is far more of a risk than any known comorbidity, illness, syndrome, disease or condition.) Therefore the final decision on priority for this vaccine is: 
1. Residents in care homes for older adults and their carers.
2. Adults aged 80+ and FRONTLINE Health & Social Care Workers. 
3. Adults aged 75+
4. Adults aged 70+ and Clinically Extremely Vulnerable people. 
5. Adults aged 65+
6. All adults 16-65 with underlying health conditions
7. Adults 60+
8. Adults 55+
9. Adults 50+
A huge amount of the population have underlying health conditions. Earlier research funded by UK Department for International Development, Wellcome Trust, Health Data Research UK, Medical Research Council, and National Institute for Health Research found that worldwide they estimate:
"The prevalence of one or more conditions was approximately 10% by age 25 years, 33% by 50 years, and 66% by 70 years, and similar for males and females. The most prevalent conditions in those aged 50 years or older were chronic kidney disease, cardiovascular disease, chronic respiratory disease, and diabetes."

Vaccination Programme UK first phase Priority order decisions collage

First journalist asked 'can you reassure the public they can have confidence in this vaccine' and 'can you explain how you decided the priorities for immunisation'. We literally just sat through a 20 minute presentation where they told us precisely this. 
Sensible press asked why the MHRA have been able to authorise more quickly than anyone else? They say it's by building a strong team, being ready to go, and then working flat out day and night and weekends. 
Press also asked what is the time between immunisation and it being effective:
"The vaccine requires 2 doses 21 days apart, and from the data that's been presented to us, people will be immune 7 days after the 2nd dose."
(The timeframe is as expected at 28 days after the first dose. I think most of the vaccines have said the second dose should be "at least 14 days after the first", so it's likely they'll all be pretty similar overall.)
"Partial immunity does occur after the first dose, and we can see some protection occurring after day 12... but best immunity is 7 days after the second dose."
Press asked about logistical challenges in immunising care home residents with a vaccine that needs to be stored at -70 degrees. It is stable for a short period at 6-8 degrees (fridge temperature) and can be transported with dry ice too, so it's more of a pain, but very possible in the UK. 
General population more at risk of actually catching COVID won't be immunised before those who aren't. It would be incredibly tricky to separate populations into those who work in an office / work from home, receptionists / back room staff etc. It makes sense, but it's a huge task already. 
The prioritisation order is national, and not dependent on which tier you are in. Tier 3 will NOT be vaccinated before Tier 1, it's all national. 
It is not possible to predict when any other vaccine will be approved. It's reliant on results, not dates. 
Press asked some really biting questions about NHS staff. 
What order will NHS staff be vaccinated and how will frontline staff be identified? There is a priority list, and it looks at risk to the individual, how much contact they have with potential COVID patients and how much contact with vulnerable patients. 
"At the moment there is no suggestion that the offer of vaccination should be compulsorily taken up. It is always an offer of vaccination, and whether somebody wants to have the vaccine or not, whether they're in the NHS or not, is at the moment a voluntary thing. But the JCVI is not a policy making body, policy is made by Ministers."
They talked about the after-effects of the vaccine. There have been NO serious adverse reactions, but safety will continue to be monitored obviously. 
ALL of the vaccines seem a bit rough, with a large number of people feeling tired, headachey and poorly for usually a day afterwards - so plan an easy next day if you can.
This is just Phase 1. When another vaccine or more stocks are available, the priority order will by re-examined.

vaccine information development timeline collage

There was a UK Briefing this evening with Boris Johnson, the Prime Minister, Jonathan Van-Tam, Deputy Chief Medical Officer and Sir Simon Stevens, Chief Executive of NHS England. 

Boris started by talking about the last few months, and says we've been waiting for the day the "searchlights of science" came to our rescue. 'The scientists have done it. They've used the virus itself to perform a kind of biological jujitsu'... yes... 
He talks about the 7 different vaccine candidates we have bought in to, and says the mass vaccination programme will begin next week. 
There are logistical challenges, and it will take "several long, cold months" before everyone who is vulnerable can be vaccinated. 
Today we've ended national restrictions and replaced them with tiers. It will continue to be tough for some sectors, but until the vaccine is deployed, we have to carry on as we are. 
Help reduce the infections in your area and reduce your local restrictions. 
It's no longer a hope that we can return to a somewhat normal life next year, it's sure and certain.
Sir Simon Stevens talks about the order for vaccination, as listed above. Initial stocks will only cover a first dose for residents in care homes for older adults and their carers, adults aged 80+ and FRONTLINE Health & Social Care Workers. 
The vaccine comes in packs of 975 doses and needs to be stored at -70 degrees, so it's not exactly a simple task. The rest of the world will be watching us to see how easy the logistics work out. 
Next week around 50 hospital hubs around England will start administering the vaccine, typically to people who are coming into hospital anyway. It hasn't yet been decided how to safely split the packs of 975 doses except in hospitals, so initial stocks will be going to hospitals until this problem is solved.  The following week GP surgeries will become involved. As soon as we have a way to get stocks delivered directly to care homes, without risking them degrading, we will.
Jon Van-Tam says he was quite emotional this morning. He went back to his train analogy from the other week. He says "the train has now stopped in the station" and it's up to people to get on. 
We have 1 authorised vaccine and we need more. It's still possible some of the other vaccines may 'fall by the wayside'. 
We need more stocks. 
We need people to take it. They need to take both doses to get full protection. 
We don't yet know if this vaccine will actually prevent transmission. We have to be patient and look at the effect it has on hospitalisations and deaths. 
All the tier measures, social distancing etc need to stay in place or we risk a 'tidal wave of infections' and the vaccine will be 'working against a headwind'. 
"Low uptake will almost certainly make restrictions last longer. Follow the guidance until we say it is safe to stop". 

Press asked "how important is this moment". Boris isn't an orator. He burbled about what we've been through, and it being a 'fantastic moment', but reiterated we have to carry on with the tough measures. 
Press asked, January and February are traditionally the heaviest months for the NHS, so should we prepare ourselves for hard restrictions? Boris says tier 3 are quite hard, and with community testing, it should drive incidence down.
Jon Van-Tam says the final 'big win' is a vaccine that reduces transmission. We can't say the percentage of transmission it'll reduce until we see it in action, but we are hopeful. Once we can see the effect, we can work out how much of the population will need to be immunised. 
There have been no hospital admissions at all in the people who have already received this vaccine as part of the trials. 

Closed Spaces
Close Contact
Jon adds:
Duration - how long will you be there? 
Volume - how loud and noisy will it be? Are people shouting or singing?

Jon doesn't believe we will ever eradicate COVID-19. He thinks we may see it become a seasonal problem. He does not believe we'll ever throw away the gloves and hand sanitiser, we will be more cautious after this for a while, and he says it might be a good thing because it will keep down lots of respiratory viruses. Boris disagrees with him quite stridently. (Guess Jon won't be doing a press conference for a while...). 
(Oh hang on...) Jon (attempts to dig out) clarifies "I do not think the government will continue to have to recommend masks and hand sanitiser forever and a day". 'But do I think some people (as in the Far East) will continue to be more personally cautious, yes I do.' 

Vaccination Priority levels JCVI

No mention of any country other than England in this briefing, but apparently the British Army will help deliver the vaccine in Scotland. Some local government in England are a bit concerned that having the army involved will be off-putting. 
Anti-vaxxers are sharing stories about a Swine Flu (H1N1) vaccine causing narcolepsy and the Thalidomide drugs causing birth defects. 
Can I remind you that when Thalidomide was created they still thought a cigarette would be good for you if you were anxious. That's definitely in the past that one, it wasn't even a vaccine and it was tested mainly on rats. 
The Swine Flu vaccine in Europe is a bit of a blurry one. 60m people received it, 60 made a claim for narcolepsy. There's been masses of research and nothing has ever been proven without doubt, but there was definitely a spike in people being diagnosed with narcolepsy during the following months. 
However.... there was a spike in Europe, where we vaccinated. There was no spike in the USA, where they vaccinated with the same vaccine, but made using a very slightly different method (that method is no longer used). There WAS a spike in China - which didn't vaccinate for H1N1 at all. So, erm... yeah. 
Taiwan also reported a spike in narcolepsy cases. "But there the increase in diagnoses occurred before the country began to vaccinate, which further supports the theory that infection with the pandemic H1N1 virus may have been associated in some places with a rise in narcolepsy cases." (Stat News)
Something definitely happened, but was it the vaccine? In my opinion it is probably more likely the Swine Flu itself. Of course, it could always be  something entirely separate... 
Science might try, but it can't always explain everything... 

Back tomorrow with the usual news report (and I do believe another press conference... )


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