Thoughts from Pontevedra, Galicia, Spain: 27.4.21

Night’s candles are burnt out, and jocund day stands tiptoe on the misty mountain tops

Spanish life is not always likeable but it is compellingly loveable

– Christopher Howse: ‘A Pilgrim in Spain’ 

NOTE: Info on Galicia here. Detailed info on Pontevedra coming soon.

Covid

Portugal: The death per million 7 day average has fallen to 3 from 300 in late January. This is even more impressive – pro rata – than the UK’s fall from 1250 to 22. 

The latest (UK-biased) overview from MD of Private Eye is below. Good on the blood clot issue.

Cosas de España

Our depressingly tribal politics get a little dirtier.

Cousas de Galiza

The inconsistent pedestrian lights I use 2-4 times a day continue to cause confusion for both drivers and pedestrians, especially when the lights for the former are flashing amber but those for the latter are off, so neither red nor green. Yesterday morning, a driver who didn’t stop and with whom I remonstrated pointed to the pedestrian lights in vindication. Which was rather self-defeating, I thought, as they were off. And yesterday evening I was confused by a driver who stopped even though the pedestrian lights were on red and then annoyed a bus driver coming the other way as I moved to his side. Mea culpa this time.

Which reminds me . . . This chap is cutting granite without wearing safety glasses. Or a shirt. A good example of the attitude to risk I mentioned the other day:-

Spain’s accidents at work number is high. But, then, so was the road accident rate when I came here 20 years ago and it isn’t now. So, things do change.

I still await my first jab, even though the talk is of doing younger folk as of this week. I went to the health centre yesterday to check if they had my correct phone number but was put off by the 30+ folk milling around outside while a doctor called out the names of patients who had appointments with her. As usual, several were no-shows. Anyway, I later called and established that:- 1. They only had by old landline number, but 2. They hadn’t yet tried to call me. So, I await an SMS on my mobile phone.

María’s Level Ground: Day 23

The UK

It’s rather ironic that a man who’s achieved his lifetime ambition of becoming prime minister should so debase the office once he got there. But he’s probably neither the first nor the last to do so.

It’s not terribly surprising that he’s now being reported to be ‘isolated and at risk of becoming uncontrollable’

The EU

Both France and Germany are effectively nationalising their airlines. Which is supposed to be illegal. But, then, we’re talking about France and Germany. One of which has perpetually broken the deficit rules, with total impunity. 

A propos . . Twenty retired generals have created a political storm in France with a call for a military takeover if President Macron fails to halt the “disintegration” of the country at the hands of Islamists. As if M Macron didn’t face enough problems, with the Covid death rate still not falling. Inter alia.

It’s reported – not to my surprise at least – that the Belgian government was warned that the EU’s contract with AstraZeneca ‘lacked teeth’. In short, it ‘didn’t include harsh consequences if the company failed to deliver vaccines on schedule’. Other governments probably received the same advice.

The Way of the World 

Baroness Boothroyd is the 91 year old ex-Speaker of the House of Commons and ‘the personification of diversity in public life’. She’s being investigated by some committee or other for failing to attend a compulsory course for members of the House of Lords called “Valuing Everyone”.

English 

The estimable chap who does the History of England podcasts cites ‘children’ as one of the very few words which still have the Old English plural ending of the letter N. In Old English, he adds, the plural could be formed using S, R and N but the latter two lost out to S in Middle English. Hmm. I’m sure I read that ‘Children’ is a very rare example of the use of both R and N. Child to childer/childre to children. A double plural, then. As is ‘brethren’. By the way, the podcast chap says no one knows the origin of ‘child’. ‘Possibly from the Sanskrit for ‘womb’. . . .

Finally  . . .

The answer to that Anglo-Saxon riddle is . . . An onion. 

I lost my water last night, thanks to yet another leak in the pipe under my garden. I have to report that coffee made with a mix of mineral water and tonic water is not a complete success. Must get more mineral water this morning.

COVID OVERVIEW: MD of Private Eye

Good news 

On 6 April, there were no Covid-19 hospital deaths reported in London, East of England or the South-West, and just 2 deaths in people aged 80-plus in all of England. New infections are very low or zero in large parts of the UK. More than 60 percent of the adult population has received one vaccine dose and more than 10 percent both doses. UK vaccines are estimated to have prevented 6,300 deaths, and many more hospital admissions with far fewer side effects than lockdown. 

Vaccine benefits v risks 

In the last year in the UK, 4.4m people have been infected with Sars-CoV-2 and there have been at least 127,000 deaths as a result. Imagine these 4.4m people had been fully immunised with the Oxford-AstraZeneca (OAZ) vaccine at the outset. At least 100,000 Covid deaths could have been prevented, and there would have been around 22 cases of a rare combination of blood clot and low platelets, with five deaths. 

Compared to risk of a clot after vaccination you are 6 times more likely to be struck by lightening in your lifetime, 11 times more likely to die in a car accident each year and 100 times more likely to get a blood clot if you use an oral contraceptive. If you are hospitalised with Covid, your risk of a clot is one in four. 

Three of the 19 who died from thrombosis following 20.2m doses of the OAZ vaccination were under 30, and those aged 29 and under will now be offered a different vaccine (though other vaccines may have similar tiny risks). In future, vaccine supply may be sufficient for people to choose which vaccine they have, but not yet. 

Will this put people off having a vaccine? With infection rates currently very low (thanks to vaccines), some may decide to wait for more safety data to emerge or hope the shield of herd immunity will protect them without a vaccine. This strategy is much riskier than having the vaccine, particularly in the long term. 

Many of those who volunteered for vaccine trials when the risks were unknown were under 30. Some volunteered to be deliberately infected with Sars-CoV-2 to help improve our understanding. Many are likely to have a vaccine not just for personal protection, but to protect friends and family, open up society, boost the economy, allow travel and encourage further medical advances from the new vaccine technology. Some people get unpleasant temporary side effects from the vaccines. But the overall chance of dying, as with just about every modem vaccine, is around one in a million. Paracetamol is much more of a risk. 

European differences 

Why did, say, Germany spot and act more quickly on the rare risks associated with the OAZ vaccine? The mistaken belief that the vaccine was less effective in the elderly meant it was diverted to younger age cohorts where the risk of clotting is more evident (though still very low). Their better-resourced health system may also be more meticulous in picking up and reporting adverse reactions. The UK has a Yellow Card reporting scheme anyone can access, but it’s a bit hit-and-miss. Rare, life-threatening events tend to be picked up, but less serious effects depend on people reporting them. The Germans may be more thorough and risk averse. Hence they, and other EU countries, are recommending a wider age range for OAZ restriction. But if it means people are denied an available lifesaving vaccine during a third wave outbreak, the approach may do more harm than good. 

Out of Africa 

African nations, with younger populations, may also move away from the OAZ vaccine; but it is cheap, easy to store and currently available. If the opt-out delays vaccination in areas with large outbreaks, this too is likely to result in far more deaths. The UK is much safer now than in winter, which saw 1,300 Covid deaths a day. Brazil has just hit 4,000 deaths in 24 hours: The good news is that China’s Corona vaccine has 73.8 percent efficacy against the Brazilian variant which accounts for 80 percent of Brazil’s cases. 

Chinese takeaway 

As predicted, the World Health Organization (WHO) fact-finding team returned from China without all the facts. Its aim was to find the origin of the Sars-CoV-2 virus based on information the Chinese government shared with it. 

The very long report places the start of the outbreak “in the months before mid-December 2019”, when the virus could have been spreading undetected. It thinks it likely it was introduced to humans via an unknown animal that acted as an intermediary between bats, but it wasn’t able to find that animal or a specific lineage of bats. 

The Sars-CoV-2 virus can infect a very large number of animals, which is bad luck for humans because it gives it multiple opportunities to reinvent itself in future. It also means the “follow the animals” studies to find the original source will be lengthy and complex, and will need to extend to countries beyond China. 

Bats v labs 

Bats are beautiful, they carry lots of viruses and they can fly long distances. They are also mammals, and the Sars-CoV-2 virus didn’t have to adapt much to spread to human mammals, which is again bad luck for us. . 

The virus picked up its infamous spike protein en route, but whether that was a pangolin or a laboratory is currently impossible to say. The WHO says the lab-leak hypothesis is “extremely unlikely”, but it has happened before. The last naturally occurring case of smallpox was in 1977, but the last recorded death was 1978. Janet Parker, a medical photographer, contracted it while working at the smallpox laboratory at Birmingham Medical School, which the WHO had commissioned to research the disease. 

What makes a lab leak less likely is that SarsCoV-2 was unknown before the pandemic, and there is no trail in public databases or research articles of any lab virus like it. If it was being researched or modified, it had not been logged and declared, which could be administrative laxity, or the virus got to the researcher before they had a chance to log it, or it was a secret project. 

The WHO wants more investigation and says “all hypotheses remain on the table”, including the very unlikely ones. We may never find a smoking gun/bat/lab, but the closer we get to the origin, the better shot we have at prevention in future. Closing off outbreaks at source is the goal.

The dirtiest of bombs 

Evolution is far better at producing bioweapons than laboratories are, and it would be hard to design one as destructive, divisive and disruptive as the Sars-CoV-2 virus. It spread silently and quickly among the young and healthy to start with, before detonating in the elderly and those unlucky enough to be susceptible. 

Covid has killed 3m people and caused an extremely unpleasant chronic disease in millions more. But its management has harmed the lives and livelihoods of billions and led to a massive spike in waiting times for non-Covid illnesses. Yet – more than a year later – there remain huge divisions among politicians, public health experts, the press and the public about how to manage it. Many people are still living in fear – the overarching aim of a terror attack. Nature, and the dangerous games we play with it, has done the extremists’ job for it. Vaccines will help us return to a semblance of normality. But do we need mass testing on top? 

Moonshot a-go-go 

Boris Johnson’s enthusiasm for mass testing is understandable. When the pandemic first hit Europe and the WHO (and MD) was screaming “test, test, test”, the UK wasn’t up to the task and abandoned community testing. Stung by this, Johnson committed up to £37bn – of which £20bn might have been spent so far – on an outsourced test and trace programme that did more testing than other countries but struggled with contact tracing and supporting isolation. We weren’t able to stop further lockdowns or a second wave killing nearly double the number than the first. 

A further complication is that around 30 percent of viral spread is asymptomatic. So Johnson’s solution of offering bi-weekly self tests to all asymptomatic adults in the UK, with results back in 30 minutes, sounds compelling. It could get some asymptomatic shedders off the street and provide mass reassurance to others, though some of it false. Like vaccine passports, a negative test doesn’t guarantee you aren’t infectious, it just reduces the likelihood. 

Also, the public like the idea of having rapid access to rapid tests that give rapid results, and that – along with vaccines – should play well in local elections. It’s also a great opportunity for someone to make a profit from up to 80m tests a week. . . 

Self-testing on trial 

The ritualistic bi-weekly self-testing of asymptomatic adults has its potential downsides. 

• Up to 40m people with no symptoms become medicalised for uncertain benefit. 

• Johnson has put up to £100bn into the Moonshot pot, when there are millions of patients waiting for treatments that have been proven to work. Could the money be better spent? 

• Mass asymptomatic testing is unlikely to pick up many infections when rates are so low. 

• We don’t know how many people will do the tests properly when unsupervised at home, and log in the results online (which is a fiddle). 

• Many people don’t follow isolation rules even if they have symptoms, so expecting people to isolate unsupervised when they don’tt have symptoms is a stretch. 

• Tracing contacts and persuading them to isolate is already a struggle. There is no point massively ramping up testing if we can’t cope with the extra tracing work it triggers. 

• Lateral flow tests (LFTs) aren’t nearly as good as PCR tests. A Cochrane review found LFTs pick up only 58 percent of asymptomatic cases and 72 percent of symptomatic ones. This may encourage risky behaviour in people who tested negative but are infectious. 

• Millions of tests will be sent by post or click and collect, for an unspecified period. That’s a big carbon footprint of plastic in the kits. 

• Once people have been vaccinated, and infections rates are low, will they still self-test when they feel fine and don’t need a test to enter a venue because they have proof of vaccination? 

Lateral thinking 

The most accurate way to use LFTs is to help speed up existing test, trace and isolate services for those with symptoms. It will pick up many positives immediately – with a back-up PCR test – allowing immediate contact tracing and support for isolation. We might manage to get more infectious people out of circulation that way. If we continue to use them to screen staff n higher risk settings (schools, hospitals and universities), this needs to be part of a study. 

Whatever we do with our warehouses full of LFTs, the programme should be properly designed and evaluated but almost certainly won’t be. Johnson and health secretary Matt Hancock are fans of disruptive innovation. Instead of meticulously designing a mass testing programme with lots of pointy-headed academics asking hard questions about risks, harms and value for money, they would rather just empty the warehouses and give it  a punt. 

An experiment in control 

For all nations managing the pandemic has been a huge bio-psycho-social experiment in control. During an outbreak, pragmatism rules. But when infection rates are low, we should properly design and evaluate interventions to learn if benefits outweigh risks. Instead, the government is advertising for “an interim head of asymptomatic testing communication who will primarily be responsible for delivering a communications strategy to support the expansion of asymptomatic testing, that normalises testing as part of everyday life”, Instead of doing a controlled experiment, Johnson is continuing the experiment in control with huge spend, little consent and no way of ‘ knowing the consequences. 

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