What do we know about the new ‘worst ever’ Covid variant?

‘Scientists have detected a new Covid-19 variant called B.1.1.529 and are working to understand its potential implications. About 100 confirmed cases have been identified in South Africa, Hong Kong, Israel and Botswana.

‘B.1.1.529 has a very unusual constellation of mutations, which are worrying because they could help it evade the body’s immune response and make it more transmissible, scientists have said. Any new variant that is able to evade vaccines or spread faster than the now-dominant Delta variant may pose a significant threat as the world emerges from the pandemic.

‘Dr Susan Hopkins, the chief medical adviser to the UK Health Security Agency, said the R value, or effective reproduction number, of the B.1.1.529 variant in the South African province of Gauteng, where it was first found, was now 2 – a level of transmission not recorded since the beginning of the pandemic, before restrictions began to be imposed. For an R of anything above 1, an epidemic will grow exponentially.’

Read here (The Guardian, Nov 26, 2021)

A tale of two pandemics: the true cost of Covid in the global south

‘As the climate crisis was telling us long before Covid blared the message, what happens in one place can have repercussions in many places. That’s why the pandemic must be understood not as an anvil-from-the-sky medical crisis, but as something far more encompassing. “Science is the exit strategy,” the head of the Wellcome Trust famously said, early in the pandemic. But, though science is necessary, it’s hardly sufficient, particularly when we’re interested not simply in exit but in re-entry. As raucous, inward-turned nationalisms continue to claim followers, we’ll need to resist the go-it-alone fantasies of autarky. Rather, a post-pandemic era calls for a richer sense of our mutual obligations.’

Read here (The Guardian, Nov 23, 2021)

Fraudulent Ivermectin studies open up new battleground between science and misinformation

‘Studies suggesting ivermectin is an effective Covid treatment relied on evidence ‘that has substantially evaporated under close scrutiny’, fresh research shows...

‘On Thursday (Sept 23, 2021), the prestigious medical journal Nature Medicine published an article authored by concerned epidemiologists and researchers who interrogated studies on ivermectin. “Many hundreds of thousands of patients have been dosed with ivermectin, relying on an evidence base that has substantially evaporated under close scrutiny,” the authors wrote.

“Several … studies that claim a clinical benefit for ivermectin are similarly fraught, and contain impossible numbers in their results, unexplainable mismatches between trial registry updates and published patient demographics, purported timelines that are not consistent with the veracity of the data collection, and substantial methodological weaknesses.”

Read here (The Guardian, Sept 25, 2021)

• The lesson of ivermectin: meta-analyses based on summary data alone are inherently unreliable

Read here (Nature Medicine, Sept 22, 2021)

Doctors treating unvaccinated Covid patients are succumbing to compassion fatigue

“Compassion fatigue is the feeling, ‘It’s hard to care when you’re overloaded but still dedicated to the task,’” Dr Kernan Manion, executive director of the Center for Physician Rights, said. “Moral injury occurs when the nurse or doctor feels that, ‘The patients I’ve dedicated my life to treating are now here because of their own negligence and now they’re imposing upon me and my team to treat them, while also exposing us to continued danger from this virus.’”

These days, Meck knows that first-hand. She is seeing more children with Covid-19 at her Missouri hospital than ever before. At 46%, Missouri has one of the lowest rates of full vaccination in the country. “I don’t even get the chance to try to show you all the split-second decisions and critical thinking and compassion I’m capable of,” Meck said. “Practising mindfulness is not going to fix moral injury.”

Read here (The Guardian, Sept 18, 2021)

‘We are witnessing a crime against humanity’: Arundhati Roy on India’s Covid catastrophe

‘As this epic catastrophe plays out on our Modi-aligned Indian television channels, you’ll notice how they all speak in one tutored voice. The “system” has collapsed, they say, again and again. The virus has overwhelmed India’s health care “system”.

‘The system has not collapsed. The “system” barely existed. The government – this one, as well as the Congress government that preceded it – deliberately dismantled what little medical infrastructure there was. This is what happens when a pandemic hits a country with an almost nonexistent public healthcare system. India spends about 1.25% of its gross domestic product on health, far lower than most countries in the world, even the poorest ones. Even that figure is thought to be inflated, because things that are important but do not strictly qualify as healthcare have been slipped into it. So the real figure is estimated to be more like 0.34%. The tragedy is that in this devastatingly poor country, as a 2016 Lancet study shows, 78% of the healthcare in urban areas and 71% in rural areas is now handled by the private sector. The resources that remain in the public sector are systematically siphoned into the private sector by a nexus of corrupt administrators and medical practitioners, corrupt referrals and insurance rackets.

‘Healthcare is a fundamental right. The private sector will not cater to starving, sick, dying people who don’t have money. This massive privatisation of India’s healthcare is a crime.’ 

Read here (The Guardian, Apr 28, 2021)

‘A tsunami of cases’: Desperation as Covid second wave batters India

‘Dr K Senthil had feared it was coming. He had feared it as he saw the reckless crush of hundreds of people taking part in large wedding parties over the past months, feared it as he saw the maskless faces of shoppers at the market, feared it as he witnessed thousands come together for political rallies in the ongoing elections in the Indian state of Tamil Nadu, where he is the president of the state medical council.

‘But despite his growing sense of foreboding, the second wave of coronavirus that began to engulf India last month has confounded even Senthil’s worst expectations.’

Read here (The Guardian, Apr 14, 2021)

Sweden has highest new Covid cases per person in Europe

‘Sweden has reported Europe’s highest number of new coronavirus infections per head over the past week and has more patients in intensive care than at any time since the pandemic’s first wave.

‘The Scandinavian country, which has opted against strict lockdowns but gradually ratcheted up its still mostly voluntary restrictions, has a seven-day average of 625 new infections per million people, according to ourworldindata.org.

‘That compares with 521 in Poland, 491 in France, 430 in the Netherlands, 237 in Italy and 208 in Germany, the data showed. The figure was many times higher than the 65, 111 and 132 per million in Sweden’s Nordic neighbours Finland, Denmark and Norway.’

Read here (The Guardian, Apr 13, 2021)

Israel and Chile both led on Covid jabs, so why is one back in lockdown?

‘Chile is in the enviable position of having vaccinated faster than any other country in the Americas. More than a third of the country’s 18 million people have received at least one shot of either Pfizer/BioNTech or China’s Sinovac Biotech vaccine. However, cases have soared to the point of overwhelming the health system and strict lockdown measures are back in place.

What went wrong in Chile?

‘The speedy vaccination programme appears to have instilled a false sense of security that led the country to ease restrictions too soon without people appreciating the ongoing risks. The country reopened its borders in November and in January introduced permits for Chileans to go on summer holiday. Without strict controls on people entering the country, and the lack of an efficient contact-tracing system, travellers may have brought infections back into the country that were not picked up.’

Read here (The Guardian, Apr 6, 2021)

Strain on NHS as tens of thousands of staff suffer long Covid

‘Intense pressures on the already overstretched NHS are being exacerbated by the tens of thousands of health staff who are sick with long Covid, doctors and hospital bosses say.

‘At least 122,000 NHS personnel have the condition, the Office for National Statistics disclosed in a detailed report that showed 1.1 million people in the UK were affected by the condition. That is more than any other occupational group and ahead of teachers, of whom 114,000 have it.’

Read here (The Guardian, Apr 3, 2021)

‘I’m scared’: Top US official shares sense of ‘doom’ as Covid cases rise

‘The US faces “impending doom” from a resurgent coronavirus pandemic, the head of the federal Centers for Disease Control and Prevention (CDC) warned on Monday. “Right now I’m scared,” Rochelle Walensky said in an emotional and unscripted moment during a White House briefing. “I’m speaking not necessarily as your CDC director, and not only as your CDC director, but as a wife, as a mother, as a daughter to ask you to just please hold on a while longer.”

Read here (The Guardian, Mar 30, 2021)

How many anti-vaxxers does it take to misinform the world? Just twelve

‘A majority of anti-vaccine propaganda can apparently be traced back to a handful of people. While de-platforming them is sometimes appropriate, there is a bigger, better solution...

‘Misinformation is never going to go away; it isn’t just a Big Tech problem, it’s an education problem. Instead of just yelling at tech companies, politicians should be focusing on what Taiwan’s digital minister calls “nerd immunity” – the government should be investing in education so people have the skills to identify fake news...

‘Finland, which was rated Europe’s most resistant nation to fake news last year, is one model of how you do this. In 2014, after an increase in disinformation from Russia, the government embedded media literacy in the national curriculum. Starting in primary school, kids learn the critical thinking skills needed to parse the modern information ecosystem. Students learn how easy it is to manipulate statistics in their maths lessons, for example. They learn how to distinguish satire from conspiracy theories in their Finnish lessons. They look at how images can be used for propaganda in art class. And this sort of education isn’t just given to children: Finnish civil servants, journalists and NGO workers are also trained in digital literacy skills.’

Read here (The Guardian, Mar 30, 2021)

How do faithless people like me make sense of this past year of Covid?

‘Many of us yearn for meaning. But in our individualistic, secular society we lack even the flimsiest of narratives to guide us...

‘Long before Covid’s arrival, it was clear this was something too many people were losing touch with. Through decades of secularisation, cheered on by irreligious liberals, not nearly enough thought was ever given to what might take on the social roles of a church. The demise of the factory and the collectivised lives that went with it marked another loss. And now, long years of cuts have obliterated many of the shared spaces we had left, from libraries and Sure Starts to community centres.

‘The pandemic has shone unforgiving light on the consequences. A British Academy report on “the long-term societal impacts of Covid-19” found that the age group most likely to experience loneliness during the first lockdown was 16- to 24-year-olds. In the past decade, spending in England and Wales on youth services has been cut by 70%. As life after Covid unfolds, such choices will look not just reckless but downright cruel.

‘Three years ago, Anthony Costello – a former director of maternal and child health at the World Health Organization – published a book titled The Social Edge, focused on the so-called “sympathy groups” that sit between the state and the individual. “Religious or therapy groups have always offered solace and peace and relaxation and friendship,” he wrote. “They help us in our spiritual quest for meaning and wellbeing.” Church groups, choirs, sport and dance clubs, he went on, “bring harmony and relaxation to tired minds” and give people “a greater sense of being alive”.

‘Costello proposed using similar structures to tackle loneliness in old age, prisoner recidivism, “stress in motherhood” and much more. Now, in the context of Covid and its long-term social effects, this sounds like something millions of us might sooner or later need. Whatever our experiences, what we have all been through is huge. And as an act of post-pandemic healing, encouraging the growth of such initiatives would surely not be too hard. Fund and create public spaces – parks, halls, arts venues, meeting rooms – and revive the most grassroots aspects of local government, and you would create roughly the right conditions.’

Read here (The Guardian, Mar 28, 2021)

'Covid is taking over': Brazil plunges into deadliest chapter of its epidemic

‘[André] Machado saw several explanations for the torrent of cases he and other doctors are now seeing, including political mismanagement and the slackening of social distancing measures, principally among the young. In recent months such containment efforts have largely collapsed, with schools and businesses reopening and Bolsonaro’s tourism minister even urging citizens to start holidaying again.

‘But the doctor suspected a third, more troubling element was also at work: an enigmatic and apparently more contagious variant called P1 that is thought to have emerged in the Amazon region in late 2020 but is now circulating across Brazil, including in the southern state of Rio Grande do Sul, where Machado works.’

Read here (The Guardian, Mar 13, 2021)

From Pfizer to Moderna: Who's making billions from Covid-19 vaccines?

‘Among the biggest winners will be Moderna and Pfizer – two very different US pharma firms which are both charging more than $30 per person for the protection of their two-dose vaccines. While Moderna was founded just 11 years ago, has never made a profit and employed just 830 staff pre-pandemic, Pfizer traces its roots back to 1849, made a net profit of $9.6bn last year and employs nearly 80,000 staff.

‘But other drugmakers, such as the British-Swedish AstraZeneca and the US pharma Johnson & Johnson, have pledged to provide their vaccines on a not-for-profit basis until the pandemic comes to an end.’

Also carried in this story are: Sinovac, Sputnik V, Novavax, CureVac 

Read here (The Guardian, Mar 6, 2021)

Coronavirus crisis unlikely to be over by the end of the year, WHO warns

‘Despite the spread of Covid-19 being slowed in some countries due to lockdowns and vaccination programs, it is “premature” and “unrealistic” to the think the pandemic will be over by the end of the year, the World Health Organization’s executive director of emergency services has said.

‘Speaking at a press briefing Geneva, Dr Michael Ryan said while vaccinating the most vulnerable people, including healthcare workers, would help remove the “tragedy and fear” from the situation, and would help to ease pressure on hospitals, the “virus is very much in control”.’

Read here (The Guardian, Mar 2, 2021) 

Will I have to wear a mask after getting the Covid vaccine? The science explained

‘Public health authorities want people to keep wearing masks and social distancing, even after they receive a vaccine. This might seem counterintuitive – after all, if someone gets a vaccine, aren’t they protected from the coronavirus?

‘The answer is complicated: the vast majority of people who are vaccinated will be protected from Covid-19, the disease caused by the SARS-CoV-2 virus. However, vaccinated people may still be able to transmit the virus, even though they do not display any symptoms. “We know now the vaccines can protect, but what we haven’t had enough time to really understand is – does it protect from spreading?” said Avery August, professor of immunology at Cornell University.

‘That is because the the SARS-CoV-2 virus may still colonize the respiratory tract, even as systemic immune cells protect the overall body from the disease it causes – Covid-19.’

Read here (The Guardian, Feb 26, 2021)

The next pandemic? It may already be upon us

‘Antimicrobial resistance (AMR) won’t race across the world like Covid-19, but its effects will be devastating. Thankfully, we already know what we need to do to defeat it...

‘Reining in the inappropriate use of antibiotics, in humans and in farmed animals, is key to staying ahead of AMR, but we also need novel anti-infectives coming down the pipeline – new last resorts. The thing holding up that pipeline to date has been the same thing that meant we had no coronavirus vaccines at the start of this pandemic: the economic incentives are few. Because antibiotics tend to be needed in relatively small quantities at a time, there are no economies of scale to be had either.

‘That’s the bad news; now for the good. Efforts are afoot to stimulate the development of novel anti-infectives. Outterson is the founder and executive director of CARB-X, which is funded by the British and German governments, the Wellcome Trust, the Bill & Melinda Gates Foundation and several arms of the US government, and which promotes the early stages of R&D – technically, the preclinical and phase 1 clinical phases. Meanwhile, last July the International Federation of Pharmaceutical Manufacturers and Associations launched a $1bn initiative, the AMR Action Fund, to finance the much more expensive phase 2 and 3 clinical trials that bring a drug – the few that get that far – to the threshold of regulatory approval. And the UK is experimenting with a new subscription-style payment model that pays drug companies upfront for access to novel antibiotics, so decoupling profit from volume sold.’

Read here (The Guardian, Feb 15, 2021)

‘Pure, liquid hope’: What the vaccine means to me as a GP

‘Clinicians everywhere are all nervous about what will happen if that loosening of restrictions occurs too quickly. Though death from Covid among the under-50s is relatively rare, it can still be a terrible, terrifying disease, capable of rendering its victims breathless and exhausted for weeks (and in some cases, months) after its fevers have run their course. One of my own patients, a nurse in his 20s, used to run 10km three or four times a week. The staff vaccination programme was too late for him: he caught Covid on the wards just before Christmas. Though he’s now back at work, he still hasn’t recovered sufficiently to be able to get back to running.

‘For the next six months, all my colleagues and I will be vaccinating as needed, as many hours as we’re able to. This week I’ve been gladly trudging the streets in the snow, vaccinating our housebound patients, and there aren’t too many still to go. In Scotland, the programme is anticipated to go on at least until 31 July, and the hope is that everyone over 50 will have had a first dose by May.

‘The numbers are daunting, but there’s a spirit of anticipation and celebration in the air. Many are starting to dare to plan for a world post-Covid, and I’m tempted to share that optimism. Opening my first box of vials, I thought of a friend in Orkney, a GP who’d already vaccinated all the over-80s of his practice, and who’d begun to call in the over-70s. We met briefly in Kirkwall, outdoors, on my journey from Orkney back to Edinburgh. “How did it feel to get started?” I asked him.

“I almost wept as I opened that box of vials,” he said, smiling at the memory. “Each one was hope – pure, liquid hope.”

Read here (The Guardian, Feb 11, 2021)

WHO team says theory Covid began in Wuhan lab ‘extremely unlikely’

‘The World Health Organization team that visited Wuhan to investigate the origins of the coronavirus pandemic has all but dismissed a theory that the virus leaked from a laboratory, while giving some credence to China’s focus on the possibility of transmission via frozen food.

‘They said the team’s work did not dramatically change the picture they had before they began, but had added important details to the story. The team found no evidence of widespread circulation of the virus in Wuhan prior to December 2019, and said it was still unclear how it got into the Huanan seafood market, where the virus was initially detected. But, they added, “all the work that has been done on the virus and trying to identify its origin continue to point toward a natural reservoir”.’

Read here (The Guardian, Feb 9, 2021)

Vaccine strategy needs rethink after resistant variants emerge, say scientists

‘Leading vaccine scientists are calling for a rethink of the goals of vaccination programmes, saying that herd immunity through vaccination is unlikely to be possible because of the emergence of variants like that in South Africa. The comments came as the University of Oxford and AstraZeneca acknowledged that their vaccine will not protect people against mild to moderate Covid illness caused by the South African variant. The Oxford vaccine is the mainstay of the UK’s immunisation programme and vitally important around the world because of its low cost and ease of use.

‘The findings came from a study involving more than 2,000 people in South Africa. They followed results from two vaccines, from Novavax and Janssen, which were trialled there in recent months and were found to have much reduced protection against the variant – at about 60%. Pfizer/BioNTech and Moderna have also said the variant affects the efficacy of their vaccines, although on the basis of lab studies only.

‘All the vaccines, however, have been found to protect against the most severe disease, hospitalisation and death.’

Read here (The Guardian, Feb 7, 2021)