danieldwilliam | Entries tagged with covid

It looks like about 55% of the world's population are fully vaccinated. I think I found this surprisingly low until I remembered that quite a lot of rich countries have been triple vaccinating people (including mine, including me, and having just had COVID and not enjoyed it much I'm not 100% against that policy.)

The rate of vaccination globally appears to be pretty steady - in a year we've gone from 0% to 55%, so about 4.5% a month. I think vaccine protection is reasonably high for about 12 months or so after your first vaccine dose. You know, ish.) Or maybe six months if the current variant is sufficient different from the ones originally targeted by the vaccine. So looking at the UK chart for cummulative 2nd and 3rd doses we plateaued about January this year. So we're going to want to start vaccinating people again sometime between July 2022 and February 2023. I guess.

I think this is probably true of other rich countries.

And I guess we'll suck up all the available vaccines again when we re-start. So the rest of the world has between 4 and 12 months to get themselves vaccinated before they start to run short - or between another +20% or + 60%.

And today there are still a lot of places for COVID-19 to get itself passed around with lots of opportunities for unhelpful variations to emerge. And in an enviroment where there is a large and increasing vaccinated population my expectation would be that emerging variants (those that prosper enough to become noticable) are more likely than not to be the more infectious and the more (current) vaccine resistant.

Which suggests another significant outbreak in the UK early next winter as immunity decreases, we spend more time indoors because of the weather and we have some time for more vigorous variants to emerge in the quarter of the people who won't be vaccinated over the summer.

Or at least that is my current assumption.

We have all had the Covids.

Fortunately comparatively mild - comparatively for a disease which has killed millions and incapacitated tens of millions. So we've all been ill.

MLW first, followed by the Captain and then me. At least that is the order of testing positive.

Generally we have been symptomatic. Including the Captain, who at not quite 12, is still in the age group expected to have mild symptoms.

We've all had symptoms some time in advance of testing positive.

As soon as MLW tested positive we went in to the sort of isolation protocol - daily testing but the Captain and I free to go outside the house as we were younger than 12 or triple vaccinated. After an ill-judged trip to rugby training we decided to just not leave the house.

As sure as dominoes deliver pizza we went down one after the other.

I had to work through the first few days of feeling properly unwell - because, well, because of course I did. This has not helped. Then I spent a few days mostly in bed, or watching films on the sofa. MLW seems to have mostly recovered other than a cough but is being careful about over exerting herself.

I am still not 100%.

The Captain is boucing off the walls, waiting for some negative tests so he can go back to school. He is relieved that having had the disease now means that he is 100% guaranteed to be allowed to go on his school week away next month. He now does not like the taste of vinegar, previously a favourite.

Major downside I can't go to Murrayfield to watch the rugby today.

Covid, even mild Covid, was not pleasant. 3* out of 10 - would not do again (but I fear I won't get any choice in the matter).

I'm not, I hope, a cruel or vindictive man. I generally try not to wish pain or suffering on my enemies and not when those "enemies" are a mass of people I find I myself in general political opposition to. I would not, I hope, wish a preventable and potentially deadly disease on someone just because I disagreed with them politically.

But I am finding myself watching the anti-vaxxer anti-lockdown movement in the US in much the same way I think I would watch carpet-bombing during World War Two.

It's clear from various data that COVID cases are more frequent and more often serious in Trump voting counties. There is a strong correlation between Trump voters and anti-vaxxer / anti-lockdown supporters. People who voted for Trump are disproportionately not getting vaccinated and ignoring public health guidance and therefore disproportionately getting sick and dying. Whilst it is undoubtedly true that being a not-Trump voter does not mean you won't catch COVID you are more likely to catch COVID if you move in the Trump supporting circles. This does include many many more or less "innocent" people. People who did what I think is the right thing but got sick because they were physically close to people who did not do the right thing. Like the allied carpet-bombing of Germany in the 1940's. I'm sure a great many people were killed, injured, made homeless, lost loved ones who were not die hard Nazis or were opposed to the Nazis but just happened to be living in a large German city during the war by an accident of birth. People like my mother-in-law. Covid, like British bombs, won't distinguish between people I disagree with politically or not - but it will disproportionately impact them.

I don't wish ill or illness on these people but, Lord help me, they won't help themselves.

I have often remarked that perception is 9/10th of everything but that last tenth part of reality will get you in the end if you ignore it. Most things are a matter of opinion. There is a great deal of ruin in a nation. However, reality will out. You can disagree about whether vaccine passports are a proportionate measure to COVID. You can take the view that COVID vaccines are worse than the disease. You can be of the opinion that the whole thing is a damned hoax gotten up by a government intent on controlling the population through fair means or foul. I don't think COVID cares. If your opinions lead you to behaviour that makes it more like that the coronavirus will prosper in your community or in your body, then prosper it will. The dead hand of Darwin will push it in to every nook and cranny that it can make a living in.

And the end result, whether I wish it or wish it not, is that more people in Trump voting parts of the US will die. Will this change their mind about how science works, whether public health measures are appropriate, whether there is a massive conspiracy between Big Pharma, Joe Biden and Bill Gates? I don't know, and as, to a certain extent they have brought this upon themselves I shrug my shoulders and I suppose I wash my hands of them.

And given that their political coalition was in a minority in the United States already having fewer voters is unlikely to do much good for their politics. Which I am not sad about but can not be happy about under the circumstances.

I have been thinking a little about vaccine passports and nightclubs and mulling over two concepts from jurisprudence and public policy; magical legal thinking and the chilling effect

Some time ago David Allen Green wrote about magical legal thinking, the notion that just passing some legislation on it's own doesn't change the world. Banning something by law doesn't make it stop in and of itself. Something else must happen for their to be an effect, typically some enforcement action. He wrote about it more recently in relation to COVID lockdown regulations.

https://twitter.com/davidallengreen/status/1312773215903772676?lang=en

The chilling effect is what happens when some rule might or might not apply to you and you are worried that either you will suffer some enforcement activity or have to perform some onerous compliance tasks. A recent example is the impact on third sector organisations of the Transparency of Lobbying Act 2014. Which regulates the campaigning behaviour of charities during election periods. For fear of non-compliance many charities restricted their campaigning activities.

And so to vaccine passports. What then is the purpose of a vaccine passport? What in law is a nightclub? What is the effect we are trying to have.

I think the proposed regulations are mostly not about regulating a specific risky behaviour undertaken by a specific group at particular risk. Lots of unvaccinated people crowded in to a small space, drinking and talking or singing loudly and moving around energetically sounds like risky behaviour during COVID, whether that's in nightclub or a sports arena or a theatre or whatever. The venue being a nightclub or not being a nightclub doesn't strike me as important to the additional risk. The risk is not changed by the magical legal application of a ban on unvaccinated people in nightclubs - as defined in the interpretation section of the relevant legislation or the dictionary. I think the regulation is mostly aimed at encouraging unvaccinated people to get vaccinated by harnessing the chilling effect. The chilling effect is the mechanism by which the ban on some behaviours has the desired policy effect of increasing vaccination rates and reducing opportunities for transmission of COVID.

Do you want to go to a nightclub - or a similar venue that might or might not be a nightclub? Then get vaccinated. That avoids you risking being turned away from the venue you want to go to.

Are you a nightclub? Or perhaps a similar type of venue? Not sure and want to avoid criminal prosecution or civil actions for damages? Then start asking your customers to prove their vaccination status?

Some ambiguity is actually helpful in achieving the policy aims as it spreads the chilling effect more widely.

People are entitled to be able to understand the law in advance. It should as much as possible be clear, unambiguous and actionable by citizens. An unclear definition of nightclubs is unfair in much the same way that an unclear definition of cafe was unfair earlier on in the pandemic and businesses were being closed. However, I think there is a crucial difference here - the level of harm from the ambiguity in definition is much less. In the earlier situation some business were being closed, some allowed to open under certain circumstances. Some closed businesses or the people working in them would be entitled to financial support from the state. Closing your business and putting your staff on furlough is a big thing. A big thing to get wrong. A big risk for the state to pass to you with an unclear set of rules.

Less serious I think to have an ambiguous definition of nightclub for the purposes of vaccine passports. Some venues that are not properly nightclubs might employ a few extra security staff. They may turn away some customers. Compared to being closed or not closed that is relatively small impact. The state may bring some prosecutions and lose them. That is not good, but in the grand scheme of things not terrible. The state may end up having to pay some compensation to those wrongly accused to operating a nightclub improperly, but not close to the same order of magnitude of compensation or support required when closing bars but leaving open cafes.

And the legislation does not have to operate for long to have the desired policy effect. If I am correct in my view that the primary aim of the legislation is to encourage twenty-somethings to make sure they are vaccinated then the mere threat of the legislation may be sufficient to drive up vaccination rates. If in six months time the courts decide that the definition of nightclub in the legislation is useless or narrows it so that it only applies to a handful of places in Scotland, but in the meantime 50,000 additional vaccinations have happened as a result of the chilling effect then the law has achieved its policy goals and at modest cost too.

I have a vaccination date scheduled with the NHS in about 10 days time.

Phoned the helpline on Andy's suggestion and they do have an appointment scheduled for me.

Should be getting the benefit of the vaccine by the end of May.

I think I have missed something in my understanding of how COVID works and I can't work out what.

I was chatting (virtually) with a friend and I blithely said I thought COVID was a solved problem.

By which I meant

We have a vaccine. It is pretty good. Future iterations of it will be better. Tick.

We have a vaccine programme. People are being vaccinated. Quite rapidly in the UK. Tick.

By the late summer we in the UK will have vaccinated pretty much everyone over the age of 16 who wants and can have the vaccine.

As a result of this deaths and serious illness from the original variant of the disease will be cut to very, very low numbers and as the vaccine seems to be pretty effective against other variants overall deaths and serious illness will be cut to very low numbers.

We have several technologies that will allow for the rapid and relatively cheap reformulation of a vaccine to better deal with new variants.

So, the position I thought we were going to end up in the UK by autumn was having had many months of low impact from the virus - potentially still many people infected but those people not getting very ill and the start of a second round of the vaccination programme aimed at other variants. We might also have a Track and Trace system worth a) the name and b) the £35 billion we spent on it. Life wouldn't necessarily be back to normal. We'd still have difficulty travelling abroad. There would still be local outbreaks. People would still be dying, but not in large numbers compared to heart disease.

The problem would be understood, a solution in hand and delivering results and question would be one of logistical execution of the inevitable rather than solving a problem.

(I'm paraphrasing the next bit).

"Yeah", she said, "but Chris Whitty says there's going to be a wave in autumn and he's the bomb!"

To which I responded that I was thinking more about the impact of another wave in terms of deaths, illness and precautions we'd have to take rather than the numbers of infections.

"He wouldn't have said it if he didn't think it would have an impact."

And to be honest, confronted with the sheer majesty of Christ Witty I don't have much of a come back but I still can't get my head around where the impact is coming from if the vaccine programme is working.

What have I missed? Because I feel like I've missed something.

Bumped in to Dad on the way back from working out this morning. We were discussing the vaccine roll-out and he wondered what was going to happen when the people who owned the Edinburgh International Conference Centre wanted it back for non vaccine related things like conferences. With a working assumption that we are going to be vaccinating approximately everyone at least annually for at least 5 years where are we going to do it?

We then went on to wonder if extreme handwashing and sanitising will continue (almost certainly), whether facemasks will persist (likely) and whether an annual COVID vaccine would increase the offering and the take up of the annual flu vaccine (very likely). Which all probably means lower levels of things like flu in the future.

My thoughts on a vaccine roll out. It will be September 2021 before anything close to normality returns.
(This is one of those blogposts mostly to layout my thinking and force myself to think something through rather than an attempt to Dunning-Krueger myself or to be oracular.)
The noises from vaccine developers seem muted but nobody has reported a massive failure. Certainly not everybody has reported a massive failure yet.
So we are probably 12 months in to an 18 month process.
That would indicate some sort of effective vaccine being announced in January / February with large scale access to it starting in February / March.
My assumptions for the first round of vaccines are
1) they have limited effectiveness compared to our usual experience of vaccines - fewer people than normal will find them protective and the protection will be less than we usually expect.
2) they will have a more time-bounded effectiveness than we are used to - perhaps six months, or 12 months
3) they will have more side-effects than we usually see, making them either unpleasant for some people or unsuitable for some people.
So useful but not a complete answer to the problem.
I'm assuming that production in the West will be geared up to provide vaccines for their entire populations over a 12-month period with say 10% surplus to be shared / exported / donated with the not-West. China will probably sort itself out quicker. Ditto the South East Asian countries with experience of SARS. Other countries will sort themselves out slower.
There will be a second round of vaccines following on about a year from the first round, these will be better in terms of protection, duration and side-effects.
By the time the vaccination programme starts in the UK I think we'll have had about 5% of the population having had the virus in a way that confers some on-going immunity from the point when the vaccine programme starts. (I'm assuming here lots of asymptomatic cases which have not been spotted.) But I'm also assuming enough churn in immunity to keep that number at 5% through out.
Assume the UK has access to a total of 60 million doses over a 12-month period, or 5 million a month, or 7% of the population a month. Then our immunity level starting in March is 5%. It rises to 12% by the end of April. By the end of September 2021, it's a 60%.
In September we start to see people who only gained a short period of immunity from the vaccine they had in March / April / May become less immune. So, our rate of increase in immunity levels slows.
60% - 70% is probably not enough for herd immunity to kick in. I believe a figure of 80% of the population having some form of immunity is required for a disease as contagious as COVID-19. However, it does mean the spread will be slower. This should help Track and Trace operations.
It would also allow those who have been vaccinated to move around with more liberty and for the country to preferentially vaccinate those who are a) at the most risk of dying b) those at the most risk of spreading the disease.
So, we might see a a limited return to normality around September next year.