Dear Prime Minister, Chancellor, CMOs and Chief Scientific Adviser
We are writing with the intention of providing constructive input into the choices with respect to the Covid-19 policy response. We also have several concerns regarding aspects of the existing policy choices that we wish to draw attention to.
In summary, our view is that the existing policy path is inconsistent with the known risk-profile of Covid-19 and should be reconsidered. The unstated objective currently appears to be one of suppression of the virus, until such a time that a vaccine can be deployed. This objective is increasingly unfeasible (notwithstanding our more specific concerns regarding existing policies) and is leading to significant harm across all age groups, which likely offsets any benefits.
Instead, more targeted measures that protect the most vulnerable from Covid, whilst not adversely impacting those not at risk, are more supportable. Given the high proportion of Covid deaths in care homes, these should be a priority. Such targeted measures should be explored as a matter of urgency, as the logical cornerstone of our future strategy.
In addition to this overarching point, we append a set of concerns regarding the existing policy choices, which we hope will be received in the spirit in which they are intended. We are mindful that the current circumstances are challenging, and that all policy decisions are difficult ones. Moreover, many people have sadly lost loved ones to Covid-19 throughout the UK. Nonetheless, the current debate appears unhelpfully polarised around views that Covid is extremely deadly to all (and that large-scale policy interventions are effective); and on the other hand, those who believe Covid poses no risk at all. In light of this, and in order to make choices that increase our prospects of achieving better outcomes in future, we think now is the right time to ‘step back’ and fundamentally reconsider the path forward.
Professor Sunetra Gupta; Professor of theoretical epidemiology, the University of Oxford
Professor Carl Heneghan; Director, Centre for Evidence Based Medicine, the University of Oxford
Professor Karol Sikora; Consultant oncologist and Professor of medicine, University of Buckingham
Sam Williams; Director and co-founder of Economic Insight
Sweden never went in to full lockdown. Instead, the country imposed a partial lockdown that was almost entirely voluntary.
The only forcible restriction imposed by the government from the start was a requirement that people not gather in groups of more than 50 at a time.
People followed the voluntary restrictions pretty well at the beginning, but that they have become increasingly lax as time has gone on.
After an initial peak that lasted for a month or so, from March to April, visits to the Emergency Room due to covid had been declining continuously, and deaths in Sweden had dropped from over 100 a day at the peak in April, to around five per day in August.
Dr. Rushworth hasn’t seen a single covid patient in the Emergency Room in over two and a half months.
COVID has killed under 6,000 people.
On average, one to two people per day are dying of covid in Sweden at present, and that number continues to drop.
In the whole of Stockholm, a county with 2,4 million inhabitants, there are currently only 28 people being treated for covid in all the hospitals combined.
Sweden seemed to be developing herd immunity, in spite of the fact that only a minority had antibodies, was due to T-cells.
Immunity may be long lasting, and probably explains why there have only been a handful of reported cases of re-infection with covid, even though the virus has spent the last nine months bouncing around the planet infecting many millions of people.
Almost all cases of reinfection have been completely asymptomatic.
People develop a functioning immunity after the first infection, which allows them to fight off the second infection without ever developing any symptoms.
England and Italy have mortality curves that are very similar to Sweden’s.
Lockdown only makes sense if you are willing to stay in lockdown until there is an effective vaccine.
Leading scientists across the world say rushing the development of a coronavirus vaccine to bring it to the public before the end of this year is unrealistic, unsafe, and even “crazy”.
Despite reports from across the world suggesting a vaccine could be ready in weeks – particularly from the United States, where “Operation Warp Speed” reportedly has officials on standby to distribute the vaccine by October, ahead of the presidential election – experts are increasingly concerned that the rhetoric is in no way matched by the data.
None of the leading vaccine candidates have yet completed clinical trials, the regulatory bodies who licence vaccines are already struggling to cope with coronavirus demands, and questions over manufacture and distribution haven’t been considered, experts say.
…In normal times, a vaccine takes up to ten years to develop, including several years of testing. Under the current plans outlined by politicians in the UK, Russia, and the United States, this has been crunched to less than 12 months.
The World Health Organization says a new polio outbreak in Sudan is linked to an ongoing vaccine-sparked epidemic in Chad — a week after the U.N. health agency declared the African continent free of the wild polio virus.
In a statement this week, WHO said two children in Sudan — one from South Darfur state and the other from Gedarif state, close to the border with Ethiopia and Eritrea — were paralyzed in March and April. Both had been recently vaccinated against polio. WHO said initial outbreak investigations show the cases are linked to an ongoing vaccine-derived outbreak in Chad that was first detected last year and is now spreading in Chad and Cameroon…
In rare instances, the live polio virus in the oral vaccine can mutate into a form capable of sparking new outbreaks.
…On Monday, WHO warned that the risk of further spread of the vaccine-derived polio across central Africa and the Horn of Africa was “high,” noting the large-scale population movements in the region.
The choice we face is stark. One option is to maintain a general lockdown for an unknown amount of time until herd immunity is reached through a future vaccine or until there is a safe and effective treatment. This must be weighed against the detrimental effects that lockdowns have on other health outcomes. The second option is to minimise the number of deaths until herd immunity is achieved through natural infection. Most places are neither preparing for the former nor considering the latter.
The question is not whether to aim for herd immunity as a strategy, because we will all eventually get there. The question is how to minimise casualties until we get there. Since Covid-19 mortality varies greatly by age, this can only be accomplished through age-specific countermeasures. We need to shield older people and other high-risk groups until they are protected by herd immunity.
Among the individuals exposed to Covid-19, people aged in their 70s have roughly twice the mortality of those in their 60s, 10 times the mortality of those in their 50s, 40 times that of those in their 40s, 100 times that of those in their 30s, and 300 times that of those in their 20s. The over-70s have a mortality that is more than 3,000 times higher than children have. For young people, the risk of death is so low that any reduced levels of mortality during the lockdown might not be due to fewer Covid-19 deaths, but due to fewer traffic accidents.
Humans have never been particularly good at eradicating entire viruses, and COVID-19 might not be any different.
More than 19 million people have tested positive for the coronavirus globally, and at least 722,000 have died. In the U.S., nearly 5 million people have tested positive and more than 160,000 have died. While scientists are racing to find a cure for the virus, there’s a chance COVID-19 will never fully go away — with or without a vaccine.
Vineet Menachery, a coronavirus researcher at the University of Texas Medical Branch, told NPR’s Weekend Edition that one of the more likely scenarios is that the spread of COVID-19 will eventually be slowed as a result of herd immunity. He said that he’d be surprised “if we’re still wearing masks and 6-feet distancing in two or three years” and that in time, the virus could become no more serious than the common cold.
The first thing to remember is that we haven’t been successful at eradicating many viruses at all. Really the lone exception is smallpox, but many of these viruses exist not only in the human population but in animal populations. So coronaviruses may be removed from the human population, like SARS coronavirus in 2002, but we know that those viruses or viruses that are similar to it still exist in nature and at any time they may gain the tools to reemerge in humans again.
Sky News host Alan Jones says people are being swept up into a sense of hysteria and alarmism around COVID-19.
There are only 17 people in hospital with the coronavirus in NSW, eight of them in intensive care, while the World Health Organisation continue to maintain that 99 per cent of all cases will experience mild symptoms.
“I don’t think there’s going to be a vaccine, and we’re going to have to learn to live with this,” Mr Jones told Sky News host Chris Smith.
“But we learned to live with a whole lot of other communicable diseases.
“More people are dying from the flu with a vaccine than are dying from coronavirus without a vaccine.”
Your immune system’s ‘memory’ T cells keep track of the viruses they have seen before.
New study led by scientists at La Jolla Institute for Immunology (LJI) shows that memory helper T cells that recognize common cold coronaviruses also recognize matching sites on SARS-CoV-2, the virus that causes COVID-19.
Having a strong T cell response, or a better T cell response may give you the opportunity to mount a much quicker and stronger response.
40%-60% of people never exposed to SARS-CoV-2 had T cells that reacted to the virus showing that their immune systems recognized the virus.
This finding turned out to be a global phenomenon and was reported in people from the Netherlands, Germany, the United Kingdom and Singapore.
This discovery suggests that fighting off a common cold coronavirus can induce cross-reactive T cell memory against SARS-CoV-2.
Article based on experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, Sweden, and of living as a citizen in Sweden.
Unlike other countries, Sweden never went in to complete lockdown. Non-essential businesses have remained open, people have continues to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public.
COVID hit Stockholm like a storm in mid-March. One day I was seeing people with appendicitis and kidney stones, the usual things you see in the emergency room. The next day all those patients were gone and the only thing coming in to the hospital was COVID. Practically everyone who was tested had COVID, regardless of what the presenting symptom was. People came in with a nose bleed and they had COVID. They came in with stomach pain and they had COVID.
Then, after a few months, all the COVID patients disappeared.
At the peak three months back, a hundred people were dying a day of COVID in Sweden, a country with a population of ten million. We are now down to around five people dying per day in the whole country, and that number continues to drop. Since people generally die around three weeks after infection, that means virtually no-one is getting infected any more.
The risk of dying is at the very most 1 in 200 if you actually do get infected.
In total COVID has killed under 6,000 people in a country of ten million.
Sweden has an annual death rate of around 100,000 people. Considering that 70% of those who have died of COVID are over 80 years old, quite a few of those 6,000 would have died this year anyway.
COVID will never even come close to major pandemic numbers like 1918 flu.
If herd immunity hasn’t developed, where are all the sick people? Why has the rate of infection dropped so precipitously?
The reason we test for antibodies is because it is easy and cheap. Antibodies are in fact not the body’s main defence against virus infections. T-cells are. But T-cells are harder to measure than antibodies, so we don’t really do it clinically.
Sweden ripped the metaphorical band-aid off quickly and got the epidemic over and done with in a short amount of time, while the rest of the world has chosen to try to peel the band-aid off slowly.
I am willing to bet that the countries that have shut down completely will see rates spike when they open up. If that is the case, then there won’t have been any point in shutting down in the first place, because all those countries are going to end up with the same number of dead at the end of the day anyway. Shutting down completely in order to decrease the total number of deaths only makes sense if you are willing to stay shut down until a vaccine is available. That could take years.
COVID has at present killed less than 6000 in Sweden. It is very unlikely that the number of dead will go above 7,000. An average influenza year in Sweden, 700 people die of influenza. Does that mean COVID is ten times worse than influenza? No, because influenza has been around for centuries while COVID is completely new.
So it is quite possible, in fact likely, that the case fatality rate for COVID is the same as for influenza, or only slightly higher, and the entire difference we have seen is due to the complete lack of any immunity in the population at the start of this pandemic.
AstraZeneca has been granted protection from future product liability claims related to its COVID-19 vaccine hopeful by most of the countries with which it has struck supply agreements, a senior executive told Reuters.
With 25 companies testing their vaccine candidates on humans and getting ready to immunise hundred millions of people once the products are shown to work, the question of who pays for any claims for damages in case of side effects has been a tricky point in supply negotiations.
“In the contracts we have in place, we are asking for indemnification. For most countries it is acceptable to take that risk on their shoulders because it is in their national interest,” he said, adding that Astra and regulators were making safety and tolerability a top priority.
Phase I clinical trials simply test the safety of a drug or vaccine in a small number of healthy volunteers — usually brave and naïve college students.
Phase II trials are responsible for testing its effectiveness in a larger number of subjects.
A hyped-up and exuberant response to a Phase I trial as seen with Moderna press release is rare and nearly unheard of.
Little information is gleaned from an investigational drug in Phase I that has many more hurdles to overcome before it successfully gets to market
77 percent of vaccines for infectious diseases make it through Phase I, but only 33 percent make it through the entire process overall.
Moderna’s RNA vaccine
Upon examining Moderna’s non-peer reviewed press release, the actual data on the vaccine’s success is even more flimsy.
When it comes to finding out whether the vaccine elicits an antibody response that could potentially fight the coronavirus, they only had data on eight patients out of the 45 patients who received the vaccine.
The only data Moderna mentioned when it comes to determining whether the vaccine was clinically effective against the coronavirus were from mice.
History also proves that success in animal models is often not replicated in human studies.
Moderna’s messenger RNA vaccine is completely new and revolutionary. Messenger RNA vaccines have never before been brought to market for human patients
It uses a sequence of genetic RNA material produced in a lab that, when injected into your body, must invade your cells and hijack your cells’ protein-making machinery called ribosomes to produce the viral components that subsequently train your immune system to fight the virus.
Some messenger RNA vaccines are self-amplifying. That means they can force the cell to replicate more copies of itself.
There are unique and unknown risks to messenger RNA vaccines, including the possibility that they generate strong type I interferon responses that could lead to inflammation and autoimmune conditions.
Oxford Vaccine Group’s vaccine:
Oxford Vaccine Group has a competing vaccine that does not need to invade and hijack our cells’ own machinery.
From a medical and clinical perspective, there is less risk of generating a type I interferon response and autoimmunity because there is no messenger RNA floating around our blood, invading our cells.
Discussion around vaccinations can be very contentious. There’s great nuance in this area and a short post will not do justice to the complex issues surrounding the usefulness and safety of vaccines. Nevertheless, while vaccines may have their role in protecting target populations from disease, not all have been proven safe to an acceptable level as shown in the resources below.
The UK government’s Vaccine Damage Payment scheme is probably the strongest proof that vaccines can be unsafe. Under the Vaccine Damage Payment scheme, people who have been severely disabled as a result of a vaccination against certain diseases can be eligible for a one-off tax-free payment of £120,000.
Conspiracy theorists are putting lives at risk?
Despite this objective fact that a compensation scheme exists for hose who have been damaged by vaccines, Health Secretary Matt Hancock claimed that conspiracy theorists are putting lives at risk:
“Those who promulgate lies about dangers of vaccines that are safe and have been approved–they are threatening lives…”
Clearly, concerns about the safely of vaccines cannot be lies if there is a vaccine damage compensation scheme in place.
Eligibility changed in 2015
Eligibility requirements for vaccines covering certain diseases are listed and change over time. Interestingly, sometime around 2015, damage from vaccines for influenza caused by pandemics are explicitly listed as not eligible.
We do not know how the government compiles is eligibility criteria or why this change was made. However, it would be worthwhile to keep an eye on this list to see if the status of the upcoming COVID-19 vaccines.
AstraZeneca protected from vaccine liability
Update 1 August 2020: On 30 July 2020, Reuters reported that AstraZeneca, the UK government’s partner for developing its COVID-19 vaccine, will be exempt from coronavirus vaccine liability claims in most countries. The countries have not been named but Ruud Dobber, a member of Astra’s senior executive team, commented:
“This is a unique situation where we as a company simply cannot take the risk if in … four years the vaccine is showing side effects.
In the contracts we have in place, we are asking for indemnification. For most countries it is acceptable to take that risk on their shoulders because it is in their national interest.”
A randomized placebo-controlled trial in children showed that flu shots increased fivefold the risk of acute respiratory infections caused by a group of noninfluenza viruses, including coronaviruses. (Cowling et al, Clin Infect Dis 2012;54:1778) From Table 3, vaccine recipients had 20 noninfluenza virus-positive ARIs and 19 virus-negative ARIs; non-recipients had 3 noninfluenza virus-positive ARIs and 14 virus-negative ARIs. These figures yield an odds ratio of 4.91 (CI 1.04 to8.14).
Such an observation may seem counterintuitive, but it is possible that influenza vaccines alter our immune systems non-specifically to increase susceptibility to other infections; this has been observed with DTP and other vaccines. (Benn et al, Trends in Immunology, May 2013) There are other immune mechanisms that might also explain the observation.
Naturally acquired herd immunity to COVID-19 combined with earnest protection of the vulnerable elderly – especially nursing home and assisted living facility residents — is an eminently reasonable and practical alternative to the dubious panacea of mass compulsory vaccination against the virus.
This strategy was successfully implemented in Malmo, Sweden, which had few COVID-19 deaths by assiduously protecting its elder care homes, while “schools remained open, residents carried on drinking in bars and cafes, and the doors of hairdressers and gyms were open throughout.
The really concerning thing is that if all the deaths taking place during lockdown are put down as Covid-19 deaths, we are going to miss the fact that the lockdown policies have caused an increase in deaths from many other things. There has been a 50 per cent reduction in people turning up to A&E. It is clear that people just do not want to bother the doctors. And a number of these people will be dying. If we muddle the Covid-19 statistics in with the other statistics, we might think the lockdown has prevented a certain number of deaths, when it has actually caused a large number of deaths.
You hear this idea that all NHS staff have been working 20 times as hard as they have ever done. This is complete nonsense. An awful lot of people have been standing around wondering what the hell to do with themselves. A&E has never been so quiet.
The chances of children dying from COVID-19:
How many people aged 15 or under have died of Covid-19? Four. The chance of dying from a lightning strike is one in 700,000. The chance of dying of Covid-19 in that age group is one in 3.5million. And we locked them all down. Even among the 15- to 44-year-olds, the death rate is very low and the vast majority of deaths have been people who had significant underlying health conditions. We locked them down as well. We locked down the population that had virtually zero risk of getting any serious problems from the disease, and then spread it wildly among the highly vulnerable age group.
It is not clear that getting the virus actually makes you immune to it in the future, and it is not clear a vaccine would either.
Professor Matteo Bassetti said he is convinced the virus is ‘changing in severity’ and patients are now surviving infections that would have killed them before.
And if the virus’s weakening is true, Covid-19 could even disappear without a for a vaccine by becoming so weak it dies out on its own, he claimed.
Professor Bassetti suggests this could be because of a genetic mutation in the virus making it less lethal, because of improved treatments, or because people are not getting infected with such large doses because of social distancing.
But other scientists have hit back at the claims in the past and said there is no scientific evidence that the virus has changed at all.
At the start of June, in response to Professor Bassetti’s claim, Dr Angela Rasmussen, from Columbia University, tweeted: ‘There is no evidence that the virus is losing potency anywhere.’
On March 25, just a day after Britain shut down, economist Professor Philip Thomas, of Bristol University, made a grim prediction.
If the country remained in lockdown for longer than two months, he warned, any lives saved would be wiped out by those lost from the impact of the inevitable recession.
Britain hit that timeline more than a fortnight ago, but restrictions largely remain in place and there is growing alarm among economists that the cure has become far deadlier than the disease.
Prof Thomas now estimates that 150,000 people could die from Covid-19 over five years under the intermittent lockdown conditions necessary to keep infection rates, or the reproduction ‘R’ number, below one if a vaccine is not found.
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