Coronavirus - Part 6 (April 2021)

Coronavirus - Parts 1, 2, 3, 4 and 5 can be accessed here and here and here and here and here

Most news is ephemeral – vide the European Super League, the death of Prince Philip, or possibly the frostiest April for 50 years.  By contrast, one news story has remained steadfastly persistent for the last year and more – Coronavirus.  No other topic holds such significance.  We want more information, more facts and more analyses.  We also want to ask more questions – there are 44 of them in this article.  Read on!

The Covid-19 numbers
During April, the world passed yet another devastating milestone – 3 million deaths attributed to Covid-19.  Those are from a global total of 140 million cases.  As the World Health Organization (WHO) reported, this worldwide pandemic remains on a steep upward curve.  In mid-April, the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, warned that, ‘Around the world, cases and deaths are continuing to increase at worrying rates … globally, the number of new cases per week has nearly doubled over the past two months.’  This pandemic is far from over.

Whereas the global situation is dire, the UK continues with mostly good news, sort of.  During most of April, Covid-19 cases, hospital admissions and deaths continued to fall and vaccinations continued to rise.  Throughout the latter half of April, new case numbers remained at a low but stubborn 2,500 plateau.  That figure was 6,000 during March.  Moreover, at the end of April only 1,700 UK residents were hospitalised with 240 on ventilators – those figures were 5,000 and 600 respectively in March.  By late-April, daily deaths from Covid-19 stood at less than 30.

Vaccine news is also positive.  By the end of April, 34 million UK residents had received one dose – that is equivalent to 50% of the population, and is the second highest in the world, behind Israel’s 62%.  And another 13 million in the UK had had their second dose, so one in four (25%) UK adults are now fully vaccinated.  And from 30 April, all those over 40 have been able to book a jab.  This good news is tempered by the fact that 20 million UK adults still have not had even one dose of vaccine.

Even so, Oxford scientists have recently confirmed that the UK’s vaccination roll-out is showing promising signs of reducing Covid-19 transmission.  After following almost 400,000 vaccinated Britons during the first four months of the roll-out, they reported that a single dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccines prevented about 65% of all infections.  Moreover, Public Health England (PHE) reported that those given a single vaccine dose are up to 50% less likely to pass the virus on compared with unvaccinated people.

India – what has gone wrong?
For much of January, February and March, cases of Covid-19 across India were relatively low, at about 11,000 each day and with less than 100 daily deaths.  Indeed, the pandemic appeared to be under control, which, for a country of 1.3 billion people, was remarkable.  Then, boom!  A second wave hit.  From mid-April, new cases rose to about 250,000 a day and by late-April an unenviable world record figure of 350,000 had been reached with over 2,700 daily deaths.  Alas, these figures are widely considered to be underestimates.  Hospitals overflowed, the rich jumped the queues, poor patients were turned away, oxygen and drugs were in short supply and traded on the black market, deaths soared with bodies stacked up for mass funeral pyres and piecemeal lockdowns were hastily arranged.  And the worst is yet to come with a projected daily peak of 500,000 cases sometime in May.

What has gone wrong?  India’s prime minister, Narendra Modi, is partly to blame.  He relished attending huge election rallies, rejected lockdowns, supported massive religious festivals and allowed bathing in the Ganges and other super-spreading events.  In addition, India’s vaccination roll-out has been slow with only about 130 million doses administered, its health system is meagre, social distancing has been patchily observed in this densely-populated country, plus political incompetence and public complacency have all played their part.  Yet, Modi, regarded by some as a ‘vaccine guru’, has previously claimed that India has ‘defeated’ the virus.  But TV and other media reports tell a very different, frightening story.

In the midst of this disaster have come reports of a new double-variant mutation, the so-called Indian variant.  But it is not so simple.  This B.1.619 variant has two mutations called L452R and E484Q, which may allow the virus to escape Covid-19 antibodies.  The former mutation have been previously detected in variants from California and Denmark and the latter in the South African and Brazilian variants.  Inexplicably, it may be that the second E484Q mutation has disappeared in some cases.  Even so, there is convincing evidence that the Kent variant, B.1.1.7, is playing a significant role by increasing transmission of the disease.  And this Indian variant has arrived in the UK – towards the end of April, 132 cases had been confirmed, up from 73 in the previous week.  However, officials from Public Health England (PHE) insist that strict border control measures have it in hand.

Poor India.  More viral data are needed – the human figures across India are all too obvious.  There is an awful irony here – India is the largest vaccine manufacturer and exporter in the world, yet its own people are largely unvaccinated.

Has India been abandoned?  Initially, help from other countries has been sluggish – the ‘me first’ approach is apparently contagious.  It has recently improved.  The US originally turned a blind eye, but has now promised to supply components essential for vaccine manufacture.  And the UK has eventually shipped small quantities of ventilator equipment and drugs.  Even hostile countries, like Pakistan and China, are now helping out.

If this second wave’s predicted peak of 500,000 daily new cases is imminent, India has few alternatives but to battle on – help is already too late for many.  But at last, Narendra Modi has admitted that a ‘storm has shaken the nation.’  Hopefully India, and the rest of the world, will learn some tough lessons to prevent that terrifying third wave.

Blood clots and vaccines
The hallmarks of a good vaccine are high levels of efficacy and safety.  Comparing the efficacy of different vaccines is a complex task because such studies are typically conducted by each manufacturer and therefore comparisons are confounded by various factors, such as different patient ages, number of doses, dosage intervals, times of post-vaccination assessment, and so on.

If measuring vaccine efficacy is complex, then determining and comparing vaccine safety is an even more complex undertaking.  Most adverse safety issues will have been identified and assessed in the phase 1, 2 and 3 clinical trials.  So researchers are now hunting for what are inevitably rare conditions, ‘adverse events’.  And if identified, it is fiendishly difficult to establish whether an apparent link between such an event and the vaccine is merely a statistical association or a causative feature.  In mid-March, the Oxford-AstraZeneca vaccine was suspected of harbouring such a safety flaw, following reports that some people had developed blood-clotting disorders, known as thrombosis with thrombocytopenia syndrome (TTS), after receiving the jab.  Hence the question – were the clots caused by the vaccine or, only statistically connected?

As a result, several European countries paused distribution of the Oxford-AstraZeneca vaccine.  The evidence was based on results from around 20 million vaccinated people in the UK and the EU, 25 of whom had experienced serious blood clots with lowered platelet counts, resulting in 9 deaths.  However, after reviewing the cases, the European Medicines Agency (EMA) could not state categorically that the adverse reports were linked causally to the Oxford-AstraZeneca vaccine.  Instead, the EMA concluded, along with health regulators worldwide, that the benefits of the vaccine in fighting the dangers of severe Covid-19 far outweighed any risks of blood clotting in the brain.

Though initially this blood-clotting alarm centred on the Oxford-AstraZeneca vaccine, it was quickly followed by doubts about the Janssen vaccine produced by Johnson & Johnson.  Both vaccines rely on adenoviruses to carry the DNA for encoding the characteristic spike protein into human cells.  Is this common feature significant?  Are mRNA vaccines, like the Pfizer-BioNTech and Moderna, safer?  Such questions are, as yet, unanswerable.  But again several countries, including those of the EU and South Africa, paused their roll-out use, though they later resumed distribution of both vaccines, but restricted them to younger age groups, those under 60, on the basis of the precautionary principle.

On 13 April, Johnson & Johnson issued a statement which included, ‘We are aware of an extremely rare disorder involving people with blood clots in combination with low platelets in a small number of individuals who have received our COVID-19 vaccine.  The United States Centers for Disease Control (CDC) and Food and Drug Administration (FDA) are reviewing data involving six reported U.S. cases out of more than 6.8 million doses administered.  Out of an abundance of caution, the CDC and FDA have recommended a pause in the use of our vaccine.  In addition, we have been reviewing these cases with European health authorities.  We have made the decision to proactively delay the rollout of our vaccine in Europe.’

On 23 April, US regulators lifted the pause they had announced 10 days earlier.  They recommended that healthcare providers resume using the Janssen vaccine after concluding the benefits outweighed the risks of serious blood-clotting issues.  However, doctors have now been warned about the potential problems, especially with women aged under 50, since of the original 6 cases, all were under 60 and it was mostly women who became seriously ill, with one fatality, within days of receiving the vaccine.

Moreover, a US study, published in mid-April, reckoned that the risk of naturally-occurring severe blood clots in the brain of Covid-19 sufferers is about eight times greater than the risk associated with taking the Oxford-AstraZeneca vaccine.  Using a database of half a million Covid-19 cases in the US, the researchers found that about 40 in a million people suffered blood clots in the brain two weeks after a Covid-19 infection.  Of those, about one in five were fatal.  Regulators believe that the Oxford-AstraZeneca vaccine is linked to a four to five in a million risk of similar clots.

The practical implications of such statistics are often hard to grasp.  The BBC has helpfully devised a neat analogy based on figures from the UK’s Medicines and Healthcare products Regulatory Agency (MHRA).  It goes like this, ‘If 10 million imaginary people were given the Oxford-AstraZeneca vaccine you might expect to see 40 of these clots – with about 10 clots having fatal consequences.  Ten deaths out of 10 million people vaccinated is a one-in-a-million chance.  That's roughly the same risk as being murdered in the next month or – if you get in a car and drive for 250 miles – the risk of you dying in a road accident on that journey.’  Does that give some perspective and comfort?

A mix and match trial

A major so-called Com-COV2 vaccine trial, led by the Oxford Vaccine Group’s Matthew Snape, is about to start studying the use of different combinations of approved Covid-19 vaccines for the first and second doses.  At the moment, the vaccines used in this trial are the Oxford-AstraZeneca, Pfizer-BioNTech, Moderna and Novavax.

The study’s purpose is to see how well people’s immune systems respond when they are primed with one type of vaccine, then boosted with another, and to see how good the response is when the second dose is separated from the first dose by different periods of time.  Another aspect of the study will be looking at how common adverse reactions, such as fever and fatigue, are after such ‘mixed’ schedules.

This type of information is important, because being able to combine different vaccines would create more flexible vaccination programmes, potentially allowing more people to be immunised more quickly.

Fancy volunteering?  The team is currently recruiting 1,050 participants at multiple locations across the UK.  In order to be enrolled in the study you must be aged 50 and over and able to provide documentation that you had your first dose of Covid-19 vaccine, either the Oxford-AstraZeneca or the Pfizer-BioNTech, through the national immunisation programme between 25 January 2021 and 20 March 2021.  In addition, you must be willing to tell the trial staff about your medical history, and you may be asked to allow the trial staff to check this with your general practitioner (GP).  If you are able to become pregnant you must be willing to practise continuous effective contraception during the study and have negative pregnancy tests on the days of vaccination.  And you must agree not to donate blood during the study.

Interested?  Do you fit the bill?  Then why not do your bit for medical science and global health?  Hurry, because 800 people have already signed up.  You can learn more about the trial at https://comcovstudy.org.uk/about-com-cov2

Another new vaccine – Valneva

‘What’s in a name?’ asked Juliet.  Stories of adverse effects with named vaccines, whether true or false, can have an adverse effect on their uptake.  The blood-clotting sagas of the Janssen vaccine with its 10-day pause in the USA and of the Oxford-AstraZeneca in the UK and elsewhere, as well as questionable efficacies against variants has demonstrably increased vaccine hesitancy towards these two vaccines, albeit probably temporarily.  Is it a case of ‘give a vaccine a bad name’?  Then maybe it is a good strategy simply to move on and employ novel vaccines with no adverse backstories.

Is that part of the UK government’s strategic thinking?  Recently it has ordered 100 million doses of a novel vaccine produced by the French pharmaceutical company Valneva, which has only just, in late April, entered its phase 3 trials in the UK and therefore yet to be approved.  The trial’s plan is to vaccinate approximately 4,000 participants with two doses of either the Valneva or the Oxford-AstraZeneca vaccine and directly compare their immune responses.  The trial is appropriately named ‘Cov-Compare’.  The Valneva vaccine – technically known as VLA2001 – is the only Covid-19 vaccine in the West that relies on the more traditional vaccine technology involving an inactivated virus, like several of the current Chinese Covid-19 vaccines.  It is hoped that Valneva will produce a more robust immune response than others and eventually be effective against numerous variants.

Compulsory vaccinations?
Want to start a heated discussion?  Then try chit-chatting about compulsory vaccinations.  In mid-April, the UK government announced plans that staff in care homes in England would be required to have Covid-19 vaccinations.  Such mandatory jabs could be introduced by the summer.  The concern is that too few staff are being vaccinated to stop the spread of the virus to their vulnerable residents.  Nationally, just under 80% of care home staff have been vaccinated, four months after they were first offered jabs.  Government advisors say that 80% of staff and 90% of residents would need to be vaccinated to protect against Covid-19.  So far, only 53% of care homes in England have met this threshold.

The plan would also require care home providers to hire only vaccinated workers in the future.  Care home bosses and trade unions are divided by the proposals.  Questions arise.  Is there a difference between compulsory and mandatory?  Would this ‘heavy-handed’ approach backfire leading to additional troubles in recruiting staff leading to the provision of a poorer quality of care?  What is the extent of the sector’s duty of care?  Is persuasion better than legislation?  Will the proposals be extended to NHS workers?  If not, why not?  Will it be, no jab, no job?  Already the Royal College of General Practitioners (RCGP) has rejected the idea of mandatory Covid-19 vaccinations for GPs and practice teams warning that it could lead to 'resentment and mistrust'.  A five-week government consultation entitled, ‘Making vaccination a condition of deployment in older adult care homes’ has already been launched.  The findings, and subsequent actions, will not be simple.  Will they be a prelude to broader Covid-19 legislation and restrictions?

What's happened to herd immunity?
In the early days of the Covid-19 pandemic, one of the ways out was considered to be by herd immunity.  That is, if enough people got vaccinated, generated sufficient antibodies and thereby gained resistance to the virus, its transmission would be blocked and society could return to normal.  This was popularised as the strategy of ‘let the disease just go’, encouraged by some specialists, notably from the USA.  That concept has since fallen out of general favour.

The so-called ‘herd immunity threshold’ was reckoned to be between 60 and 70% of a population.  In other words, two-thirds of people would have to exhibit immunity either from vaccination or past exposure to Covid-19.  However, this is beginning to look like an unlikely prospect.  Why?  For several reasons, including vaccine hesitancy, the emergence of new variants, a lack of vaccine supplies and waning immunity.  This means the pandemic will probably develop into more localised epidemics, much like that of influenza.

One of the foundations of the concept of herd immunity is that an infected person is isolated from susceptible others so breaking the chain of transmission.  Current vaccines are good at preventing symptomatic Covid-19, but it is generally unclear to what extent they protect people from catching the disease, or from spreading the virus to others.  If vaccines cannot block transmission, then herd immunity will only be obtained by vaccinating everyone.

Another reason for herd immunity failure is that the vaccine roll-out has been uneven and uncoordinated worldwide.  While in theory, a global mass strategy could have controlled, even wiped out, the virus, this was never going to happen.  Starting in December 2020, Israel was first and fast out of the blocks – and by mid-March had vaccinated at least 50% of its adult population with the required two doses of the Pfizer-BioNTech vaccine.  By contrast, Israel’s neighbours, such as Egypt, Lebanon and Jordan have yet to vaccinate even 1% of their citizens.  In addition, while countries are targeting the elderly, there remains the problem of vaccinating children.  Pfizer-BioNTech, Moderna and Oxford-AstraZeneca have now started clinical trials with teens and children as young as three, but the results are months away.

Geography also plays a part.  Covid-19 typically occurs in localised clusters.  Some of this depends upon community vaccination policies and community hesitancy.  As resistance to the measles vaccination has demonstrated, pockets of disease resurgence do occur.  On the larger scale, if surrounding countries have low vaccination rates and populations are allowed to mix, new outbreaks are more likely.

New variants pose a continuing threat.  Will they be more transmissible and more resistant to current vaccines?  The longer they are allowed to spread, the more time these and other variants will have to emerge and scatter.  The case of the city of Manaus in Brazil provides a cautionary tale.  Apparently Covid-19 cases in that city slowed down last year, perhaps due to herd immunity because at least 60% of the population had been infected.  But in January 2021, a huge surge of cases occurred after the emergence of the new P.1 variant.  In other words, previous Covid-19 infections did not grant protection – in fact, all the new cases were caused by P.1.  It seems that even high levels of immunity cannot protect against Covid-19 variant resurgence.  In fact, high levels of immunity can create an environment favourable to new variant production, even of a type capable of infecting vaccinated people.

It is clear that immunity comes from either vaccines or infection.  But the big question is, how long does it last?  Knowledge of other coronaviruses – and other disease vaccines – suggests that immunity wanes with time.  As yet, there are insufficient data to make a realistic assessment of Covid-19 vaccines.  If vaccine-based immunity is ephemeral, say only months, then booster doses of vaccines may become essential over time, as with influenza.

Finally, changes in human behaviour need to be factored in.  For instance, if Israel is close to a ‘herd immunity threshold’, lockdowns are likely to be eased, social distancing and mask wearing become more relaxed, more people interact with one another, more people are exposed to the virus.  The outcome will be bad.  By contrast, as a positive spin-off of such behavioural changes, the recent flu season has been unusually mild.  Why?  Probably because of the widespread use of non-pharmaceutical interventions, like distancing and mask wearing.  But as the lockdown rules ease it will be difficult to stop people reverting to pre-pandemic behaviours.  Whereas neither vaccination alone nor herd immunity will make Covid-19 disappear, the combination of vaccines plus behavioural changes are likely to make its dominance diminish.

And what about the future?
We all know about Monday 21 June, the first day of summer, but more especially ‘freedom day’, when all Covid-19 restrictions are planned to be lifted across the UK.  Many, including the government, consider that social distancing, mask wearing and so on should continue cautiously, perhaps into 2022.  Yet in April, a group of senor scientists, many of whom have consistently opposed lockdown measures, wrote an open letter, published in The Mail on Sunday (25 April), calling for all restrictions, including, ‘Mandatory face coverings, physical distancing and mass community testing should cease no later than 21 June along with other controls and impositions.’  And they declared, ‘It is more than time for citizens to take back control of their own lives.’  Is this foolhardy and overhasty?  Are they not concerned about the possibility/probability of new variants and/or a Covid-19 resurgence while the disease runs wild worldwide?

Bill Gates, the man largely responsible for the benefits (and otherwise!) of Windows computing, has predicted the world will be back to normal by the end of 2022.  In an interview on Sky News, he explained that his optimistic forecast was based on the success of vaccination programmes in the US and UK freeing up supplies, ‘… so that we’re getting vaccines out to the entire world in late 2021 and through 2022.’  Really?  That fast?

Some adverse effects of Covid-19 will take even longer to repair.  For example, the pandemic has disrupted programmes of prevention and treatment for a host of other diseases.  As countries went into lockdown last year, mass vaccination campaigns for measles, polio, meningitis and other diseases ground to a halt.  Millions of children have been left at increased risk of contracting these deadly diseases.  Health facilities have closed as health-care workers were redeployed to fight the pandemic.  Shipments of medicines and medical devices have been delayed and fewer people have sought treatment at clinics for fear of catching Covid-19.  In other words, our current battle against Covid-19 has caused serious long-tern losses in the war against polio and other preventable diseases.  Such stalled preventative medicine will surely require catch-up time way beyond 2022.

The elderly and the vulnerable in the UK are likely to be offered a third Covid-19 vaccine dose this autumn along with their seasonal flu jab.  The UK government is about to finalise the purchase of 40 million, plus an extra 60 million, doses of the Pfizer-BioNTech vaccine.  It is believed that these extra doses will be used for the vaccination of people in their twenties, who will be advised not to take the Oxford-AstraZeneca vaccine because of its possible link to blood clots.  There are reports that the Joint Committee on Vaccination and Immunisation (JCVI), which advises on the strategy for the UK, is still deciding whether or not to recommend use of the Oxford-AstraZeneca vaccine for people in their thirties.  So, will the excess stock of Oxford-AstraZeneca vaccine be used as the winter booster jab for the elderly, or will we be offered a new, reconfigured anti-variant vaccine?  Time will tell.

The origin of Covid-19
Just a gentle reminder, strictly speaking, SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) is the name of the virus and Covid-19 is the disease caused by that virus.

We now know many of the negative features of the coronavirus SARS-CoV-2, including its devastation of human health and its global reach – it is truly a disease without borders.  But where did it all start?  It is a question with, so far, no satisfactory answers.

In mid-January 2021, the World Health Organization (WHO) sent a team of experts on a month-long fact-finding mission to Wuhan, China to investigate the origins of the Covid-19 pandemic.  Its Report, long overdue because of political and scientific difficulties, was published on 31 March.  The USA, UK and 12 other countries responded by implicitly accusing China of ‘withholding access to complete, original data and samples.’  Nevertheless, the Report concluded that the virus probably originated in bats and was passed to humans through an intermediate animal.  But fundamental questions remain about when, where and how SARS-CoV-2 first infected people.  In order to trace the origin of the virus the team sought to track down the earliest human cases.  It determined that the first person known to have Covid-19 was an office worker in Wuhan, who began showing symptoms on 8 December 2019.  But it was reckoned that the virus had been spreading in that city of 11 million people before then, because it was well-established by later that month.

Yet evidence for such an earlier spread is vague.  Chinese researchers had previously examined patient reports from hospitals in Wuhan written between October and December 2019, and identified fewer than 100 people who had symptoms of Covid-19.  They then tested the blood of 67 of those people for antibodies generated by past infection with SARS-CoV-2, but, contrary to expectation, found none.  This suggests that a cluster of Covid-19 infections did not exist before December 2019.  But were all the records examined meticulously so that all Covid-19 cases were identified?  Stored blood samples from across China should also have been examined to show if the virus was spreading in the general population before December 2019.

There is evidence that examination, albeit not sufficiently precise, of blood-bank samples from southern China had tested positive for antibodies against SARS-CoV-2.  This is the region where close relatives of the SARS-CoV-2 virus have been previously found in bats and pangolins.

To complicate the search, scientists in Europe had reported finding antibodies against SARS-CoV-2 in samples taken at European blood banks from November 2019 onwards.  Does that suggest Europe as the origin?  Not necessarily, because Wuhan is a well-connected city, so it could still be the seat of the virus with travellers spreading it to Europe and elsewhere.

It is commonly thought that the markets in Wuhan played a key role in the origin and spread of the virus.  Maybe it was here that the intermediate animal that passed the virus from bats to people was located, though it has not been identified.  Nevertheless, researchers think it might have been a wild species of some sort that are typically sold live as human food in such ‘wet markets’.  Early in the pandemic, investigators proposed that the Huanan Seafood Market in Wuhan was the culprit, because it sold fresh and frozen animals and many of the earliest infections were in people who had visited there.  But other early cases were not associated with this market.  Viral material was identified in drains and sewage at the market, but none was found on any animal carcasses.  Yet, how did the virus get into the market?  And was it via an animal?

The WHO team identified ten stalls selling wildlife, either wild or farmed, that could have brought the virus from farms in southern China.  Some wild animals, such as rabbits and ferret-badgers, are susceptible to SARS-CoV-2 or related viruses.  These farms and their workers needed to be inspected.  And what other animals were sold in other Wuhan markets?

The WHO team concluded that the virus probably jumped from live animals to people, or maybe from infected frozen wild animals, again from farms in southern China.  On the other hand, the route could have been from infected people, who handled wild animals.

One of the key unknowns is which animal was the intermediary that passed the virus to people?  First, of course evidence is needed to prove that the virus can exist in that particular animal species.  During 2019 and 2020, researchers in China tested some 30,000 wild, farmed and domestic animals, but found no evidence of active or past SARS-CoV-2 infections, except in a few Wuhan cats during March 2020.  Again, the WHO team questioned the thoroughness and scope of this testing.

So what is the outcome of this visit by the WHO investigative team?  Sadly, not much.  It has raised lots of questions, but provided few answers.  What next?  There may not be a ‘next’.  The passage of time will have diminished memories, degraded or destroyed many samples, changed patterns of trade and sales outlets – the centre of Wuhan will have been irrevocably altered and cannot ever be recaptured.  Just as crime scenes need immediate investigation, so do scenes of biological mystery.  We will now probably never definitively know the origin of the SARS-CoV-2 virus.  All we are left with is little more than a handful of speculations.

Antivirals Taskforce
At the end of April, the UK government launched an Antivirals Taskforce.  Its primary remit is to identify treatments to be used at home by people who have tested positive for SARS-CoV-2 infection, or who have had contact with a confirmed case, to stop the virus spreading and to speed up their recovery time.

The aim is to find at least two effective treatments this year, in either a tablet or capsule form.  Such putative drugs will go through clinical trials and could be rolled out as early as this autumn.  The hope is that these novel treatments will prevent future waves of infection and limit the effect of new viral variants, especially during the coming winter.

The government’s chief scientific adviser, Patrick Vallance, said, ‘Antivirals in tablet form are another key tool for the response.  They could help protect those not protected by or ineligible for vaccines.  They could also be another layer of defence in the face of new variants of concern.  The Taskforce will help ensure the most promising antivirals are available for deployment as quickly as possible.’

There are already dozens of antiviral drugs (most with near-impossible names) used for other diseases that could be repurposed for treating Covid-19 patients.  For example, there are oseltamivir and baloxivir currently used for treating influenza, dexamethasone as a general anti-inflammatory steroid and also sarilumab and tocilizumab as monoclonal antibody medicines for rheumatoid arthritis.  It is somewhat odd to see tocilizumab listed as a potential Covid-19 treatment since a recent report in the New England Journal of Medicine (2021, 384: 1503-16) by Rosas et al., concluded that, ‘… the use of tocilizumab did not result in significantly better clinical status or lower mortality than placebo at 28 days.’  In addition, there are new drugs, such as molnupiravir, a protease inhibitor.  And there are already approved drugs, such as casirivimab and imdevimab to be administered together for the treatment of mild to moderate Covid-19 in adults.  Those pharmacy shelves look ripe for harvesting.

Overcoming vaccine hesitancy
Vaccine hesitancy is still a global problem.  How to convey the seriousness of Covid-19 and the benefits of vaccination?  The UK has taken the coercive route with TV propaganda adverts and heart-to-heart pleadings from ‘celebrities’.

Boston, Massachusetts has taken the reward approach.  Several businesses there are now offering freebies to the vaccinated.  For example, you can get a free 2-hour bike hire from the Bluebikes company, or a free beer from Budweiser, or a free glazed donut from Krispy Kreme, or a free ride to and from a vaccination site with Lyft, the second largest ride-sharing company in the US.  Or presumably all four at once.  Just flash your vaccination certificate.

This is called ‘incentivization’ and I’m all for it.  That notwithstanding, I didn’t even get a sticker after either of my two jabs.  But I did get free protection from Covid-19.

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