2007 - 2021

Covid-19 at Christmas; No Comfort and Little Joy

The Armistice that ended the first World War was signed at 5.10am on 11th November 1918, the subsequent ceasefire effective from 11am that morning. In the five or so hours between the signing and the ceasefire 2738 men were killed in fighting, their graves a monument to futility.

I am reminded of this lately whenever I hear people talk of a “near normal Christmas” at the very time when we await the start of the Covid-19 vaccination programme in the new year.

Disclosure: I am, I’m afraid, one of the new breed of armchair epidemiologists. Untrained, unqualified and wholly unreliable, what follows carries no professional authority whatsoever.

Christmas in our house is a performance in two parts; On Christmas Eve my side of the family come to ours for supper; my Dad, my brother and sisters and their families, together with our own brood and our granddaughter. Twenty-odd folk across four generations, us adults co-opting the excitement of the kids while they chatter about Santa Claus, clatter about the house and spill Cumberland sauce on the carpet.

Christmas Day and it’s the turn of my wife’s side of the family. Gathered for dinner at my sister-in-law’s, her boys home for the week with their partners, her partner’s family joining us, all of us suffering the taxi anxiety of my mithering mother-in-law, bless.

We’ve got school pupils and a teacher, health care professionals and a cancer patient, university students and a retired lecturer, and two octogenarians. In all, there are 33 people comprising 16 households from 6 areas of the UK jammed in to two houses over 24 hours in Glasgow.

I know this because I figured it all out and, in classic armchair epidemiologist style, turned it into a Venn diagram of interlinked households complete with virus transmission routes and risks. Having seen the picture for themselves my family think I’m nuts, and to be fair I share their concerns, but there you have it. There’s a shed-load of us.

Each week the ONS publishes the results from its Covid-19 infection survey, a representative sample of over 100,000 people tested each week to track the prevalence of the virus in the community. The most recent report estimates that more than 1% of the UK population has been infected with Covid-19 in the past week, with considerably higher prevalence amongst school kids and young adults. On this basis, were we to have Christmas tomorrow I reckon there’s about a 2/1 chance that at least one of our family group would be infectious.

We know that Covid-19 spreads by social interaction and that it spreads more readily with close contact. And we know that it spreads more easily in crowded indoor spaces, and more easily again over an extended period of time. A multi-generational Christmas dinner with a dozen or more people sat cheek by jowl for most of the day represents an utter feast for the virus. With two elders in their 80s and others with vulnerabilities, it’s not going to happen, is it?

In this light, and with three vaccines awaiting final approval, I’ve decided that this Christmas my singular job is to make sure that my Dad lives long enough to get vaccinated.

That means I will continue not to see him indoors, and consequently he won’t spend time with us at Christmas this year. We’ll pop round to his place if the weather’s kind and chat in the garden as long as the cold allows, failing which it’ll be Zoom and the digital Christmas promised by Jason Leitch.

All of which is all very well and good, but it rather ignores everyone else’s point of view.

For me it’s a skoosh; I get to spend Christmas with my wife and our children while our wee granddaughter sprinkles the magics round the house. My father though needs to choose between three of his children, and between one set of grandchildren or another. My sisters are pitted one against the other, my brother hopelessly out-gunned, the grandchildren are collateral damage. On the other side of the family things are no happier.

These are the dilemmas being faced by families up and down the country. With government guidance permitting 3 households to mix at Christmas, parents have to choose between their children, partners between their own family or their in-laws, elders between loneliness or infection risk. It’s horrid. There’s little comfort and joy in any of this. The human reaction is to make a little allowance for ourselves, bend the rules. It’s Christmas after all. Spread a little happiness.

However, the problems don’t end there. Although the government is permitting up to three households to mix, that doesn’t mean we ought to. The consequence of people moving across the UK and of increased social contact is an inevitable increase in infections. Around 25% of infected people have no symptoms of illness and are unaware that they’re infectious at all. Most others are infectious two or three days before symptoms emerge, oblivious to the risk they pose to close contacts meantime.

While ONS estimates a little more than 1% of people are currently infected, the prevalence of infection differs markedly across different areas of the country and between different groups. One consequence of permitting travel during the Christmas period is that infection rates will level up, areas with low rates receiving inbound infections from areas of higher prevalence.

In Scotland during the past week the rate of prevalence of infection is around 120 new cases per 100,000, but this hides significant differences regionally. On the mainland, the lowest rates of infection prevalence are in Dumfriesshire and in the Highlands, with fewer than 25 cases per 100,000 people reported in the last week. This compares with a rate of around 200 in Glasgow and Lanarkshire.

Across the UK the situation is worse. The rate in some areas of the Midlands is in excess of 400 cases per 100,000, with some towns on the east coast and in Kent reporting a rate of more than 600 recently. As people move from areas of higher prevalence to areas of lower prevalence to spend Christmas with family and friends, so the virus will move with them. More interaction means more infection, more infection means more illness, and more illness means more death. Such is the inescapable logic of Coronavirus.

I recall something said in the summer by Devi Sridhar, professor of Global Public Health at Edinburgh University, and an advisor to Scottish Government and SAGE. Following the release of the long springtime Lockdown, the reopening of the economy and the restart of international travel she predicted: “We will pay for our summer vacations with winter lockdowns”. It wasn’t a popular opinion at the time but sure enough, here we are in November with most of the UK living under the most severe restrictions.

What’s less acknowledged is where the virus came from this time around. Last month the Nextstrain project – a European collaborative research team tracking the spread of the virus – reported that around 80% of new infections in the UK during September and October were of a specific strain of the virus that originated in Spain in June. The inference drawn is that the current wave of the virus in the UK was seeded by holidaymakers returning home from Spain in the summer. And of course, in August we were all encouraged to eat out to help out. That helped out the virus no end.

Armed with this knowledge, and given current infection prevalence in the country, we can easily understand the risk of permitting mass travel across the UK at Christmas. We paid for summer holidays with winter lockdown, and it seems likely that we will pay for Christmas with a third wave in the New Year. Virtually every public health professional, epidemiologist and government advisor says the same.

This is particularly frustrating given the progress made in Scotland in recent weeks. The restrictions introduced in October with the start of the school holidays served to apply the brakes to an accelerating infection rate. Prevalence peaked towards the end of October and since then it has been steadily reducing, falling by more than 25% in the past fortnight. Indeed prevalence in Lanarkshire has halved this month. With the additional Tier 4 measures introduced in the central belt last week, we can expect the infection rate to fall further and faster next week and the following.

Moreover, the Scottish Government is considering extending the schools’ Christmas holidays to four weeks, and given what we saw following the week-long October break, we can expect a significant and positive impact on infections.

Recent experience in Scotland has shown that the sum of the changes we’ve made to our behaviour, together with the blend of tier 2 and tier 3 measures and the impact of contact tracing is effective in containing the virus. We can be confident that if we succeed in getting the infection rate to a low level, we can maintain it at a low level while the vaccination programme rolls out.

We’ve signed the armistice, we just need to sit tight and wait for the ceasefire.

In the meantime, thank goodness we don’t have a social tradition at Hogmanay.

Comments (30)

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  1. Michael says:

    Hi, do you accept that the thrust of the above is summarized in your following paragraph and can be paraphrased as something like: don’t be a dick, do you bit? – “…with three vaccines awaiting final approval, I’ve decided that this Christmas my singular job is to make sure that my Dad lives long enough to get vaccinated.”

    As reported in the BMJ, are you aware that: “… None of the trials currently under way are designed to detect a reduction in any serious outcome such as hospital admissions, use of intensive care, or deaths. Nor are the vaccines being studied to determine whether they can interrupt transmission of the virus.” – https://www.bmj.com/content/371/bmj.m4037

    1. Anndrais mac Chaluim says:

      That’s right. The purpose of vaccines, including flu vaccines, isn’t to stop old people from dying; it’s to facilitate ‘herd immunity’ and manage the spread of viruses through the population while they’re active so that it doesn’t become an epidemic. Old people die; that’s what they do.

      That vaccines aren’t ‘cures’ is hardly controversial or, indeed, news.

      1. Michael says:

        How does a vaccine “facilitate ‘herd immunity’” if it doesn’t reduce serious outcomes such as hospital admissions, use of intensive care and deaths or interrupt transmission of the virus?

        1. Anndrais mac Chaluim says:

          It enhances the herd’s resilience to the effects of the virus, basically by creating a barrier between the virus and its hosts for as long as the virus is active, thereby reducing the incidence of disease in those infected. Over time, the virus eventually disappears from the population altogether as a result of natural selection. Again basically, vaccines work by giving evolution a helping hand.

          1. Anndrais mac Chaluim says:

            I take your point though: that’s how it would work, but will it?

            I guess we’ll see, won’t we?

          2. Michael says:

            “I guess we’ll see…” does not reassure me that I should give your views and opinions on this issue any weight.

            I was – and I believe many sensible people on these islands stil are – l living under impression that trails and testing before mass rollout are carried out exactly so we don’t have to just “guess we’ll see”!

            Did you read the BMJ piece?

          3. Anndrais mac Chaluim says:

            Yes, I did. The authors have doubts over whether the vaccines will in fact work. I’m just saying that the proof of the pudding will be in the eating.

            And for heaven’s sake don’t weight my opinions. I’m just thinking out loud. Like Kierkegaard, I speak without authority.

          4. Michael says:

            “I take your point though:”. No, you have completely missed my point, which is that most of us would reasonably expect vaccines to be tested for efficacy regrading the outcomes mentioned above. But that is not happening with the current candidates. Isn’t that new news to most people and worth knowing and reporting?

            Isn’t the point of trials not to have to just hope and pray?

            I can’t really believe that we’ve got to the point that posting something factual and clear to understand results in the kind of nonsense comments you’ve posted above..

            If you’ve read the article, and understood its content, please tell me what you are taking issues with and why you responded as you did to my posting it?

            I thought Bella was interested in empowering it’s readers with facts and fact based analysis. But recently it seems Bella is much more interested in promoting pre-determined agendas using fact-less hyperbole and emotional manipulation.

          5. “I thought Bella was interested in empowering it’s readers with facts and fact based analysis. But recently it seems Bella is much more interested in promoting pre-determined agendas using fact-less hyperbole and emotional manipulation.”
            What’s the basis for this claim?

          6. Michael says:

            Thank you Mike – this is an entirely appropriate response from you.

            Let me say first, that I really do respect and value what you have done and continue to do with Bella. And I do believe you are very sincere and well intention in your witting. I’m also sorry if at anytime my comments are too harsh.

            I do get frustrated that often there are unquestioned assumptions that underpin you writing and the writing of others who are published here, as well as an indulgence in trying evoking emotional reactions, over putting forward evidence based arguments. I, and others, have often been ridiculed, shamed and insulted here for pointing this out. I am not going to go back over Bella articles to evidence this claim now. But I will point it out in the future for you to ignore or respond to as you wish. Suffice to say, that even the article above assumes a bunch of unproven positions as facts.

            For example, the writer states that: “Each week the ONS publishes the results from its Covid-19 infection survey, a representative sample of over 100,000 people tested each week … The most recent report estimates that more than 1% of the UK population has been infected with Covid-19 in the past week” and then goes on to make a bunch of points and arguments based on this “fact”, without acknowledgement that this test data is highly questionable.

            We know from a recent a court case and expert statements that the main test used – the PCR test – is highly inaccurate, to the point of being dangerously misleading. The ONS Coronavirus (COVID-19) Infection Survey, UK: 26 November 2020, says: “We use current COVID-19 infections to mean testing positive for SARS-CoV-2, with or without having symptoms, on a swab taken from the nose and throat.” And we learn from the Survey’s “Method” page that: “We take swabs to detect microbes of the infection caused by the coronavirus (COVID-19) so we can measure the number of people who are infected. To do this, laboratories use real-time reverse transcriptase polymerase chain reaction (RT-PCR) … the RT-PCR technique provides no information about prior exposure or immunity. To address this, we also collect blood samples to test for antibodies ” And goes on to say however, that: “We do not take blood from anyone in a household where someone has symptoms compatible with COVID -19 infection, or is currently self-isolating or shielding, to make sure that study staff always stay at least two metres away from them.” From this is seems reasonable clear that the PCR test is the primary test from which the Survey data is based.

            However, a recent court case in Prtugal provided a “verdict that condemns the widely-used PCR test as being up to 97-percent unreliable.” And former Chief Scientific Advisor with Pfizer, Dr Michael Yeadon, has explaining his concerns with the PCR test and the dangers of false positive results feeding into shape inappropriate policy responses to the current situation. I could cite further credible examples of those expressing concerns about the use of the PCR test.

            Of course this would not matter if the issues where not so important. But tens of thousands of peoples lives are being put at risk from not using medical services as they would under normal circumstances, mental health deterioration, lose of livelihoods etc. In fact, we are seeing the reshaping of our economy and society in favour of huge, centralised, tech adapted, global corporations and big government partners. This is all highly concerning.

            If Bella is to continue to have value, for me at least, then I would like to contribute to trying to keep some sanity here and help provide an evidence based playing field here, if nowhere else. I see a lot of faith based assumptions being parroted on these pages and people being ridiculed or shamed for question them. I think this is wrong.

            Thanks Mike for the opportunity to have my say.

            (NOTE: I would provide links but, understandably, the Bella site is set up to filter out for moderation comments with more than one link included)

          7. Anndrais mac Chaluim says:

            ‘…most of us would reasonably expect vaccines to be tested for efficacy…’

            Why do you think they’ve not? My experience is that armies of scientists all over the world (many of whom have been conscripted away from other work) have been working tirelessly to develop and test vaccines, and we’re now beginning to see the fruits of their gargantuan efforts. Are you suggesting that these vaccines should not be rolled out because they’re untrustworthy? Is the global scientific community, with the exception of a few honourable dissidents, really a worldwide conspiracy of snake-oil merchants?

            Sure, the testing might (and I say ‘might’) not have been as extensive and rigorous as it might have been in normal circumstances, but these are not normal circumstances.

            Like I say: if they work, they work; if not, then… back to the drawing board. That’s REAL science: when push comes to shove, it’s trial-and-error rather than belt-and-braces stuff.

          8. Michael says:

            “Is the global scientific community, with the exception of a few honourable dissidents, really a worldwide conspiracy of snake-oil merchants?” ~ said without irony. I love it 🙂

            “Like I say: if they work, they work; if not, then… back to the drawing board. That’s REAL science: when push comes to shove, it’s trial-and-error rather than belt-and-braces stuff.” ~ No, that’s gambling at other peoples expense.

            Are you saying that it is reasonable to rollout a new treatment that has not been tested for whether it provides “any reduction in any serious outcome such as hospital admissions, use of intensive care, or deaths. Nor … to determine whether [it] can interrupt transmission of the virus.” ?

            The following is the most sensible thing you’ve said on this issue so far: “And for heaven’s sake don’t weight my opinions. I’m just thinking out loud. Like Kierkegaard, I speak without authority.”

            Which is it: are you educating me about how REAL science is done, or; should I put no weight in your opinions?

          9. Michael says:

            “Why do you think they’ve not? ” ~ because the BMJ explicitly says that this is the case. I’m losing the will to live here. You accept this and them proceed as if this is still disputed. Have you got other evidence? Please explain what you think these vaccines have been tested for?

          10. Anndrais mac Chaluim says:

            It’s not unreasonable to roll it out, given the work that’s been done and the circumstances that obtain.

            I get most of my information from Oxford University’s COVID-19 vaccine web hub. The scale and extent of the research, development, and testing work being carried out by and on behalf of the Oxford scientists worldwide is breathtaking and certainly unprecedented. You’ll find an almost daily progress report on the Oxford testing programmes there.

          11. Michael says:

            Thanks – I will take a look. Are you seeing compelling evidence for its efficacy that you could share?

            Just because a lot of work has been done does not necessarily mean anything – Edison/light bulbs etc. Neither does the circumstance mean much. We’re really not seeing many more deaths from respiratory causes than usual. There is no argument to just rollout whatever you have got because we’re all going to die tomorrow. It just simply is not the case. It is a basic understanding from psychology that fear over rides rationality.

          12. Anndrais mac Chaluim says:

            And the BMJ doesn’t explicitly say… [from which you imply…] Some scientists writing in the BMJ explicitly say… [from which you imply…] Other scientists, writing in the BMJ and elsewhere, explicitly say something different [from which you can’t imply what you imply and would have us believe].

            You’re not going to shake my scepticism. Science is inherently doubtful, and I doubt.

          13. Michael says:

            Are you saying that the tests are designed otherwise than reported in the BMJ? Are other’s writing for the BMJ disputing the report I have cited? Evidence? I’m not trying to shake your skepticism. I’m just trying to get some sense and consistency from you 🙂

          14. Anndrais mac Chaluim says:

            No, I’m saying that that the article to which you refer doesn’t imply what you say it implies.

            There are dozens of articles in the BMJ (e.g. Majeed and Molokhia, in BMJ 2020;371:m4654) that express no doubts as to value of rolling out the new vaccines.

          15. Michael says:

            Majeed and Molokhia, in BMJ 2020;371:m4654 are not considering the current testing or vaccines effectiveness. The article is written based on the underlying assumptions that the vaccines will be effective and safe. The article is addressing a set of different, primarily logistical, issues. It is interesting that the article also assumes that the vaccines will save lives – which current tests are not testing for: “and successful vaccination programme should be provided promptly so lifesaving vaccinations can begin at scale, proceed rapidly through all at-risk populations in the UK and finally allow something resembling normal life to return.”

            I’m not even sure what you are arguing anymore – that the BMJ article I cited should just be ignored! Move along. Nothing to see here. You’re logic and arguments are wildly incoherent. You are an expert and not and expert. I give in.

  2. Axel P Kulit says:

    I understand testing the vaccine, including for side effects, will be a lengthy process, so we could have a longer wait, or higher risks. Lockdowns are working but we may need them for a long time.

    1. Michael says:

      I know the sentiment: “lockdowns are working”, is endlessly repeat to us by sections of the media. For claims with such huge consequences on so many people’s lives, I think it is incumbent on those repeating the claim to provide at least a single reference to strong evidence that the claim is actually true. Please can you provide your reference/s?

      1. Anndrais mac Chaluim says:

        ‘For claims with such huge consequences on so many people’s lives, I think it is incumbent on those repeating the claim to provide at least a single reference to strong evidence that the claim is actually true.’

        Indeed; it’s incumbent on you – as it is on all of us – to demonstrate the truth of your claims. Meanwhile, it’s incumbent on me to doubt it.

        1. Michael says:

          What claim have I made that you would like me to provide evidence/references to support?

          Usually it is the article author who is expected to demonstrate that they are not pushing inaccurate information.

          But so far, I’m the only person on this thread who has cited anything!

          1. Anndrais mac Chaluim says:

            Well, for me, it’s incumbent on anyone who’s making a claim on my belief to justify that claim.

            You’re asking us to believe that rolling out of the vaccines that have been developed will be a waste of time and resources on the basis of an article that argues (probably quite rightly) that the current phase III trials are not actually set up to prove what the public thinks they’ve been set up to prove. That the public is mistaken about the purpose of the trials that have now taken place is a pretty flimsy pretext on which to base a claim that they shouldn’t be rolled out. I smell sh*t*.

          2. Michael says:

            I’m not making a claim. I’m bringing attention to what the BMJ has reported (cited and evidenced).

            I’m not asking you to believe anything. I have brought attention to a report from the BMJ that current phase III trials are not actually set up to prove what the public thinks they’ve been set up to prove.

            “That the public is mistaken about the purpose of the trials that have now taken place is a pretty flimsy pretext …” ~ I suppose you are a dodgy dossier apologist too. We should dispose informed debate and choices?

            Where have I suggested that the vaccines shouldn’t be rolled out. ~ you are resorting to “re-framing” and creating straw-man arguments. It is not becoming of you.

            “I smell sh*t*”. ~ and resorting to insults.

            The game’s up Chaluim, and you know it 🙂

            You twist and turn, don’t direct answer questions, don’t provide evidence, you logic is inconsistent and your arguments incoherent. Why should I pay attention to anything more that you have to say?

          3. Anndrais mac Chaluim says:

            Great! We’re in agreement, then. Peter Doshi’s article purports to show nothing more than that the vaccine tests haven’t been set up to prove what the public thinks they’ve been set up to prove, there’s nothing wrong with rolling out the tested vaccines, and Tony shouldn’t be overly worried about his dad getting vaccinated.

            I’m glad we got all that sorted out.

  3. Hank Rearden678 says:

    Respectfully, before you rush to get the rushed vaccine, please know there’s never been an RNA vaccine before. Please know the manufacturers are exempt from liability for their own product (so hey believe in it) and please know about the 2009 vaccine disaster which is horribly similar https://youtu.be/4BLOZ55E0NA

    1. Anndrais mac Chaluim says:

      I presume you’re talking about the H1N1 influenza virus vaccine.

      Yes, there’s a lot of controversy surrounding that, which significantly undermined public confidence in its safety, with the result that there was only a 27% uptake among Americans, which meant that the pandemic lasted longer than it might otherwise have done. There were also long delays and logistical cock-ups in rolling a vaccine out, which didn’t help.

      Partly as a result of the 2009-10 fiasco, the scientific community has been improving its regime of vaccine development in order to be able to create and test vaccines more quickly and accurately, while health authorities have been improving the logistical efficiency or their pandemic response.

      1. Michael says:

        So the uptake among “Americans [was low], which meant that the pandemic lasted longer than it might otherwise have done.” And even though it was ineffectively dealt with, how many people died from H1N1? What was the cost of the ineffective repose and who personally gained from the wasted spending? Looking at these questions would provide helpful analysis.

        1. Anndrais mac Chaluim says:

          Pandemics aren’t measured in terms of how many individuals die, but in terms of the cost of their disruption to public life and its productivity. They’re public health phenomena, not private. Privately, dying from the effects of contracting Covid-19 is no worse than dying from being struck by a bus.

          Whether or not the cost of the ‘cure’ outweighed the cost of the ‘disease’ with regard to America’s response to the 2009 pandemic is indeed a moot point, however. The mistakes the Americans made at that time were expensive ones, and a lot of profits were undoubtedly made from those mistakes. It will be interesting to see whether the same can be said of our response to the current pandemic when the time comes to evaluate it.

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