Vaccines

Majority of Covid Hospital Admissions Over Winter Were Vaccinated, PHE Study Shows

The Government announced results from two new vaccine studies from Public Health England (PHE) yesterday. One looks at how much protection the vaccines offer against death once a person is infected, the other at how much protection against hospitalisation with COVID-19 the vaccines offer.

The study on deaths is the more straightforward of the two. It looks at PCR positive cases in England between December 8th and April 6th. It finds among 80+ year-olds: 16.1% (1,462/9,105) of unvaccinated cases died versus 9.2% (99/1,072) of cases at least 21 days after their first Pfizer dose, 11.3% (33/293) of cases at least 21 days after their first AstraZeneca dose and 4.7% (6/128) of cases at least seven days after their second Pfizer dose. These correspond to unadjusted relative risk reductions of 43% (Pfizer 1), 30% (AZ 1) and 71% (Pfizer 2) respectively.

Among 70-79 year-olds it finds 4.0% (1,147/28,875) of unvaccinated cases died versus 2.7% (15/549) for Pfizer 1, 2.1% (10/484) for AZ 1 and 0% (0/7) for Pfizer 2. This corresponds to unadjusted relative risk reductions of 33% (Pfizer 1), 47% (AZ 1) and 100% (Pfizer 2).

Once adjusted for sex, clinical risk factors, age and being a care home resident, these become relative risk reductions of 44% (Pfizer 1), 55% (AZ 1) and 69% (Pfizer 2). This level of reduction in the mortality rate among the vaccinated over-70s once infected is encouraging. The lack of data on deaths within 21 days of the first jab and seven days of the second jab is disappointing. Why do we have yet another study on vaccine efficacy with no accompanying analysis of safety?

The second study looks at whether vaccination protects against hospitalisation. Unlike the first study, it doesn’t look at those already infected (testing positive) to see whether they are hospitalised, but at those who are hospitalised to see whether they’ve been vaccinated. It analyses 13,907 admissions in trusts participating in a surveillance programme between December 8th and April 18th. It excludes those who caught the virus in hospital. It also excludes those whose positive PCR test was more than five days before admission (1,230 cases), the reason for which is not explained. The breakdown of admissions by sex, age and vaccination status is shown in the table below.

Notice that a majority of admissions in this period – 57% – had received at least one vaccine dose. An earlier study that I noted before, from the ISARIC4C consortium, had found just 7.3% of hospital admissions over a similar period had received at least one vaccine dose. The reasons for this huge discrepancy are unclear, but given that the earlier figure made headlines for showing how effective the vaccines are, and for the sake of clarity in data, it should be cleared up.

Britons Catching Covid after Being Vaccinated Get Milder Symptoms

According to the data gathered by the ZOE Covid Study app based at King’s College London, Britons catching coronavirus post-vaccination get a milder form of the disease. Sarah Knapton, the Telegraph‘s Science Editor, has more.

The team at King’s said as the number of people being vaccinated increased, those reporting an infection after the jab was rising, but the symptoms had changed.

Prof Tim Spector, lead scientist on the ZOE Covid Study app, and professor of Genetic Epidemiology at King’s, said: “Whereas in the past about half of people had classic symptoms in the first week, less than a third do now, if they’ve had a vaccination.

“And so you’re gonna get less symptoms, they’ll be less severe, they won’t be classic, so do keep an open mind and do get a test when we ask you to, that way we’ll keep a close eye on it, and make sure that even if mild, you’re not going to pass it on to other people.

“The importance of our survey is getting even greater because the disease is shifting. The fact that we haven’t relied on those three symptoms like official government ones allows us much more breadth to find out what’s really going on, and whether not only the new various [sic] might be causing different symptoms.”

A third of UK adults are now fully vaccinated against Covid-19, latest figures have shown. A total of 17,669,379 people have received both jabs, the equivalent of 33.5 per cent of all people aged 18 and over.

Meanwhile, 35,371,669 people in the UK have now received a first dose of vaccine, the equivalent of 67.2 per cent of the adult population.

King’s estimates the current risk of a Covid-19 infection for the unvaccinated is one in 46,855, falling to 1 in 97,616 after the first dose, and 1 in 167,341 after the second dose.

Time to reopen Boris?

Worth reading in full.

Just Five New Covid Deaths Recorded in Last 24 Hours

Britain’s daily coronavirus deaths fell by nearly 30% today, as the number of people who have received a second dose of a Covid vaccine soared past 17 million. MailOnline has more.

Officials also recorded just five lab-confirmed deaths within 28 days of a positive Covid swab, 28.6% less than the number recorded a week ago.

The latest figures show that nearly 35.2 million Britons have been given at least one dose of Covid vaccine, after another 119,349 first injections were administered yesterday.

The NHS also dished out a further 449,716 second doses, bringing the total number of people fully vaccinated against the disease to 17.2 million.

Some 66.8% of adults have had a first jab, while nearly a third have had their second.

Worth reading in full.

Vaccine Booking Site is National Disgrace

What follows is a guest post by our technology correspondent. He’s pretty unimpressed by the NHS’s vaccine booking site, following news of various data breaches that have hit the headlines in the past 24 hours. Incidentally, he’s right about you being able to find out anyone’s vaccine status if you enter a few of their details on to the booking site. I was able to find out my sister’s status within two minutes.

The Guardian and Telegraph report that the NHS’s covid vaccine booking site has a “glitch” which reveals people’s vaccine status. That’s a big problem, as the Guardian points out, because it leaves all of us in the U.K. open to coercion, bullying and scams whether you have had the vaccine or not.

It is also not a “glitch” as the Telegraph describes it. The Guardian is closer with “seriously shocking failure”. To be clear, this is not an unintended bug introduced by a hapless programmer that occurs in obscure situations. It is a design flaw that shows the people responsible for your most private data do not understand the absolute basics of online privacy and security.

So, what is the problem? Essentially, if you know a little bit about a person: their name, date of birth and postcode, when if you enter that into the site it takes you to one of three different screens depending on whether you have had zero, one or two jabs. If you see a test centre finder, the person has had no jabs. If you see a request for a reference number, they have had one jab. If you see a screen saying you have had both of your appointments, then they have had two jabs. So, there you have it, the entire nation’s vaccine status available to anyone who cares to do a bit of online digging. I just tried it for some people I know, and I now know their vaccine status. There is no attempt to check that you are who you say you are. Not even the most basic authentication. It is a completely open database of the entire nation’s vaccine status. Even worse, it is still online now, more than 24 hours after the scandal broke in the press and the NHS being contacted by the regulator.

To recap, this is extremely private data, about every person in the UK, and it is openly available to everyone in the world. The site has not been taken down, even temporarily. It is equivalent to the Government providing a website that tells you if someone is overdrawn at their bank or not. But this is arguably more private than that data. This is why privacy is so important. This is why we should be so reluctant to give our data to people who cannot look after it, such as NHS Digital. The riposte of “if you haven’t done anything wrong then you have nothing to fear” doesn’t work. None of us have done anything wrong, but because NHS Digital has screwed up, we are all now vulnerable to scammers, fraudster and criminals, and there is nothing we can do about it.

The response from NHS Digital is as shocking as their ignorance of online security: “people should not be fraudulently using the service”. Is that a joke? Is that what passes for security, asking fraudsters not to access the site? The NDG – National Data Guardian for Health and Social Care – is not much better and apparently toothless: “The NDG has contacted the organisations which run the website to ensure that they are aware of the concerns that have been raised and will discuss with them the twin important aims of protecting confidentiality whilst maintaining easy access to vaccinations for the public.”

Ensure they are aware of concerns? They should be demanding that the site is immediately taken down and prosecuting NHS Digital management. This is a disgrace and a national embarrassment. Serious action needs to be taken immediately.

Under-40s to be Offered Alternative to AstraZeneca Jab

The Joint Committee on Vaccination and Immunisation (JCVI) has issued new guidance today saying that adults aged 30 to 39 without underlying health conditions should be offered an alternative to the Oxford-AstraZeneca vaccine. MailOnline has more.

Britons under 40 should be offered an alternative to the Oxford/AstraZeneca Covid vaccine due to its link to rare blood clots, health officials announced today.

Advisers made the recommendation after more adults suffered the potentially-fatal clotting disorder in the past week.

They said the absolute risk of the clots is still “extremely small”, affecting around one in 100,000 people given the British-made jab.

So far regulators have spotted major blood clots in 242 people, of whom 49 died. But they are occurring more in younger adults, with a rate of around one in 60,000 under-40s.

Experts said the infection rate in the UK is now so low that the risk of the rare clots outweigh that of Covid in younger adults, who often only suffer mild illness. They will be offered the Pfizer or Moderna vaccines instead.

That final point is interesting. Does it mean that health officials have calculated that the risk of dying from a blood clot after being receiving the AZ jab is greater than the risk of someone under-40 with no underlying health conditions dying from Covid? To date, 49 people have died from blood clots after being given the AZ vaccine. If we assume that at least a half of the 35 million Britons who’ve been inoculated got an AZ jab (a conservative assumption), that means the risk of dying from a blood clot after receiving the AZ vaccine is ~49/17,500,000.

So is the JCVI saying that the risk of someone under-40 with no underlying health conditions dying from COVID-19 is < 49/17,500,000?

Even I hadn’t realised the risk was quite so infinitesimally small.

Worth reading in full.

Study Claims Pfizer Vaccine is 95% Effective in Over 65s. But Should That Be 74%?

A new population study from Israel, published in the Lancet on Wednesday, finds that the Pfizer vaccine is 95.3% effective against SARS-CoV-2 infection once a person is fully vaccinated (defined as being a week past their second dose). It also finds the vaccine is 94.8% effective in those aged 65 or older once fully vaccinated.

This is in line with other studies and is a very encouraging result. However, as with previous studies, it’s not clear how well the researchers have taken into account the fact that infections were declining anyway during the study period and whether this has led to an over-estimation of vaccine effectiveness.

To test this I accessed the data available from the Israeli Government. I looked at how many cases occurred in each age group each week alongside the proportion of that age group that had been fully vaccinated by that week. This allowed me to calculate how many infections we would expect to occur among vaccinated people in each age group each week if you assume the vaccines don’t have any effect. I then added these together to give a baseline number of cases in each age group to compare against the number of actual cases among the vaccinated as reported in the study. The results are shown below.

I calculated we would expect 43,826 infections among the vaccinated out of a total of 237,700 in the study period (January 24th to April 3rd) if the vaccines have no effect, which is 18.4%.

The study reports 6,266 infections among the vaccinated out of a total of 232,268 during the study period, or 2.7%. (I wasn’t able to discover why the study had about 2.3% fewer infections than the Israeli Government data broken down by age, but by using proportions we can avoid this discrepancy affecting the calculation.)

A proportion of 2.7% is 85.4% lower than a proportion of 18.4% that we estimated if the vaccines had no effect. This suggests a vaccine effectiveness of more like 85% than 95%.

Looking now at the crucial older age group, if the vaccines had no effect I have calculated we would expect 11,332 infections among the vaccinated aged 60 and over out of a total of 29,489 infections in that age group during the study period. The study found 2,201 infections among the fully vaccinated aged 65 or more. (It doesn’t state how many infections there were in total in this age group so we can’t calculate a straightforward proportion from the study.)

We need to adjust our expected figure of 11,332 to allow for the fact that it includes those aged 60-64 (the study uses different age brackets from the publicly available Government data). From the table above this will be about half of the infections in the 60-69 age group, or 2,834. We also need to reduce the expected figure by around 2.3% to allow for the different infection totals of the study and Government data. This gives us an expected figure of 8,329 infections among the vaccinated over 65s.

The 2,201 figure from the study is 73.6% smaller than 8,329, suggesting a vaccine effectiveness among the over 65s of more like 74% than 95%.

It’s not clear why the authors of the study did not do an analysis similar to this one. Taking into account the background prevalence of the virus should be basic, to avoid over-estimating the effectiveness of vaccines when they are rolled out during the decline of the epidemic.

The study (which was funded and approved for publication by Pfizer) briefly mentions lower vaccine effectiveness 2-3 weeks after the first dose, but does not give any information about effectiveness or infection incidence in the first 14 days. This means it gives no more information about the post-vaccination infection spike observed in other studies, though the silence here may be telling.

A further question is why the researchers gave no finer-grained detail about those older than 65 when they must have had the data to do so, and more than half of Covid deaths are in those aged over 80.

An effectiveness of 85% overall and 74% among the over 65s is still good, but it is not as good as the 95% figures in the study. As so often with vaccine studies, on closer inspection you’re left wondering whether you’re getting the full and accurate picture.

Why is the World’s Most Vaccinated Nation Locking Down Again?

Seychelles, an archipelago nation in the Indian Ocean with a population of about 98,000, is locking down again – even though it has fully vaccinated more than 60% of its adult population with two vaccine doses, more than any other country in the world including Israel.

The country has banned the intermingling of households, closed schools, imposed curfews on bars and cancelled sporting activities for two weeks as infections surge.

The country began vaccinations in January using a donation of Chinese vaccines from the United Arab Emirates. According to Bloomberg, by April 12th, “59% of the doses administered were Sinopharm vaccines and the rest were Covishield, a version of AstraZeneca’s shot made under licence in India.”

The Government put the surge down to people being less careful, particularly over Easter. However, setting aside whether population behaviour is a plausible explanation, this doesn’t explain why the vaccines are not preventing transmission or infection.

Britain Records One Covid Death in Lowest Daily Toll in Nine Months – Yet Boris Doggedly Sticks to Roadmap

The U.K. recorded its lowest Covid death toll in nine months yesterday, while infections fell to a level not seen since September. MailOnline has more.

Department of Health statistics showed this was only the third time deaths had fallen to this level, after August 3rd and 30th. July 30th was the only day of the pandemic to see zero victims recorded.

Health bosses also posted another 1,649 coronavirus cases, down by a fifth on the 2,064 last Monday. It was the fewest positive tests since September 2nd, before the second wave spiralled out of control.

Figures tend to be lower on Mondays because fewer people are available over the weekend to process paperwork to record a death. Separate date of death statistics, which lag by around a fortnight, show around 15 Brits are still succumbing to the virus every day – similar to levels seen at the end of summer, when ministers were happy to let Britons mix with few curbs despite no one being inoculated.

Britain today passed the landmark of having dished out 50million Covid vaccines, after another 250,000 jabs were dished out yesterday. Around 34.6million people have now had their first dose, and 15.4million – or 30% of all adults – are fully inoculated.

Health Secretary Matt Hancock hailed the “massive” achievement and insisted we are going to have a “great British summer”, while Boris Johnson said he could see no reason why England’s next planned relaxation on May 17th could not go ahead.

Despite the success of the vaccine roll-out coming alongside falling cases and deaths, the PM poured cold water on holiday hopes, warning putting lots of countries on the travel ‘green list’ could risk an “influx of disease”. His comments came hours after the EU unveiled plans to let vaccinated Brits in for summer trips.

Mr Johnson insisted Number 10 will be “cautious” amid bitter Cabinet wrangling over how far to loosen the border restrictions this month. Mr Hancock and chief medical officer Chris Whitty are said to be among those pushing for quarantine-free states to be kept to an absolute minimum.

On a pre-election visit to Hartlepool this afternoon, Mr Johnson also claimed there is a “good chance” that current social distancing rules will be scrapped on June 21st – touted as England’s independence day.

Worth reading in full.

Major Study Finds “Abundance of Patients Admitted to Hospital With Covid Within Seven Days of Vaccination”

A new study of Covid hospital patients has found once again a spike in infections post-vaccination – what the authors call “an abundance of patients admitted to hospital within seven days of vaccination”.

The ISARIC4C consortium’s COVID-19 Clinical Information Network (CO-CIN) enrolled 52,280 Covid patients who were admitted to hospital between December 8th and April 10th. Of these, 3,842 had received at least their first vaccine dose, which is 7.3% or one in 14.

The researchers found that the median time between receiving a first jab and the onset of Covid symptoms was nine days. Since the median time from infection to symptom onset is five days, this suggests the majority contracted the disease in the days after vaccination.

The graph above shows how many of the vaccinated Covid patients experienced symptom onset on each day since vaccination. Note the massive spike on the day of vaccination and the three days afterwards. Although the authors do not say it in so many words, clearly the vaccines here are bringing on the symptoms. Why else would the frequency of symptom onset increase by 400% from the day before vaccination to the day of vaccination and in the following days?

The authors offer a few potential explanations. They suggest elderly and vulnerable people who had been shielding may have become infected through the exposure involved in the vaccination programme. Or perhaps they stopped shielding or being careful as soon as they got vaccinated, wrongly assuming they were immune.

The authors also raise the possibility that recent asymptomatic or mild COVID-19 could be triggered by vaccination into “symptoms likened to COVID-19 symptoms including fever”.

The study’s co-lead Dr Calum Semple, Professor in Child Health and Outbreak Medicine at the University of Liverpool, was clear where he stood on this, saying that the spike indicated “people are letting their guard down because they’ve been vaccinated. There is evidence here that people are unfortunately assuming that they’re protected very quickly after vaccination and that’s not the case.”

Such behavioural change was likewise blamed by Michael Day writing in the BMJ in March. Dr Clare Craig wrote a thorough riposte in the same journal, pointing to ONS data showing that the vaccinated did not increase their social contact and asking how it would explain similar spikes in care homes. She suggested other explanations were more likely, such as a drop in white blood cells in the days after vaccination as observed in the Pfizer trial, which may temporarily suppress immunity.

The spike in symptomatic Covid from day zero plainly cannot be explained by behaviour change, and as the authors suggest looks very much like the vaccine somehow re-triggering an old or existing Covid infection.

The good news from the study is that the vaccinated did not make up a large proportion of those hospitalised with Covid during December and January, though by late February and March (when all the over-65s were vaccinated) they made up a sizeable chunk of a much reduced total.

The authors note that the first dose of the vaccine doesn’t appear to reduce death among the high-risk hospitalised, saying “mortality appears to remain high for people in high-risk vaccination tiers who are admitted to hospital with symptomatic SARS-CoV-2 infection (COVID-19) despite vaccination 21 days or more previously”. It is not clear if this is a temporary effect owing to adverse effects of the vaccine or a permanent gap in the protection it offers.

How much longer can governments and scientists ignore the evidence of the post-vaccine spike in infections, found in study after study? When will they stop lazily blaming people for getting themselves infected and commit to investigate it properly?

Coronavirus Spike Protein Alone May Cause Lung Damage

Research on mice has found that exposure to the SARS-CoV-2 spike protein by itself, without the rest of the virus or any viral replication, is enough to cause COVID-19-like symptoms, including severe inflammation of the lungs. Dr Pavel Solopov, Research Assistant Professor at Old Dominion University in America, who led the research, told the Medical Xpress:

Our findings show that the SARS-CoV-2 spike protein causes lung injury even without the presence of intact virus. This previously unknown mechanism could cause symptoms before substantial viral replication occurs.

The researchers injected genetically modified mice with a segment of the spike protein and compared them after 72 hours with a control group injected with saline. The outcome was unmistakable, according to the Medical Xpress.

The researchers found that the genetically modified mice injected with the spike protein exhibited COVID-19-like symptoms that included severe inflammation, an influx of white blood cells into their lungs and evidence of a cytokine storm – an immune response in which the body starts to attack its own cells and tissues rather than just fighting off the virus. The mice that only received saline remained normal.

The researchers did not, according to this report, indicate whether the finding has any significance for the vaccines and their side effects. The Pfizer, Moderna, AstraZeneca and Johnson & Johnson vaccines all work by delivering genetic material that induces cells around the body to produce the spike protein, which the immune system then becomes primed to recognise. A question arising from this research is whether, if the spike protein is pathogenic in its own right and not just a means of gaining entry to cells, this explains any of the Covid-like side-effects of the vaccines, including some of the rare serious ones.

Other research has suggested that “the SARS-CoV-2 spike protein (without the rest of the viral components) triggers cell signalling events that may promote pulmonary vascular remodelling and pulmonary arterial hypertension as well as possibly other cardiovascular complications”. These matters should continue to be investigated.

Worth reading the Medical Xpress report in full.

(Image: Using a newly developed mouse model, researchers found that exposure to the SARS-CoV-2 spike protein alone was enough to induce COVID-19-like symptoms including severe inflammation in the lungs. The left images show healthy mouse lung tissue while the right images show tissue from mouse lungs exposed to the spike protein. Credit: Pavel Solopov, Old Dominion University.)