Coronavirus - how is it/has it affected you?

road2ruin

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This has just been leaked, not been confirmed however based on the previous leaks followed by official announcement it sounds plausible….

  1. An announcement to be made to the public this Sunday confirming that vaccination of healthy 12-15 year-olds WILL go ahead. Likely to be a decision made by Chris Whitty and the other CMOs, given the JCVI’s position and the fact that no senior politician wants to take responsibility for it.
  2. The start date for first jabs in arms has been delayed until September 13th, a week longer that originally planned. The end date by which time we are required to have offered a Pfizer jab to all healthy 12-15 year olds remains November 1st. Uptake of 75% is expected, although I think that’s a little high, particularly in light of today’s JCVI announcement. We have had to complete a planning return setting out numbers of schools and vaccinations planned for the week beginning Sept 13th – there’s going to be a big push to maximise the number of vaccinations given in schools during the first week, consent be damned.
  3. All relevant documents including those relating to consent forms, consent process, national protocols, etc. will only be released to NHS Trusts on Monday Sept 6th, the day after the Whitty announcement is expected. It will be interesting to see how they get around the Green Book consent protocols.
  4. There is some consternation within the programme that NHS trusts only found out from the BBC, not the national team leaders, that the top-up third dose (not the booster) for the immunologically suppressed will go ahead from Sept 6th. The booster programme is still planned to start on Sept 20th with priority for care homes and health and social care staff likely to be first.
 

Ethan

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This has just been leaked, not been confirmed however based on the previous leaks followed by official announcement it sounds plausible….

  1. An announcement to be made to the public this Sunday confirming that vaccination of healthy 12-15 year-olds WILL go ahead. Likely to be a decision made by Chris Whitty and the other CMOs, given the JCVI’s position and the fact that no senior politician wants to take responsibility for it.
  2. The start date for first jabs in arms has been delayed until September 13th, a week longer that originally planned. The end date by which time we are required to have offered a Pfizer jab to all healthy 12-15 year olds remains November 1st. Uptake of 75% is expected, although I think that’s a little high, particularly in light of today’s JCVI announcement. We have had to complete a planning return setting out numbers of schools and vaccinations planned for the week beginning Sept 13th – there’s going to be a big push to maximise the number of vaccinations given in schools during the first week, consent be damned.
  3. All relevant documents including those relating to consent forms, consent process, national protocols, etc. will only be released to NHS Trusts on Monday Sept 6th, the day after the Whitty announcement is expected. It will be interesting to see how they get around the Green Book consent protocols.
  4. There is some consternation within the programme that NHS trusts only found out from the BBC, not the national team leaders, that the top-up third dose (not the booster) for the immunologically suppressed will go ahead from Sept 6th. The booster programme is still planned to start on Sept 20th with priority for care homes and health and social care staff likely to be first.
This is the right decision, but a pitiful way of making it. The JCVI totally wimped out, even saying they were not taking education or societal issues into account. That is a pathetic excuse. Even setting that aisde, their decision based on health grounds alone is different from a number of highly credible bodies in other countries. I suspect Govt wanted to push this decision out to the CMOs and the whole thing has been orchestrated.
 

larmen

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Haven’t the Americans vaccinated kids for a little while now? There must be some learning about effectiveness and complications based in that.
 

Ethan

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Haven’t the Americans vaccinated kids for a little while now? There must be some learning about effectiveness and complications based in that.
The risk to kids from Covid is low, but not zero, and deaths, inflammatory complications and long Covid have occurred. The risks of the vax are very low. There has been much made of myocarditis as a complication of vaccination, but it has been a transient and mild complication and very very few bad outcomes. Kids transmit Covid, so are part of the herd immunity issue, and we already vaccinate kids for the benefit of others and not themselves, a good example being boys getting HPV vaccine.
 

ColchesterFC

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Take the last group (and delete one vax cases for simplicity):

Of the 1,644 deaths of people aged 50 or over…..

437 (27%) were unvaccinated,

1,054 (64%) had received both doses.

So, approximately 93% of people over age 50 have been double vaccinated. Therefore, 27% of deaths arise in the unvaccinated 7% of the population, and 64% cases in the vaccinated 93%.

So the relative benefit of vaccination is (27/7)/(64/93) = 5.6, so the risk of death is 5.6 times greater for unvaccinated comapred to vaccinated.
Not a direct response to your post but a question for you @Ethan. I saw this quote earlier today (when I clicked on the trending on Twitter).....

"Based on scientific trials from around the world, experts say that COVID-19 vaccines that have reported results have shown to be close to 100% effective at preventing hospitalizations and deaths. This includes vaccines with lower efficacy rates, which reflects how well the vaccine works in a controlled setting, and does not account for a vaccine's ability to prevent serious illness."

Looking at the figures above, 64% of those that died of Covid had received both doses of the vaccine so how can the vaccine be "close to 100% effective at preventing hospitalizations and deaths" when so many who are vaccinated are still dying of Covid? Or maybe this should be a question aimed at statisticians rather than a qualified doctor. I accept that some who have been double jabbed are still going to die of Covid as the vaccine is less than 100% effective, but can't get my head around the suggestion of it being close to 100% effective against death.

I'm by no means a Covid denier or anti-vaxxer as I've followed all the rules to date and am double jabbed myself I just can't work out how they have reached the conclusion they have.
 

Swinglowandslow

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This is the right decision, but a pitiful way of making it. The JCVI totally wimped out, even saying they were not taking education or societal issues into account. That is a pathetic excuse. Even setting that aisde, their decision based on health grounds alone is different from a number of highly credible bodies in other countries. I suspect Govt wanted to push this decision out to the CMOs and the whole thing has been orchestrated.
Seems to me that the JCVI recommended not to vaccinate ( which you disagree with on health grounds , in that you have in past pointed out vaccinated people spread the virus less.)
BTW - I agree they should be vaccinated.

But the government rejected that advice and will have the vaccinations go ahead.
But you don't want it as simple as that. Can't have the government doing something you think is right ?.
Hence the conspiracy theory😀😀
 

larmen

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@ColchesterFC agree it seems an odd quote without more context. Re your statisticians comment, this guy may be worth a read if missed it before :
https://forums.golfmonthly.com/threads/coronavirus-how-is-it-has-it-affected-you.104530/post-2394622
Health numbers while logical are often very counter intuitive.

The weirdest one I have seen was a test that is 95% accurate on a really rare illness, on a positive result it’s still more likely to be a false positive than a right one. Makes no sense, 95% should be good, but the math adds up.
 

Ethan

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Not a direct response to your post but a question for you @Ethan. I saw this quote earlier today (when I clicked on the trending on Twitter).....

"Based on scientific trials from around the world, experts say that COVID-19 vaccines that have reported results have shown to be close to 100% effective at preventing hospitalizations and deaths. This includes vaccines with lower efficacy rates, which reflects how well the vaccine works in a controlled setting, and does not account for a vaccine's ability to prevent serious illness."

Looking at the figures above, 64% of those that died of Covid had received both doses of the vaccine so how can the vaccine be "close to 100% effective at preventing hospitalizations and deaths" when so many who are vaccinated are still dying of Covid? Or maybe this should be a question aimed at statisticians rather than a qualified doctor. I accept that some who have been double jabbed are still going to die of Covid as the vaccine is less than 100% effective, but can't get my head around the suggestion of it being close to 100% effective against death.

I'm by no means a Covid denier or anti-vaxxer as I've followed all the rules to date and am double jabbed myself I just can't work out how they have reached the conclusion they have.
We would need to know a lot more about the data. How many of the vax were at least 2 weeks ago, whether Covid was considered to be the cause of death or an element of a more complicated death picture. Also, some vax'd people change their behaviour after vax, thinking they are invulnerable.
 

Ethan

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Health numbers while logical are often very counter intuitive.

The weirdest one I have seen was a test that is 95% accurate on a really rare illness, on a positive result it’s still more likely to be a false positive than a right one. Makes no sense, 95% should be good, but the math adds up.
It is all to do with prevalence. A small percentage of a very big number may be larger than a large percentage of a small number. If 1% of a population of 1,000,000 has Covid, then there are 10,000 cases. A Covid test which will detect 95% of true positives and 95% of true negatives will correctly identify 9,500 cases, miss 500 cases, misidentify 49,500 as cases, but correctly identify 940,500 as not having Covid. So the false positive cases are 5 times the true positive, and if you have a positive test, you are, on average, much more likely not to have Covid than have it.

If 30% of the population has Covid, then of the 300,000 cases, the test will correctly identify 28,500, miss 1,500, misidentify 35,000 as cases and correctly identify 665,000 as not having Covid. Still more false positives than true positives.

The problem arises because there is trade off between true positive detection (sensitivity) and true negative detection (specificity), so tests need to have a focus - the identification of true cases or the reliable confirmation of negativity.
 

Ethan

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Seems to me that the JCVI recommended not to vaccinate ( which you disagree with on health grounds , in that you have in past pointed out vaccinated people spread the virus less.)
BTW - I agree they should be vaccinated.

But the government rejected that advice and will have the vaccinations go ahead.
But you don't want it as simple as that. Can't have the government doing something you think is right ?.
Hence the conspiracy theory😀😀
Not a conspiracy theory at all.

The terms of reference for the JCVI are as follows:

To advise UK health departments on immunisations for the prevention of infections and/or disease following due consideration of the evidence on the burden of disease, on vaccine safety and efficacy and on the impact and cost effectiveness of immunisation strategies. To consider and identify factors for the successful and effective implementation of immunisation strategies. To identify important knowledge gaps relating to immunisations or immunisation programmes where further research and/or surveillance should be considered.

and further:

In order to assess whether a national NHS-provided vaccination programme can be considered cost effective (or not), JCVI uses the methodology and criteria of the National Institute for Health and Clinical Excellence (NICE). Using the NICE approach, a vaccination programme can be considered to be cost effective if the health benefits (both the direct health benefits to those vaccinated and the indirect health benefits to the unvaccinated population) are greater than the opportunity costs measured in terms of the health benefits associated with programmes that may be displaced to fund the new vaccination programme. In other words, the general consequences for the wider group of patients in the NHS are considered alongside the effects for those patients who may directly benefit from the vaccination programme of interest.

Those extracts from the documents available on Gov.uk make it clear that the remit of the JCVI is a broad one, and the advice they have routinely offered has been broad, including the benefit to others (i.e. through effects on transmission). In 2017, the JCVI recommended extension of HPV vaccination to adolescent boys. The main effect of this is to prevent later transmission to female sexual partners, and carries negligible benefit to adolescent boys, so to now consider Covid vaccination to precisely the same age group and restrict the consideration to the personal benefit-risk is completely inconsistent, especially when the evidence for effectiveness and immediate short-term impact of Covid vaccination is so much stronger. There has not been an example in recent years where the issues have been so much focussed on transmission and wide societal effects, yet the JCVI suddenly decides to take a narrow view based only on the personal benefit-risk to the recipient. And lo and behold, the Govt then calls on the CMOs to consider it and within hours, press briefings begin that the CMOs will overturn this advice and roll out all the materials already prepared as soon as this week. It seems pretty obvious that the Govt wants this, but doesn't want to own it, as they would if their committee made the decision or of they over turned that advice, but the advice now comes from the CMOs, thus putting it one step further away from Govt.

You can believe what you want. I have worked in the NHS administrative structure and if you don't think this sort of scenario is entirely possible, you are mistaken. It happened at the start of this pandemic when Vallance was rolled out as the main voice behind the herd immunity strategy.
 
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DanFST

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At risk of rocking the boat, had my first PCR test this week.

1) I can 100% see where the £37bn is going for 2 years, incredibly efficient with lots of friendly and helpful staff working every day. Fantastic effort from all involved.

2) Vaccination works, well at least for me I think it did. I got covid before lockdown 1 and was convinced I was going to die. I would lay on my back for hours, then be moved onto my front often passing out from not being anle to breathe in the process. This time after double vaccination, every symptom was the same but 50% as bad. resulting in a very uncomfortable couple of days, but nothing like last time.
 

Ethan

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At risk of rocking the boat, had my first PCR test this week.

1) I can 100% see where the £37bn is going for 2 years, incredibly efficient with lots of friendly and helpful staff working every day. Fantastic effort from all involved.

2) Vaccination works, well at least for me I think it did. I got covid before lockdown 1 and was convinced I was going to die. I would lay on my back for hours, then be moved onto my front often passing out from not being anle to breathe in the process. This time after double vaccination, every symptom was the same but 50% as bad. resulting in a very uncomfortable couple of days, but nothing like last time.
I strongly agree with 2, but not 1. I am glad you had a smooth process, as you should have, but that offers little insight into how that budget is allocated or spent. Testing and contact tracing could have been done better and at a fraction of the cost using existing resources and drafting in other NHS and PHE staff to support. Most of the tricky cases were done by them anyway.
 

DanFST

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I strongly agree with 2, but not 1. I am glad you had a smooth process, as you should have, but that offers little insight into how that budget is allocated or spent. Testing and contact tracing could have been done better and at a fraction of the cost using existing resources and drafting in other NHS and PHE staff to support. Most of the tricky cases were done by them anyway.
I fail to see how NHS and PHE staff could do a "better" job at traffic management, security and admin of handing out and collecting samples, than all the guys and girls that were there today being paid £10 an hour. Nor why they should be used in that capacity, or where even the numbers would come from.
 

Ethan

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I fail to see how NHS and PHE staff could do a "better" job at traffic management, security and admin of handing out and collecting samples, than all the guys and girls that were there today being paid £10 an hour. Nor why they should be used in that capacity, or where even the numbers would come from.
The track and trace system is a bit more complex than the bit you saw. That is the easy bit. The hard bit is having a system that accurately identifies cases, and efficiently identifies contacts and persuades them to isolate or get tested. The latter but was abysmal and could, and should have been done by PHE and NHS. PHE and NHS staff already provide local contact tracing for outbreaks of a range of conditions, and in this past pandemic, they handled most of the tricky cases.

As for how to staff it, there were a lot of PHE and NHS staff whose usual jobs were suspended due to Covid, but who had the skills needed. There were also loads of doctors and nurses happy to volunteer for various tasks from testing to vaccination, and willing to do so without pay, but we weren't called - it seems the private companies preferred untrained people at £10 an hour.
 
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Swinglowandslow

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Ethan, you are saying, are you not
" and if you have a positive test, you are, on average, much more likely not to have Covid than have it. "

Frankly, I think that is statistics baffling common sense.
It takes a situation where someone gets some symptoms before they then go for a test.(usually). Let's say it comes back positive.
He is treated as having Covid. He isolates, etc
If it walks like a duck, quacks.....etc

I can only imagine you are talking about everyone taking a test, with or without symptoms?
Even so,
How many of us here who took a test which came back positive would consider themselves likely not to have Covid.?
 

Ethan

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Ethan, you are saying, are you not
" and if you have a positive test, you are, on average, much more likely not to have Covid than have it. "

Frankly, I think that is statistics baffling common sense.
It takes a situation where someone gets some symptoms before they then go for a test.(usually). Let's say it comes back positive.
He is treated as having Covid. He isolates, etc
If it walks like a duck, quacks.....etc

I can only imagine you are talking about everyone taking a test, with or without symptoms?
Even so,
How many of us here who took a test which came back positive would consider themselves likely not to have Covid.?
Well, it comes down to this issue of a low probability in a large population versus a high probability in a small population. Screening tests are always balanced between the risk of missing true cases and the risk of falsely identifying people as being cases. In this case, the tests err on the side of accepting that you will falsely identify people as being cases but that is preferable to missing true cases.

Exactly the same issues apply to treat screening, for example. A lot of women are identified by mammography as having a suspicious lesion when they don't have ideas, and further testing is needed to sort it out, causing distress and sometimes injury as the tests become more invasive. It is inherent in all screening.

On the numbers, it all depends on the prevalence in the local population, whether you are testing 'for cause' or routine screening and the precise setting of the test, but in general, in low prevalence circumstances there is a high chance that a positive test in a random person is inaccurate. so lots of people who self isolated, and their families or bubbles, probably did so unnecessarily. This is amplified by the track and trace and NHS Covid apps, which then use these positive tests in people who may not be cases to demand others self isolate.

I am not in favour of widespread testing except using highly sensitive research grade testing for epidemiological studies, and testing people with symptoms or a high chance of being infected, i.e close contacts of known symptomatic cases. I have not been tested once for Covid and never downloaded the NHS Covid app. Testing is being used as a means of reassuring the public. The Govt have never released figures for the test positive rate within subgroups, those tested for symptoms, those routinely screened for work or college, epidemiological surveys. Without that breakdown, the testing data is just a big, but pretty meaningless, number.
 
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