I have not posted for a while. The basic reason for this, is that the whole scientific/medical community has been very uncertain as to where we are in this pandemic.
So I only really want to post when there is a reasonable chance the information will be reasonably accurate and helpful.
In the earlier phases this has been much easier than now. The uncertainty arises around issues of watching the effect of vaccines, and getting handle on the effect of how the virus changes.
A major issue has been the severe limitations arising out of the lack of reliable laboratory means of assessing immunity. Current technology is close to useless in this regard. So we are reduced to crude time line evaluations as to who gets what, who gets ill from Covid-19, how badly and if they die. That may surprise some, but that is where we are.
Antibody tests are flawed, as they don't tell the whole story, as they measure neutralizing and non neutralizing antibodies. We have no ability to test on mass for just neutralizing antibodies. In addition we have no easy and reliable means to test T-cell immunity in broad swaths of the population. So that essentially limits us to crude outcome studies.
There was a recent editorial in JAMA decrying this problem
So this has had the effect of not being able to accurately asses the immunity from vaccines, natural infection or both. When you add mutant variants the picture can become more clouded.
There was a recent key paper in Lancet
from UK data that sheds some light on this problem. The Minnesota State Health department has stated doing tallies of breakthrough infections and deaths resulting from these events.
The bad news is that the vaccines seem to be only 34% effective at preventing breakthrough. However they still remain around 90% effective against hospitalization and death. The bad news is that breakthrough and asymptomatic infections result in as much initial virus shedding as in the non vaccinated. However, the duration of the shedding is significantly shorter.
This is another JAMA editorial on breakthrough infections
We do not have good data on the differences in effectiveness of the different vaccines. This may be because it has not been accurately tracked. Data from Israel indicates the effectiveness of the Pfizer vaccines undergoes significant decline in the 2 to 3 month time frame and declines from then on. There is some suggestion the Modern vaccine is better. This is soft. Natural infection plus vaccination, appears to produce better, and longer lasting immunity.
The Delta variant has been a big issue, and thought to be the leading cause of the rising breakthrough infections.
This is the latest data from the Minnesota State Health department.
[The Minnesota Department of Health in the past week identified another 7,821 breakthrough coronavirus infections among more than 3.2 million fully vaccinated people in the state, including another 111 people who died of COVID-19 despite their immunizations. The state's breakthrough total as of Monday reached 64,844 infections — more than 2% of the fully vaccination population — and 483 COVID-19 deaths.]
Roughly 20% of Minnesotans over 18 have had booster doses of vaccine.
The UK leads us by about six weeks from the onset where the infection became pandemic.
The UK is now believed to be in transition from pandemic to endemic infection status at this time. If so we will follow soon.
However the case rate is worryingly high if the endemic infection rate, hospitalization and deaths remains at the current level. It has plateaued close to the midway point between the peaks and troughs of the pandemic for about a month now.
The problem is that it is keeping hospital occupancy at 94 to 95 percent. The waiting list for non urgent and semi-urgent care are totally unacceptable, with no solution in sight for this.
The public and the economy will not tolerate a return to restriction.
Hopefully the new antivirals, soon to go before the regulators will provide relief from this situation. I think this is the good news here. Vaccination, sensible individual low tech precautions, and antivirals will reduce Covid-19 infections to just a nuisance. That has to be the hope.
On a personal note. My wife's sister and her husband both had breakthrough infections, despite full vaccination, after a trip from where they live in Kingsland Herefordshire to Southampton in Hampshire. My sister in law is yet to recover her sense of smell. No hospital care was involved, but by all accounts the experience was very unpleasant for both.
My wife has just got back from her first outing delivering booster shots. A half million Minnesotans have received booster jabs so far.
I think that is the best I can do to shed some light on the state of play.