25th February 2021
UK COVID Deaths – Daily 323 / 7-Day average 434
Total UK COVID Deaths within 28 days – 122,070
Total UK Deaths with COVID-19 on the death certificate – 135,613 (up to 12th Feb)
James Cook Hospital – Total COVID deaths – 581
All COVID cases within South Tees Hospitals Trust – 120
James Cook Critical Care
COVID cases – 25 (15 ventilated)
Non-COVID cases – 39 (24 ventilated)
On Monday the Prime Minister announced his road map out of lockdown. Understandably, after letting things get really out of hand in January, it would seem the Government are taking a more cautious approach this time. Twice bitten, thrice shy appears to be underpinning the new timetable for easing restrictions.
The first step on the road to freedom begins on 8th March when all pupils in England will return to school. My three children will be glad to return and there will, doubtless, be parents up and down the land who are ecstatic at the prospect of schooling being returned to the schools.
The rest of the road map lays out the grand plan to ease lockdown in successive steps, culminating in the lifting of all restrictions on 21st June. Obviously, Boris has not been foolish enough to promise to stick to this timeline but it is all strangely reminiscent of his previous promise last summer that it would all be over by Christmas.
That’s not to say that there hasn’t been significant progress in the battle against COVID-19 over the past two months. Indeed, today saw the lowering of the nation’s alert level from level five (‘a material risk of healthcare services being overwhelmed’) to level four (‘transmission is high or rising exponentially’). I have to say that, given how things are here at James Cook, it seems perhaps a little premature.
Critical Care is currently at 75% of our ‘super-surge’ capacity. This is the absolute maximum number of patients that we can look after without having to ventilate in the hospital corridors. This has not changed significantly over the past month. Other hospitals within our region and, for that matter, the rest of the country seem nowhere near as busy. Our neighbours in Newcastle, Gateshead, Durham and Darlington are all currently at somewhere between 28% and 42% of their absolute limit.
Over the last week, the total number of COVID patients in the hospital has stubbornly refused to fall. We still are looking after a large collection of very ill patients who are all fighting for their lives. We have 13 patients receiving CPAP out on the wards and four of our seven Intensive Care Units remain designated COVID units. Very few of our patients are in an age-group that currently qualifies for vaccination and many of them are surprisingly young; three of our current CPAP patients are in their 20’s.
Clearly there is still an awful lot of community transmission of COVID-19 still occurring despite the current restrictions. I can therefore only conclude that it will be the pace of vaccination, not the extent of restrictions that will determine how quickly the pandemic is brought under control.
Luckily there is some encouraging news on the vaccine front. Data from Public Health England’s SIREN study has shown that a single dose of the Pfizer-BioNTech vaccine led to a 70% reduction in cases of COVID-19 amongst healthcare workers who were regularly tested for the virus. This reduction in cases rose to 85% after a second dose. The results suggest that the vaccine does help to reduce transmission as fewer infections will inevitably mean less transmission.
The same study also suggests that a single dose of the same vaccine is 57% effective against symptomatic COVID-19 infections in those over 80 years of age. This level of protection was evident from 3-4 weeks after vaccination. A second dose raised protection further, with up to 85% protection against symptomatic disease following the second jab.
Earlier this week, Public Health Scotland released data from their EAVE II study, showing that hospital admissions due to COVID-19 were reduced by 85% and 94% by a single dose of the Pfizer-BioNTech and AstraZeneca vaccines respectively.
Over the past month, hospitalisation and death rates have continued to fall across all age groups. Most of this has been attributed to the ongoing effects of the lockdown. But it now looks as if we are beginning to see the effects of vaccination; the biggest falls in admissions and deaths are occurring in those age groups who have been vaccinated and are now protected. Out of 8000 people who were admitted to hospital, only 58 of them had been vaccinated.
This data is particularly encouraging for those who have been reluctant to use the AstraZeneca vaccine. You are probably aware that there are a number of European countries who are not using this vaccine in those who are over 65. It started with the Germans (doesn’t it always?) where stories began appearing in newspapers reporting that a German study had found that the AstraZeneca vaccine was only 6.3% effective in this age group. They also cited the fact that the AstraZeneca Phase 3 clinical trials only included a small number of people over the age of 55.
However, a lack of data on older patients is not proof of a lack of effect. The German study only included a tiny number of people who were over 65 and so the figure of 6.3% was essentially meaningless. Unfortunately, the damage appears to have been done. Although the European Medicines Agency approved the AstraZeneca vaccine for all age groups across the European Union, Germany’s vaccine commission said it could not recommend its use in people aged over 65. Austria and France followed suite with President Macron going further and wrongly claiming that the AstraZeneca vaccine was ‘quasi-ineffective’ for those over 65. In Belgium, the vaccine is only being given to those under 55.
Such policies will, I suspect, ultimately prove foolish. Public confidence in the AstraZeneca vaccine has plummeted and many people in Germany are refusing to have it. Only about 17% of the delivered doses have been given and despite appeals from the German Health Minister, tens of thousands of vaccine doses are sitting on shelves. Given the generally slow roll out of the vaccine programme across Europe, further delays will have significant consequences. Whether the new emergence of encouraging data will turn the tide remains to be seen.
Of course, not all news on the vaccination front is good. The potential storm on the horizon comes in the form of concern about the efficacy of existing vaccines against new variants. Reassuringly, both the Pfizer-BioNTech and AstraZeneca vaccines appear very effective against the now ubiquitous UK ‘Kent’ variant. Unfortunately, far less is known about their efficacy against the South African one. Results from a laboratory study involving the Pfizer vaccine suggest that this variant may reduce antibody production by two-thirds. Similar studies using the Moderna vaccine suggest a six-fold reduction in the antibody response. However, it is still unclear what this means in the real world. The antibodies that were produced in these studies were still able to neutralise the virus and it is not yet known what level of antibodies are required for protection. Indeed, in the only clinical trials involving people to date, both the Pfizer and Moderna vaccines did confer some protection despite producing an antibody response that was lower than that produced in the lab studies. Unfortunately, more information is needed before clinical efficacy can be accurately determined.
The AstraZeneca vaccine’s effectiveness against the South African variant has also been called into question. Both laboratory and clinical trials have suggested significantly reduced efficacy against the variant, with little or no protection against mild and moderate disease. The South African Government has therefore subsequently halted its use of this vaccine. Whilst this may seem alarming, the study only involved young people who do not tend to be badly affected by COVID-19. It was therefore impossible to assess whether the vaccine protects against severe disease. Both Johnson & Johnson and Novavax have also warned that their vaccines appear less effective against the South African strain. However, in clinical trials conducted in South Africa, both vaccines offered complete protection against severe disease and death. The AstraZeneca vaccine works in a similar way to the Johnson & Johnson one and so you would expect that the AstraZeneca one should offer a similar level of protection.
There is also still a widespread belief amongst experts that all vaccines should confer protection against severe disease caused by the current new strains of COVID-19. The WHO still recommends that all current vaccines can be used in areas with new variants. Vaccine-conferred immunity is not just about antibodies; other immune responses, such as T-cells, may also protect against disease and these responses may still be effective against the variants such as the South African one. Ultimately, it is a vaccine’s ability to protect against severe disease that is its most important role.
It is almost certain that our current batch of vaccines will have to be modified to work better against the new strains of COVID-19. Such new vaccines will inevitably be more effective against mild and moderate disease and will help to reduce transmission. However, with every passing week, new evidence suggests that the vaccines we do have are still able to stop serious illness and death. This should still be more than enough to bring the pandemic under control.