- June/July 2021: Covid-19 may seem to be under control- but we are not there yet.
- The World Picture: Snapshots Of Instability.
- Australia: The Great Delta Experiment.
- Vaccination Chaos, Politics.
- Australia: The Great Delta Experiment.
- So Where Are We Now? Vaccines don’t mean it is over!
- Vaccination Levels by Country.
- Pandemic Severity By Country: July 2021.
- Vaccination can even make things worse?
- Alternative Strategies: Should we just live with the virus?
June/July 2021: Covid-19 may seem to be under control- but we are not there yet.
After sending the world into chaos in 2020, now in mid 2021, most developed countries look to be on track to put this outbreak behind them. Vaccination programs are considered successful, and deaths are falling even in the few places cases numbers are not falling. But it is not clear how vaccines will lead us out of the pandemic, with spread not eliminated yet and new variant emerging it seems unclear if the virus will stop being a threat without ever continuing vaccinations and perhaps even restrictions.
I will update this page during July 2021.
The World Picture: Snapshots Of Instability.
Australia: The Great Delta Experiment.
Australia at one point looked to be an example of a Covid-19 success story. In the first half of 2021 no one died from a locally acquired case of Covid-19 in Australia, and while there are some situations where masks have been required there are rare and life has been very similar to life pre-Covid-19. No limits on dining or group gatherings and full crowds at sporting events are the normal levels. However, even back in March 2021, there were signs Australia could be in the eye of the storm, and now the cracks in that previously rosy picture have started to emerge and with some of the virus getting through quarantine and triggering lockdowns, Australia is no longer necessarily a great place to be during the pandemic. The storm still may pass, but right now around 1/5 of the Australian population are in lockdown.
In the first half on 2021 only one person in Australia died from Covid-19, and that person was infected outside Australia with the infection detected in arrival quarantine. In the same time period, two people died from complications from being vaccinated, which means there was more risk from the vaccine than the virus during this period. This can sound like a successful vaccination program where a relatively small number of deaths and hospitalisations are acceptable given the elimination of deaths from the disease. Except that most people are not vaccinated.
Australia has been a country being an unvaccinated person vulnerable to the virus been of a less risk the process of vaccination. Of course this has always been offset by the potential threat that emerges if Covid-19 does get through quarantine, as actually happened in late June 2021.
Unlike neighbouring New Zealand, where sufficient does of multiple vaccines for the entire population were secured to ensure the greatest certainty of a safe and effective vaccine, Australia put most of ‘the eggs in one basket’ in the form of the Astra-Zeneca vaccine. While the risk from Astra-Zeneca is extremely low, any risk takes a new perspective in a country where Covid-19 is not in circulation. The result is vaccine hesitancy.
Then it gets worse. Older people are typically the most risk adverse, and also the most vulnerable to Covid-19. So the greatest vaccine hesitancy would be expected with older Australians and the Astra-Zeneca vaccine. However since the risk of side effects from Astra-Zeneca is also older people, the Australian government faces the dilemma of requiring the Astra-Zeneca vaccine for those 60 and over. A 59 year old or younger person is recommended to have the Pfizer vaccine to avoid the risk, making the decision to be vaccinated just that much harder for a 60 year old. The result is that the age group most at risk if not vaccinated, are provided with the greatest risk from being vaccinated!
It is an understandable dilemma as the Australian government do no have enough vaccines to be able to avoid using Astra-Zeneca, creating the situation where the most risk adverse group are forced to be vaccinated with the vaccine presenting the greatest risk.
Sydney: The Delta Lockdown Experiment.
Early in the pandemic, New Zealand proved that a sufficiently strong lockdown could eliminate Covid-19 completely, without the difficult to impose on a western society measures used in China. Then, despite the national government in Australia declaring the economic cost of eliminating the virus would be too high, the state governments of Australia, who are in charge of health, proved that lockdowns could in most cases result in an open society, and the lowest medical and economic cost to society. The only catch was that quarantine would be required at the border.
When cases broke through quarantine, contact tracing and in the worst situations, snap lockdowns, kept Covid-19 at bay every time.
Until the delta variant of the virus, which has been described as Covid-19 on steroids. Sydney now has a cluster of the delta variant, and it is unproven anywhere in the world that lockdowns as imposed in Australia can stop this variant. So far, no country that has had outbreaks of the delta variant has eradicated spread of the outbreak.
Politics and Lockdown Dissent.
Some of the community and even senior members of the state government have pushed for simply letting the virus circulate in the community in Sydney and beyond and living with the consequences. The example of South Africa where the delta virus is causing the medical system to collapse as a third wave occurs, and the reality that with less than 9% of the population fully vaccinated the hospital system in Australia would also collapse has not stopped faction fighting within the government.
The national political approach to the pandemic is also complex, with the ruling party having originally positioned solutions as choice between economic and health outcomes, now still holds that view despite overwhelming evidence that the best health and economic outcomes are aligned, but the government now also supports border closures and seems in no rush for the pandemic to end after having seen state governments who have kept borders closed and avoided cases shown to be extremely popular with voters. The national government seems to be conflicted between an ideology that dictates no lockdowns to save lives, and the popularity of being open due to zero cases.
India: First Impact Site of Delta, and a dramatic recovery?
The second wave in India began to take hold at the start of March accelerated acutely until mid May when it started to recede almost as rapidly as it began. It is hard to give full credit to vaccines for rapid decline in cases as even now only just over 5% of the population are fully vaccinated. A significantly higher percentage, as many as 21%, are recorded as having a first vaccine dose, but given cases started falling two months ago, very few of those who now have one dose would have been vaccinated when cases began their rapid decline.
Lockdowns were resisted where possible, despite hospitals exceeding capacity.
“We have to save the country from lockdown,” Modi said in an address to the nation on April 20. “We have to try hard to avoid lockdowns.” Since then, the leaders of 35 of 36 of India’s states and union territories have imposed their own restrictions, including night curfews, partial closures and week-long lockdowns. These kind of short-term, localized measures are drastically different from the approach taken the last time India faced a coronavirus wave.CNN
It seems likely that a combination of lockdowns, vaccines and particularly heard immunity may have all played a role in bringing the outbreak under control. The official death toll was staggering, but widely believed to represent significant underreporting by at least a fact of two, and perhaps even a factor closer to five.
India’s official death toll is around 359,000 though The New York Times estimates it could be as much as 1.6 million.New York Times via Yahoo.
UK: Reopening, seriously, what immunity?
As the delta variant takes hold, cases are again surging in the UK. Despite the surge in cases, the UK plans to end all restrictions.
There are advocates for, and against, this reopening. Even with the rise in cases, deaths in the UK are well under control. There are however recent disturbing signs, and the suggestion that by opening with cases rising, the UK could risk becoming a variant factory.
There is also the more disturbing suggestion that plan in the UK could be to allow younger children to gain herd immunity through infection despite data suggesting children may be more at risk with delta and other new variants, and that people may be exposed to brain damage through ‘long covid‘.
Given the fact that so many people in Britain been infected with Covid-19 and/or vaccinated, the UK presents a case that ‘immunity’ may affect only disease severity, and does significantly impact spread.
The UK seems committed to not waiting for herd immunity before reopening, as explained in this article, the reason for opening now while cases are still rising, is that the surge of cases now, will be less what would if reopening at a later date. Either way, the UK is expecting case numbers to surge following re-opening. Given the definition of ‘herd-immunity‘ is that when herd immunity is reached, cases do not increase even when restrictions are removed, the UK is definitely planning to reopen without having achieved herd immunity. This could be because the UK feels herd immunity is not possible, or because they believe that some degree of herd immunity is best reached by infections, rather than vaccinations.
USA: A mystery to the decline in cases?
In the US, cases began to decline in mid January, despite vaccination levels at the that time still being quite low.
While the more recent drop in cases from April may be directly attributable to vaccinations, it seems most likely that the drop in January was at least in part due to herd immunity through infection, not vaccination.
Most reported cases are not people in their 20s, despite this age group being the most socially active and thus most likely to come in contact with the virus. Statistically there is reason to believe far more people have immunity from even asymptomatic infection then is suggested by recorded case numbers.
The likelihood that the decline in cases is not entirely due to vaccinations, means that there may be overconfidence on the effectiveness of vaccines administered so far being sufficient to combat the outbreak alone.
There seems no other explanation for the fall in cases from mid January other than herd immunity through infection within the local pockets of spread. Such immunity could be short term, localised, and can stop spread within a community once a sufficient number of people in contact with each other within the community have been infected. However, since evidence is that vaccinated or immunised people do not prevent spread, there may be a more effective level of immunity in the immediate few weeks following infection which for that time, has an increased effectiveness in blocking reinfection and spread.
If the current low case numbers are due to some herd immunity in addition to 50% of the population who have been vaccinated, then having this 50% of people vaccinated is not by itself sufficient to prevent future outbreaks. Lower case numbers result is a lack of new herd immunity from infections, which must be replaced by increased herd immunity from vaccination. If vaccination rates plateaux, cases will again rise.
The big question for the US is what size the 5th wave will be. Cases are rising, so there will be a 5th peak on the cases graph. The growth in cases is reported also triggered by newer variants such as delta or even delta plus. It would seem the biggest risks for the US, would be a waning in immunity from those who are immune by being infected, or those immune through being vaccinated, or either a strain more effective at spread or capable of infecting previously vaccinated or infected people. The threat to the US is amplified by social media, and assumptions of “it’s over” which combine to leave the US ill equipped to respond if there is another wave.
The lift in cases is sufficiently small that you have to look closely, a 5th wave is starting. Or a 4th wave if the peak in early August 2020 is consider part of the wave that peaked in October. Either way, after months almost no reported cases at all, cases are again starting to rise, despite Israel having administered more vaccinations than any other country, with almost 6 million of the 9.4 million population fully vaccinated, plus the immunity from infections. Israel shows that, over 1 million verified infections and thus an inevitably at least 3x larger number of actual infections, for at total of likely 75% of the population immune, the delta strain means Covid-19 can still spread.
An update at this time has to record the figures for Japan with the Olympics running from July 21 to August 8th. Japan is also at the start of a 5th wave with cases again rising. Japan with 130 million people has so far had less total cases at this time than Israel, and while there are more cases per day in Japan than Israel, on a per capita basis there are more cases in Israel, despite Japan only having vaccinated hat would also cases are now higher than Israel, despite Japan having less than half as many people vaccinated, and an extremely low percentage of people with immunity as a result of having been infected.
So Where Are We Now? Vaccines don’t mean it is over!
Vaccination Levels By Country: July 2021.
This page on the Australian ABC web site has a data on vaccination levels by country, with both percentage with first dose and percentage fully vaccinated. I have saved data and plan to post a concise list of status as at 8th July 2021.
Pandemic Severity By Country: July 2021.
Although underreporting would make the data imperfect, the worldometers.info coronavirus countries page, when sorted by “deaths per 1M population” provides a league table of the severity of outbreaks in different countries. Currently, with Peru having the highest rate at number 1, Hungary at number 2, and the USA is at 21, just lower than the UK at 20, and with Mexico at 22. Brazil 10, Belgium 13 and Italy 16 all have had a worse time than the US while India, despite recent outbreaks, would still be ranked down at 107 if their data could be trusted. Sweden is at 36 while neighbours Norway is at 129 and Finland is at 120. Luckier countries include South Korea at 160, Australia at 164, Taiwan at 167, Singapore 198, New Zealand at 199, Vietnam 203, Greenland 214, and Micronesia at 222.
Vaccination can even make things worse?
Australia, at 164 on the table, as with just over 25% of countries having less deaths per million population so far, has needed some restrictions to manage these above average results. Typically these above average results have been the result of:
- strict measures cases do emerge
- tight border controls
- quite normal life most of the time when there are no outbreaks.
The reward for strict measures to eradicate spread, is that once spread is eradicated, life can be relatively normal. Outside of relatively short snap lockdowns, what remains is mostly border restrictions, with the countries in this group typically enjoying far greater freedoms and better economic outcomes than countries where Covid-19 outbreaks are not brought fully under control. However, not matter how successful, no country has been able to just ignore Covid-19.
The promise is that, once vaccinated, whatever measures these countries do have, typically border quarantines, can finally go away. Note that for example Australia, has had 35 deaths per million people, New Zealand 5 deaths per million. Peru has had 165 times Australian death rate, and 1,000 times as many deaths per million as New Zealand. The USA has had it 50 times and 350 time the death rate. All countries in this most fortunate 25% that have largely escaped so far, will have their worst outcome if, following vaccinations, other measures including quarantine are removed.
So long as vaccinated people can still spread the virus, this so far lucky 25%, will most likely have more deaths and negative health outcomes once vaccinations result in open borders. Considering that, within many of the countries with low case number now, a post vaccinated world will in some ways in some places be worse than before people were vaccinated.
Alternatives Strategies: Should we live with the virus.
Even the post vaccine world is worse than 25% of countries experience so far. Certainly it is a far worse world than prior to the pandemic. While vaccinations have far, far, lower health risks than Covid-19 itself, a life of being vaccinated is not completely free of risks either, and still some people with suffer from the disease itself, even if far fewer die from the disease. That is provided future mutations from a still globally circulating virus do not derail progress.
Should we be considering an alternative to simply vaccinating people and then living with it?