The tide is surely turning. I hope so.
In today’s “The Times” (and backed up by Professor Tim Spector who has been running the respected ZOE study) it seems that the politicians, and clinicians outside the DoH, are optimistic that the Omicron peak has been reached, at least in London, and that the rest of the UK will follow. Work from both the UK and Denmark confirms that Omicron is much less likely to produce severe illness, which the brigade suggesting that the South African experience was due to a population difference should find encouraging. Today’s figures are in line with this; no sudden spike n admissions, and certainly no increase in deaths. It is also now clearly being suggested that the problem in the UK is not the numbers of SARS-CoV-2 patients being admitted to hospital, but the large numbers of staff who are isolating because of a positive test – which is what I suggested yesterday.
If someone has a positive test, whether it be PCR or lateral flow (LFT), the likelihood that they will be infectious once the LFT reverts to negative is close to zero. I suggest therefore that the testing strategy for NHS staff be changed. LFTs will confirm infectivity and should become the baseline for testing. If staff are forced to isolate on the basis of a PCR test they may remain off work far longer than is necessary, not least as we still have no idea what the PCR cycle threshold is in current use. I suspect it is over 30 in most labs, so the false positive numbers must be very large. Indeed, if Omicron is overall little worse than a bad cold I am beginning to wonder why we are testing at all. Caution is reasonable; over-caution is damaging. My sources suggest that Covid-19 is still a major problem in the over-65s, and one must take special precautions with this group, maybe, but anyone who develops serious disease needs serious treatment – and it still seems that patients are presenting quite late and thus missing, perhaps, the window of opportunity.
Meanwhile I awoke from a nightmare early this morning having been informed my PCR test was positive, and I needed to repeat it until it wasn’t. It took me a good ten minutes to get the whole dream out of my head and force myself to remember I had not had one. And, just in case, I did an LFT this morning (I have no symptoms, so you might wonder why I am obsessing. No comment.). It was, of course, negative.
I was also, once fully awake and calmed down, thinking about clinical trials again. I believe that the dexamethasone and tocilizumab trials were unnecessary. Back in May 2020 I postulated that the IL-1 antagonist, anakinra, might also be a useful agent, as in other cytokine storm syndromes and in Kawasaki disease. It has an advantage over tocilizumab of being cheaper and has a shorter half-life. Lo and behold! There’s a paper in “The Lancet” testing it! See https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00216-2/fulltext, and yes, it appears to reduce severity in patients with investigation markers of a cytokine storm.
What a surprise. It actually appeared in August but I took my eye off that ball, not least because an earlier paper (https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30556-7/fulltext) found no benefit. Suffice it to say that the European Medicines Agency licensed its use in Covid-19 on December 17th. As with the other two, I wonder how many lives might have been saved if the need for a trial had been discounted in May 2020 as I argued, scientifically but unsuccessfully. I will put this point to the inquiry.
Postscript: Today (5th January) the BBC reports that “PCR not needed after positive lateral flow under new plans”.
The advice appears to rely on the same NEJM paper as I quoted on 3rd January. Is the DoH finally listening to me, or is this a happy coincidence (in which case I will claim that I was there first).
The Wry Observer 
Generally, we think that doctors are well educated, thoughtful and caring, so we listen. The BBC featured a hospital consultant challenging Sajid Javed about losing his job if unvaccinated. He said that the scientific evidence wasn’t adequate.
Now I’m confused!
About 50M people have had 3 jabs. I haven’t heard of any serious reactions. An overwhelming proportion of patients in critical care are unvaccinated. What better evidence does he want?
I don’t think there is much doubt over whether vaccines reduce the risk of serious consequences (ie Covid-19, which to me is the life-threatening bit of SARS-CoV-2 infection, although the two terms are used loosely, which causes confusion). They do. The question is – can we identify (a) those who are at risk of Covid-19 – answer, yes, it’s the obese, genetically predisposed. those with concurrent serious medical disorders and the elderly and (b) can we treat it if it happens – answer also yes. Of course, the more people who are vaccinated the more likely it is, statistically, that admitted patients will have been vaccinated, but of course the fact that you had a positive test on or after admission does not imply that Covid-19 is the cause of the admission. Indeed it’s estimated that 40% of admitted patients are admitted with something else, and the coronavirus test is incidental. There again, some 30% of “Covid” patients have acquired it in hospital.
That’s a long preamble to your question. Vaccination is unquestionably effective in reducing the number of people getting severe disease consequent upon SARS-CoV-2 infection. It does not, and never could stop you from acquiring the virus. So it won’t reduce the number of hospital staff who might get it. Its only benefit, as I see it, is that it would significantly reduce the risk of any such staff from becoming seriously ill, which may not have any major effect because most of them are in low-risk groups to begin with. It will have no effect on staff numbers who test positive (we can argue about whether, with Omicron, it matters but that’s another story). On that basis, compulsory vaccination is a waste of time except in the limited area of severe disease prevention in staff. And it follows therefore that while vaccination may be sensible, if folk have genuine concerns about it they should not be compelled to have it.
There are a few significant side-effects, although things such as myocarditis are frequent in patients with Covid-19 and I think the risks have been seriously overblown. You have only to look at the figures compiled from adverse event reporting to realise that most of them are common things that occur commonly, and that cause and effect are unlikely. But compulsion will cause substantial difficulties in the NHS if the result is a loss of staff – 10% perhaps? And how many unvaccinated have actually had an infection anyway (the Djokovic argument)? We don’t know. While I think vaccination is sensible, and should certainly be pushed very hard for the high-risk groups, I suspect that in a court of law if someone was to prove past infection then that would be a legitimate excuse not to be vaccinated.
As for doctors being well-educated that is not exactly true. They are well-taught, but I have seen so many errors, both in clinical practice and research, that they may not be as well-educated as you hope. As an example a German acquaintance of mine asked a sample of medics what percentage was represented by 1 in 1000, and some 30% got it wrong.
“the evidence that lockdowns don’t work was not that good back then”: the evidence that lockdowns might be expected to work was, on the other hand, non-existent. Adopting lockdowns was an act of either (i) sheer stupidity, or (ii) political cowardice, giving a panicking population the tough response it demanded. The illicit party rather suggests that (ii) is the correct explanation.
Unfortunately the entire world was seduced by the lockdown plan – partly, I suspect, because governments were terrified that if they did not, following the lead from China (which initially started it, and might have been expected perhaps to have inside information to justify it), they would be pilloried if they didn’t, and got it wrong. Heads I win, tails you lose. Almost every country did it – and at least one can argue that being able to compare places that did with places that didn’t (eg Sweden and some US states) one had a trial of sorts.
Of course, as I have said several times before, no-one’s lockdown was a real lockdown, excepting perhaps New Zealand. There were too many exceptions (eg delivery drivers and even, sadly, health professionals). Had every single person isolated it would have worked.