Coronavirus

[johnu]

A big part of the vaccination problem in (continental) Europe is that certain countries in the vaccine supply chain (notably the US and UK) are acting very selfishly (sometimes called "vaccine nationalism") and refusing to allow companies to ship any vaccines out of the country.

I'm not sure about the locations of vaccine production factories. However, the US has contracts for 300 million Pfizer doses, and 300 million Moderna doses for a population of around 330 million. With a significant number of anti-vaxxers and a few with legit medical reasons not to get vaccinated, plus all the children who are not covered by the emergency use authorizations, that's more than enough vaccine to cover everybody who is eligible. Plus there is a contract for 100 million doses from J&J, and contracts from some other companies like Sanofi, GlaxoSmithKline, Novavax, and AstraZeneca which do not have emergency use authorizations yet. Those companies all seem to have 100 million dose orders except AstraZeneca which has an agreement for 300 million.

 

So the US has enough doses under contract to eventually vaccinate everybody with 2 different vaccines. I heard the US has a warehouse full of the AstraZeneca vaccine that it has refused to share, which is weird because AstraZeneca hasn't even applied for an emergency use authorization. But some countries have put AstraZeneca on hold because of blood clots and I haven't kept up on what's going on there.

[Cyberyeti]

What I've heard is that the J&J vaccine has a manufacturing plant in Europe, but they send it to the US for bottling, at which point the US refuses to ship any back to Europe. A big part of the vaccination problem in (continental) Europe is that certain countries in the vaccine supply chain (notably the US and UK) are acting very selfishly (sometimes called "vaccine nationalism") and refusing to allow companies to ship any vaccines out of the country. The fact that the EU is not doing this is helpful to the world at large (especially poorer countries not involved in vaccine manufacture) but hurts the EU itself in the short term.

 

Of course, the EU also has somewhat more conservative vaccine approval processes (perhaps if the Sputnik vaccine was approved the supply situation would be better?) but basically the same vaccines are approved in the EU and US and the vaccination rates are very different despite the EU generally having better organised healthcare systems.

 

I think this is a slight mischaracterisation of the UK's position. We supply some of the contents of the Pfizer vaccine made in the EU.

 

The EU's faux outrage at AstraZeneca (when they have hundreds of thousands of doses they can't get into arms because people don't want them) is ridiculous. Apparently the Netherlands has only got 44% of its doses into people. It's much more efficient to have them go into UK arms where there's less resistance, and then we can let other people use the other jabs once we're done.

 

This article seems to summarise it reasonably fairly https://www.bbc.co.uk/news/56483766

[cherdano]

I think this is a slight mischaracterisation of the UK's position. We supply some of the contents of the Pfizer vaccine made in the EU.

 

(...)

 

This article seems to summarise it reasonably fairly https://www.bbc.co.uk/news/56483766

 

I don't think this BBC article is good summary of the overall story. First of all, the EU has administered about 80% of its AZ vaccine doses overall, which seems a completely healthy ratio given that

In my understanding, it goes as follows.

 

• The UK government started directly supporting the development, setting up manufacturing etc. of the "Oxford vaccine" quite early.
  
• In exchange, it asked for quite a bit of control - e.g. it insisted Oxford would partner with Astrazeneca, which would set up production in the UK and Europe, rather than the US company Merck, which might have produced them in the US and made them subject to US export controls. (And this despite Astrazeneca having no experience in vaccine manufacturing.)
  As part of this licensing deal with Astrazeneca, it also insisted on preferential access to the vaccine, including (in the beginning) 100% of the doses manufactured in the UK.
  
• In the EU, development and setting up of manufacturing capabilities were instead left to the companies. It was still supported by the EU - on the one hand, upfront by research grants or loan financing of which BionTech had received plenty (pre-pandemic), and of course after the fact via procurement contracts. But this setup made the EU a normal customer of Pfizer/BionTech, on equal rights with every other country.
  

I.e., in some sense the UK nationalised vaccine developments, in both senses of the word. So it isn't unfair to accuse it of "vaccine nationalism". But I am still not sure the EU, and the rest of the world, would have been better off otherwise - the UK wouldn't have had exclusive access to the doses produced in the UK. But manufacturing might have been slower, and Oxford would have partnered with a company charging for profit, rather than following the "no profit during the pandemic"-promise AZ made.

[Cyberyeti]

I don't think this BBC article is good summary of the overall story. First of all, the EU has administered about 80% of its AZ vaccine doses overall, which seems a completely healthy ratio given that

In my understanding, it goes as follows.

 

• The UK government started directly supporting the development, setting up manufacturing etc. of the "Oxford vaccine" quite early.
  
• In exchange, it asked for quite a bit of control - e.g. it insisted Oxford would partner with Astrazeneca, which would set up production in the UK and Europe, rather than the US company Merck, which might have produced them in the US and made them subject to US export controls. (And this despite Astrazeneca having no experience in vaccine manufacturing.)
  As part of this licensing deal with Astrazeneca, it also insisted on preferential access to the vaccine, including (in the beginning) 100% of the doses manufactured in the UK.
  
• In the EU, development and setting up of manufacturing capabilities were instead left to the companies. It was still supported by the EU - on the one hand, upfront by research grants or loan financing of which BionTech had received plenty (pre-pandemic), and of course after the fact via procurement contracts. But this setup made the EU a normal customer of Pfizer/BionTech, on equal rights with every other country.
  

I.e., in some sense the UK nationalised vaccine developments, in both senses of the word. So it isn't unfair to accuse it of "vaccine nationalism". But I am still not sure the EU, and the rest of the world, would have been better off otherwise - the UK wouldn't have had exclusive access to the doses produced in the UK. But manufacturing might have been slower, and Oxford would have partnered with a company charging for profit, rather than following the "no profit during the pandemic"-promise AZ made.

 

Is it AZ or one of the others that's being made in India ?

 

Also the UK negotiated penalty clauses for non supply with AZ, the EU didn't, which is why AZ was supplying the UK from Europe to meet the agreed contracts. Whether this is a good thing I'm not sure

 

Where are you getting that 80% EU figure from ? because France and Germany are MILES below that and they're the 2 biggest. In fact if you follow the link in the article, very few countries are over 80% so at the time of the article I very much doubt your figure (Spain, Poland and Italy are below 80% too IIRC, it's only places like Hungary, the Czech Rep and Lithuania that are over).

[Zelandakh]

Current estimates for Germany are:-

 

AZ: 3109351 single dose; 2177 double dose; 2466072 stored

BNT: 6857330 single dose; 4340796 double dose; 1158049 stored

Mod: 580588 single dose; 191802 double dose; 989210 stored

[pilowsky]

Johns Hopkins has provided an excellent Dashboard to track COVID19.

It now has a vaccine tracker as well.

http://bit.ly/JHVacTrac

[pilowsky]

Some data is now emerging about the extent of excess mortality as a result of the pandemic.

This paper was published in July 2020 in JAMA - a very trustworthy source.

They conclude - inter alia - that:

 

 

Key Points

 

Question: Did more all-cause deaths occur during the first months of the coronavirus disease 2019 (COVID-19) pandemic in the United States compared with the same months during previous years?

 

Findings: In this cohort study, the number of deaths due to any cause increased by approximately 122 000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths.

 

Meaning: Official tallies of deaths due to COVID-19 underestimate the full increase in deaths associated with the pandemic in many states.

 

Results: There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19–reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths.

 

 

Daniel M. Weinberger et al., Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020 (1 July 2020)

 

JAMA Intern Med. 2020;180(10):1336-1344. doi:10.1001/jamainternmed.2020.3391

 

 

[kenberg]

There are some numbers from CDC that possibly take into account further analysis since that July 2020 article. See

https://www.cdc.gov/...vid19/index.htm

 

For March, April, May of 2020 they report the number of covid deaths as

March 7094

April 65239

May 38188

This totals

110,521

 

This number is more comparable to the increase in the number of deaths from any cause, but of course still noticeably smaller.

 

We have to allow for some ambiguity. The numbers above are called All Deaths Involving COVID-19.

There is a footnote explaining that this means

"Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1."

I am not familiar with code U07.1 and I intend to stay in that blissful state.

 

 

From what I have seen, the cause of death that appears on a death certificate is technically accurate but fairly often it is far from the whole story. Researchers know this and with covid I suppose they are trying their best to understand whether, say, the death is from pneumonia or from pneumonia that was brought on by covid, but it could be a tough call.

 

 

Anyway, the bottom line appears to be that yes, some deaths that are not listed as covid deaths might well be deaths that would not have occurred if the patient had not been exposed to covid.

[hrothgar]

Financial Times had a good article discussing excess deaths today

 

Here's a key chart

 

 

https://twitter.com/jburnmurdoch/status/1379499695395995649/photo/1

[Cyberyeti]

 

Anyway, the bottom line appears to be that yes, some deaths that are not listed as covid deaths might well be deaths that would not have occurred if the patient had not been exposed to covid.

 

Yes but also some of them were deaths where Covid was involved of people who were very old, frail and sick for other reasons and would have died in the next few months anyway.

 

In the UK excess deaths were negative in the months after that peak for that reason.

 

You also have the other excess deaths where other treatment is delayed, or because of mental health breakdowns (suicides and homicides). Covid/lockdown causes these, but is not on the death certificates.

[hrothgar]

 

 

You also have the other excess deaths where other treatment is delayed, or because of mental health breakdowns (suicides and homicides). Covid/lockdown causes these, but is not on the death certificates.

 

Here in the US, the total number of suicides decreased significantly

[Cyberyeti]

Here in the US, the total number of suicides decreased significantly

 

We don't know here, the official figures for suicides for last year won't be published for another 6 months, but according to the relevant charities domestic violence has massively increased (and I suspect that will affect the suicide and homicide figures).

[kenberg]

Yes but also some of them were deaths where Covid was involved of people who were very old, frail and sick for other reasons and would have died in the next few months anyway.

 

In the UK excess deaths were negative in the months after that peak for that reason.

 

You also have the other excess deaths where other treatment is delayed, or because of mental health breakdowns (suicides and homicides). Covid/lockdown causes these, but is not on the death certificates.

 

Yes, I agree that many of the deaths were people who did not have all that much longer to live anyway. That has relevance to how we think about the deaths but a death from covid is still a death from covid. It depends on just what we want to assess.

 

 

Not for the first time, I will mention that I am 82. We do see life a bit differently. A fair number of friends are no longer around. A recent obit of a friend went into some detail about her early life, Becky and I were impressed that anyone even knew that much about her, and decided that if we wish to have that detailed an obit maybe we need to start writing it. Hardly a thought that would have occurred to me twenty years ago.

Still, I plan on being around for a while. I am not making any twenty year plans but I am being careful about covid.

 

Anyway, stats are tough. Most need to be taken with a grain of salt. For example, I got my covid shot through the University of Maryland Medical System. They asked if I would be willing to respond to a brief daily email questionnaire tracking my health. Sure. So the first question is "How is your general health?" Hmmm. The answer "As 82 year old general health goes, I would say it is good" is not one of the allowed answers. So I just check good. I won't bother you with the various qualifications that I could make to that "good".

 

 

It seems clear that covid has had a very substantial impact on our health and on the death rate. The exact numbers? Well, others can argue.

[Cyberyeti]

Yes, I agree that many of the deaths were people who did not have all that much longer to live anyway. That has relevance to how we think about the deaths but a death from covid is still a death from covid. It depends on just what we want to assess.

 

 

Not for the first time, I will mention that I am 82. We do see life a bit differently. A fair number of friends are no longer around. A recent obit of a friend went into some detail about her early life, Becky and I were impressed that anyone even knew that much about her, and decided that if we wish to have that detailed an obit maybe we need to start writing it. Hardly a thought that would have occurred to me twenty years ago.

Still, I plan on being around for a while. I am not making any twenty year plans but I am being careful about covid.

 

Anyway, stats are tough. Most need to be taken with a grain of salt. For example, I got my covid shot through the University of Maryland Medical System. They asked if I would be willing to respond to a brief daily email questionnaire tracking my health. Sure. So the first question is "How is your general health?" Hmmm. The answer "As 82 year old general health goes, I would say it is good" is not one of the allowed answers. So I just check good. I won't bother you with the various qualifications that I could make to that "good".

 

 

It seems clear that covid has had a very substantial impact on our health and on the death rate. The exact numbers? Well, others can argue.

 

You are a year or so younger than my father, who also with qualifications is in good health and has had his 2 jabs. He in his capacity as an archaeologist has written obituaries for some of the national papers for some of his contemporaries. He may not merit one in the national press but someone will have to write one for other places.

[barmar]

Yes, I agree that many of the deaths were people who did not have all that much longer to live anyway. That has relevance to how we think about the deaths but a death from covid is still a death from covid. It depends on just what we want to assess.

In general, even if someone is close to death, we consider whatever time they have left to be valuable, and medical professionals and care givers usually try to extend it as much as possible. Other than assisted suicide by request of the suffering patient, anything that cuts short this time is considered tragic (and assisted suicide is also controversial, illegal in many places).

 

So if someone dies 2 months sooner than they otherwise would have because of COVID, it makes sense to consider this an excess death.

[Cyberyeti]

In general, even if someone is close to death, we consider whatever time they have left to be valuable, and medical professionals and care givers usually try to extend it as much as possible. Other than assisted suicide by request of the suffering patient, anything that cuts short this time is considered tragic (and assisted suicide is also controversial, illegal in many places).

 

So if someone dies 2 months sooner than they otherwise would have because of COVID, it makes sense to consider this an excess death.

 

I actually disagree with this having lost relatives who were in so much pain from cancer that the drugs to relieve that robbed them of any mental capacity, and people in late stage Alzheimers who didn't know who their closest relatives were. They were effectively already dead some time before their hearts stopped beating. Dying a few days or weeks early due to Covid might not be such a bad thing in these cases.

[kenberg]

In general, even if someone is close to death, we consider whatever time they have left to be valuable, and medical professionals and care givers usually try to extend it as much as possible. Other than assisted suicide by request of the suffering patient, anything that cuts short this time is considered tragic (and assisted suicide is also controversial, illegal in many places).

 

So if someone dies 2 months sooner than they otherwise would have because of COVID, it makes sense to consider this an excess death.

 

Yes, or rather yes but.

 

 

I would not like someone saying "Oh, so Ken dies from covid, so what, he is going to die from something soon anyway". I would not like that at all. The "but" is that in emergencies with many people dying sometimes the choices are really tough. To be a bit theatrical, in a burning building if a rescue worker can rescue me or rescue a twenty-year-old but not both of us, I can imagine him choosing the twenty-year-old (especially if she is attractive :) ). But there could also be thinking from a different perspective. Not long ago, hospitals were overwhelmed. You would hear of ambulances carrying seriously injured people being turned away for lack of bed space. I can imagine planners thinking "Well, these older people are more likely to need hospitalization than the young are so let's give the vaccine to the older ones, it will free up some beds". And then, if you are studying the economic impact of half a million deaths, it probably matters just who is doing the dying.

 

But definitely, I would not want to be thought of as a "Who cares?".

 

A note to Cyber: I can well imagine a time when I would say "Hey, it's over. Stop with the pointless attempts to avoid reality". But it's a long way from there to thinking of covid as no big deal or as a welcome solution.

 

We are hopefully getting the vaccine to many. Nonetheless, there will still be some getting it and some not yet getting it. . We can argue about priorities, but we cannot eliminate priorities, Not yet.

I'm satisfied enough with the way it is being handled.

[Winstonm]

Choosing to die earlier than necessary is an act of courage for those with a fatal disease as it is an abandonment of hope. Hope - tempered by realism - should remain the Provence of the ill person.

[pilowsky]

I think we went through this discussion about a year ago when this all started. I note that opinions are substantially the same.

 

An important side benefit of the current pandemic is that (anecdotally - from speaking to my local Doctor) the number of all infections in the community has declined dramatically.

 

When COVID first emerged, I developed a bit of a cold and was tested. It turned out to be a rhinovirus - I've been polishing my horns ever since - and so I quarantined myself so as not to communicate it in Bridge clubs.

 

As bad as COVID is (really bad), any RTI (respiratory tract infection) is potentially lethal to Bridge players.

 

Apart from the occasional callow youth, almost all the people that play Bridge are textbook cases of co-morbidity.

Including emphysema, heart transplant, cancer, diabetes, atrial fibrillation, and that's just the healthy people.

 

All good reasons for playing "behind screens".

 

Just to repeat myself all over again.

 

[barmar]

I actually disagree with this having lost relatives who were in so much pain from cancer that the drugs to relieve that robbed them of any mental capacity, and people in late stage Alzheimers who didn't know who their closest relatives were. They were effectively already dead some time before their hearts stopped beating. Dying a few days or weeks early due to Covid might not be such a bad thing in these cases.

This is why we have living wills, DNRs, etc. -- so you can make your preferences clear before you get to the point that your decisions can't be trusted.

 

And even with those instructions, it's still sometimes a difficult judgement call as to whether the patient actually meets the criteria they specified for pulling the plug. This is not an easy problem, and if there's any doubt the doctors will usually err on the side of keeping the patient alive (you can't undo the other decision).

[barmar]

I would not like someone saying "Oh, so Ken dies from covid, so what, he is going to die from something soon anyway". I would not like that at all. The "but" is that in emergencies with many people dying sometimes the choices are really tough. To be a bit theatrical, in a burning building if a rescue worker can rescue me or rescue a twenty-year-old but not both of us, I can imagine him choosing the twenty-year-old (especially if she is attractive :) ). But there could also be thinking from a different perspective. Not long ago, hospitals were overwhelmed. You would hear of ambulances carrying seriously injured people being turned away for lack of bed space. I can imagine planners thinking "Well, these older people are more likely to need hospitalization than the young are so let's give the vaccine to the older ones, it will free up some beds". And then, if you are studying the economic impact of half a million deaths, it probably matters just who is doing the dying.

Sounds a lot like the Trolley Problem -- you're damned if you do, damned if you don't, and you have to pick one.

[pilowsky]

The solution to the trolley problem is to move the person that is alone on the track to the other track.

That way you can get all of them at the same time.

[Zelandakh]

The

is to move the person that is alone on the track to the other track.

That way you can get all of them at the same time.

[pilowsky]

Well done Mark! Good to see we are both reading the same philosophical treatise.

[cherdano]

Btw, here is a study just for our dear friend Cyberyeti:

A new large study of 21 high- & upper-middle-income countries found that suicide numbers "remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period"