Vaccine rollout in the UK

[lpm]

Hmm. The first thing the Roche N thing does is change the denominator in the Table 4 you posted above. The far right hand column takes cases per 100,000 not vaccinated. Assuming flat 20%, this column needs adjusting to cases per 80,000 not protected, i.e. divide by 0.8.

This pretty much gives equal figures for the rates in the two right hand columns, for the 40-79.

This at least removes the puzzle of why the rate per 100,000 appears lower for the unvaxxed. But still leaves the mystery of why it isn't noticeably higher like in the <40s and >80s.

[shpalman]

"Earlier in this report": pages 5--7.

Vaccine effectiveness against symptomatic COVID-19 has been assessed in England based on community testing data linked to vaccination data from the NIMS and from the COVID Infection Survey. Current evidence is primarily from older adults, who were among the earliest group vaccinated. Estimates of vaccine effectiveness range from around 55 to 70% after 1 dose, with little evidence of variation by vaccine or age group (3, 4, 5). Data on 2 doses is indicates effectiveness of around 65 to 90% (3, 6).
...

Effectiveness against infection

Although individuals may not develop symptoms of COVID-19 after vaccination, it is possible that they could still be infected with the virus and could transmit to others. Understanding how effective vaccines are at preventing infection is therefore important to predict the likely impact of the vaccination programme on the wider population. In order to estimate vaccine effectiveness against infection, repeat asymptomatic testing of a defined cohort of individuals is required. Studies have now reported on vaccine effectiveness against infection in healthcare workers, care home residents and the general population. With the Pfizer-BioNTech, estimates of effectiveness against infection range from around 55 to 70%, with the Oxford-AstraZeneca vaccine they range from around 60 to 70% (5, 13, 14, 15). With 2 of 2 doses of either vaccine effectiveness against infection is estimated at around 65 to 90% (5, 13).

Effectiveness against transmission

As described above, several studies have provided evidence that vaccines are effective at preventing infection. Uninfected individuals cannot transmit; therefore, the vaccines are also effective at preventing transmission. Data from Scotland has also shown that household contacts of vaccinated healthcare workers are at reduced risk of becoming a case, which is in line with the studies on infection (16). There may be additional benefit, beyond that due to prevention of infection, if some of those individuals who become infected despite vaccination are also at a reduced risk of transmitting (for example, because of reduced duration or level of viral shedding). A household transmission study in England found that household contacts of cases vaccinated with a single dose had approximately 35 to 50% reduced risk of becoming a confirmed case of COVID-19. This study used routine testing data so would only include household contacts that developed symptoms and went on to request a test via pillar 2. It cannot exclude asymptomatic secondary cases or mildly symptomatic cases who chose not to request a COVID-19 test (17).

COVID report Week 36 Table 1.png (202.16 KiB) Viewed 2804 times

3. Lopez Bernal J, Andrews N, Gower C, Robertson C, Stowe J, Tessier E and others. ‘Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on COVID-19-related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study.’ British Medical Journal 2021: volume 373, n1,088
4. Public Health England. ‘Public Health England vaccine effectiveness report – March 2021. Public Health England 2021
5. Pritchard E, Matthews PC, Stoesser N, Eyre DW, Gethings O, Vihta K-D and others. ‘Impact of vaccination on SARS-CoV-2 cases in the community: a population-based study using the UK’s COVID-19 Infection Survey.’ medRxiv 2021: 2021.04.22.21255913
6. Public Health England. ‘Public Health England COVID-19 vaccine surveillance report: 20 May 2021 (week 20)’ Public Health England 2021

13. Hall VJ, Foulkes S, Saei A, Andrews N, Oguti B, Charlett A and others. ‘COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study.’ Lancet 202
14. Shrotri M, Krutikov M, Palmer T, Giddings R, Azmi B, Subbarao S and others. ‘Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study.’ Lancet Infectious Diseases 2021
15. Menni C, Klaser K, May A, Polidori L, Capdevila J, Louca P and others. ‘Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study.’ The Lancet Infectious Diseases 2021
16. V Shah AS, Gribben C, Bishop J, Hanlon P, Caldwell D, Wood R and others. ‘Effect of vaccination on transmission of COVID-19: an observational study in healthcare workers and their households.’ medRxiv 2021: 2021.03.11.21253275
17. Harris RJ, Hall JA, Zaidi A, Andrews NJ, Dunbar JK, Dabrera G. ‘Impact of vaccination on household transmission of SARS-COV-2 in England.’ Public Health England 2021

[shpalman]

UK rules out Covid vaccinations for children

the Guardian still reckons they will

And they still still reckon they will

hey guess what

(good)

[OffTheRock]

the Guardian still reckons they will

And they still still reckon they will

hey guess what

(good)

I don’t think Us4Them are going to be pleased. I expect there is going to be quite an increase in anti-vax and children don’t get covid stuff on social media.

[shpalman]

Why infection rates among double-vaccinated older adults look worse than they are in the Conversation.

Apparently it's because "we don’t know how many people are in England".

Specifically, we know how many people have been vaccinated but with such high coverage, being out by a few million on the remaining unvaccinated population completely changes the case rates in that group.

[Sciolus]

the Guardian still reckons they will

And they still still reckon they will

hey guess what

(good)

I don't get why this is a decision. The risks to children are exceedingly small. The benefits to children as individuals are also extremely small, and JCVI has gone hung up on which tiny number is smaller. But they are following a false dichotomy between "no children may be vaccinated" and "all children should be vaccinated". Surely we should just make it available and let children (and their parents) decide how much they value the benefits both to themselves and to wider society.

[shpalman]

And they still still reckon they will

hey guess what

(good)

I don't get why this is a decision. The risks to children are exceedingly small. The benefits to children as individuals are also extremely small, and JCVI has gone hung up on which tiny number is smaller. But they are following a false dichotomy between "no children may be vaccinated" and "all children should be vaccinated". Surely we should just make it available and let children (and their parents) decide how much they value the benefits both to themselves and to wider society.

I think that is indeed exactly what this is.

Chris Whitty stresses that it is an offer (ie vaccination would not be compulsory).

Seems like the main benefit they factored in, compared to the JCVI, was the benefit of not missing school.

I don't get why this was such a laboured decision.

[Bird on a Fire]

So how does this work? If there's an outbreak, vaccinated kids have to keep going to school but the unvaccinated ones can stay home?

It doesn't seem quite as strong as incentive as keeping folk out of nightclubs.

[raven]

So how does this work? If there's an outbreak, vaccinated kids have to keep going to school but the unvaccinated ones can stay home?

It doesn't seem quite as strong as incentive as keeping folk out of nightclubs.

Well, that's perhaps not a strong incentive for kids. But it might be for parents.

[lpm]

The booster jabs seem straightforward. As expected, apart from using half doses of Moderna.

Care homes first, then down the 1-9 age groups with at least 6 months between second doses and booster. A 50 year old would typically have had the second dose in mid June, so will boosters will mostly be done by Christmas.

Along with the extra flu jabs it's going to be a busy few months for arm stabbers.

[lpm]

And they still still reckon they will

hey guess what

(good)

I don't get why this is a decision. The risks to children are exceedingly small. The benefits to children as individuals are also extremely small, and JCVI has gone hung up on which tiny number is smaller. But they are following a false dichotomy between "no children may be vaccinated" and "all children should be vaccinated". Surely we should just make it available and let children (and their parents) decide how much they value the benefits both to themselves and to wider society.

There's no possible way any child or parent could properly make an informed decision, when weighing the balance between the two tiny things.

It has to be experts making the decision and it seems obvious they should be very careful about that decision. It's all pretty irrelevant in the wider scheme of things for society in general and won't affect the course of the epidemic, so why not labour over the exact details.

[OffTheRock]

The booster jabs seem straightforward. As expected, apart from using half doses of Moderna.

Care homes first, then down the 1-9 age groups with at least 6 months between second doses and booster. A 50 year old would typically have had the second dose in mid June, so will boosters will mostly be done by Christmas.

Along with the extra flu jabs it's going to be a busy few months for arm stabbers.

The supply chain issues from the ‘global lorry driver crisis’ might help us out here. Fewer flu jabs to jab with, more time for jabbing in schools.

[shpalman]

Javid says the vaccine programme is also being extended to cover 12 to 15-year-olds. The government will move “with urgency” to implement this.

So having dicked about over the decision for several weeks it's now urgent.

[OffTheRock]

Javid says the vaccine programme is also being extended to cover 12 to 15-year-olds. The government will move “with urgency” to implement this.

So having dicked about over the decision for several weeks it's now urgent.

Be interesting to see how many schools have had to contact PHE because they’ve met the DfE criteria of having an outbreak in school. Not that that does much other than triggering open windows and some extra cleaning.

For those that haven’t already had covid, how helpful is one dose of Pfizer going to be over 4-6 months? Is not giving 2 doses to 12-17 year old going to be a bit of a risk over the medium term?

[Sciolus]

I don't get why this is a decision. The risks to children are exceedingly small. The benefits to children as individuals are also extremely small, and JCVI has gone hung up on which tiny number is smaller. But they are following a false dichotomy between "no children may be vaccinated" and "all children should be vaccinated". Surely we should just make it available and let children (and their parents) decide how much they value the benefits both to themselves and to wider society.

There's no possible way any child or parent could properly make an informed decision, when weighing the balance between the two tiny things.

It has to be experts making the decision and it seems obvious they should be very careful about that decision. It's all pretty irrelevant in the wider scheme of things for society in general and won't affect the course of the epidemic, so why not labour over the exact details.

JCVI are only allowing themselves to worry about the two tiny numbers, but members of the public can make a decision about the much larger effects that JCVI are refusing to, namely the population-level and family-level effects of the risk of spreading infection, and the effect on schooling and education. They may not be particularly informed about those either, but as long as the individual risk is tiny, we shouldn't put too much stress on informed consent imo.

[lpm]

There simply aren't really members of the public who can do that.

99% of the general public are confused about the risk of Covid. They've been told to worry about it, so they worry about it. They equate the risk to grandma with the risk to Amelia going off to first day in reception class.

[Herainestold]

There simply aren't really members of the public who can do that.

99% of the general public are confused about the risk of Covid. They've been told to worry about it, so they worry about it. They equate the risk to grandma with the risk to Amelia going off to first day in reception class.

The problem is that much of the data we have is based on earlier variants and Delta is much worse in all aspects especially to younger people and children. The data coming out of America is troubling. High death rates and whole schools shut down. Things are not good.

[bob sterman]

The problem is that much of the data we have is based on earlier variants and Delta is much worse in all aspects especially to younger people and children. The data coming out of America is troubling. High death rates and whole schools shut down. Things are not good.

What evidence do you have to support the claim that paediatric mortality rates (e.g. IFR/CFR) are higher for delta than earlier variants?

CDC reports say this is not the case...

https://www.aappublications.org/news/20 ... ons-090321

CDC: Delta variant causing increase in pediatric COVID-19 cases, not severity

“Although we are seeing more cases in children and more overall cases, these studies demonstrated that there was not increased disease severity in children,” Dr. Walensky said. “Instead, more children have COVID-19 because there is more disease in the community.”

[Millennie Al]

Be interesting to see how many schools have had to contact PHE because they’ve met the DfE criteria of having an outbreak in school. Not that that does much other than triggering open windows and some extra cleaning.

Can we replace the old saying "closing the stable door after the horse has bolted" with "opening the windows after you've already spread Covid"?

[shpalman]

In cases where parents withhold consent but the child wants to go ahead, the guidelines say the vaccination teams will determine if the child is able to make an informed decision – known as Gillick competence – and “make every effort to contact a parent to check before they proceed”.

“If a parent objects to their child being vaccinated but the child wants to be vaccinated and is judged to be Gillick competent, the healthcare professional will try to reach agreement between the parent and child. However, the parent cannot overrule the decision of a Gillick competent child,” the guidelines state. In that scenario the child will be vaccinated.

How long can a healthcare profession spend trying to do that while trying to vaccinate 3-4 whole yeargroups?

[OffTheRock]

In cases where parents withhold consent but the child wants to go ahead, the guidelines say the vaccination teams will determine if the child is able to make an informed decision – known as Gillick competence – and “make every effort to contact a parent to check before they proceed”.

“If a parent objects to their child being vaccinated but the child wants to be vaccinated and is judged to be Gillick competent, the healthcare professional will try to reach agreement between the parent and child. However, the parent cannot overrule the decision of a Gillick competent child,” the guidelines state. In that scenario the child will be vaccinated.

How long can a healthcare profession spend trying to do that while trying to vaccinate 3-4 whole yeargroups?

Almost none, which is why it's just not going to happen in schools. The same thing technically applies to the HPV vaccine with 'consent' forms sent home to parents but I don't remember seeing loads of stories about how schools have vaxxed their kid against their will.

[raven]

“If a parent objects to their child being vaccinated but the child wants to be vaccinated and is judged to be Gillick competent, the healthcare professional will try to reach agreement between the parent and child. However, the parent cannot overrule the decision of a Gillick competent child,” the guidelines state. In that scenario the child will be vaccinated.

How long can a healthcare profession spend trying to do that while trying to vaccinate 3-4 whole yeargroups?

Yeah, not very practical.

I was very surprise to hear the vaccine minister suggest schools would be sitting parents down in a room with their offspring & mediating between them. I don't know the legal ins and outs of Gillick competency, but as the original intent was to allow reasonably competent older teens to access contraception privately, without parental involvement or even knowledge, it seems strange to suggest you need to involve parents for it. Especially as I know that in my neck of the woods, schools very much do dispense contraception and advice without reference to parents. To kids smetimes as young as 12, I believe.*

It's almost as if the government threw that out just to soothe all those fractious backbenchers who've drunk the freedom coolaid and are now fretting about the awful prospect of kids choosing to get vaccinate (or not) for themselves.

*from what I can tell, mostly because of a high teen pregnancy rate. Which party was it that vehemently disaproved of teen pregnancies again?

[raven]

Be interesting to see how many schools have had to contact PHE because they’ve met the DfE criteria of having an outbreak in school. Not that that does much other than triggering open windows and some extra cleaning.

Why don't I fetch that for you....

Screenshot 2021-09-16 at 00-38-02 PHE Influenza Surveillance graphs 26 August 2021 - clusters[...].png (40.34 KiB) Viewed 2410 times

Schools have only been back a week and a bit, so it's a bit early to see lots of clusters yet. But what might have made it urgent is that cases in 10-19 yr olds have started to outstrip those in 20-29 yr olds:

Screenshot 2021-09-16 at 00-36-06 PHE Influenza Surveillance graphs 26 August 2021 - age & region.png (201.76 KiB) Viewed 2410 times

[OffTheRock]

“If a parent objects to their child being vaccinated but the child wants to be vaccinated and is judged to be Gillick competent, the healthcare professional will try to reach agreement between the parent and child. However, the parent cannot overrule the decision of a Gillick competent child,” the guidelines state. In that scenario the child will be vaccinated.

How long can a healthcare profession spend trying to do that while trying to vaccinate 3-4 whole yeargroups?

Yeah, not very practical.

I was very surprise to hear the vaccine minister suggest schools would be sitting parents down in a room with their offspring & mediating between them. I don't know the legal ins and outs of Gillick competency, but as the original intent was to allow reasonably competent older teens to access contraception privately, without parental involvement or even knowledge, it seems strange to suggest you need to involve parents for it. Especially as I know that in my neck of the woods, schools very much do dispense contraception and advice without reference to parents. To kids smetimes as young as 12, I believe.*

It's almost as if the government threw that out just to soothe all those fractious backbenchers who've drunk the freedom coolaid and are now fretting about the awful prospect of kids choosing to get vaccinate (or not) for themselves.

*from what I can tell, mostly because of a high teen pregnancy rate. Which party was it that vehemently disaproved of teen pregnancies again?

Throwing stuff out there to soothe the fractious is all they have now. They seem to have raised the issue in that weird will they/won’t they period and pissed off the anti-vaxxers even further. They can’t take it back by saying teens won’t be able to consent if their parents haven’t because that wouldn’t be true (although this isn’t usually a problem for them) even though that’s the only thing that will please people.

Dragging legal guidelines for treatment of minors into it is a unnecessary fight to have picked. It could just have been handled the same way it’s handled when kids turn up for an HPV or flu jab without the consent form.

[OffTheRock]

Be interesting to see how many schools have had to contact PHE because they’ve met the DfE criteria of having an outbreak in school. Not that that does much other than triggering open windows and some extra cleaning.

Why don't I fetch that for you....

Screenshot 2021-09-16 at 00-38-02 PHE Influenza Surveillance graphs 26 August 2021 - clusters[...].png


Schools have only been back a week and a bit, so it's a bit early to see lots of clusters yet. But what might have made it urgent is that cases in 10-19 yr olds have started to outstrip those in 20-29 yr olds:
Screenshot 2021-09-16 at 00-36-06 PHE Influenza Surveillance graphs 26 August 2021 - age &amp; region.png

I did mean since the start of this term, rather than last year. I think the DfE have raised the threshold slightly. I think it’s now 5 children in a class within a 10 day period or 10% of children. That might be 10% of the school, but different people from government and the DfE have used that figure in slightly different ways so God knows.

Last year it was 2 cases in a class, which I think is the PHE definition, but this year that’s more likely to be due to them getting covid independently outside of school.