There’s a comedy trope that I think of as “second person confession”. The person starts telling a generic story in the second person, except that the details of the story start getting weirdly specific, morphing into an embarrassing or disturbing confession. Something like, “You know how it is, you’ve just been working all day, you come home exhausted, you want nothing more than to eat a sandwich and zone out on the couch. And then you get a call from some guy you barely know, who wants to meet up for some reason, and you’re about to tell him to fuck off, when he reminds you that you’ve known each other since the summer when you were 17, and he’s the only person who knows where you hid that body…”
So, Boris Johnson, the cringeworthy master of does-he-mean-this-to-be-a-joke, commented recently on the need for all of us lazy British workers to get back to the office, in these terms:
My experience of working from home is you spend an awful lot of time making another cup of coffee and then, you know, getting up, walking very slowly to the fridge, hacking off a small piece of cheese, then walking very slowly back to your laptop and then forgetting what it was you’re doing.
Thinking back to his pre-election bus hobby, it makes me wonder if there’s some embarrassing story about cheese that he’s trying to push down in the Google search rankings…
The single-celled parasite toxoplasma gondii is known to structurally change the brains of infected mice to cause them to lose their fear of cats. This transformation aids the fitness of the pathogen essential for the pathogen to complete its life cycle, because it can reproduce sexually only in cat guts. The fungus Ophiocordyceps unilateralis infects carpenter ants, and then
it grows through the insect’s body, draining it of nutrients and hijacking its mind. Over the course of a week, it compels the ant to leave the safety of its nest and ascend a nearby plant stem. It stops the ant at a height of 25 centimeters—a zone with precisely the right temperature and humidity for the fungus to grow. It forces the ant to permanently lock its mandibles around a leaf. Eventually, it sends a long stalk through the ant’s head, growing into a bulbous capsule full of spores. And because the ant typically climbs a leaf that overhangs its colony’s foraging trails, the fungal spores rain down onto its sisters below, zombifying them in turn.
The rabies virus is well known to induce aggression in its hosts, leading them to bite others and so transmit the virus in its saliva.
Is any of this relevant to humans? Toxoplasma infection is found in around 30% of UK residents — acquired from contact with pet cats — and there is evidence that it may contribute to schizophrenia. There is strong evidence that prenatal maternal infection raises the risk of the child going on to develop schizophrenia. But this is presumably just a byproduct of the essential neuropathogenicity that promoted the pathogen’s fitness in mice.
I was thinking of this, though, when I saw this new study:
Executive dysfunction following SARS-CoV-2 infection: A cross-sectional examination in a population-representative sample
People who had previously suffered a Covid infection “reported a significantly higher number of symptoms of executive dysfunction than their non-infected counterparts”. Executive dysfunction, according to Wikipedia, is “a disruption to the efficacy of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes… Executive processes are integral to higher brain function, particularly in the areas of goal formation, planning, goal-directed action, self-monitoring, attention, response inhibition, and coordination of complex cognition.”
Perhaps coincidentally, we have seen, since the start of the pandemic, an upsurge of seemingly inexplicable emotionally overwrought rejection of measures that might prevent the individual from spreading the virus, or from catching it again oneself, especially masking and vaccination. Could it be that this is itself a neurological sequela of a Covid infection, that manipulates the sufferer’s brain, like the carpenter ant’s, to maximise the spread to conspecifics? Or that, like a hacker “backdooring” a compromised system, the virus has evolved to make its host pliable to future infection, once the immune response has waned?
Another update of my Covid booster saga. After the only walk-in vaccination centre in Oxford decided to stop accepting walk-ins I looked about for other options. I was now eligible for a booster, but couldn’t sign up for an appointment, because only NHS-delivered vaccines count. I considered getting an appointment for a nominal first vaccine, but worried that that might just get me into trouble. I heard that the NHS had suddenly decided to start registering vaccinations performed abroad, and that would allow me to get a booster. (The website even suggested that you may be given a booster vaccine at the appointment, but you may not, and the appointment is really only to register your information.) But, bizarrely, the registration has to be done in person, and the nearest place is Reading, 25 miles away. So I could take the train, possibly get infected on the way, in order to get a booster.
Instead, I saw that there was a pharmacy offering drop-in vaccinations in Aylesbury, about 17 miles from Oxford, and connected by a reasonable route for cycling. And they were open Sunday. The weather was good, so I set out a bit after 8 on my bicycle, arriving around 9:45, shortly after they opened at 9:30.
“Do you have an appointment?” “No. I’m here for a walk-in.” Funny look. “This is listed on the NHS website as a walk-in site.” “It was, until yesterday, when we ran out of vaccine.” “I just cycled two hours from Oxford.” “If you want you can wait in that queue over there and try your luck.” There were about a dozen people waiting already. I ended up being the last walk-in they let in, and I got the booster.
A student of mine waited 6 hours in the rain yesterday for a booster. I remember a German colleague commenting many years ago that he liked American university libraries because the librarians consider it their job to serve the readers with books. Unlike German librarians who consider it their job to protect the books from the readers.
The NHS — meaning, the larger dysfunctional system of the NHS and its many private subcontractors — seems to have a similar attitude toward vaccines. Better that ten should go unvaccinated than that one ineligible person should be vaccinated.
The UK government is apparently desperately eager to get the whole population fully protected with three doses of Covid vaccine, to try and head off the mounting omicron wave. In a particularly awkward mixed pharmaceutical metaphor they promised to put the programme “on steroids”. But not so eager that they’re willing to resort to extreme measures like… just letting people get vaccinated.
The NHS website says people will be contacted for appointments six months after their second dose. But the government announced more than a week ago, following new advice from the Joint Committee on Vaccinations and Immunisations (JCVI), that “the booster will now be given no sooner than 3 months after the primary course.”
Having been initially vaccinated in Germany I can’t get on the list for an appointment anyway, so I decided to cycle down to Kassam Stadium, south of Oxford, the only nearby vaccination centre offering walk-in service. The fellow managing the queue was friendly and helpful, but told me that the current regulation — until they get new rules from the government — is actually a completely arbitrary seeming five months gap for people over 50 years of age (which I haven’t seen reported anywhere) — and six months for people over 40. (And no boosters for younger people.
So, no booster yet for me…
Update (8/12/2021): The NHS has now opened up boosters to people who had their second dose more than 3 months ago. Except, the bad people who had their first doses in foreign lands — including, if I understand correctly, Scotland — are still excluded.
[update 10-12-2021]: Yesterday mid-afternoon the official NHS website for vaccination information reported that anyone over 40 could get a booster at a walk-in site 3 months after their second dose. So I cycled down to Kassam Stadium again this morning. And again I was turned away. This time they agreed that I was eligible according to the NHS rules, but they have their own rules at this centre, and they’re not changing until Monday.
Not that it matters, because they also — my partner found this out when she went in the afternoon — decided spontaneously as of 2pm today to stop accepting walk-ins at all.
I’m all in favour of naming Covid variants after Greek letters — not least because there is a fixed number of them, so when we teach omega presumably we know we’re finished. Clearly, though, people at WHO recognised that alphabetical order needed to be superseded when the next major horror was due to be designated Nu. I’m sure the WHO was seeking to head off the following awkward conversation a few months from now:
Have you heard the news about Covid?
What’s that?
About the new Covid variant?
Sure. I had it a couple of months ago.
You can’t have had it a couple of months ago. It’s new.
Nu. That’s what I said. It knocked me out for a week.
That’s the old variant.
Wait, the nu variant is old?
That’s right.
Hold on a minute. How many variants have you got?
Well, you got your alpha variant, your delta variant, then your nu variant, and then this here variant that got discovered just recently.
It’s pretty new isn’t it. Kind of like a new variant.
Oh, no, the experts on TV say it had twenty different mutations from the nu variant.
So if I came down with this… novel variant, and I went to the hospital, and they sequenced the virus, could they tell me which variant I have?
Sure.
And what would they tell me?
They’d tell you you have the new variant. No reason to keep it secret.
Apparently, a conference in Florida to promote the use of anti-parasite treatment Ivermectin for Covid, turned into a super-spreader event.
“I have been on ivermectin for 16 months, my wife and I,” Dr Bruce Boros told the audience at the event held at the World Equestrian Center in Ocala, adding: “I have never felt healthier in my life.”
Boros is now reported to be gravely ill with Covid, and at least six other physicians who attended were also infected. It seems to me, if you don’t want people to dismiss your miracle treatment as “horse de-wormer”, you might choose to hold your national gathering somewhere that is not an equestrian center.
The US federal government has ordered that all nursing home personnel need to be vaccinated against Covid, which seems like an absolute least-you-could-do sort of measure, given the extraordinary risk of outbreaks among the frail elderly. But there’s a problem.
The American Health Care Association, a nursing home lobby, said it appreciated the order but that the mandate should apply to other healthcare providers as well so that workers who refuse vaccination won’t have a reason to change jobs within the industry.
Surely there can’t be that many openings for medical staff who aren’t willing to take minimal steps to protect their patients? Well…
David Grabowski, a professor of healthcare policy at Harvard Medical School, said that, because many nursing home aides are paid only the minimum wage or slightly higher, they would be more likely to seek out work at retail establishments. “The risk isn’t that they go to the hospital down the street—the risk is they go to Starbucks or Target,” he said in an interview. “It’s great if you want to mandate the vaccine, but you also want to make sure these workers are making a living wage.”
Hmm… if Starbucks is hiring unvaccinated care-home nurses to sling lattes for the same salary, there must be some vaccinated baristas who want to transfer in the other direction. What’s that you say? You can’t just hire any bored 20-year-old to care for the elderly? You need training and experience to do the nursing job, and it’s a far more gruelling job!
Then why are they earning the same salary? Low salaries are not immutable constants of nature, however much employers would like to suggest they are. Like
Jon Green, CEO of Pinewood Manor Nursing and Rehabilitation in rural Hawkinsville, Georgia, said the “vaccines are necessary for control of the virus,” but “if we would have mandated it ourselves, it would have caused [many workers] to leave.’’
The UK government is holding fast to its plan to drop all pandemic restrictions as of 19 July, even in the face of rapidly increasing infection rates, hospitalisation rates, and Covid deaths — all up by 25-40% over last week. And numerous medical experts are being quoted in the press supporting the decision. What’s going on?
To begin with, Johnson has boxed himself in. He promised “Freedom Day” to coincide with the summer solstice, and then was forced to climb down, just as he was from his initial “infect everyone, God will recognise his own” plan last March, on realising that his policies would yield an unsustainable level of disruption. The prime minister has, by now, no reputation for consistency or decisiveness left to protect, but even so he probably feels at the very least that a further delay would undermine his self-image as the nation’s Fun Dad. At the same time, the the new opening has been hollowed out, transformed from the original “Go back to living your lives like in pre-pandemic days” message to “Resume taxable leisure activities, with the onus on individuals and private businesses to enforce infection-minimisation procedures.” Thus we have, just today, the Transport Secretary announcing that he expected rail and bus companies to insist on masking, even while the government was removing the legal requirement.
But what are they hoping to accomplish, other than a slight reduction in the budget deficit? The only formal justification offered is that of Health Secretary Sajid Javid, who said on Monday
that infection rates were likely to get worse before they got better – potentially hitting 100,000 a day – but said the vaccination programme had severely weakened the link between infections, hospitalisations and deaths. Javid acknowledged the risks of reopening further, but said his message to those calling for delay was: “if not now, then when?”.
“Weakened the link” is an odd way of putting a situation where cases, hospitalisations, and Covid deaths are all growing exponentially at the same rate. What has changed is the gearing, the chain and all of its links is as strong as ever. In light of that exponential growth, what should we make Javid’s awkward channeling of Hillel the Elder?
I’ll talk about “masking” as synecdoche for all measures to reduce the likelihood of a person being infected or transmitting Covid. We need to consider separately the questions of when masking makes sense from an individual perspective, and from a public perspective. The individual perspective is straightforward:
On the societal level it’s more complicated, but I do find the argument of England’s Chief Medical Officer Chris Whitty… baffling:
“The slower we take it, the fewer people will have Covid, the smaller the peak will be, and the smaller the number of people who go into hospital and die,” he said. By moving slowly, he said modelling suggested the pressure on the NHS would not be “unsustainable”. Prof Whitty said there was less agreement on the “ideal date” to lift restrictions as there is “no such thing as an ideal date” . However, he said a further delay would mean opening up when schools return in autumn, or in winter, when the virus has an advantage and hospitals are under more pressure.
We may argue about how much effect government regulations have on the rate of the virus spreading, but I have never before heard anyone argue that the rate of change of government regulation is relevant. Of course, too rapid gyrations in public policy may confuse or anger the public. But how the rapidity of changing the rules relates to the size of the peak seems exceptionally obscure. To the extent that you are able to have any effect with the regulations, that effect should be seen directly in R0, and so in the weekly growth or contraction of Covid cases. If masking can push down the growth rate its effect is essentially equivalent at any time in terms of the final infection rate, but masking early gives fewer total cases.
To see this, consider a very simple model: With masking cases grow 25%/week, without masking they shrink 20%/week. So if we have 1000 cases/day now, then after some weeks of masking and the same number of weeks without masking, we’ll be back to 1000 cases/day at the end. But the total number of cases will be very different. Suppose there are 10 weeks of each policy, and we have four possibilities: masking first, unmasking first, alternating (MUMU…), alternating (UMUM…). The total number of cases will be:
Strategy
Total cases
masking first
57 000
unmasking first
513 000
alternating (MU…)
127 000
alternating (UM…)
154 000
Of course, the growth rate will not remain constant. The longer we delay, the more people are immune. In the last week close to 2 million vaccine doses have been administered in the UK. That means that a 4-week delay means about 4 million extra people who are effectively immune. If we mask first, the higher growth rate will come later, thus the growth rate will be lower, and more of the cases will be mild.
The only thing I can suppose is that someone did an economic cost-benefit analysis, and decided that the value of increased economic activity was greater than the cost of lives lost and destroyed. Better to let the younger people — who have patiently waited their turn to be vaccinated — be infected, and obtain their immunity that way, than to incur the costs of another slight delay while waiting for them to have their shot at the vaccine.
The young were always at the lowest risk in this pandemic. They were asked to make a huge sacrifice to protect the elderly. Now that the older people have been protected, there is no willingness to sacrifice even another month to protect the lives and health of the young.
The Robert Koch Institute produces estimates of variants of concern on Wednesdays. My projection from two weeks ago turns out to have been somewhat too optimistic. At that point I remarked that there seemed to be about 120 delta cases per day, and that that number hadn’t been increasing: The dominance of delta was coming from the reduction of other cases.
This no longer seems to be true. According to the latest RKI report, the past week has seen only a slight reduction in total cases, compared to two weeks ago, to about 604/day. And the proportion of delta continues to double weekly, so that we’re now at 59%, meaning almost 360 Delta cases/day. The number of Delta cases has thus tripled in two weeks, while the number of other cases has shrunk by a similar factor. The result is a current estimated R0 close to 1, but a very worrying prognosis. We can expect that in another two weeks, if nothing changes, we’ll have 90% Delta, around 1100 cases in total, and R0 around 1.6.
Of course, vaccination is already changing the situation. How much? By the same crude estimate I used last time — counting single vaccination as 50% immune, and looking back 3 weeks (to account for the 4 days back to the middle of the reporting period, 10 days from vaccination to immunity, and another 7 days average for infections to turn into cases), the above numbers apply to a 40% immune population. Based on vaccinations to date the population in 2 weeks will be 46% immune, reducing the R0 for Delta to around 1.5. In order to push it below 1.0 we would need to immunise 1/3 of the remaining population, so we need at least 64% fully immunised. At the current (slowed) rate of vaccination, if it doesn’t decelerate further, that will take until around the middle of September, by which point we’ll be back up around 10,000 cases/day.
Germany is in a confusing place with its pandemic developments. Covid cases have been falling as rapidly here as they have been rising in the UK: More than 50% reduction in the past week, dropping the new cases to 6.6 per 100,000 averaged over the week, under 1000 cases per day for the first time since the middle of last summer. At the same time, the Delta variant is rapidly taking over. Last week the Robert Koch Institute reported 8%, thisweek it’s 15%. Virologist Christian Drosten, speaking on the NDW Coronavirus podcast this week (before the new Delta numbers were available) spoke of the 80% level in England that, he said, marked the watershed between falling and rising case numbers.
I think this is the wrong back-of-the-envelope calculation, because it depends on the overall expansion rate of the virus, and the difference between Delta and Alpha, which is likely particularly large in the UK because of the large number of people who have received just one AstraZeneca dose, which seems to be particularly ineffective against Delta. There’s another simple calculation that we can do specifically for the German situation: In the past week there have been about 810 cases per day, of which 15.1% Delta, so, about 122 Delta cases per day. The previous week there were about 1557 cases per day, of which 7.9% Delta, so also about 123 Delta cases. That suggests that under current conditions (including weather, population immunity, and social distancing) Delta is not expanding. This may mean that current conditions are adequate to keep Delta in check, while Alpha and other variants are falling by more than 50% per week.
This suggests a very optimistic picture: that total case numbers will continue to fall. Within a few weeks Delta will be completely dominant, but the number of cases may not be much more than around 100 per day. And that ignores the increasing immunity: The infections reported this week occurred in the previous week, and the immunity is based on the vaccinations two weeks before that. With about 1% of the population being vaccinated every day, we should have — relative to the approximately 70% non-immune population* 20 days ago — already have about 15% reduced transmission by the first week in July. And at current vaccination rates we can expect, by the end of July that will be 30% reduced, providing some headroom for further relaxation of restrictions without an explosion of Delta cases.
That does raise the question, though, of why the general Covid transmission rate in Germany seems to be lower than in the UK. I don’t see any obvious difference in the level of social-distancing restrictions. Is it just the difference between single-dose AZ versus Biontech? If so, we should see a rapid turnaround in the UK soon.
* I’m very roughly counting each dose as 50% immunity.
Common Infirmities 