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NHS planning to start covid vaccination of under 50s by end of January (hsj.co.uk)
49 points by BellLabradors 15 days ago | hide | past | favorite | 82 comments



You would think they would prioritize teachers and other personnel in the schools.

There is no excess mortality for those under 14, as covid goes after the ACE2 receptor, which mostly gets activated at puberty.

https://www.nytimes.com/2020/07/20/parenting/coronavirus-chi...

Getting kids back to school seems like a high priority.


Honestly, excess deaths so far are relatively low, 10-20% increased risk of death this year...

https://raw.githubusercontent.com/lettergram/covid19-analysi...

In terms of what that means, if you're 15 - 45; 1 per 1000 people die in a given year.

This year it'll be 1.2 per 1000, for the 15 - 45 age range.[1]

This goes across the board, for 45-64 you're looking at an increase from 1/500 to 1.2/500... etc, etc.

[1] http://www.bandolier.org.uk/booth/Risk/dyingage.html


That's because we've put our countries into lockdown. If we hadn't then do you think the deaths would have been far higher? (I think the answer to that is 'yes'). Unfortunately we can't stay in lock down forever...


Also "10-20% increased risk of death this year" is fucking massive


It still approaches zero.

edit-to-add:

I recall during our new parent class the lecture where they were discouraging the use of pain drugs during birth because it increased the chance of a bad outcome by 2x or 4X. (I can't remember the actual value the nurse said.)

When I asked what is the actual chance of a bad outcome and what is 2x of that. She didn't know and didn't like me pointing out in front of the class that 2x was probably still pretty close to zero.


An X% increase in all-cause mortality is far more significant than an X% increase of one specific medical risk. You are comparing apples to oranges.


I am not trying to compare the two metrics. Getting instantly down voted for my initial comment reminded me of how that nurse acted 25 years ago.


No, it isn't and no they wouldn't.

Sweden, Belarus and now Switzerland are proving that if you don't do lockdowns you get ... nothing. Same kind of epidemic as everywhere else. Nothing out of the ordinary and a year that's comparable to any flu year.

Look at the data for parts of Switzerland that didn't lock down for the second wave (which is most of it, including where I live). It goes into remission anyway, without overflowing hospitals or mass deaths.

Remember that the only reason you believe deaths would be far higher without lockdowns is epidemiologists predicted that. But they have a long track record of making predictions that are always wrong. This time they were wrong again, just like all the other times. There was never any experience based justification for lockdowns or even restrictions of any form: only models, which have turned out to be buggy and unrealistic.


Sweden had +30% death rate in April compared to an average year, and it was the most deadly month in >decade if I'm not mistaken.

It's definitely not comparable to any flu year, although definitely not crazy bad (unlike other countries).

In case of Poland, with ~5-10% infected population, the last month was the most deadly since the last decade (and possibly - since the WW2):

https://infogram.com/liczba-zgonow-w-dobie-epidemii-1hnp27w9...


This kind of month-to-month comparison is misleading because flu waves (which is what COVID is comparable to) are usually happening a bit earlier than April. So just comparing April-to-April, and then putting it in percentage terms, and then not comparing to other waves of excess mortality that are normal, obscures what's really going on. Your image seems to show that, prior peaks are of course clustered around January.

But look at total mortality so far in Sweden for 2020. Nothing special, on track to be a normal year. They had a very mild 2019 so it'll probably be higher than that, but nothing special in context. Same for Switzerland.

It's definitely not comparable to any flu year

I suspect you're using the word "comparable" differently to me. Biologically, sure it is. It hits the older a bit harder and the young not at all, so in some ways it's actually better than flu. However with flu since ~2000 there have been vaccines, and for COVID there isn't, so that makes it a bit worse. But if you widen your historical context and look at years before the flu vaccines arrived, then it's entirely comparable to flu years in the sense that mortality numbers are ending up very similar or even the same.

Look at the long term data for Sweden to put things in perspective:

https://swprs.org/wp-content/uploads/2020/10/sweden-monthly-...

Or for the UK

http://inproportion2.talkigy.com/

The world has seen far worse within living memory.

W.R.T. Poland, you didn't have a COVID first wave at all, and your second is correlated with the rest of Europe so you're going to be "doubling up" compared to some other places. But your epidemic peaked on November 11th, which means death will also soon peak, and therefore your results will look hardly different to other countries, none of which have experienced the huge waves of death that were supposedly going to engulf any country that didn't lock down. That's what matters: not whether COVID is 10% or 30% worse than a typical post-vaccine flu wave, or whether it's the same as a pre-vaccine flu wave. Those are all minor details. What matters is that the world is being put through crazy totalitarian restrictions and evil based on predictions that it'd be 10,000x worse than flu. And those predictions are all totally, completely, unambiguously wrong.


It's not just about deaths this year. COVID is known to do damage to the lungs and heart, even in some mild cases. There is a lot of research to do here, but the long-term impact could be significant.


Schools are open in England.


I was going to make nearly this same comment.

The productivity of working from home would go WAY up with this, so you could keep higher risk groups from interacting for longer (at least in my household - a kid running around is a MAJOR distraction)



Article now says 'Under 50s from End of January' - post title needs updating.

Also, non paywalled take on the news:

https://metro.co.uk/2020/11/20/covid-vaccine-to-roll-out-to-...


From the article:

"The HSJ says the plan it has seen lays out the priority groups for receiving the vaccine, and the dates they'll be offered it:

Beginning of December: Healthcare workers, care home residents and care home staff

Mid-December: People aged 80 or over

Late December: Those aged 70 to 80

Early January: Everyone aged 65 to 70, as well as all high and moderate risk under 65s Mid-January: Everyone aged 50 to 65

Late January: Everyone else over the age of 18 (but most of this group would be vaccinated during March, the report says)"

Didn't realise it was paywalled, sorry.


that sounds incredibly ambitious (if not unrealistic) to me, how is that supposed to work? Currently, there's only a single vaccine that's probably going to hit the market in Europe soon, and that's the Biontech/Pfizer one. They said they'll have 50 million doses available in December, but that's for both the US as well as the EU and the UK (which means 25 million people can get vaccinated in total). How is that possibly enough for health-care workers and care-home residents in the UK as well as people aged 80 or over?

And it's going to be a similar situation in January and February, sure Bntch/Pfizer will produce a decent amount of vaccines specifically for the European market in Belgium and Germany, but again that's going to be hardly enough for everyone over the age of 18 in the UK - especially given the fact that those doses will have to be shared with all other European nations.


You have a second vaccine, from Moderna, that looks like it will be approved in the EU for December as well.

https://www.bloomberg.com/news/articles/2020-11-20/eu-could-...

Once both are approved, assume that production can be ramped up even further.


afaik, the Moderna vaccine is only going to be available outside the US in Spring (around March, April)


I'm also not sure how they can possibly arrive at this with Pfizer and Moderna alone. I'm assuming it's factored in an Oxford approval.


Curious, are people planning to take the first vaccine that becomes available? I can't imagine taking a vaccine for covid anytime soon, least of all as the first round.


If my countries healthcare professionals are willing to take it then I will. They're more qualified to judge the risk than anyone else.


Upvoted.

This is my general rule in life: do what the professionals do.

Of course I have family members who are completely mistrusting of, say, medical professionals, and believe crap on the internet instead.


Healthcare professionals may be more qualified to judge medical risks. But ultimately it's a decision taken with no long term data for either the status quo or the intervention.

You can extrapolate long term data from SARS and MERS for tail risks of contracting COVID; but there's no other similar immunizations to extrapolate from.

By the time a vaccine is available for me (not in any risk categories; fairly poor access to COVID testing in my county, which I assume would mean poor access to vaccines, too), I'd guess we would have a lot more data on any immediate negative effects, so there's some confidence building; but it's still a choice between an unknowable risk and an unknowable risk.


There would be immediate quantifiable benefits in terms of how people live their lives however. Being vaccinated is likely to allow society to move back to some level of normalcy.

Balanced against long term unknowable personal health risk as you say.

In the end my pov is it's better to get on with living now and if a vaccine offers that then I'll take it.


they didn't judge the risks of oxycontin very well. as a general rule judgement is largely an evaluation made based on past results... do we have any precedent of a vaccine being fast tracked like this? presumably the safeguards in place exist for a reason, if not then why isn't every vaccine fast tracked?


You can never guarantee that in the future we won't realise an existing consensus won't be shown to be flawed, but without the benefit of hindsight is there any option more consistently reliable than following healthcare professionals & experts in related scientific fields?



Yeah, that's the thing…

> I can't imagine taking a vaccine for covid anytime soon, least of all as the first round.

Well good for you, unless you're a doctor or nurse, you can’t. And by the time you ^are^ eligible, there will be millions of others who have the vaccine, and more data.

Granted, not the months or years of data you usually see with a vaccine, but that’s as abnormal as everything else these days…


You have to weigh the risk of the vaccine vs the risk of the disease. If you are in 100% control of your exposure, sure wait. But if you aren't in control of your exposure (e.g., have to go to work, have kids in school), then there is no reason to think the risk of the vaccine is anywhere close to the risk of getting Covid. I have kids in school, and can't wait until it is available.


Unless you live in a cave I'm not sure you'll be able to reduce your exposure that much. I mean you go to the shops to buy food right?

Supermarkets are the largest vector btw


> Supermarkets are the largest vector btw

Cite, please. This matches nothing I have seen.

The biggest vectors seem to be Number 1: churches and Number 2: bars/restaurants.


Sure:

https://news.sky.com/story/covid-19-supermarkets-most-common...

Edit: ok re-reading the article it says supermarkets were the most common place visited before testing positive, but then PHE states this is no proof that is where it's contacted.


In fact, it's almost guaranteed to not be the place where you contracted it.

I suspect that the issue is that people are going "Oh, I need a Covid test. If it's positive, I'm going to have to semi-quarantine. Let's stop at the grocery store before getting the test."


I think two things are being confounded here: (1) places most likely to contain people with COVID; and (2) places most likely enable COVID to infect someone.

Many people go to supermarkets; they’re like central hubs in a network. It doesn’t mean that as much transmission happen there as in smaller confined places like houses and bars.


You are probably conflating risk of infection per person with total number of persons at risk. It can be true that churches and bars are more risky for those that visit them, while more people get infected at groceries and big-box stores just by dint of high volume at lower risk.

Just anecdotally this matches something the mayor of El Paso said a week ago - 33% of their cases were "big-box", followed by bars and restaurants, then "everything else".


Social gatherings and schools followed closely by nurses and old aged homes.

Restaurants account for less than 10-15%


Cite, please


>I mean you go to the shops to buy food right?

I live in New York and haven't been to a supermarket since March. It isn't hard to reduce your exposure to near zero if you have the gumption and the resources.


While I'd rather see people with higher risk than me get the vaccine first, I would absolutely take it if I was able to.


I'd rather school teachers got them so I could stay home and work.


I've generally been of the opinion that by the time it becomes available to me (I'm not in an especially at-risk demographic, not a healthcare worker, etc.), I won't be part of the "first round," and we'll know a good bit more about the safety of these vaccines than we currently do (which is already a decent bit as I understand it, given the size of these trials).


these flu related vaccines already go to high risk (e.g. elderly) first so a lot of the risk is already factored in to the benefit they can provide.

having said that, yes i'd have it if i could go eat in a restaurant again.


You wouldn't get a choice of vaccine, the NHS would decide.


Help me understand what risk you're concerned about. Have there been other mRNA vaccines where an adverse effect showed up in general use that wasn't caught in clinical trials?


There haven't been any other mRNA vaccines at all.

This is the very first one, and on an accelerated schedule.

So the answer to your question is unknown, and whoever goes first gets to be part of the large study answering that question.

Personally I'm going to wait for either a conventional vaccine, or at least a year or so by lots of other people. (It helps that I'm 90% sure I had it already, and I'm low risk on top of that.)


There’s nothing accelerated about it.

Plus severe side effects would have been seen during phase 3 trials anyway.


> Have there been other mRNA vaccines...

There haven’t been other approved mRNA vaccines, period. And COVID just isn’t that big of a concern for most people.

There’s every reason for people to decide they don’t want to rush out to get this highly innovative and novel vaccine injected into their bodies.


Thanks. I only hovered over mRNA on a wikipedia page[0] and saw the word "fragment", so I knew it wasn't live or attenuated viruses, but didn't realize how novel this vaccine type is.

That said, I'd still rush out and get it. I'm more concerned about the unknowns of Long Covid than I am about the unknowns of the vaccine. https://en.wikipedia.org/wiki/Long_Covid

[0] https://en.wikipedia.org/wiki/COVID-19_vaccine#Clinical_tria...


When the first sentence of a Wikipedia article has a large ”Citation Needed” flag, it’s a good indication you should probably stop reading.

Medical science is really hard and often unintuitive. There was a great study that came out last week about statins and the nocebo effect [1] which I think is a great example of how hard it is to get good data on clinical symptoms.

But this is exactly the calculus that people will try to perform based on their own perspective on the relative risks. There’s certainly plenty of unknowns and cause for uncertainty.

https://www.bbc.com/news/health-54951648


"I'm more concerned about the unknowns of Long Covid than I am about the unknowns of the vaccine."

Unless you are in a high-risk group, this should not be a serious concern. There is almost no evidence for "long covid". The vast majority of the evidence is anecdotal, self-reported clusters of symptoms that resemble other common illnesses:

https://sebastianrushworth.com/2020/11/17/what-is-long-covid...

When you look for higher-quality evidence for the syndrome, you find studies like this one, from the CDC, which defined "long-term" as "symptoms lasting longer than two weeks", where "symptoms" mostly resemble the aftermath of any mild respiratory illness -- fatigue, cough and headache were the most common:

https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm

As for more specific studies, there have been a few papers about heart inflammation that have been widely circulated, but nearly all of these have been shown to have serious statistical flaws:

https://mobile.twitter.com/ProfDFrancis/status/1298514453642...

The narrative about athletes with heart damage have been shown to be exaggerated, at best, and physicians no longer MRI recommend screening of athletes without outward symptoms:

https://www.upi.com/Health_News/2020/11/04/Heart-inflammatio...

https://www.si.com/college/2020/10/28/big-ten-covid-protocol...

https://images.saymedia-content.com/.image/cs_srgb/MTc2NDI1M...

More generally, physicians are recommending that these sorts of MRI-based fishing expeditions play no role in screening of otherwise healthy people who have recovered from Covid-19:

https://cvctcardiobrief.com/?p=20977

Covid-induced strokes also appear to be a case where cherry-picking statistics has driven a narrative of fear:

https://academic.oup.com/neurosurgery/advance-article/doi/10...

There are currently two clinical trials registered to investigate the question. The earliest we will have any high-quality data on this subject is 2022:

https://clinicaltrials.gov/ct2/show/NCT04411147 https://clinicaltrials.gov/ct2/show/record/NCT04362150


There's even less evidence for a negative outcome from taking the vaccine.


This has nothing to do with my comment.


Vaccines have to be proven safe, versus “Long Covid” has to be proven real. It’s just a different standard of proof for an elective treatment.


> The vast majority of the evidence is anecdotal

True. But how does that compare to evidence that the vaccine will have serious adverse effects?


I don't know. It has nothing to do with my comment.

I'm simply pointing out that the evidence for "long covid" is incredibly weak. One should use that to adjust their priors for any outcome.


> Under the plan, everyone who wants to would have been vaccinated by early April.

It's going to be really interesting to see how this plays out, once vaccines start to become widely available. I would hope that some "social inertia" will help convince people who are "on the fence" or otherwise skeptical about getting vaccinated, as they see more folks get it and the case numbers hopefully start to flatten out or drop.


I hope so, but the more I read about cults and mind-control the less I believe we'll have a good outcome.


>I hope so, but the more I read about cults and mind-control the less I believe we'll have a good outcome.

The real crazies are a (regrettably) loud minority. We only need around a 75% vaccination rate with a 95% effective vaccine to get to herd immunity. I've no worries at all we'll be there by the end of summer.


That seems high to me. If R0 is 2, shouldn't a 50% vaccination rate (with 100% effectiveness) get you to an effective R0 of 1?


No, because people engage in riskier behavior when they start to feel safer, driving up R0.


By riskier you mean normal.


Well, we’ve been restricted for so long I would expect a portion of the population to be much more out and about than they were even pre-COVID as a sort of overcorrection.


On the other hand, a number of people have gotten so used to the lock down and risk aversion protocols, it may be a long time before they feel comfortable letting anyone else in their personal space.


It may or may not also be more "normal" as you put it, but that's not at all relevant to what we're discussing here.


I am in no way anti-vax. I personally have a lot more than the average person does, because of my adventures around the world. I've always felt comfortable getting vaccines in the past, and I encourage others to do so.

In the case of the COVID-19 vaccine I am more than a little concerned it has been rushed into mass production, and we don't have years of data about side effects and possible long-term consequences. We have certainly screwed up enough things in the past to put doubt in my mind we can rush something like this and not make a mistake we won't know about for 5-10 years. I was talking to a Doctor friend last night who said she has concerns because a couple of the vaccines use genetic material.

I'm not saying I won't get it, but I doubt I'll be one of the first to rush, and I may drag my heels a little to see what happens.


If you can get ~30% of the population to vaccinate (especially the more vulnerable groups, who will have more incentive to do so), things will already get much better. We won't be at the herd immunity threshold but I think all but the riskiest things could go back to normal.


As far as I know it is not encouraged and possibly not available for people in my age range to receive flu vaccines from the NHS. I have a higher mortality risk from the flu than from covid. From a purely selfish point of view I don't understand why the flu vaccine is difficult to get but the covid vaccine will be easy. It might make sense when you take into account the wider social costs but the situation seems weird to me. I'm not anti-vaxx. I actually want to get a flu vaccine based on advice from my doctor in Australia but I haven't because it looks like it would be an ordeal to get one from the NHS.


Ask your GP, there are lots of guidelines about who is automatically entitled to it mainly based on age, pregnancy, and similar but if your gp agrees you should have it because of your risk you can get it regardless.

More detail: https://www.nhs.uk/conditions/vaccinations/flu-influenza-vac...

If not a high street pharmacist can give you one for ~£8


Flu vaccines are becoming more available in the UK from next week and most chemists will give you the jab. Given the UK government's track record and the impact of border delays due to Brexit it is unlikely that Covid jabs will start en masse until April and will then proceed so slowly as to fail to achieve any chance of herd immunity. There is also a growing Facebook fed anti vaxx movement in the UK which is troubling and the govt is unlikely to compel vaccination.


Flu vaccines have to be incubated in chicken eggs, so production capacity is limited by the rate at which chickens lay eggs.

Whereas the COVID vaccines are based on mRNA


Couldn't it play out the other way? As case numbers drop, people think that the vaccination isn't necessary anymore?


Yeah, I think this is a definite possibility too. The next few months should be interesting.


With a 99.9% survivability rate for people under 50, it really isn't necessary for a large portion of the population.


You have to think beyond yourself. There will be at-risk groups that are also not able to take the vaccine but are protected by closing the infection vectors from others.


Those at-risk groups should be prioritized for the vaccine and the rest of the population should be free to choose for theirselves, since they have sovereignty over their own bodies.


But they don't have sovereignty over their neighbors. If you want to make that argument, fine, but they have to not infect anybody if they get it. They can't cough in public, ever. They can't sneeze. They can't even breathe. Doing so is affecting other peoples' sovereignty over their bodies.


No. Diseases are nothing new in the world, my friend. Individual rights did not die just because a novel coronavirus about 20-30% deadlier than the flu showed up. Sorry, these debates were settled when far worse diseases were around than Covid-19, including smallpox, polio, measles, yellow fever, Rocky Mountain fever, Spanish flu, tuberculosis, HIV, and more. You don't get to dictate what others do with their bodies. Your risk factor is on YOU. If you want the vaccine, which is supposedly only 90% effective (notably less than the 99.9% effectiveness of young immune systems), then you can get the vaccine. End of story.


So you see people as being free to infect others but not free to not be infected. And you see that as "individual rights".

Now, if you're arguing that people shouldn't be forced to be vaccinated, I agree with you. But you could make the same argument that people shouldn't be forced to wear masks, and I'd say "then don't allow them into the store".


Which vaccine?


I'd assume the Biontech/Pfizer one, and maybe the Oxford/AstraZeneca pending trial-data and approval. Though things seem to be taking a little while with that vaccine, so let's see


I wish I knew - but speculating... it might be that O/AZ is the one that gets used (if the results are any good) because there are 100m doses already made and available and it requires only normal refrigeration so should be easier to actually get out there. I really hope that they get some good results...




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