Coronavirus – Part 7 (May 2021)

Dr John Ling has been an authoritative writer and speaker on all matters relating to bioethics for many years and it also a member of Affinity’s Social Issues Team. His personal blog is regularly updated and is well worth a read. He has been following the pandemic very closely and writing informative and wise comment as things develop. This is his latest contribution:

Coronavirus – Part 7 (May 2021)

‘… the race between our vaccination programme and the virus may be about to become a great deal tighter.’  Boris Johnson, 14 May 2021.

The Covid-19 numbers

By the end of May, the worldwide Covid-19 data reached 170 million cases and 3.5 million deaths.  In the UK, there have now been over 4.4 million confirmed cases and nearly 128,000 people have died.  However, throughout most of May, these UK figures remained broadly unchanged.  For instance, the number of new cases plateaued at about 2,500 each day, while the death rate was typically less than 10 per day.  Such stability provides some reassurance that the virus is being largely contained.  Moreover, in late-May only 900 UK Covid-19 patients were hospitalised with 120 on ventilators – those figures were 1,700 and 240 respectively in April.

However, a new facet of the UK pandemic has been the onset of coronavirus hot spots.  Data released at the end of May showed a daily upswing to over 4,000 new cases.  Up to 75% of these were thought to be caused by the so-called Indian variant, B.1.617.2.  But were these increases the result of simple viral spreading, more vigilant testing, or the easing of recent lockdown restrictions?  These variant attacks, though too early to translate into hospitalisations, may halt the lifting of all Covid restrictions planned for the UK on 21 June.  Could this be the start of a third wave?

The UK vaccination programme remains on target.  During May, the landmark of 60 million given jabs (38 million primary plus 24 million booster doses) was passed.  Currently, most areas of the UK are vaccinating anyone aged over 30.  Just 7 months after the ambitious vaccination roll-out began, the target of offering a first jab to all UK adults by 31 July still looks realistic, though half of all UK adults are waiting for their second jab and a quarter have not yet had their first.

Further afield, Covid-19 is ravaging in several places, but nowhere worse than in India with as many as 400,000 new cases and 4,000 deaths in a single day during May.  In total, India has recorded 26 million cases and more than 300,000 deaths.  It has now become the epicentre of the global pandemic.  The plight of its people, struggling in overstretched hospitals, searching for medical oxygen and gathering wood for funeral pyres will be among our harsh and lasting images of the pandemic.

By contrast, though still reporting the highest total of deaths in the world – some 600,000 – the spread of coronavirus in the US continues to slow.  For instance, during a week in mid-May, the country enjoyed no days in which Covid-19 infections exceeded 30,000 cases – its lowest figure since June 2020.

As ever (but not for ever), let the truth be retold, ‘This pandemic is far from over.’

India’s pandemic

No country has been harder hit by Covid-19 than India.  During the country’s second wave, in the week leading up to 13 May, it reported an average of 4,029 deaths every day.  At the same time it suffered a world record of 414,188 new cases in just one day – 5 times more than its nearest contender, Brazil.  And, of course, these figures, from a country as diverse as India, are underestimates.  There is good evidence, such as the discovery of scores of bodies floating in the Ganges, that Covid-19 deaths are inadequately recorded among its rural populations.

But Covid-19 is not India’s only current medical dilemma.  During May, more than 9,000 cases of a deadly ‘black fungus’ disease were reported.  This infection, caused by exposure to mucor moulds and known as mucormycosis, has been increasingly seen among patients recovering and recovered from Covid-19.  It has a mortality rate of 50% and is thought to be linked to the use of steroids in Covid-19 treatments and diabetes in immune-compromised patients.  Treatments, sometimes involving the removal of an eye, are expensive and in short supply.

The B.1.617 variant

This is the so-called ‘Indian variant’, though India’s government has, perhaps understandably in the face of angry criticism about its handling of severe shortages of oxygen, vaccines, hospital beds and life-saving drugs, recently ordered social media platforms to cease using that term.  Yet its use is simply shorthand, akin to the ‘Kent’ and ‘South African’ variants, rather than tripping over their clumsy labels of B.1.1.7 and B.1.351.  The original B.1.617 variant, now generally referred to as B.1.617.1, first appeared in India in October 2020 and is believed to be the principal cause of the recent second-wave surge across India.  According to the World Health Organization (WHO), B.1.617.1 has now been detected in as many as 50 countries across six continents.

As this Indian variant has spread across the world, three different ‘sub-lineages’ have been identified, each with a different mix of mutations.  However, there is currently no evidence that any are more deadly than earlier variants of coronavirus, but they are believed to spread more quickly.  Indeed, B.1.617 mutations may make them easier to pass on, and/or make them more resistant to the immune system’s responses.  These include the L452R mutation, which may help the virus escape the body’s response (as induced by either infection or vaccination).  And it may increase the binding of the virus to ACE2 receptors on the surface of human cells thereby easing the onset of Covid-19 infection.  And the P681R mutation (also present in the Kent variant) may make transmission easier.  In addition, the B.1.617.1 and B.1.617.3 sub-lineages also carry the E484Q mutation, similar to the E484K mutation first identified in the South African variant.  This may also help the virus evade the immune response.  So, in a nutshell, B.1.617 may be no more deadly than earlier variants, but it probably does spread more easily and quickly, perhaps by as much as 50% – no more virulent, more transmissible.

Outside of India, the country with the most recorded B.1.617 cases is the UK.  All three sub-lineages are now present in the UK.  On 6 May 2021, Public Health England (PHE) named one of the three sub-lineages, B.1.617.2, as a ‘Variant of Concern’ after a steep increase in UK cases, from 202 to 520 in a single week.  By the end of May, the UK weekly cases had risen to 6,959, double the previous week’s figure of 3,535.  As Boris Johnson stated, the government is ‘anxious’ about this variant.

UK infections of B.1.617 were first discovered in Bolton during mid-April, where, by the beginning of May, 71 cases had been recorded.  Initially, the cases were linked to international travel, to widespread community transmission in areas of dense urban housing and to regions with low vaccination rates.  As Matt Hancock confirmed, the majority of people in hospital with Covid-19 in Bolton were eligible for the vaccine but had not had it.

The variant soon became dominant in NW England, in Bolton and nearby Blackburn with Darwen, as well as Sefton and distant Bedford.  Then it was detected in Nottingham, South Northamptonshire, Leicester, Hillingdon and other London areas.  It was spreading, and fast.  Additional surge testing, tracing, and isolation support measures were deployed in these hot spots together with enhanced drives to vaccinate people.  Data on the B.1.617.2 variant showed the number of cases across the UK had risen from 1,313 cases to 3,424 during a mid-May week.  Tests indicated that B.1.617.2 was outcompeting the two other B.1.617 sub-types, and replacing B.1.1.7, the Kent variant, as the most common variant driving new infections in the UK.  Was this due to its predicted 50% greater transmissibility?  Then on 21 May, the government, amid some communication confusion, advised people not to travel unnecessarily into and out of eight designated hot spots, including Bolton, Blackburn with Darwen, Leicester and Hounslow, and to avoid meeting indoors.  Were these case increases the inevitable outcomes of easing restrictions?

Failures in the NHS Test and Trace (NHST&T) service may also have contributed to this spread of the B.1.617.2 variant.  A software error meant that eight local authorities did not have access to the full data on positive test results in their areas between 17 April and 17 May.  Apparently, this IT glitch meant that 734 positive tests were not reported to local authorities, meaning that contacts could not be traced locally.  For example, Blackburn with Darwen council was eventually told about 164 cases of which it had been unaware.  The people affected were subsequently traced, but another 130 infected people had passed their 10-day isolation period and could not be followed up.  Furthermore, the UK government delayed adding India to its red list of countries, from which travellers must quarantine in a hotel on return, until 23 April, almost a week after the problems with the NHST&T service started.

And as if to confirm the dynamic and unpredictable nature of variant emergence and transmission, at the end of May, yet another one, known as VUI-21MAY-01 or AV.1, was designated a ‘Variant Under Investigation’ by Public Health England (PHE).  There had been 49 cases of this variant, mainly concentrated in Yorkshire and Humberside.  Though it has been detected in the UK, Greece and Chad, its origin and impact remain unclear.

Of variants and vaccines

Because the proliferation of variants, both new and old, are of the greatest public concern, the burning question arises, can the current vaccines cope?  Hitherto, the experts had provided merely mumbled messages of optimism.  But on 22 May, Public Health England (PHE) published the outcome of a study entitled, ‘Effectiveness of COVID-19 vaccines against the B.1.617.2 variant.’

The results showed that two doses of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccines are highly effective against the Indian variant, as they are against the Kent variant.  Both vaccines were only 33% effective against the Indian variant just three weeks after the first dose compared with 50% against the Kent variant.  However, after two doses of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccines, their efficacy against the symptomatic disease of the Indian variant was approximately 60% (66% against the Kent variant) and 88% (93% against the Kent variant) respectively.  It is thought they are likely to be even more effective at preventing the more serious consequences of hospital admissions and deaths.

The authors of the study concluded, ‘Overall, we found high levels of vaccine effectiveness against symptomatic disease after two doses.  These estimates were only modestly lower than vaccine effectiveness against the B.1.1.7 variant.  It is likely that vaccine effectiveness against more severe disease outcomes will be greater.  Our findings would support maximising vaccine uptake with two doses among vulnerable groups in the context of circulation of B.1.617.2.’

These data caused the Health Secretary, Matt Hancock, to enthuse, ‘This new evidence is ground-breaking – and proves just how valuable our Covid-19 vaccination programme is in protecting the people we love.’  Moreover, he is ‘increasingly confident’ that the final stage of easing restrictions in the UK can now take place on 21 June.  In other words – go, get your booster shot.  And, next month, by the time you read Coronavirus – Part 8 (June 2021), we may well be free(ish).

Vaccines from Janssen and CureVac

On 28 May, the Medicines and Healthcare products Regulatory Agency (MHRA) approved yet another vaccine for use in the UK – that makes four in total.  This Janssen vaccine is manufactured in Belgium by a subsidiary company of the American pharmaceutical giant, Johnson & Johnson.

This vaccine had already been authorised by the US Food and Drug Administration (FDA), the World Health Organization (WHO) and the European Medicines Agency (EMA).  However, two days before the UK approval, on 26 May, the Belgium government had suspended its use for those under the age of 41.  Why?  Because the EMA was reviewing the death of a 37-year-old woman in Belgium who suffered from blood clots and low platelet counts after receiving the Janssen jab.

This Janssen product has the dual advantage as a single-dose vaccine that can be stored in a domestic fridge.  It is reported to provide 67% protection against Covid-19 infection and 85% against the severe disease and hospital admissions.  Like the Oxford-AstraZeneca it is an adenovirus-based vaccine and has similarly been linked to some rare blood-clotting issues.  This means that it will probably be recommended in the UK only for people over 40, perhaps as a booster in the autumn.  The UK has ordered 20 million doses for expected delivery later this year.  The UK’s Joint Committee on Vaccination and Immunisation (JCVI) has yet to announce its proposed patient cohort for this Janssen vaccine.

The world has quickly become accustomed to the novel technology of mRNA-based Covid-19 vaccines.  Two of the most successful and widespread jabs employ this know-how, namely, those made by Pfizer-BioNTech and Moderna.  Together, they have already delivered protection to tens of millions of people across some 90 countries.  They are about to be joined by a third mRNA vaccine developed by a collaboration between the biotech giant GlaxoSmithKline (GSK) and CureVac, a small German biopharmaceutical company.

CureVac’s first-generation mRNA Covid-19 vaccine, known as CVnCoV, is currently in late-stage Phase 3 human testing with 36,500 participants.  Planned regulatory approval from the European Medicines Agency (EMA) is expected by early June 2021.  Then production, prior to its roll-out, will be stepped up to 300 million doses this year and one billion in 2022.

CureVac has also developed a second-generation mRNA vaccine, officially known as CV2CoV.  It is expected to deliver broader protection against newly-emerging variants.  In Phase 1 trials, started in June 2020, CV2CoV showed strong immune responses.  In addition, it has demonstrated effectiveness against a number of Covid-19 variants, including B.1.1.298 (the Danish), B.1.1.7 (the Kent) and B.1.351 (the South African).  GSK and CureVac are expecting to launch the Phase 2 human clinical trials of CV2CoV in the third quarter of 2021.

The COV-Boost study

‘Compare and contrast’ sounds like examination rubric.  But at last, a clinical trial has been launched to assess the effects of giving third booster doses of seven different Covid-19 vaccines.  This COV-Boost study is being led by University Hospital Southampton NHS Foundation Trust and is being funded by £19.3 million of government money.

It will be the first in the world to provide data on the impact of a third dose on people’s immune responses.  The study, which will take place at various sites in England, Scotland and Wales, will involve 2,886 participants and vaccinations will begin in early June.  The seven vaccines on trial are from Oxford-AstraZeneca, Pfizer-BioNTech, Moderna, Novavax, Valneva, Janssen and CureVac.  You can sign up at https://www.covboost.org.uk/home

The experimental design of the trial is comprehensive.  Third vaccine doses will be given at least 10 to 12 weeks after a second dose and could be a different brand to the one originally used.  All participants will be monitored throughout the study for any side effects and will have blood samples taken to measure their immune responses on days 28, 84, 308 and 365.

Initial findings are expected in September.  The results are important to inform the UK’s Joint Committee on Vaccination and Immunisation (JCVI) on the efficacy and likelihood of any proposed booster Covid-19 vaccination programme this coming autumn.

Should children be vaccinated against Covid-19?

Vaccinating children from a few weeks old against measles, mumps, polio, diphtheria and several other deadly diseases, is a routine and widely-accepted medical procedure.  So what about Covid-19 jabs for youngsters?

Some countries have started.  For example, in mid-May, the US Food and Drug Administration (FDA) expanded its authorisation for the use of the Pfizer-BioNTech vaccine to include adolescents from 12 to 15 years of age.  Already around 600,000 US youngsters have been vaccinated.  Next year, the USA plans to vaccinate even younger children if the future safety data warrant such a strategy.  Although the UK is making significant progress vaccinating adults, any decisions relating to children are currently on hold.

Here is the crucial question – will vaccinating children save lives?  That question is clouded by international dimensions.  For example, in poor countries, would it be best if vaccines designated for children were given to healthcare workers and the vulnerable?  The World Health Organization (WHO) maintains that wealthy countries should postpone plans to immunise children and instead donate the vaccines to the rest of the needy world.  Moreover, it is clear that children are very rarely seriously affected by Covid-19.  Children typically display only mild symptoms, or are asymptomatic.  A multinational study, published during May in The Lancet, reckoned that worldwide fewer than 2 out of every million children die from Covid-19.  On the other hand, vaccinating children could help save adult lives by contributing to herd immunity and thereby disrupting the spread of the virus.  And while young children do not generally appear to be super spreaders, older teenagers can be.  In the UK at present, it is only children judged to be at ‘very high risk of exposure and serious outcomes’ who are being vaccinated.

So perhaps it is surprising that more than 25% of 16 and 17-year-olds in England have Covid-19 antibodies in their blood despite most remaining unvaccinated.  Do such children already have sufficient immunity without the need for vaccination?  Could such immunity be a valuable legacy of Covid-19 hot spots?

Perhaps, if there were unlimited quantities of vaccines, the case for the extensive jabbing of children might be more convincing.  As yet, the risks and the benefits of such a policy have not been fully weighed.  As yet, there is no satisfactory answer as to whether it would be a worthwhile strategy.

UK public inquiry within a year

Some politicians and commentators have pressed for an early, even an immediate, public inquiry into the government’s handling of the pandemic.  Others want to wait until after the plague is largely over and after the expected resurgence during the coming winter to allow a more comprehensive retrospective.

In mid-May, the UK government announced that the inquiry will begin formally in April 2022.  Boris Johnson, speaking in the House of Commons, said, ‘It is absolutely vital for the sake of the bereaved, for the sake of the whole country, that we should understand exactly what happened, that we should learn the lessons.  We owe it to the country to produce answers within a reasonable timescale.’  The inquiry will be on a statutory basis and will be able to compel, ‘the production of all relevant materials and take all evidence in public, under oath.’

There will be much to unearth.  Critics of the government’s Covid-19 strategies want answers about why, for instance, it waited so long to impose lockdowns, failed to protect care home residents and their carers in the early stages of the pandemic, and did not ensure sufficient stocks of personal protective equipment (PPE) for health workers.  In addition, there have been allegations of cronyism surrounding contracts for healthcare equipment.  And, perhaps above all other questions, is this, why has the UK suffered one of the worst Covid-19 death tolls in the world, with almost 128,000 fatalities?

The Wuhan great escape

In Coronavirus – Part 6 (April 2021), the origin of the Covid-19 virus was discussed.  In particular, the inconclusive outcome from the World Health Organization’s (WHO) team of experts after its month-long fact-finding mission to Wuhan was cited.  The WHO team concluded that the virus probably jumped from live animals to people, probably originating in bats and probably passing to humans through unidentified intermediate animals, or maybe from infected frozen wild animals, or perhaps from farms in southern China.

However, there is another, maybe better, theory in circulation.  And it is gaining some traction.  It says that the pandemic started when the coronavirus escaped from a laboratory in Wuhan.  In fact, some scientists have named the facility as the Wuhan Institute of Virology (WIV).

The WHO team dismissed this ‘lab leak’ theory.  Peter Ben Embarek, the head of the WHO team, said it had examined various hypotheses and concluded that the evidence weighed against the WIV or another of Wuhan’s labs being the source.  He maintained that while ‘accidents do happen’, virus leaks from high-level biosafety labs are ‘extremely rare’ and the WIV set-up made it ‘very unlikely that an escape could happen from a place like that.’

However, in a recent letter to the journal Science (14 May 2021), under the title, ‘Investigate the origins of COVID-12’, a group of mainly US scientists from leading universities criticised the WHO team for rejecting the leak theory.  They wrote, ‘Yet more investigation is still needed to determine the origin of the pandemic.  Theories of accidental release from a lab and zoonotic spillover both remain viable.  Knowing how COVID-19 emerged is critical for informing global strategies to mitigate the risk of future outbreaks.’

And they continued, ‘As scientists with relevant expertise, we agree … that greater clarity about the origins of this pandemic is necessary and feasible to achieve.  We must take hypotheses about both natural and laboratory spillovers seriously until we have sufficient data.  A proper investigation should be transparent, objective, data-driven, inclusive of broad expertise, subject to independent oversight, and responsibly managed to minimize the impact of conflicts of interest.  Public health agencies and research laboratories alike need to open their records to the public.  Investigators should document the veracity and provenance of data from which analyses are conducted and conclusions drawn, so that analyses are reproducible by independent experts.’

And there are other supporters of the ‘lab leak’ theory.  A US intelligence report had previously stated that three staff members from the WIV became ill in autumn 2019, shortly before the first patient with Covid-like symptoms was recorded in the city on 8 December 2019.  Now that report has been revised to ‘staff were hospitalised’ in November 2019.  Did they have Covid-19?  The WIV has yet to share publically its research logs, health records and so on.  In mid-May, the US House Intelligence Committee raised ‘serious concerns’ that the original outbreak of Covid-19 pandemic was linked to the WIV.  On 26 May, a key meeting of the WHO’s decision-making body is expected to discuss in detail the next phase of an investigation into the origins of Covid-19.  Chinese authorities have long rejected the ‘lab leak’ theory instead suggesting that the virus entered China in food shipments from another country.

These persistent denials, doubts and theories are set to linger.  Maybe they will never be settled.  Yet, it would be nice to know definitively where this wretched virus originated.

How to vaccinate the world

Experts say that people in poor countries will probably not be vaccinated against Covid-19 before the end of 2022.  That seems like a distant endgame, but how would even that remote goal be achieved?

True, the world has already taken possession of hundreds of millions of doses – hats off to the pharmaceutical and biotech companies for their manufacturing prowess, a round of applause for the scientists who have designed and produced the different vaccines in record time, and a warm smile for the politicians who have somehow managed Mission: Impossible so far.  But the world needs not millions, but billions of doses.  About 11 billion doses will vaccinate 70% of the world’s population, assuming two doses per person.  This is also the quantity needed to achieve herd immunity.

But this will not be a simple exercise.  For a start, there are obvious global inequalities.  Look at a table of the proportion of adults who have had one dose.  The list currently runs from Gibraltar at 100% through to the UK at 57% and finally to lowly Syria at 0%.  ‘Levelling up’ needs to become more than a political slogan.

And there are other disparate factors.  What about, for instance, the ordering, paying, distributing, let alone the actual event of vaccinating?  Have you experienced the poverty, bureaucracy, road conditions and healthcare facilities in, say, Nepal or Mali?

And why should poor countries be tied into competing for vaccine purchasing contracts with rich countries?  Already there is the COVAX project (see Coronavirus – Part 5 (March 2021)), a scheme in which international funders have pledged to supply sufficient doses to vaccinate one-fifth of the world’s population.  So far it has garnered 1.1 billion doses.  A modest beginning.

Or why not encourage poor countries to manufacture their own vaccines?  It may be technically difficult, but surely it is not impossible.  After all, there is considerable expertise around the world.  The principle of ‘give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime’ makes sound vaccine sense too.

By the beginning of March it was reckoned that global production of vaccines had reached 413 million doses.  Production growth over the coming months is expected to be exponential, so by the end of 2021 the total is predicted to be between 9.5 and 12 billion doses.  Yet some analysts think these numbers are too optimistic because they exclude problems with raw material supplies, export licences, distribution networks, political setbacks and so on.

And vaccines are not just liquids in syringes.  For a start they can require 200 or so components, often to be purchased from competitive global markets.  They include the chemical reagents for culturing and purifying the vaccines but also the glass vials, filters, laboratory equipment and a 101 other minor accessories.  All are essential to arrive at the ‘fill-and-finish’ final product.  Encouragingly, some previously competing companies are collaborating in these tasks.  For example, GSK (UK) and Novartis (Switzerland) are manufacturing 100 million and 250 million doses, respectively, of the vaccine for CureVac (Germany).  The biggest deal involves Oxford-AstraZeneca (UK), which has signed manufacturing contracts for 2.9 billion vaccine doses with 25 companies in 15 countries.

There are three main types of Covid-19 vaccines – viral vector; whole virus, and messenger RNA (mRNA).  They represent 22%, 35% and 43% respectively of the current total global production.  Of these, mRNA vaccines are relatively simple to generate, but awkward to scale up.  Production bottlenecks inevitably occur because of the novel components required and their limited number of suppliers.

But delays and glitches are not just practical, they are also intellectual.  That is why India and South Africa plus 100 other countries, including the United States, Russia and China and organisations such as the WHO, are campaigning for temporary waivers of the intellectual-property rights on the various vaccines in order to ease their manufacture in poorer countries.  This, the campaign’s supporters argue, will unleash production.  But this India–South Africa proposal is being opposed, most notably by the EU, the UK, Japan and most of the big pharma companies.  They argue that waiving intellectual-property rights is complex and unnecessary, and even undesirable.  As yet, it remains ‘an idea in progress, but making progress’.

Vaccinating the people of the world ASAP is a massive undertaking.  As has been said many times, ‘No-one is safe until everyone is safe.’  Now it looks as though it will be the end of 2022 until we will all be Covid-19 secure.

Smell that Covid virus?

Have you ever been sniffed for drugs (or explosives!) by a dog at an airport?  Have you ever been tested for coronavirus by a lateral flow test (LFT)?  Now the two technologies have been merged.  A preliminary study has recently shown that sniffer dogs are remarkably adept at detecting the infection on the clothes of Covid-19 patients – dogs have up to 100,000 times more sensitive noses than humans.  Clothing from both variant sufferers and from those who were asymptomatic did not faze these ‘canine biosensors’.

Six dogs were trained by the Medical Detection Dogs charity.  The best performer, Tala, a golden labrador, was able to identify Covid-19 samples with a 94% accuracy, while even the poorest performer was 82% accurate – a typical LFT is reckoned to be 83% correct.  Even so, the dogs returned 16% false positives, or, in other words, 48 people on a planeload of 300 passengers.  The procedure obviously needs tweaking.  Nevertheless, trained dogs could be a faster, cheaper and more accurate means of initially screening people, say at airports and large spectator events.  It is estimated that two dogs could screen 300 people in 30 minutes.  Positive suspects could then be confirmed, or otherwise, with the gold-standard PCR (polymerase chain reaction) tests.

Additional smelly environments are wastewater treatment plants.  Once it was realised that people infected with Covid-19 shed whole virus particles and viral fragments in their faeces, the science of ‘sewage epidemiology’ received an upgrade and sewage-surveillance programmes became fashionable.  More than 50 nations are now monitoring the spread of Covid viruses in sewage.

The UK government has recently expanded its sewage-testing programme to detect early signs of the presence of the coronavirus.  The current effort is considerable.  Almost 70% of England’s population is now covered and their excreta is being analysed for genetic fragments of the virus – a new, dedicated analytical laboratory in Exeter had been opened for that purpose.  Over 500 locations are being monitored and sampled at least 4 days per week.  It is reckoned that this sewage-based testing can pick up infection hot spots a week before conventional medical-based tests.

This additional detection scheme is an early-warning system and able to identify local outbreaks as well as the existence of variants.  It is already being used to monitor and track the spread of the Indian variant.  Its great advantage is its ability to test for the virus at a community level and therefore alert local councils and their public health teams to target resources more accurately.

Good things from Covid-19?

It is a hard, and perhaps even hard-hearted amid the legions of maladies and deaths, to find anything good to emerge from this Covid-19 pandemic.  But here and there are little rays of sunshine.  Two such have been dubbed the ‘Chris Whitty effect’ and the ‘Nightingale effect’.

Apparently, the affable Dr Whitty, chief medical officer for England, has inspired thousands of additional school students to apply for careers in healthcare – consider the power of his straight-talking, fact-laden TV appearances.  According to figures from the Medical Schools Council (MSC) and the Universities and Colleges Admissions Service (UCAS), applicants to university courses in medicine for autumn 2021 entry have jumped by 20% and those for nursing by 25%

In addition, the ‘Nightingale effect’ has increased the number of nurses, midwives and health visitors in the NHS by 3.5%, that is, by more than 11,000 staff during the last year.  Such a surge in applicants and employees in the caring professions must count as good news.