Where is herd immunity?

warm welcome to today's talk friday the 15th of october now it appears that cases in the states are going down apparently due to herd immunity but in the uk we're not seeing this it's quite uh quite difficult to explain really but let's have a look at some orientation slides first of all before we go on to that so here we have the new daily confirmed cases that we often look at new zealand at the bottom there a few australia going up technically australia's got slightly more than canada at the moment you can probably see there the green line is australia moving up to the netherlands where we've got a bit of an increase it seems europe's getting a bit of an increase and we see that again in ireland where there's been a bit of an increase but the united states going down nicely as we've just mentioned and uh the uk well in terms of pure cases they're really the less said the better it's uh the cases are still surging ahead in the uk uh now what really matters of course is the number of pages in hospital purpose and this is the real thing that matters it doesn't matter if people get a little bit or a little bit of a cold not too big of a problem but netherlands will see lowest then canada and then ireland but ireland with a slight upward trend uk really sort of you have to say levelish to slightly increasing in hospitalizations for the uk and the united states going down albeit from a pretty high peak but a very welcome reduction in the stress in the hospitals in the united states there but in the uk i know there's areas where it's still really quite a problem where it's using a lot of nhs resources so it must still be bad in the united states so even though we've got dramatic improvement it's still really making quite a big uh dent and impingement on the ordinary care that's still desperately required so it's still a problem in terms of the r value the reproductive value and that line is our one there so let's see where we're at with these countries that we're keeping an eye on at the moment so just bear in mind that this is the r1 line here so cases in the united states are below one so are still going down and canada they're below one so they're still going down australia the united kingdom island netherlands and sadly new zealand got a fairly high r value now you can't take too much of this because it's based on low numbers so you don't need another few dozen another dozen cases or so would increase the r value in new zealand whereas in the uk it would take many thousands to do that but uh interesting sort of trend then of course the big thing is we're currently heading into autumn this is kind of the big the biggest unknown really as we head into autumn time now um let's look now at the just briefly some news from the united states this is about the modern booster vaccines now i think it's fair to say this is a pretty contentious issue really so the cdc hasn't said anything yet that hasn't adjudicated but the food and drug administration their specialist independent advisory panel now i don't know who's in this and how independent it is but their advisory panels unanimously voted to give booster doses to people who had the modern vaccine which of course is a big chunk of the people in the united states 65 and older and for adults are at high risk of severe illness and that'll probably be extended to people with occupational risk as well after six months and they've recommended a half dose so it is going to be a lower dose now i do kind of like this because i always like to give the lowest possible dose for the best therapeutic or in this case best prophylactic effect so that's kind of good the thing that's a bit concerning is is is uh jacqueline miller head of moderna's infectious diseases therapeutic area so modern are presenting lots of data indicating why a third dose is necessary now no one is saying there's anything wrong with this data but of course many of us have difficulty uh forgetting that the pfizer and the moderna vaccine are both making the companies a lot of money these are both for profit vaccines but nevertheless we'll look at what they're saying six to eight months after vaccination antibody levels dropped in vaccinated recipients well yes we know that and after half a booster dose this was a study of i think it's just a study of 300 patients from what i remember um half dose booster at least six months after initial vaccination restored antibody levels well it would do but we've noticed before the antibody levels are not really a very good indicator of immunity levels it's much better to consider the memory cells the memory t cells the killer cells the helper cells and the the memory uh b cells that are probably more important in the longevity or i would say are more important in the longevity of the immune response so you kind of get the idea that the impression that attention is being focused on on one particular aspect of immunity whereas immunity is a spectrum of responses the natural killer cells of course we now know that there's a specific response in the natural killer cells as well this isn't mentioned it's simply antibodies and of course we know that antibodies weighing over time anyway that's that's pretty well known so that's not surprising and they also say the people from the original trial there's a clear uptake in breakthrough infections that's infections after the vaccine in july and august because they had the vaccines earlier now that is more convincing data there but if people are actually getting infections but we believe that protection against hospitalization and severe illness and death remains remarkably strong so um i think there's still a question mark over that in the states uh we'll interest we'll see what the f which way the fda jumps officially but then of course the cdc will have to verify that and within the next this is we're probably going to get a decision on this in the next few days and then um hopefully there'll be some sort of decision on the uh janssen uh johnson johnson vaccine soon this is still not decided upon so they've decided on the booster pattern for the pfizer and now the modern has been recommended so that is uh that is where we are at the moment now i'm going to move on to the uk now because we have a remarkably high number of cases office for national statistics data here uh weekend of the 9th of october people that had covered 19 in the week in other words the prevalence in england it was up in wales it was up in northern ireland it was up in scotland thankfully it was down but up in all of these other three countries now england the prevalence was 1.63 that's one in 60 people wales it was 1 in 45 people northern ireland 120 people and uh scotland it was down to one if it was either week before one in 80 people so pretty high percentages of people here particularly in wales one in 45 people so over two percent of people there actually infected in that week high prevalence figures indeed and we'll look at some of the implications of this now people testing positive positive antibodies in the uk as a whole 93.6 so we can see that it seems fairly obvious that people well we don't know this but it looks likely that people are testing positive for antibodies are also getting the infection so um reinforcing the idea that antibodies is only one aspect of infection that we need to uh one aspect of immunity we need to look at now office for national statistics has also started talking about mortality displacement interesting concept um mortality displacements didn't off uh did not offset excess deaths by mid 2021 let's look at what they mean about that so the say there's some evidence of mortality displacement during the pandemic of course so this is when vulnerable people die sooner than expected basically so a lot of the people that have died of covet would have died in the next days weeks months or year or two after that so that is certainly true because it's vulnerable people and older people that have died and if a lot of people die all of a sudden uh in the early stages that's happened in some of the waves this can potentially lead to a lower than average period of mortality after that so you can have a higher period of mortality for a period of time followed by a lower period of mortality but what's the balance between that what what does it equal the balance between that well these periods of below average mortality did not offset the high numbers of death since the beginning of the pandemic in other words there has been excess death so they're taking the third of january 2020 to the second of july 2021 so that's what that's that's 18 months of data isn't it that's a lot of data and they've calculated 97 991 excess deaths in england and wales compared to what have been expected in a non pandemic year now this doesn't tell us if a lot of these people that died would have died the year after or the year after what would be much more useful to know is the years of useful life lost now i don't know anyone that's done that calculation yet but clearly someone that dies in their 80s if they die when they're 82 well they could have died when they were 84 anyway so they're losing less life than someone who dies at a younger period of time that would be a much more useful calculation never seen it done never seen a paper on it but i suspect it will come in time we'll keep an eye out for that um so within 28 days of a positive test it's 138 000 have died so far as of today that's as of the 15th of october on the death certificate 161 000 it looks like quite a few of these then were displaced deaths and the real figure is nearer to 98 000 excess deaths people that would be alive now had it not been for covered 19. whereas quite a few of these would have died already and quite a few of these would have died already because they are mortality displacement so i don't know if that's good news or bad news it's just an observation really but i think it does show that um a lot of people that died would have died anyway but they did die sooner which of course is still is still bad now let's look at some of the zoe symptom tracker data now so in this first graph we see the number of new symptomatic cases now this is the total number of cases here so we see it's about what 70 000 people per day there in total but of those pretty well 19 000 about 19 000 there have been doubly vaccinated so we see there's about 19 000 people that are doubly vaccinated they're still getting symptomatic infection every day now this does look a bit disappointing but when we remember that um i think it's 78.8 percent of the population now have been doubly vaccinated over the age of 12. we see that actually although there's about 70 000 people here all together so about 50 000 of these that from there to there is occurring in in the minority and 20 of the population that are unvaccinated so we are seeing a significant effect of protection there of the vaccines against symptomatic infection even a low 19 000 people are getting infected every day who have been doubly vaccinated now this is the instance by age group so this blue one at the top here is uh basically school age children no well not to 18 and that was going up of course as the schools go back started to go down now which is is good to see but this is probably not the fact i don't think this is the effect of vaccination it's too early this is more the effect of a community immunity i think there's not enough of this group have been vaccinated but what we do see is that this group appears to be been transmitting the infection to this group now this group here is the 35 to 55 which of course is their parents generation so this generation here seems to have been transmitting it to this generation there and the k the problem is now will this generation here transmit it to their parents to these children's grandparents in the older age group that are much more vulnerable to um severe illness and hospitalization and that is the risk at the moment prevalence by region um well we actually see that whales are still high but starting to go down this green line here is the midlands which is going up now this green line here for the midlands is increasing and these are a concern because these are areas of low vaccination so for example peterborough and leicester uh 59 of the population only doubly vaccinated birmingham i think it's only 55 manchester's about the same 54 in manchester i think low vaccinated areas but these are areas with high ethnic minority populations which have suffered particularly in previous waves so there is a risk for these populations that don't seem to be taking up the vaccine as readily they are more prone to hospitalization severe illness and indeed death in the autumn when we are expecting more cases in unvaccinated people and the other concern is long covered here a bit more and long covered in a minute but well over a thousand people a day developing long covered as as after the the previous uh the previous surge so some pretty interesting uh pretty interesting data there from the from the zoe covered symptom tracker app which is always always useful so they're the links for that i always post the links uh long coverage we said we were concerned about now this is from the office for national statistics um an estimated 1.1 million people in the uk currently experiencing some degree of long-covered that's a lot of people 1.17 of the population were experiencing self-reporting long-covered which is still high um up from the uh the previous week where it was under a million now of the number that currently have it here that of this 1.1 million 77 had or suspected they had covered 19 at least 12 weeks previously so here it's gone for 12 weeks so people basically on welfare three months after the infection but 37 of the total had or suspected they had copper 19 at least one year previously so over 400 000 people in england wales have had problems for a year or more now and this has got obvious implications for the individuals and indeed for national productivity people that said symptoms adversely affected the day-to-day activity of around that's around two-thirds of the 1.1 million and these figures are probably going to be the same in the united states or anywhere else so this is a big burden of um a big burden of morbidity and basically we don't know which way this is going to go are these people going to remain uh unwell for another few weeks or another few years or another few decades we don't know yet this still remains to be seen uh fatigue is the most most common symptom 56 of the 1.1 million get fatigue shortness of breath 40 percent get that loss of smell or taste 32 difficulty concentrating 31 they're the main features so talking about this high incidence all together let's just look at before we look at tim spector let's just look at that actually um the way things are going in the uk it's not it's not looking good so people testing positive up eleven point five percent of the week deaths of five five percent on the week patients admitted hospital also up on the week so we are seeing this this and it's consistent between the the zoe coffee symptom tracker up in the the official figures roughly the same indication so tim specter is saying this uh uk seems to be slowly waking up to the fact that covered 19 cases are too high but the reality is they've been sawing for months and many countries have put us on their red list so not doing tim's not particularly happy as am i uh infections remain high in young people and looking to be spilling over into the 35 to 55 year olds as we said the parents generation and if these sp creep over into the over 55s now these these are tim's word could spell disaster for the nhs this winter so no question that if the infection has gone we know the infection's gone from children to parents if it goes from parents to their parents to grandparents there are going to be particular problems particularly in these areas with low vaccination that we've looked at so um it's it's still there's still another another few months of difficulty to come and likewise in the states cases could well increase as as autumn now encroaches and it is really getting quite cold and autumnal now people are getting inside and shutting the doors just a quick more look at some uk data we'll look at the uh the cases in the uk uh so as we know um pretty consistent with the coverage symptom tracker data actually um they're still going up they're still going up and healthcare is actually creeping up a bit the number of people in hospital at the moment um so um 870 827 patients admitted in the day over 7 000 people with covered in hospital and these are beds that we could really really do with for treating people that are on waiting lists it really is a problem i think over 5 million people on waiting lists deaths thankfully not going up dramatically but still being maintained at uh not in significant levels and with as we've said the risk to go up more as autumn approaches now what is happening with herd immunity now in the states is it that herd immunity is kicking in and cases are going down in the states we certainly hope that is the case but we are concerned about autumn in terms of herd immunity in the uk now again this is tim spector on his latest uh video saying that of course we did think herd immunity will kick in at about 65 70 percent but when with the new more transmissible variants basically it seems to keep going up tim spector says it's now a minimum of 85 percent but we do know that 78 have been doubly vaccinated now and over nine percent 90 percent have antibodies so we are probably getting towards it but tim says professor specter says it it's with cases so high it's clear that herd immunity isn't happening and basically who could disagree with that with the figures that we've just seen so it is disappointing if you'd said to me that when there's 80 of people doubly vaccinated about 90 of people single vaccinated 93 point whatever it was four percent not even 94 like 94 of people with antibodies would we have returned immunity if you'd asked me like 18 months ago i said well of course of course but we haven't we haven't um then tim spector reinforced his idea about symptoms these are the latest symptoms that he's getting still inconsistent with the government guidelines this is just laughable current symptoms in the vaccinated doubly vaccinated in children runny nose is the most common head then headache then sneezing then sore throat then cough loss of smell or taste is dropped down below the top five but this does vary a bit and that's the official uk site that we've just um just looked at so that's a quick sort of sketch of where we are at the moment as we head into autumn my belief is still basically the same i do think there's going to be more cases in the states in autumn uh certainly in the uk i think we're going to see an increase in hospitalizations in the uk in autumn unfortunately but i really do believe that the herd immunity effect the community the the community immunity effect is going to start kicking in by the end of 2021 and the cases will be going down even though it's still winter i'm hopeful that cases will be going down by january february next year but we have still got this next few months to get through and of course many parts of the world are nowhere near the vaccination levels that we are in the more affluent western countries okay we'll leave that for today i think and thank you for watching

Channel: Dr. John Campbell

Views: 408,824

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: FVBzaTnDZKo

Length: 21min 20sec (1280 seconds)

Published: Fri Oct 15 2021