When will this shit end?

[steviewevie]

it's ok..don't panic...mass testing will save us again...

[incident]

12 minutes ago, stuartbert two hats said:

Thanks both, exactly the kind of info I was looking for 🙂

One thing I should add..

Both Novavax and the Janssen 2-dose regiment have a substantial part of their Phase 3 trials in the UK (Janssen might still be recruiting if anyone is interested), so while the current situation here is grim it might actually accelerate results.

[ace56blaa]

22 minutes ago, steviewevie said:

 

I'm in cambs a tier 2 area between two tier 4 areas and our numbers have skyrocketed this week. 

[Matt42]

Can’t sleep. Got some weird feeling that something yet is still to happen.

It’s definitely the bleak midwinter 

[Ryan1984]

I’ve got a friend who lives on his own but he has bubbled with his parents. He lives in Tier 2 and they are in 4. Is he still allowed to visit them as he’s been doing throughout the year? Essentially, do support bubbles trump tier restrictions?

[squirrelarmy]

2 minutes ago, Ryan1984 said:

I’ve got a friend who lives on his own but he has bubbled with his parents. He lives in Tier 2 and they are in 4. Is he still allowed to visit them as he’s been doing throughout the year? Essentially, do support bubbles trump tier restrictions?

Support bubbles can continue for those who are living alone joining in with another household

[steviewevie]

3 minutes ago, Ryan1984 said:

I’ve got a friend who lives on his own but he has bubbled with his parents. He lives in Tier 2 and they are in 4. Is he still allowed to visit them as he’s been doing throughout the year? Essentially, do support bubbles trump tier restrictions?

Don't think he is....from here

https://www.gov.uk/government/publications/making-a-christmas-bubble-with-friends-and-family/making-a-christmas-bubble-with-friends-and-family

Areas in Tier 4

If you live in a Tier 4 area, you must follow the rules in your tier over the Christmas period. This means that you cannot meet other people indoors, unless you ordinarily live with them, or they are part of your existing support bubble. Outdoors, you can only meet one person from another household.

Areas not in Tier 4

If you do not live in a Tier 4 area, you may see a maximum of two other households (your ‘Christmas bubble’) on Christmas Day (25 December). You cannot see anyone from a Tier 4 area.

You should think very carefully about the risks and only form a Christmas bubble if you feel you absolutely need to. Wherever possible, discuss alternatives to meeting up in person.

[Guest]

6 minutes ago, Ryan1984 said:

I’ve got a friend who lives on his own but he has bubbled with his parents. He lives in Tier 2 and they are in 4. Is he still allowed to visit them as he’s been doing throughout the year? Essentially, do support bubbles trump tier restrictions?

Yeah he is, support bubbles continue regardless of the different tiers.

[Toilet Duck]

18 minutes ago, stuartbert two hats said:

It's clever that they seemed to have preempted the Achilles heel of the Oxford vaccine. Was it something that the Oxford lot had considered? Or did they think they were pretty likely to be safe because they used a chimp virus?

They hoped the chimp virus would get around it, but it was an issue with the SARS vaccines, so this was one way to tackle it. The Russians took a different approach, maybe the combination of the two will be even better! 

[Zoo Music Girl]

Support bubbles basically become part of your household so you treat them the same as your household as I understand it.

[Guest]

4 minutes ago, Zoo Music Girl said:

Support bubbles basically become part of your household so you treat them the same as your household as I understand it.

Yeah that's it.

[stuartbert two hats]

2 minutes ago, Toilet Duck said:

They hoped the chimp virus would get around it, but it was an issue with the SARS vaccines, so this was one way to tackle it. The Russians took a different approach, maybe the combination of the two will be even better! 

It certainly makes sense. Although it also looks like the half dose/full dose approach seems to work pretty well too.

Hmm, does this suggest issues with booster shots further down the line? If we lose immunity at different rates, could we still have an immune response to the delivery mechanism, even as our protection against COVID itself fades, meaning that we can't reuse an existing adenovirus vaccine?

[Chef]

 Can anyone (@toiletduck) translate if there’s anything new in this? 

[Toilet Duck]

17 minutes ago, stuartbert two hats said:

It certainly makes sense. Although it also looks like the half dose/full dose approach seems to work pretty well too.

Hmm, does this suggest issues with booster shots further down the line? If we lose immunity at different rates, could we still have an immune response to the delivery mechanism, even as our protection against COVID itself fades, meaning that we can't reuse an existing adenovirus vaccine?

Wouldn’t expect it to have any impact on Pfizer or Moderna since they are just lipid coated mRNA, not very immunogenic until the mRNA is turned into spike protein our cells, so it shouldn’t be an issue. May well need to mix and match the ones delivered by viruses though (we’ve no idea yet what kind of lingering response to the vector there might be). Hopefully there will be a whole bunch approved by the time we have to worry about though! 

[Leyrulion]

59 minutes ago, incident said:

One thing I should add..

Both Novavax and the Janssen 2-dose regiment have a substantial part of their Phase 3 trials in the UK (Janssen might still be recruiting if anyone is interested), so while the current situation here is grim it might actually accelerate results.

How do you sign up?

[stuartbert two hats]

19 minutes ago, Toilet Duck said:

Wouldn’t expect it to have any impact on Pfizer or Moderna since they are just lipid coated mRNA, not very immunogenic until the mRNA is turned into spike protein our cells, so it shouldn’t be an issue. May well need to mix and match the ones delivered by viruses though (we’ve no idea yet what kind of lingering response to the vector there might be). Hopefully there will be a whole bunch approved by the time we have to worry about though! 

Yeah, that's true. By the time we need a booster, we shouldn't be limited to reusing the same kind of adenovirus vaccine, at least not on the same people.

[efcfanwirral]

1 hour ago, Matt42 said:

Can’t sleep. Got some weird feeling that something yet is still to happen.

It’s definitely the bleak midwinter 

I've been the same last couple of days. Feels like majorly historic times but I can't quite work out why - something beyond the covid/Brexit stuff 

[incident]

11 minutes ago, Leyrulion said:

How do you sign up?

Registrations for that specific (Janssen 2 shot) trial is here, or the general NHS trial registry is here.

[stuartbert two hats]

5 minutes ago, efcfanwirral said:

I've been the same last couple of days. Feels like majorly historic times but I can't quite work out why - something beyond the covid/Brexit stuff 

I'm not sure anything else is needed, they're pretty historical things.

[RobertProsineckisLighter]

6 minutes ago, efcfanwirral said:

I've been the same last couple of days. Feels like majorly historic times but I can't quite work out why - something beyond the covid/Brexit stuff 

I'll have a quid on:  The Queen's speech including the line 'I thought fuck it I'll sort this mess myself, and threw Boris in the tower'

[efcfanwirral]

Its literally just trying to get through the next day for this lot at the moment...

[Toilet Duck]

22 minutes ago, Chef said:

 Can anyone (@toiletduck) translate if there’s anything new in this? 

So...it’s the first proper report I’ve read on this variant. Gives a lot more detail as to why they are concerned. Basically, this variant has a lot of changes in it, but 3 in particular are at the root of why it is being monitored. They are in the gene that codes for the spike and have been independently shown to likely have an impact on transmissibility, but what the impact of all 3 together is remains unknown. They are isolating the variant and studying it in the lab to see exactly what they do.

One of the changes in the spike gene results the loss of a bit of it. This causes one of the parts of the PCR test to stop working (the other two parts still do, so you can still pick up positive cases...some labs use this 3 gene test, some use a two gene version that doesn’t include the spike gene, so would miss this). This has made it easier to use PCR results as a proxy for the new variant instead of having to sequence all the samples (which takes much longer). They have checked by sequencing them as well and about 99% of samples where the spike PCR failed it was because the patient was infected with this variant. That has allowed them to reconstruct the growth of this variant and compare it to other variants over the same time period. While the model has to ignore other factors that might be driving transmission (human behaviour mostly), it is certainly outpacing other variants over the last few weeks and they now attach high confidence to this assessment.

What does this mean? Well, it looks like this variant is more transmissible, but it’s not certain (no assumptions are made in the model, so there could be underlying reasons why it is spreading rapidly). They also need to get a better breakdown of the age of infected individuals (which might inform some of the reasons for the rapid spread). Some of the changes are in regions that our immune system makes antibodies to, but not the only regions, so the vaccines should still work just fine (monoclonal antibody therapies might need to be adapted if they were used as there is some data suggesting one of the changes could stop specific antibodies from working, but cocktails should still work ok). There is also no evidence it causes more severe disease. Indeed, it also has another interesting deletion in it (not in the spike, but in a gene called ORF8). Previously this has been associated with less severe disease, but that’s not completely confirmed yet either. Could this be a weaker but more infectious virus? Don’t know yet!

Anyway, still not definitive yet, but there are multiple lines of evidence now suggesting that this could spread more easily, hence, the prudent thing to do is to try to contain it. We’ve seen other early datasets like this and it hasn’t turned out to be a more transmissible form (the underlying assumptions that can’t be modelled were at the root of it), but wise to be cautious here.

[zahidf]

 

 

[zahidf]

 

[mattiloy]

24 minutes ago, Toilet Duck said:

So...it’s the first proper report I’ve read on this variant. Gives a lot more detail as to why they are concerned. Basically, this variant has a lot of changes in it, but 3 in particular are at the root of why it is being monitored. They are in the gene that codes for the spike and have been independently shown to likely have an impact on transmissibility, but what the impact of all 3 together is remains unknown. They are isolating the variant and studying it in the lab to see exactly what they do.

One of the changes in the spike gene results the loss of a bit of it. This causes one of the parts of the PCR test to stop working (the other two parts still do, so you can still pick up positive cases...some labs use this 3 gene test, some use a two gene version that doesn’t include the spike gene, so would miss this). This has made it easier to use PCR results as a proxy for the new variant instead of having to sequence all the samples (which takes much longer). They have checked by sequencing them as well and about 99% of samples where the spike PCR failed it was because the patient was infected with this variant. That has allowed them to reconstruct the growth of this variant and compare it to other variants over the same time period. While the model has to ignore other factors that might be driving transmission (human behaviour mostly), it is certainly outpacing other variants over the last few weeks and they now attach high confidence to this assessment.

What does this mean? Well, it looks like this variant is more transmissible, but it’s not certain (no assumptions are made in the model, so there could be underlying reasons why it is spreading rapidly). They also need to get a better breakdown of the age of infected individuals (which might inform some of the reasons for the rapid spread). Some of the changes are in regions that our immune system makes antibodies to, but not the only regions, so the vaccines should still work just fine (monoclonal antibody therapies might need to be adapted if they were used as there is some data suggesting one of the changes could stop specific antibodies from working, but cocktails should still work ok). There is also no evidence it causes more severe disease. Indeed, it also has another interesting deletion in it (not in the spike, but in a gene called ORF8). Previously this has been associated with less severe disease, but that’s not completely confirmed yet either. Could this be a weaker but more infectious virus? Don’t know yet!

Anyway, still not definitive yet, but there are multiple lines of evidence now suggesting that this could spread more easily, hence, the prudent thing to do is to try to contain it. We’ve seen other early datasets like this and it hasn’t turned out to be a more transmissible form (the underlying assumptions that can’t be modelled were at the root of it), but wise to be cautious here.

Thanks TD, i would also add that the ’variant of concern’ only accounts for 1400 of the observations whilst the other accounts for c33k.

Given the relatively small sample for the VOC and that they have not made any additional assumptions, based on this report, it raises the possibility that there is underlying bias in the sample (exposure to superspreader events, age profile of the patients in particular (they do mention at the beginning that more work is ongoing into age distribution of obs)). And therefore that the difference in growth could be attributable to other things.

Not sure if this is all they’ve based it on but if they’ve done such an impactful press release based on this without first looking at controlling for the differences in the characteristics of the patients in the sample I think thats pretty poor.

Edited December 22, 2020 by mattiloy