Waiting for the all clear

It’s great news that our wonderful NHS staff and volunteers are storming forward with the UK’s vaccination programme. Still, I worry about people being lulled into a false sense of security once they have had their first and even second jab.

Most of us will have had, or be getting, the AstraZeneca (Oxford) vaccine. It has an efficacy rate of 70 percent compared to the Pfizer-BioNTech vaccine’s 95 percent. These efficacy rates are based on the trials and mark the difference between those who had the vaccine and those who had a placebo (a solution that wasn’t the vaccine). If there’s no difference between the vaccine and placebo groups, the efficacy is zero. If none of those who became sick had been vaccinated, the efficacy is 100 percent.

What we do not know, yet, is the effectiveness of the different vaccines and whether they match the efficacy rate identified in the trials. This is vital, because it is not unusual for the effectiveness rate to turn out lower than the efficacy rate, and that means higher numbers of people becoming ill, requiring hospital, long-term care and support, or not surviving and adding to the already atrocious death rate than the trial data alone had predicted.

I’ve had my first dose of the AstraZeneca (Oxford) vaccine. I would have preferred to have one of the many with a higher efficacy rate, but there is no choice when you are called for your jab. I would also have preferred one, just for my feeling of confidence, that didn’t rely upon my immune system as the AZ one does. However, I was told by a consultant that this shouldn’t make a difference to its effectiveness in my body (I have Type 1 diabetes – an auto-immune condition).

I am very grateful for living in a country that has managed to roll out the first doses of its vaccination programme so well thanks to our NHS, local Government and volunteers. I am not impressed with the fact that my Government has time and again failed to follow the advice and kept the virus in circulation where variants have evolved threatening the effectiveness of the vaccines we have waited for. Like many people with a chronic condition, I have felt like I have been sitting on a time-bomb this past year waiting for the bomb disposal unit to arrive with a working vaccine. Despite having had my first dose, I am still waiting for the all-clear.

I understand why it is easier to use the AstraZeneca vaccine than one with a higher efficacy rate that has to be kept at such low temperatures. Still, I would question why people with underlying conditions, such as diabetes, are not offered the one with the highest efficacy result given the mortality rate – one in three deaths in hospital of people with underlying conditions had diabetes.

My fear is the Government will again lift the constraints too early, and the prize of an effective rate that matches the efficacy rate – itself no guarantee of returning to life pre-COVID-19 – will not be met. Even if it is, the difference between a 70 and 95 percent effectiveness rate is still enormous in human misery terms and cost to our NHS.

I’m afraid my 18 years working with a number of the people who have been making these decisions in Government does little to give me much hope. However, I would never discourage anyone from having whatever vaccine is offered. Even a low efficacy rate is better than zero

* Adrian Sanders is a Focus deliver in Paignton, Devon, and was the MP for Torbay from 1997 to 2015.

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55 Comments

  • Wouldn’t continuing the lockdown restrictions longer than necessary also lead to human suffering and further pressure to our NHS???

  • I sympathise with the concern expressed above but in order to get as many people protected as quickly as possible I believe that the government has made the right decisions on the vaccine roll out. Also, in the early days when there was greater uncertainty about supplies and production difficulties, not to mention efficacy, trying to offer different groups different vaccines would have been a risky nightmare.

    Managing the easing of the lockdown will not be easy either. Perhaps we should wait until the death rate stabilises then use changes in that as a feedback on the effect of reducing restrictions. The problem with that is the time lag.

  • I think that it is worth noting that the BBC reported “No-one who received the Oxford vaccine was hospitalised or became seriously ill due to Covid.”

    https://www.bbc.co.uk/news/health-55302595

    There has also been a more recent study that suggests slightly higher efficacy – the BBC reporting that in this trial “a single dose of the Oxford vaccine offered 76% protection for three months, and this went up to 82% after the second dose.”

    https://www.bbc.co.uk/news/health-55910964

    There are though questions about the “herd immunity” of vaccines that are less effective and you need a very high take-up to get to enough effective protection to give herd immunity (R rate less than 1) – and even a 10% reduction in efficacy can make quite a difference.

    There is also the unknown question of variants and we are approaching the most dangerous time for variants. If there is no virus around then it can’t mutate. And if there is no vaccine then there is no evolutionary pressure to try and evade the virus. At the moment we still have quite a high level of virus and we have the vaccines. That said killing your host who you need to survive for you to survive is not a good strategy for a virus.

    I did like this video on youtube from PBS in America on a demonstration on the efficacy of vaccines:

    https://www.youtube.com/watch?v=Et_J8_x4qBs

    And keep taking the vitamin D – no cure or prevention but *might* make covid slightly less severe if you do get it – and helpful in the prevention of other diseases.

  • I am glad that the comments are rather more positive than the article itself. An efficacy rate of 70% is fine if it means, as reported, that there will be few hospitalisations and even fewer deaths among those who have received the vaccine. Given that thousands die of the flu each winter,we need to be realistic about how low we can drive down the number of those succumbing to covid and staying in lockdown until the death rate is zero is unrealistic and ignores the collateral damage of the covid lockdown.
    The great news is that within six months nearly all the adult population will have had the vaccine and as a consequence the hospitals will no longer be packed with sick and dying coronovirus patients. At that point, if not a little earlier, we need to open up the country. It may be that the number of cases will rise at that point, but of the young are not badly affected and the old have the vaccine…….?

  • Lorenzo Cherin 17th Feb '21 - 4:54pm

    I am relived that we see this piece from Adrian Sanders. I have been involved in research during this crisis and written about it in forums, and articles. But here I avoided it after the ” we need the science to say that, where is the evidence?!” types made for less of the liberal, democratic, in conversing or expressing things, more of the evidence tramples, discussion!

    This article easily the most important, in a while, sums up what I have been thinking, saying. From someone who was an mp not known for being timid, it is mild compared to my feeling on this.

    I believe we as a nation are too grateful for what is given , top down, and also too irresponsible about health. As citizens of a country that has the worst results re covid, I think the country is celebrating the efficiency of the vaccine role out, rather than the efficacy of the vaccine! the government has got so much wrong, what it gets right it is intent on us thinking, is amazing.

    Adrian does not emphasise my concern, that the vaccine he had, is possibly almost wholly ineffective against the variants already with us.

    I believe as soon as the Astra zeneca was reckoned to be only, perhaps as low as ten per cent effective for the South Africa variant, it should have been halted.

    We ought to , as Liberals, be sustaining concern and criticism, not cheerleading and celebrating, where we are worried.

    Pfizer is better. Fact. Why does this country have to have second best after the worst results so far?

    Yes, a government partnership with ,an elite university ,and a huge pharma company, not represent, the best of how to do things, if results warrant this approach and reaction ?

    Or to my current way of thinking on this, three areas of power, each an area of justifiable questioning, by Liberals, concerned about centres of power?

    I believe, if we do not keep all restrictions for many months , and these results for Astra Zeneca afre proven, fully , that it does not work against variants, we are going to be even further from the best countries, the USA having caught up, as they are using Pfizer and as it says to on the packet!

    I am very worried and saddened by this, as someone whose wife has suffered a lot over years of pain from chronic condition as a result of a car accident, and terrible lack or treatment!

    I want better for her, and all of us!

  • Steve Trevethan 17th Feb '21 - 4:54pm

    Might it be the case that an effectiveness rate of over 50% is rarely achieved by a flu jab?
    https://en.wikipedia.org/wiki/Influenza_vaccine

  • Lorenzo Cherin 17th Feb '21 - 5:00pm

    Apologies for typos! I feel too much on this for speedy typing out comments in response, rather than my usual way on this, real effort put in, on articles.

  • We need to know what the exit strategy is.

    We were told that the arrival of vaccines was a game changer but even having vaccinated 15 million and counting there is still a reluctance to open up. It feels like the goalposts are being shifted all the time.

    Scientists are on a spectrum of opinion as are any experts and there will always be some voices saying it is “too early” to open up. However, “Zero Covid is impossible and nonsensical. The virus won’t be eradicated but society should be able to live with it as we do with influenza, a serious disease managed by vaccines and naturally acquired immunity.

  • Adrian Sanders 17th Feb '21 - 5:16pm

    Michael1 and Peter – In answer to your comments I must just point out that this was an opinion piece for Lib Dem Voice, not a paper for the Lancet. Nevertheless, my source for an efficacy rate of 70% was from the 8th February, not the BBC report from the 2nd February https://www.biospace.com/article/comparing-covid-19-vaccines-pfizer-biontech-moderna-astrazeneca-oxford-j-and-j-russia-s-sputnik-v/

    Of course, the efficacy rate of any vaccine could be significantly higher or lower than the average given the age and health of the patient. This is why my point is we need to know the effectiveness rate before we ease off on the restrictions although the higher the efficacy rate, probably, the higher the effectiveness rare.

    Chris Coy – Even if 70 percent turns out to be the effectiveness rate it means without any variants, and the virus remaining in global circulation, I might become ill 3 times in the next 10 years. It is a “might”, but those among the three million who have diabetes, just one infection can lead to death and this has to be more likely at 70 percent than 95 percent. My experience of over 30 years of the flu vaccine at a 25 to 50 percent rate of effectiveness depending on the year, is that I’ve had the flu at least 10 times, though thankfully it was a mild version for 6 of those infections. So, I hope for a similar variation with the AZ COVID-19 vaccine.

    The flu comparison doesn’t really help us, unless your argument is we should wait until we have reduced the COVID-19 deaths (118,185 so far) to the annual flu deaths rate (around 22,000), in which case we could be in lock down even longer before we have the data to make an informed comparison.

    Mark Cox – As for the impact lock downs have on peoples’ health, I don’t think anyone is any doubt that the affect is negative and adding to the pressure on the NHS. But no one is arguing for the lock down to last longer than necessary, the debate is over when necessary ends. What we need to look at is the excess deaths excluding COVID-19, in order to compare them with COVID-19 to make the correct judgement, and if I am reading this correctly https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html there are more COVID-19 deaths than excess deaths.

  • Marco, you need to know but do not assume all the rest of us do.

  • John Marriott 17th Feb '21 - 6:10pm

    @Michael1
    I watched the ping pong ball and mousetrap demo. Hilarious but very educational.

    Yes, me and the missus have been taking a daily Vitamin D tablet, as recommended by David Davis MP, for a number of years. Now we’ve had our first shot of vaccine, with hopefully another in April we can then, I assume, expect a booster in the Autumn, which I reckon will become an annual event like the ‘flu jab. Mind you, that’s not stopping Steve Baker and his bloody libertarian ‘Covid Recovery Group’ (formerly masquerading as the European Research Group) banging on about early liberation. Pity he ever left the RAF!

  • @Adrian Sanders

    Thanks for the further comment. One of the roles surely of commenting is to correct and add to the factual accuracy of the original article. The Biospace article you quote is based on the original study of last year. The BBC article (although dated earlier) draws upon further data admittedly not yet peer-reviewed but from the respected Lancet. It also notes: “There were no hospitalisations in the ChAdOx1 nCoV-19 group after the initial 21 day exclusion period, and 15 in the control group”

    A very significant factor is that the Oxford vaccine seems to prevent death and indeed hospitalisation. There are some caveats in that people in the trials are younger and healthier but it does seem to be the case. But having said that – I’d want to have a vaccine that had lower efficacy in completely stopping the disease but did prevent me dying! – That’s sort of important!

    I have been critical of almost every aspect of the Government’s handling of the covid crisis. But not on the vaccine – it was absolutely right to go with a range of suppliers and technologies – with it being a question of fate & luck which were available first & which worked – esp. with the new mRNA vaccines. And all available doses of all the 3 approved vaccine are being deployed as fast as they are being made available to Britain. And the UK has ordered around 400m doses over all suppliers for 53m adults – including 40m from PFizer/BNT &17m from Moderna – it was a question of what got produced & approved first.

    The new mRNA method has basically never been used in a vaccine for humans before. It was not clear whether it would succeed and the anti-vaxers point out that we don’t yet have data on the long-term safety of these type of vaccines by definition

    If you are in Australia with virtually no covid deaths than there is a debate to be had on which vaccine to have. But the British government gave us a very high death rate of well over 1,000 a day! At that rate virtually anything that is effective – especially if it prevents (virtually all) deaths is a good idea! And letting us get back to the NHS being able to treat other diseases which it is struggling to deal with while covid rages.

  • @ Adrian Sanders

    The problem with comparing figures for Covid and Influenza deaths is that they are recorded differently.

    A Covid death is defined as any death within 28 days of a positive test regardless of the role Covid played and whether there were other causes. Hence why we end up with 118,185 deaths attributed to Covid.

    By contrast, Influenza deaths are only estimates because it is not a notifiable disease and we don’t test for it as aggressively as with Covid. It is likely that influenza, pneumonia and other infections play some role in quite a large number of deaths especially for people who are already very ill but are not the main cause of death.

    https://publichealthmatters.blog.gov.uk/2020/08/12/behind-the-headlines-counting-covid-19-deaths/

  • @John Marriott

    Gosh – we’re in agreement 🙂 !!!!!!!!!!

    On Vitamin D – I don’t know how much you are taking – but I’d look into taking 1,000-2,000 IUs a day. The British Government says up to 4,000 IUs a day is safe – you can get vitamin D toxicity but that seems to be at about 20,000 IUs a day. But everyone should do their own research and not take health advice from random internet comments (!) and it is important to note on Covid, it *might* be that vitamin D helps with the severity of it but it is not prevention or cure.

    @Adrian Sanders

    I should have added to my comment that we of course need to see whether the vaccination programme is in reality being effective before we ease lockdown measures.

  • One thin’s for sure, covid-19 has shone a light on the awful level of inequality that exists in UK 2021.

    According to the Guardian tonight : “A “perfect storm” of low wages, cramped housing and failures of the £22bn test-and-trace scheme has led to “stubbornly high” coronavirus rates in England’s most deprived communities, an unpublished government report has found.

    A classified analysis by the Joint Biosecurity Centre (JBC), produced last month, concluded that “unmet financial needs” meant people in poorer areas were less likely to be able to self-isolate because they could not afford to lose income.

    In two of the UK’s worst-hit areas, Blackburn-with-Darwen and Leicester, the study found that more people seeking financial help to self-isolate had been rejected than accepted. It said: “This could increase the likelihood for individuals to be unable to comply with self-isolation requirements as a result of their unmet needs.”

    The report, marked “Official Sensitive”, and seen by the Guardian, will pile pressure on ministers to improve government support for the millions of people who do not currently qualify when they are ordered by law to quarantine at home. Dido Harding, the head of NHS test and trace, has estimated that at least 20,000 people a day are not complying fully with isolation orders, allowing the virus to spread”.

    It’s high time Lib Dems tried to redeem themselves from the legacy of 2010-15 by campaigning now to turn the tide on poverty and inequality.

  • My partner and I are getting our first vaccine a week today, I have no idea whether it will be Pfizer or Oxford, according to my GP, they are using both, but it depends on what one will be available on the day.

    Even though I am still a mere spring chicken @ 45 🙂 I am getting vaccine early due to being in vulnerable group, that being said though, due to the limited supply of Pfizer vaccine, I would prefer that Pfizer was reserved for the elderly population.

    I will still carry on being cautious and will not change my behaviours despite being vaccinated at least until I have had the 2nd shot in 12 weeks time.

    It angers me when we keep hearing from the antilock-downers that we should be opening up more quickly beings the first 15 million have been vaccinated. Those most clinically vulnerable have not all been vaccinated yet and had the required 3 week after the dose for it to even start to become effective.

    Also we do not know how this vaccine is going to perform in the real world, whilst there is great hope, there is a vast difference from a clinical trial performance and performance in the real world, trials took place whilst there was vigorous social distancing measures, masks and lockdowns in place. We do not how strict trial participants applied those rules to themselves.
    If we were to end lockdowns and social distancing completely in the “real world” before being able to analyse the efficacy of vaccines on large scale population in real time, it could be a recipe for disaster and undo all the gains that we have had in driving this virus back down and hospital admissions.

    It has to be done slowly and with a measured approach so that data can be analysed carefully.

    I do think that the Government should have been stricter on its Borders, during this time due to the New strains that are out there which might prove to be able to evade the vaccines, it would have surely been better to get everyone vaccinated with Oxford and Pfizer whilst putting a ban on international travel and giving the vaccine makers the time to develop the 2nd generation jab that will be modified to address the new variants and these shots could have then been delivered in the autumn.

    There are more important things at stake than foreign holidays right now

  • Vitamin D Supplementation.

    Michael 1 17th Feb ’21 – 7:48pm:
    On Vitamin D – I don’t know how much you are taking – but I’d look into taking 1,000-2,000 IUs a day.

    It needs to be rather more than that to obtain an optimum level. Dr. John Campbell, who produces daily video reports on the pandemic, has been advocating vitamin D supplementation since January last year. He has been taking 3,000 IU (75µg) per day. This week he discovered he’s still deficient based on the result from a self-test kit…

    ‘Vitamin D, blood levels’:
    https://www.youtube.com/watch?v=uS2VObw1UeI

    This open letter from scientists and doctors is informative as each signatory states the amount they are personally taking; the average is just under 5,000 IU (125µg) per day…

    ‘Over 200 Scientists & Doctors Call For Increased Vitamin D Use To Combat COVID-19’:
    https://vitamind4all.org/letter.html

    Research shows low vitamin D levels almost certainly promote COVID-19 infections, hospitalizations, and deaths. Given its safety, we call for immediate widespread increased vitamin D intakes.

    For an explanation of the underlying science…

    ‘Vitamin D news and science’:
    https://www.youtube.com/watch?v=B01ZlRfMnmU

    Vitamin D is best taken in combination with magnesium, vitamin K2, and a quality fat.

  • Little Jackie Paper 17th Feb '21 - 10:29pm

    Marco – exit strategy?

    You’re living in it. Haven’t you worked it out?

    Look at the penultimate paragraph for the insight. If we’re not ‘constrained’ then we’re nothing but a ‘cost to the NHS.’ Vaccination isn’t a guarantee, its pure smoke and mirrors.

    NHS isn’t there to protect us now. We exist for it. I can see it now. Xmas 2021: stay at home, protect the vaccine, save lives.

    What a time to be alive.

  • Vitamin D Efficacy.

    Michael 1 17th Feb ’21 – 7:48pm:
    …it is important to note on Covid, it *might* be that vitamin D helps with the severity of it but it is not prevention or cure.

    The results of a large-scale Randomised Controlled Trial with calcifediol (activated form of vitamin D) has just been published…

    ‘Spain, convincing therapeutic evidence’ [13th. February 2021]:
    https://www.youtube.com/watch?v=oYK9-zvJF_k

    ‘Covid-19 and Vitamin D – Success of Calcifediol in Barcelona’ [15th. February 2021]:
    http://www.drdavidgrimes.com/2021/02/covid-19-and-vitamin-d-success-of.html

    The Barcelona study of the use of Calcifediol in the treatment of Covid-19 pneumonia:

    74% efficacy in the need for transfer to ICU

    68% efficacy in reduction of deaths.

    There is some evidence that it also reduces the risk of infection…

    ’25-Hydroxyvitamin D Concentrations Are Lower in Patients with Positive PCR for SARS-CoV-2’ [9th. May 2020]:
    https://www.mdpi.com/2072-6643/12/5/1359/htm

    Many authors have suggested the involvement of vitamin D in reducing the risk of infections; thus, we retrospectively investigated the 25-hydroxyvitamin D (25(OH)D) concentrations in plasma obtained from a cohort of patients from Switzerland. In this cohort, significantly lower 25(OH)D levels (p = 0.004) were found in PCR-positive for SARS-CoV-2 (median value 11.1 ng/mL) patients compared with negative patients (24.6 ng/mL); this was also confirmed by stratifying patients according to age >70 years. On the basis of this preliminary observation, vitamin D supplementation might be a useful measure to reduce the risk of infection. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations and to confirm our preliminary observation.

    ‘SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels’ [17th. September 2020]:
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239252

    SARS-CoV-2 positivity is strongly and inversely associated with circulating 25(OH)D levels, a relationship that persists across latitudes, races/ethnicities, both sexes, and age ranges. Our findings provide impetus to explore the role of vitamin D supplementation in reducing the risk for SARS-CoV-2 infection and COVID-19 disease.

  • In some respects it is unfortunate that with the pace of on-going research that this article is already a little dated, just missing the latest results from Israel, where they are deploying the Pfizer vaccine with some impressive results, with trial groups of 600,000 people.
    However, what is noteworthy that even with a real-world efficacy rate of 94% they are finding they are needing over 80% coverage to gain an effective level of herd immunity.

    From this, you can see why the UK government is considering the use of CoViD19 vaccination certificates within the UK, as it could enable the relaxation of social distancing rules in certain circumstances to the benefit of specific sectors of the economy.

  • Little Jackie Paper 18th Feb '21 - 12:19am

    Roland

    I’m not worried. I’m sure we’ll see the country’s foremost liberal party come out with fierce opposition to coerced medical procedures and back door ID cards.

  • John Marriott 18th Feb '21 - 9:29am

    @Michael1
    @Jeff
    I take what is classed by the provider as ‘Super Strength’ Vitamin D tablets. On the back of the box it says ‘equivalent to 1000 IUs’. I reckon that’s strong enough without running the risk of overdosing, which might not be a good idea.

    I have been pushing the merits of Vitamin D to boost the immune system on LDV for quite a while now. In fact I have also taken on board that one of the significant reasons that dark skinned people are getting serious doses of COVID might be because, living here, their skins cannot absorb the same amount of Vitamin D via the meagre amount of sunlight we get compared with places from where they or their ancestors originated as those of us with white skins.

    As a non scientific person that seems a reasonable hypothesis to me.

  • @John Marriott – a few years ago my GP diagnosed Vitamin D deficiency and put me on very high doses for 3 months. I was told to drop back to a maximum of 25 mcg (1,000 IUs) per day for regular use and have been taking them ever since. Apparently higher doses on a regular basis can lead to problems.
    Vit D has clear health benefits for everyone living through our grey winters, and I am intrigued by the research that seems to suggest it may help us to fight Covid. In fact, everyone who has been shielding has been offered a free 4 months supply of Vit D.

  • Helen Dudden 18th Feb '21 - 9:56am

    A doctor friend of mine likes Ffizer. I would have thought that because of the high figures, it should have been the choice.
    I know I use CBD for pain relief, because of a health condition I can’t use opiates. The problems over CBD have been a storm in an egg cup. It contains no THC or very little. Vitamin D was suggested at the beginning.
    I’ve used Manuka Honey, silver dressings, and tea tree oil to heal when a infection in my leg refused to heal with antibiotics. I was told by one doctor there is plenty of evidence to show that natural alternatives can be extremely useful.

  • I find this conversation distressing. There are pros and cons of both vaccines available in the UK so I was happy to accept anything that would stop me dying of Covid or being hospitalised. Not long ago we didn’t know there would even be a vaccine! Let’s keep a sense of perspective

  • @Meg Thomas – the fact is that all Covid vaccines, whatever their efficacy, will help to build the immunity within the population. It doesn’t really matter which one we have individually, or even if some people can’t or won’t have the vaccine (as long as it isn’t too many), as long as the vaccination programme continues as it has started.
    We are so fortunate in the UK to have one of the highest vaccination rates in the world.

  • Little Jackie Paper 18th Feb '21 - 10:49am

    Mary Reid

    Well said.

  • @ Little Jackie Paper

    “I’m sure we’ll see the country’s foremost liberal party come out with fierce opposition to coerced medical procedures and back door ID cards.”

    It may well be that some of us have to set up such a party (the “Free Democrats” perhaps?)

    This party would take its inspiration from David Howarth’s pamphlet “What is Social Liberalism” in particular this excellent section:

    “One should not, however, exaggerate the differences between classical and social liberalism. Both begin, and end, with the view that a state that fails to secure political freedom is not legitimate. Both reject the conservative view, for which the main advocate in Britain is the Labour Party of Tony Blair and Gordon Brown, that security is always more important than liberty. That view attributes to the state a wildly exaggerated capacity to provide security – not only because of the all-too-apparent limitations of the competence of state officials to keep us safe but also because, as the arbitrary power of the state increases, the more the state itself becomes a source of insecurity. The citizens of the Soviet Union were not more secure because of the immense arbitrary power of the Soviet state – they were less secure. The politics of fear, as practised in Britain by Labour, is ultimately self-defeating. It will destroy both the very freedoms it is the state’s task to preserve and security itself.

    That is not to say that liberalism denies any significance to security. It is just that it values security only in so far as it contributes to freedom. Tony Blair’s view, in contrast, seemed to be that the only right that matters is the right to life. He would have sacrificed any political freedom if he thought that by doing so he would save a single life. One wonders what our forebears who sacrificed their lives for political freedom, from the seventeenth century to the twentieth, would make of the view that political freedom is not worth a single life. One wonders what the Blair doctrine would have implied in 1940, when we could have avoided a great many deaths in exchange for sacrificing the political freedom of the whole of Europe.”

    https://www.markpack.org.uk/132261/orange-bookers-social-liberalism-whats-it-all-about/

  • Very much agree with Mary’s very sensible comments.

    Interesting you mention Vitamin D, Mary. Highly recommended – and no doubt puts an additional spring etc., into old codger John Marriott’s step.

    Vitamin D is part of the complicated clever conundrum of medication I have to take after having a transplant ten years ago. My equally complicated though vulnerable immune system means I must be careful about too much sun for fear of skin cancer. The treatment : 1 hat, 2 Adcal (Vit – D) tablets daily, followed by three mile walk along the coast. Seeing the gannets dive, and the odd self satisfied looking seal, is a free bonus…. but equally efficacious in every way.

    Counting all those tablets over the years, now exceeding 7,000, also helps with the sleep at night.

  • Steve Trevethan 18th Feb '21 - 12:31pm
  • Matt Wardman 18th Feb '21 - 12:34pm

    @David Raw.

    Counting my insulin jabs over the last 20 years – I reckon just over 50k – makes me go ouch rather than snore 🙂

  • @Jeff

    Thanks very much for those references – very useful. I was aware of the Barcelona study. But the letter from (mainly) doctors who are all taking high doses of Vitamin D is particularly compelling and I think I will aim to take 2,000 IUs a day. I think also that if I was diagnosed with covid or got the symptoms I would take 10,000 IUs a day – certainly at the beginning.

    Having said all that the media and advocates of a particular supplement etc. can over-hype one study and one helpful substance (even if not saying its a cure or prevention).

    It does seem though that there are a number of different aspects that also back this up – general correlations (which is not causation), some plausible mechanisms on how it *might* help etc.

    It is also interesting to speculate why those humans that migrated to less sunnier climates evolved lighter skins and it must be that it bestowed some evolutionary advantage – possibly the production of vitamin D whereas you get enough Vitamin D in sunnier areas with darker skins and less skin cancer.

    I think that some caution is needed in that the UK government say that the safe level is 4,000 IU a day – although on its website the Endocrine Society of the US it says that toxicity is only likely to occur at taking 20,000 IUs a day – obviously it is not ethical to do experiments on toxicity levels but some cases of toxicity have been seen were people were taking 20,000 IUs

    It has also to be said that a survey a few years ago showed that only around 20% of people in the UK were deficient in Vitamin D (but see below) so it can’t be fully the case that lack of vitamin D is causing all the problems with covid – equally though it is likely that those that are more likely to get severe covid are probably corelated with having vitamin D deficiency – although they are of course corelated with other conditions at the same time.

  • Continued… (sorry!)

    Interestingly the BMJ paper below notes “However, no current consensus exists about the definition of vitamin D deficiency, so each study may use different standards. The Endocrine Society of the USA defined vitamin D deficiency as 25(OH)D below 50 nmol/L, while the criterion of Public Health England is 25(OH)D less than 25 nmol/L.” So the BMJ paper coded for deficiency (below 25) and insufficiency (above 25 but below 50) as well as sufficiency (above 50).

    there is information at https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro

    http://europepmc.org/article/MED/33408196 from the BMJ is an interesting read. This had 450,000 participants in the UK but aged 40-69 so there is some bias in the age range. Only 45% were sufficient in Vitamin D. 42% insufficient and 14% deficient (rounding makes it up to 101%).

    Over half of those with an Asian background in the UK were not just insufficient in Vitamin D but deficient – as were over a third of those with a black ethnicity.

    But (so long as you avoid toxicity) there is no downside to taking vitamin D – it’s safe and cheap (about 1p for 12.5 micrograms – 250 IUs) and may help with other diseases such as MS (MS is more prevalent in less sunny climates) – and see patient.info for a list of diseases that low Vitamin D is associated with (and again correlation is not causation).

  • John Marriott 18th Feb ’21 – 9:29am:
    I take what is classed by the provider as ‘Super Strength’ Vitamin D tablets. On the back of the box it says ‘equivalent to 1000 IUs’.

    1,000 IU is only “Super Strength” by comparison to the NHS’s recommended daily intake of 400 IU (10µg) which is a legacy figure to prevent rickets. Compared to the levels our skin synthesises during summer UV-B exposure it’s low strength. 1,000 IU would only take a few minutes to make with the sun high in the sky around midday during the summer in someone having 25% of white skin exposed (shorts and T-shirt). 1,000 IU is inadequate to obtain optimal vitamin D serum levels during winter.

    In fact I have also taken on board that one of the significant reasons that dark skinned people are getting serious doses of COVID might be because, living here, their skins cannot absorb the same amount of Vitamin D via the meagre amount of sunlight we get compared with places from where they or their ancestors originated as those of us with white skins.

    Indeed, natural selection is thought to be the reason why man evolved lighter skin after moving away from the equator. Children born with lighter skin were better able to synthesise vitamin D, conferring more resistance to viral infections and were therefore more likely to survive to pass those genes on.

    Skin pigmentation is mentioned in Dr. John Campbell’s video: Vitamin D news and science:
    https://www.youtube.com/watch?time_continue=1464&v=B01ZlRfMnmU

    Figures are given for vitamin D serum levels in Maasai tribesmen. As they have always lived near the equator and are outside most of the day, their skin pigmentation has long-ago evolved to be perfect for their natural UV-B exposure and consequently they have optimum vitamin D levels: 40-60ng/ml.

  • @Mary Reid @John Marriott @David Raw

    Our official advice is that taking 4,000 IUs a day of vit D is safe. https://www.gov.uk/government/publications/vitamin-d-supplements-how-to-take-them-safely/vitamin-d-supplements-how-to-take-them-safely

    If you can take a blood test to see what you blood level of vitamin D is and get it above the “sufficient” level (50) if it is below it by taking a higher dose supplement.

    In addition the Endocrine Society in the US states that it is only likely that if you take >20,000 IUs a day that there is a risk of toxicity

    https://www.endocrine.org/clinical-practice-guidelines/vitamin-d-deficiency
    https://academic.oup.com/jcem/article/96/7/1911/2833671

    But people should consult their doctor and particularly if they have any of contra-indications referenced such as having had kidney stones.

    But my feeling is that this is an area where GPs are behind the science as they’re busy & rightly conservative. But the same happened with dietary cholesterol and the advice not to eat eggs. In fact it is no considered that dietary cholesterol does not contribute to blood cholesterol and eggs have micro-nutrients that help eye health and in fact if you swap a breakfast egg for bacon that is probably harmful – saturated fat and too much red and processed meat causes cancer.

    But get a Vit D blood test for their level of Vit D in their blood ad increase supplementation in consultation with your GP if its below “sufficient” (50).

    Personally I think in a time of covid – it is better to head towards 2,000 IUs and people who are working outdoors will get more than 2,000 IUs & there have been no reports of any adverse effects as I say I have changed my mind on this and I also tend to believe that it is better to have one’s blood level above the US deficiency levels (50) as supposed to the lower UK one.

    Importantly the BMJ study showed that 43% of those taking Vitamin D supplement were either deficient (7%) or insufficient in Vitamin D (36%) – indicating that the standard vitamin D pill of say around 12.5 micrograms (250 IUs) is not enough.

    But I would suggest that the balance of risks while covid is still around does suggest taking a higher dose of vitamin D than a lower dose (and I’d say as a non-doctor 2,000 IUs). And importantly higher vitamin D levels are associated with less incidence of other diseases.

  • John Marriott 18th Feb '21 - 3:32pm

    While Pfizer and Moderna might be more effective, the difficulty of their storage means that a more ‘traditional’ vaccine like the Oxford might be more suitable in countries where refrigeration is a problem. As Mary wrote, any vaccine that is effective is welcome. So I just wish that people like President Macron would just put a sock in it! It’s fine to look after number one; but we really have got to immunise people all around the world, otherwise we just increase the likelihood of more variants developing, not that some are inevitable, which is why we can probably expect an annual booster shot.

  • @john Marriott

    Sorry – were back into disagreement 🙂 !

    While I pointed out where I disagreed with Adrian. I do believe that we are adults and we can and should have a debate about the best courses of action. And I believe that’s the best possible vaccine as soon as possible.

    The PBS video I referenced suggests for a virus with a reproduction rate of 3 which is what covid is thought to have had in “normal” circumstances than you need an effective protection of 66.7% (1-1/3).

    IF the Oxford vaccine has a protection of 70% even a take up rate of 90% doesn’t get you there (70% X 90% is 63%)

    But as I outlined given the high death rate and the current lockdown virtually any vaguely effective vaccine is going to save a lot of deaths particularly among the more vulnerable.

    If you are in Australia then there’s a greater debate to be had!

    But I strongly believe that the best thing is a vigorous debate – as we have on um… Ldv!

  • Lorenzo Cherin 18th Feb '21 - 4:55pm

    Very good to read the very few who do what I ask, though get no interaction here on, question the current emphasis on Astra Zeneca.

    Today in a CNN report, it seems the UK signed the concluding paperwork on Astra Zeneca, the day after the EU!

    Did they and the government lie?

    https://edition.cnn.com/2021/02/17/europe/uk-astrazeneca-vaccine-contract-details-intl/index.html

  • John Marriott 18th Feb '21 - 4:59pm

    @Michael1
    I’m not sure where we are disagreeing. You seem so absorbed with facts and figures that you do not appear to have understood what I have written.

    My point was that, although the Oxford vaccine might be getting a bad press from some quarters at the moment, its ease of storage, plus the fact that it is being initially offered at cost might make it a better bet than other more sophisticated vaccines, especially in the Third World. Even you have admitted that “virtually any vaguely effective vaccine is going to save a lot of deaths”.

    So, with what part of the above are you in disagreement?

  • Adrian Sanders Wed 17th February 2021 – 2:00 pm:
    Most of us will have had, or be getting, the AstraZeneca (Oxford) vaccine. It has an efficacy rate of 70 percent compared to the Pfizer-BioNTech vaccine’s 95 percent.

    That’s not a valid comparison as the Phase 3 trials used different methodologies to assess efficacy. The Pfizer / BioNTech only tested participants for Covid who self-reported symptoms, whereas in the Oxford / AstraZeneca study some participants were tested weekly regardless of any symptoms thus detecting asymptomatic infections. What is efficacy for? The prevention of infection? Symptomatic infection? Transmission to others? Hospitalisation? ICU admission? Death? All these may vary differentially after a single dose and after both doses depending on the spacing.

    The vaccine trials were conducted over last summer and through the autumn into winter. It therefore seems likely, given the evidence for the efficacy of vitamin D cited in posts above, that participant’s vitamin D levels may be a significant confounding variable which has not, so far, been considered.

    To make a valid comparison we need real world data from matched cohorts of recipients where the different vaccines have been given concurrently in the same geographical area and population.

  • @john Marriott

    Good – I am glad that we are still in agreement 🙂 !

    Where I was disagreeing was when you said “I wish Macron would put a sock in it” and other posters (admiiedly not you and I may not have made clear) who said we shouldn’t debate the Oxford vaccine.

    Macron may have been motivated by a bit of Brit bashing but there are valid criticisms of the Oxford vaccine made by serious medical commentators – the trials had very few over 65s in it and the dosing was a bit of a mess etc. Along with what the exact efficacy rates were as raised here.

    I believe we are adults and we are capable of digesting and considering the detailed facts.

    Since you raise the.issue of my being obsessed with facts and statistics can I respectfully suggest you are as well and I suspect you had one of the approved vaccines rather than “Michael’s special vaccine” which has 100% efficacy rate – honest I tried it on myself and I haven’t got covid – (I jest of course) but it shows how we are all reliant on good quality statistics.

    I may be drunk but at least the street lamps are illuminating my path in life!

    Look into raising your vit d dose it may be the wrong thing to do but at least look into the studies – seriously!

  • John Marriott 18th Feb '21 - 6:15pm

    @Michael1
    Talking of “street lamps” reminds me of the saying; “An expert uses statistics rather like a drunkard uses a street lamp, namely for support rather than illumination”. By the way, have you got some ‘kompromat’ on the LDV editors? Whenever I try something longer, as you tend to produce, I keep getting told to shorten it!

  • Mary Reid 18th Feb ’21 – 9:55am:
    …everyone who has been shielding has been offered a free 4 months supply of Vit D.

    But, only at 400 International Units (10µg) a day. Not nearly enough.

    I would say this dose is too low, by quite a long way. So that’s happening. Is that enough to make any difference. Probably not. A great missed opportunity. Is it better than nothing? Well absolutely, it’s better than nothing.

    – Dr. John Campbell…

    ‘Post vaccination contagion’ [24th. January 2021]:

  • @John Marriott

    TVM for the comment. It was a riposte to the quote you mention &/which you accused me of some months (years ago?) & now I’ve finally (!) thought of a riposte, I wanted to get in !!!!

    The important point is that we rely on the (good) use of statistics to guide our medical (& life) choices – and I suspect that few will be taking me up on my special 100% effective vaccine! Remember the plural of anecdote is not data!

    I would say that those that don’t use statistics and facts are still drunk but lost and without a map.

    Of course the improper use of statistics is rife. But it’s worth people reading people like Prof Sir David Spiegelhalter and Tim Hartford and Radio 4’s More or Less. I have to say one of the few things that has been vaguely helpful in my life me from school was some education in statistics & probabilities. In contrast I have never spoken a work of French since I sat my O-level – a good use of 8 years – not! And while the internet is lambasted as a purveyor of fake news – one of the excellent things about it is that you can go to the lancet or specialist sites and see whether what someone says is true or not.

    We need much better education on how to interpret science and statistics and the reporting of scientific studies – even by the BBC (see the NHS Choices website for a more rounded view of stories in the news).

    But one of the good things about “science” is that they normally publish a discussion of the limitations of their studies in their paper and there’s a vigorous discussion of this among scientists and that should not just be limited to “scientists”.

    And it would perhaps help if politicians included a “limitations” section in their manifestos!

    But I always try and think “is that really the case” when I see a fact or stat – and often it isn’t and indeed sometimes I feel motivated to point that out on LDV.

    There was a recent thread on scientific heroes. And someone that should be included is Jon Snow, the “father” of epidemiology who by gathering facts and statistics showed that cholera in London came from infected water not other sources as was thought – and saved many lives in the process.

    To cure me of “confirmation bias” you will be pleased to know that I have been going on anti-vax websites ahead of getting a covid vaccine to try and rid me of the notion that it’s a good idea (seriously!) – unfortunately (or perhaps not!) they have yet to convince me!

  • PS

    (As it didn’t fit in my previous comment)

    On length of comments – sadly I can’t reveal what I have on the LDV editors 🙂 ! But while I know you are against facts and experiments – my experiments show that over about 2,500 *characters* (not words) gets rejected but under is OK.

    PPS

    Googling – there’s a quite interesting discussion of the use and origin of the drunkard – street lamps quote at:

    https://quoteinvestigator.com/2014/01/15/stats-drunk/

  • John Marriott 18th Feb '21 - 10:18pm

    @Michael1
    What did they say about Neil Kinnock? He never used five words when twenty five would do. Quite frankly, you lost me after your first paragraph. Just watch that Vitamin D intake!

  • @John Marriott

    I thought I was reasonably clear. What didn’t you understand and may be I can elucidate?

    But it comes down to:

    Good use of statistics means much better and healthier lives.
    Ignoring statistics (or misusing them) means much worse and less healthy lives.

    For example as you can see from my references – keeping your vitamin D blood level well above the UK recommended level (probably from at least 2,000 IUs a day) means significantly fewer bone fractures. If you want to ignore that then fine – that’s your choice!

    BTW you should also take D3 as supposed to D2.

    But I am sure you will be asking your doctor to get out the leaches! People will look back on medicine today and shake their heads in disbelief – just as we do as regards medical practice 200 years ago – and it has only improved from the work of people like Jon Snow who disproved what most doctors thought at the time through the use of statistics.

  • John Marriott 19th Feb '21 - 7:57am

    @Michael1
    “Elucidate”? Please, no! I suppose this is your idea of a “vigorous debate”, which, from your side, seems to consist of spraying facts and figures at your ‘opponent’, with the occasional attempt at humour.That’s just so much ‘white noise’ to me. Was that your technique on the doorstep when you went out canvassing in the good old days? If so, I bet you got a few glazed looks! I won’t pick you up on anything else you have written in this current thread as I do not wish to unleash another torrent. Hasta la vista!

  • @John Marriott

    Oh really – come on!

    It seems – with respect – that your approach is to make a few allegedly “clever” sarcastic remarks.

    As I say – it makes no difference to me whether or not you think on Vitamin D, I’m right or wrong.

    That’s more than fair because I’m not a medical authority.

    I think the frustration that I, @Jeff & indeed David Davis (whose approach you praise & BTW says in the “Vitamin D for All” letter he is taking 6,000 IUs of Vit D a day) have is that there’s good evidence taking a high dose (and more than 1,000 IUs) of Vit D is a good idea.

    Now it’s important that you don’t take my word of it – I’m not a doctor. But I’d urge you to look into it – that’s why I & @Jeff have given you the references.

    Now like you, until Wednesday, I thought that 1,000 IUs was enough. But I’ve changed my mind.

    As with everything you have to say what is the downside – there is absolutely no downside to taking 2,000 IUs – other than you may be wasting 5p a day. I’d risk 5p – for, as the US Endocrine Soc. points out, significantly improving your prognosis for a wide range of diseases.

    Now I’d urge 3 things:

    1. Consult your doctor but be aware that they might be behind the curve on this

    2. Get a blood test – if you are sky high on vitamin D (above 50) then obviously dial back on this. But many (?most) taking vitamin D – even 1,000 IUs – are likely to be surprised at their level.

    3. Other things are also important. Get fitter (and I think you said you cycle which is excellent) – but the equivalent of a 20 min walk a day is probably the best “medicine” anyone can take – and to be frank 40 mins, 1 hour – or more is even better!

    But given a lifestyle of X and a lifestyle of X plus (at least) 2,000 IUs of Vitamin D a day then the latter is better.

    As I say you have you have two choices – be sarcastic, dismiss the science and have a worse prognosis.

    OR look into the science, improve (as I believe and 115 professors do) your prognosis for diseases with no possible downside.

    The choice is entirely yours! But I’d just venture to suggest the best course of action is (to me at least) glaringly obvious!

    Given you are already taking 1,000 IUs – I suspect that despite your protestations you do have a sneaking respect for science and the facts. It is just that as I say I was surprised that 1,000 IUs is not enough (most likely)!

  • John Marriott 19th Feb '21 - 12:47pm

    @Michael1
    Torrent unleashed, hey? As the late Ronald Reagan said to Jimmy Carter (still happily with us) in that 1980 Presidential Debate; “There you go again!”

  • John Marriott 19th Feb '21 - 1:02pm

    @Michael1
    And, in case you want to fact check, Reagan repeated the phrase to Walter Mondale four years later.

  • @John Marriott

    A good swipe at me – and indeed “there YOU go again!”

    As I say you can make digs at me or you can consider your own health in light of the science and the facts.

  • Michael 1 18th Feb ’21 – 1:38pm:
    I think also that if I was diagnosed with covid or got the symptoms I would take 10,000 IUs a day – certainly at the beginning.

    That would be too late as it takes a couple of weeks for the liver to convert vitamin D3 (cholecalciferol) into the active form, calcifediol. Hence the use of calcifediol in the Barcelona study.

  • Matt Wardman 21st Feb '21 - 3:22pm

    A quick note that the “AZ vaccine efficacy = 70%” statement in the header is based on a dosage interval of 3 weeks in the piece linked, whilst the UK dosage interval is actually 10-12 weeks when the vaccine is at its most effective.

  • @Michael 1
    “IF the Oxford vaccine has a protection of 70% even a take up rate of 90% doesn’t get you there (70% X 90% is 63%)” [18th Feb ’21 – 4:01pm]

    This supports the effect being seen in Israel: The Pfizer vaccine has an efficacy of 90% (2 doses), so a take-up rate of 80% gets you: 90% x 80% = 72%

    Assuming the UK also administers 2 doses of the Oxford/AZ vaccine (efficacy of 82.4%), it seems we need to vaccinate at least 81% (82.4% x 81% = 66.7%) of the population.

    So whilst it is right we question, I think the question isn’t so much whether Oxford/AZ will or will not get us “there” but whether a single dose (of either Oxford or Pfizer) is going to be an effective defense beyond 12 weeks.

    Personally, I suspect the Government will be using some carrot and stick: linking the end of lockdown with a very high vaccine take-up (98% ?) and linking people’s ability to do non-socially distanced stuff to having had the vaccine.

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