Wednesday, 24 February 2021

Zero tolerance for Zero Covid

Years ago I debated Gabriel Scally on the issue of plain packaging. He was wrong then and he's wrong now. He thinks the UK should pursue 'Zero Covid'. I explain why I disagree in this New Statesman article.
 

There is a belief among some people that the first lockdown could have achieved total suppression of the virus if it had only been kept in place a little longer. This is delusional. Lockdowns do not have a universal definition, but mine is the period between pubs being closed and pubs being open (along with the rest of the hospitality industry and it no longer being illegal to meet friends and family indoors). By this measure, the first lockdown in England lasted three and a half agonising months. Throughout this period, the case rate fell, but with diminishing returns. We never really got below 500 positive tests a day (and you can double that number because half the infections were not reported). The lowest number of total infections in England estimated by the Office for National Statistics was 14,000 on 9 July. 

We tried a lengthy lockdown, and we never came close to defeating the virus. Case numbers were roughly halving every four weeks. It takes a long time to get from a thousand to zero at that rate. A massive, Wuhan-style effort could have sped it up but there are a lot of people who cannot work from home and a lot more who are prepared to break the rules when they last for too long. We don’t have the geographical advantages of New Zealand or the ruthlessness of the Chinese Communist Party. We can’t even stop people entering the country on dinghies. 

Perhaps in June 2020, Boris Johnson could have persuaded a weary public to accept another few months of lockdown, along with even tougher restrictions. I somehow doubt it, but it doesn’t matter. We are not in that situation now. 

 




Tuesday, 23 February 2021

Nicotine pouches

The Observer has noticed nicotine pouches and it isn't happy.
 

Flashing an ice-white smile for her 50,000 followers on TikTok, a fresh-faced young woman pops a flavoured nicotine pouch into her mouth, as one of Pakistan’s most popular love songs plays in the background.

More than 3,000 miles away, in Sweden, another social media starlet lip-syncs for the camera, to a different pop tune. The same little pouches, made by British American Tobacco, appear in shot.

Critics say that such viral videos, even if they aren’t paid-for adverts, are the consequence of a global marketing push designed to offset dwindling cigarette consumption by recruiting the nicotine consumers of the future.

 
By that standard, I guess any social media post that shows a product counts. I don't know what the law is in Pakistan, but you can advertise snus in Sweden so I'm sure you can advertise a tobacco-free equivalent.
 

BAT makes much of how such products are helping adult smokers switch to less harmful alternatives, under the slogan “A Better Tomorrow”.

By 2023, the company expects to be targeting 500 million nicotine consumers with £100bn a year to spend. Products other than cigarettes are driving much of that growth.

 
Good! 

Financial results released last week showed an annual pre-tax profit of £8.7bn as “non-combustible” products began contributing to earnings for the first time. The number of customers using them jumped by 3 million to 13.5 million, as the pandemic sparked a migration from cigarettes to more lung-friendly nicotine-delivery methods.

 

Happy days. It's a win-win for business, consumers and 'public health'. 

But not in Observer world...
 

However, such products are far from risk-free and the trend for promoting them via social media and popular influencers is causing concern.

 
Not just not risk-free, but far from risk-free! So what, exactly, are the risks? Alas, the lengthy article never gets round to saying. Nor does it get round to naming the 'critics' who are 'concerned' about this, except someone from an organisation called Corporate Accountability which seems to be against big businesses in general.
 
The Observer article is based on an article from the 'Bureau of Investigative Journalism', the organisation that famously got Newsnight in a lot of trouble over Lord McAlpine and which is now funded by Mike Bloomberg to write anti-vaping pieces and be generally negative about tobacco harm reduction. It finds a critic from within 'public health', but it's just the corpulent know-nothing Martin McKee whose opinion is worthless.

The gist of it is that BAT markets its nicotine pouches and people under the age of 18 might try to buy them.

Lyft has no tobacco in it but does contain nicotine, making it an over-18s product. Yet multiple TikTok videos feature Swedes who appear to be of school age using them.
 
Do they, aye?

In Spain, a campaign for BAT’s heated tobacco product Glo has been fronted by boy band Dvicio, via Instagram and a series of concerts. The “boys” are all in their late 20s or early 30s, but were last year’s summer cover stars for tween magazine Like
 
This is lame stuff and BAT have responded with some fairly obvious points.

"Our social media accounts are age-gated so they are only visible to those users who have confirmed that they are 18+ (or other applicable minimum age),” it said.

The company added it was essential it marketed “reduced-risk” products so smokers were aware of them.

 
To be clear, these are good products. If anything, they should be advertised more. Everyone knows what cigarettes are but I bet most smokers are unaware of nicotine pouches. They are not 'far from risk-free'. They are as risk-free as nicotine patches, the only 'risk' being a caffeine-level increase in heart rate, as far as I can tell. They can't be sold to children and if adults want to buy them, that is up to them. End of story.


Monday, 22 February 2021

Exiting lockdown at a snail's pace

The government promised that its strategy for exiting lockdown would be based on data not dates. Instead, it has produced a rigid and anally-retentive plan focused on arbitrary dates which acts as if we haven't learned anything from previous lockdowns and assumes that we don't know anything about the vaccines coursing through 18 million people's veins.

We're going to look ridiculous when we've vaccinated all the priority groups before the rest of Europe and are still hanging out in parks while the rest of Europe has reopened. I fear the quack modellers at Imperial and Warwick have had too much influence again.

I've written about this for the Telegraph.
 

Anyone minded to look at the data can see that both the current lockdown and the vaccination programme have exceeded expectations. Despite experts warning that the ‘UK variant’ would make it impossible for R to fall much below 1, the number of new infections has fallen by 80 per cent since the start of January. 

Eighteen million people - a quarter of the adult population - have had their first jab of a vaccine that is working better than anyone could have hoped. Research from Israel not only shows that two doses of the Pfizer vaccine is 95.8% effective in preventing hospitalisations, but that even a single dose reduces the risk of symptomatic infection by 85%. The Oxford/AstraZeneca is also exceeding expectations, with a study suggesting that a single dose is 76% effective in preventing symptomatic disease and 100% effective in preventing hospitalisation. Recent research from Scotland found that a single dose reduced the risk of hospitalisation by 94%. 

With 95 per cent of the over-70s having received at least one jab, there can be no justification for making the nation wait until May to get a haircut. The timeline put forward by the Prime Minister would be excessive even if we didn’t have vaccines. In the first lockdown, almost everything was open after three and a half months. This time around, despite the 32 million people in the priority groups on course to have at least one dose of a vaccine by April, there are doubts about whether we’ll be able to go to the pub or have a holiday in the UK by May. 

 


Friday, 19 February 2021

A debate with Terence Kealey about intellectual property

I recently took part in an IEA head-to-head debate with Terence Kealey about intellectual property. I am broadly in favour, he is broadly against. Check it out.




Tuesday, 16 February 2021

Anti-alcohol academic wants pub booze ban

Last May, the Scottish government gave £500,000 of taxpayers money to Niamh Fitzgerald to do some research into how pubs could safely reopen. Fitzgerald is no stranger to taxpayers money. In October, she was given £1.1 million by the National Institute for Health Research to study the effects of pub opening hours on ambulance call outs. She has also had money from the Scottish government to study minimum pricing.

If you're familiar with the SNP's attitude towards alcohol, you won't be surprised to hear that she is a keen advocate of minimum pricing and not too keen on the sale of booze. She is the director of the Institute for Social Marketing, the old stomping ground of the fanatic Gerard Hastings, and is deputy director of SPECTRUM, which was set up in 2019 as a research institute but which rapidly became yet another state-funded lobby group. 
 
 
The fruits of Fitzgerald's labour were published today, conveniently overshadowing the news that alcohol consumption fell in Scotland during lockdown
 
Pubs might need curfews and alcohol bans to stop Covid spreading, experts warn
 
Pubs might not be able to prevent Covid from spreading without curfews or alcohol bans, warn scientists.

A team of Scottish researchers examined Covid-19 measures in licensed premises last summer and found some worrying "pinch points" which could see the infection spread.

They say blanket closures, curfews or alcohol sale bans could be more likely to be deemed necessary to control the spread.

 
Who could have guessed that a neo-temperance campaigner who come to such a conclusion? Scotland has already experimented with alcohol-free pubs during the pandemic. It didn't work well for the pubs or their customers, but the 'public health' lobby rather liked it. The fact that pubs cannot survive without selling alcohol is of no concern to academics.
 
The study used to justify this preordained conclusion involved interviews with some people from the hospitality industry and a spying mission in 29 premises when the pubs reopened in the summer. The researchers found a number of transgressions which they list sombrely, including 'customer mixing and overcrowding in toilet areas' and 'a brief bit of singing' during a football match. 
 
They conclude:

Despite efforts on the part of premises, and detailed guidance from government, potentially significant risks of COVID-19 transmission persisted in a substantial minority of observed bars, especially when customers were intoxicated. Blanket closures, curfews, or alcohol sales bans are more likely to be deemed necessary if such risks cannot be acceptably, quickly, and cost-effectively reduced through support and sanctions for premises operators.

Normally we rely on bodies like Trading Standards to see how well regulations are being adhered to. One benefit of using nationwide data from such organisations is that we get a more accurate picture than if we rely on anti-alcohol academics having a mooch around a handful of boozers. 
 
Of course, rules and guidelines will sometimes be breached, as they are everywhere from time to time. It is almost impossible to remain two metres apart from everyone in a supermarket, for example, but nobody is suggesting they be banned from selling food.
 
The fact remains that there is very little evidence that hospitality venues are a major source of infection. If they were, you would expect those who work in pubs to be at high risk of infection and yet, as the Scottish Licensed Trade Association points out...

One widely reported survey, by industry group UKHospitality, spanned 12,522 hospitality venues across the UK that employ a total of 358,000 people. It found that in the 14 weeks since July 4, 1,728 staff members had been infected with Covid, equating to an employee infection rate of 0.48% across 20 million work shifts across the UK.

According to this survey, the customer infection rate was found to be even lower – with just 780 customers infected with the virus over the 14-week period, which equates to a 0.06% customer infection rate per venue.


If, as the study concludes, transgressions were only found in a minority of pubs, the solution is to police the regulations properly. Banning pubs from selling alcohol would throw the baby out with the bathwater, but that's fine with the Institute for Social Marketing and SPECTRUM because they don't like the baby and are not particularly keen on the bathwater. 

Since the start of the pandemic, I have been documenting the actions of the corona-vultures of 'public health'. These are the people who are supposedly experts in public health and yet have nothing to contribute when a genuine public health appears. Instead, they use the crisis to advance their existing agenda and even criticise those who are trying to help.

This seems to me a classic example. It is also a classic example of the endemic sock-puppetry of the Scottish state wherein the SNP dishes out money to activist-academics who share its agenda. 

The emergence of a vaccine for COVID-19 has got the corona-vultures worried. They fear they only have a few more months of using the pandemic as an excuse for their petty authoritarianism. But that will be long enough for them to try out their most drastic experiments. In the short term, they can go wild. In the long term, their aim is to keep as much emergency regulation on the books as possible when the emergency is over.


Friday, 12 February 2021

The COVID modellers have jumped the shark

Academics from Warwick have modelled the effects of vaccinating the population and removing 'non-pharmaceutical interventions' in England over the next eighteen months. The study was produced, I think, on 13 January. The findings are certainly eye-catching.
 

In their best case scenario, lockdown reduces R to 0.8 and 3 million vaccines are delivered each week from February (with 1 million a week delivered in January). Lockdown ends on 22 February and all NPIs are dropped by July. 
 
This means that everybody who wants a vaccine has had one (or, indeed, two) by the summer. The authors nevertheless predict that England will see 2,000 deaths per day in August. If the vaccines don't work as well as expected, this rises to nearly 5,000 per day.

I am only an interested amateur and am happy to be put straight, but WTF?!? Last August, when there was no vaccine and minimal NPIs, England had about eight deaths a day. At the height of the winter second wave, it had 1,238 deaths (January 19th). 
 
5,000 deaths per day is more than 70 per million. Even the worst hit countries such as Belgium and Czechia never got above 30 per million at the height of their epidemics. And yet these guys think that it could far exceed than that in Britain in the summer after the vaccines have been fully rolled out. Even in their best case scenario, there would still be 1,000 deaths a day.

When your model gives you such an implausible result, you have to question your assumptions. So what are they?

According to the brief text, the authors expect all these deaths to come about because some people will refuse to take the vaccine and some people who take the vaccine won't be protected. 

Uptake: Throughout we assume 95% uptake in care homes, 85% in the general population above 50 and 75% in adults below 50 for the first dose. This drops to 75% for the over 50s and 66% for the under 50s for the second dose.

 
People aged under 50 are almost irrelevant in terms of Covid mortality so the figure to focus on is 85%. 
 
Here are their assumptions about protection against symptomatic disease...
 

Efficacy: We sub-divide into the effects of protection against symptoms (disease efficacy) and reduction in transmission – we assume that transmission blocking acts by stopping infection. Disease efficacy is taken as 70% and 88% after dose 1 rising to 88% and 94% after dose 2 for the Oxford and Pfizer vaccine respectively. Transmission efficacy is taken to be 48% rising to 60% for both. Protection is lagged by 14 days after the dose is delivered.


This roughly reflects what the trials have shown us about these vaccines.

The authors don't provide a figure for the total number of deaths in their projected third wave, but it looks around twice as bad as the second wave which has killed about 60,000 people in England and will probably end up killing around 75,000. So, as a very rough estimate, they're suggesting there will be 150,000 deaths after everybody who wants a vaccine has had one. That's more than all the deaths we've had already. Unsurprisingly, the authors call for the government to hold back on relaxing lockdown, although quite what this would achieve is unclear: the lesson of the study is that COVID-19 will get us all eventually.

Imperial have also done some modelling. This study was produced on 14 January, the day after Warwick's. It makes exactly the same assumptions about transmission efficacy and disease efficacy. Unlike Warwick, they assume vaccine uptake is 85% across all age groups. They assume that NPIs are gradually lifted on the first day of each month but do not say which ones. As with Warwick, all NPIs are lifted by 1 July.

The assumptions are therefore very similar and the conclusions are only slightly less gloomy. Like Warwick, they predict a massive summer wave and 130,800 dead even under their most optimistic scenario.
 

 
Again, the authors encourage the government to be extremely cautious in relaxing the lockdown.

In both cases, they are predicting a dramatic rise in cases followed by a steep fall. The Warwick model shows a classic epidemiological bell curve. Both models imply that everyone who can get infected will get infected and that the death toll will only be ameliorated by the vaccines providing a measure of protection against symptomatic disease. The lack of a resurgence in winter 2021/22 suggests that the epidemic will have run its course after this final, devastating wave leaves no one left to infect.

If the assumption is that nearly everyone gets infected, the 15% of the population who are not vaccinated will die at the normal rate of about 1 in 100. A smaller proportion of the 85% who are vaccinated will die. That's still a lot of deaths. 

But there are two big problems.

Firstly, both models underestimate how many people will take the vaccine. So far, 91% of the 80+ cohort have taken it and 96% of those aged 75-79 have taken it. That's a lot more than 85% assumed in these models.

Secondly, and more importantly, the estimates of disease efficacy (the reduction in risk of getting symptomatic disease) are roughy correct, but the authors seem to have overlooked the crucial point about the AstraZeneca vaccine which is that there were 'no severe cases and no hospitalisations' in the trials. The vaccine seems to be 100% effective in preventing death from COVID-19. The Pfizer vaccine is 95% effective in preventing symptomatic disease altogether, so the number of deaths that would occur among the cohort who take it would, presumably, be very low (in Israel, there were 4 severe cases and no deaths among 523,000 vaccinated people).

It is incredible that neither study factors in the effect of the vaccines on severe disease and mortality. You can forgive them for not predicting that so many people would take up the vaccines, but we've known about the AZ vaccine's ability to prevent severe disease and death since November.

Their results seem to be based entirely on transmission and the prevalence of symptomatic disease. The mortality figures they come up with are so enormous, I can only assume they jumped to the conclusion that the fatality rate would be the same for someone who was vaccinated as for someone who wasn't. It seems hard to believe they would make such a basic error. Perhaps someone can explain what I'm missing?

Obviously I'm just some chump barstool epidemiologist, but to a simple man like me, it seems that if we have a vaccine that is 100% effective in preventing death, we won't have any COVID-19 deaths except among the minority of people who don't take the vaccine (which, to be blunt, is their problem; there are not enough of them to overwhlem the NHS). Even if it turns out to be a bit less effective than 100%, it's very hard to see how the kind of mortality figures in these studies can be justified.

The rate of transmission implied in these models doesn't seem plausible when 30% have already had the virus (according to Neil Ferguson), 85% have had the vaccine and it's summer, although both sets of modellers do seem to assume that Kent variant is extremely infectious. Maybe it is, but transmission isn't really the issue when people are protected from severe disease and death.

So why isn't this crucial factor included in the models?
 
UPDATE (23 February)
 
This pyramid of piffle has been formalised in a SAGE document and used to lobby against ending the NPIs in May. See this thread.


Monday, 8 February 2021

COVID-19 and vaping

In my fifteen years reading and writing about junk science, I have occasionally wondered if the day would come when a relative risk of 1% would be considered newsworthy. That day has finally arrived thanks to the Telegraph...
 
Vapers with Covid-19 up to 20 per cent more likely to transmit it than infected non-smoker, study finds 

Vapers who have Covid-19 are up to 20 per cent more likely to transmit the virus, spreading it in clouds of smoke, a study has found.

Bystanders exposed to low intensity expirations from an infectious vaper in indoor spaces, such as houses and restaurants, are one per cent more likely to catch coronavirus, researchers from Italy, Mexico and New Zealand found.

 
The study in question is a pre-print by Sussman et al. It's not an epidemiological study and it doesn't attempt to measure risk. Instead, it measures air exhalation and respiratory droplets in indoor places. It essentially tries to answer the question of how much more air vapers exhale than non-vapers and whether this has any implications for the spread of SARS-CoV-2. 

The answer is that vapers do exhale a bit more. One per cent more at normal low intensity, rising to 5-17 per cent at high intensity. From this it can be inferred that somebody who has COVID-19 and is vaping would exhale more potentially infectious droplets than someone who is not vaping. 

The authors are careful to point out that this needs to be put in context with other things people might do that would increase the amount of respiratory droplets they exhale. Talking, for example, doubles or triples the amount. Coughing increases it even more.

Unsurprisingly, the Telegraph has not run with the talking angle. The journalist (not Sarah Knapton for once) doesn't inspire confidence in her knowledge of the subject by repeatedly referring to e-cig vapour as 'smoke' and does not explain what the 'up to 20%' [sic] risk is compared with (ie. someone breathing but not speaking, singing, coughing etc.).

The researchers themselves come to a more measured and less sensationalist conclusion:
 

Risk assessments are essential to provide evidence based support for preventive and mitigating policies that have been proposed and enacted worldwide... Our risk assessment provides valuable information for safety policies in this scenario: low intensity vaping only produces a minuscule (∼1 %) extra contagion risk with respect to the control case scenario of continuous breathing. Safety interventions should consider that abstention from vaping would not produce a noticeable safety improvement, but could generate an undesired level of stress and anxiety under long term confinement. High intensity vaping produces a higher increase of relative risk, but still well below speaking and coughing.


In terms of keeping Covid-safe, they advise keeping a distance of two metres from vapers, as you would with another else.

And that's really all there is to it, but expect the 'vapers spread Covid' meme to circulate as a result of this irresponsible reporting (the Daily Mail has also got in on the act).


On a different note entirely, a bit of housekeeping. Has anyone else found that it takes ages for this blog to fully load up these days? The sidebar, in particular. Blogger made some 'improvements' a few months ago which made writing blog posts more difficult and seemed to slow everything down. I've considered leaving the platform, but I mostly use this blog to link to my articles elsewhere these days and I can't be bothered with the hassle.

I have been remiss in looking at the comments in the last year or so. Apologies for that. I used to get a email with each comment but those dried up ages ago. I have now put the Disqus moderation page in my bookmarks and will make more of an effort to read and reply to you in the future, so do keep them coming.

I mention all this at the bottom of this post because I know only loyal readers will get this far!