February 4 2021

The London School of Tropical Medicine and Health believe there are now 293 Covid 19 vaccines in preparation around the world. Only 10 have regulatory approval in at least one country. 70 more are now in clinical trials. Many of the others will never see the light of day.

There are 4 distinct types available based on either, nucleic acid, the whole virus, a protein sub unit, or a viral vector.

Lancaster University are working on a nasal spray version rather than an injection. They claim promising results so far using mice. Can you imagine the job of squirting the vaccine up the nose of a mouse!

The Pirbright institute have turned to pigs to try and develop a vaccine that can remain at room temperature and does not need refrigeration at all.

Whole or live vaccines take longer to develop because of safety issues working with a live vaccine, but in the end are cheaper to make and can be particularly useful for immunocompromised patients. This group of vaccines include the Chinese Coronovac and the Valneva vaccine which the UK has an order in place for.

The antivaccination campaign does not seem to be quietening down. I note Piers Corbyn has been arrested yet again for distributing and “sharing malicious communications”. Apparently, he is behind a leaflet in which corona virus vaccination is compared with Auschwitz. It includes a frankly obnoxious cartoon drawing.

The controversies about the use and abuse of face coverings continue to rumble on across the world, with little agreement about their efficacy and use. I am interested in your opinions about them. I think the first question I ask my self is Why am I wearing a mask? What do I expect from it? And am I correctly using the correct sort for the job and am I using it in the right way?

In medicine most of us wear masks to protect our patients from our germs that we might cough and splutter up whilst working at close quarters, doing an operation or dressing a burn or wound. We might wear a mask to avoid giving our germs to a patient who is immunocompromised, with no resistance to infections, perhaps because they have no white blood cells. We would usually wear one at the same time as other protective PPE such as gloves and gowns. Only in very long surgical operations would we wear one for longer than 3 hours.

It’s relatively rare, unless working in an infectious diseases unit, that we will wear a mask to protect ourselves from a patients coughing up nasty germs that could affect us. Examples of such conditions are active tuberculosis, pneumococcal pneumonia, ebola, typhoid and cholera. The latter two are spread in excreta rather than an air born route. Again, we would only wear a mask for the period of time we were in the same room as the patient.

With Covid we are expecting everyone including the majority with no formal training or understanding to wear them all day if working in a supermarket or in a public transport system. Is this correct or fair? We struggle to find much science that helps us. There is one study from the Lancet which suggests a person only has a 3% chance of catching Covid from a contact if wearing a mask.

How many of you, medical background or not, can honestly say they can wear a mask correctly for a whole hour without touching or adjusting it.?

Then there is the question of re-use. We have all seen large numbers worn wrongly. I have seen a mask shared, taken off one person and given to another to wear. I have seen holes cut in them to allow smoking and when restaurants were allowed to be open you could take one off to eat!

Over the years I have worn a variety of devices to protect me in special situations, from full face respirators to help with the dust during the Moorgate train disaster to full closed breathing apparatus and oxygen cylinders in smoke logged buildings. I still do not know the best way to protect from Covid apart from staying at home and that is probably still the best.

Scotland has reported that the rate of positive tests in the last 24 hours has fallen below 5% for the first time in a month. This is significant because the WHO say 5% or less is one of the key indicators of a pandemic coming under control.

Sweden is following Denmark in developing digital vaccination certificates for residents to use for travel overseas, meet elderly relatives in a care home or eat in a restaurant. They will be held on a mobile phone and are expected to be ready to use by June 1st. Sweden also plans to immunise everyone over the age of 16 by the last weekend in June.

The figures today show an unusually high number of Covid tests done, 801,949. The number testing positive is 20,634.This is heartening, so few from so many tests. It represents a drop of 25.7% in the last week and the rate of new cases has fallen to 242.8 per 100k. Still a fair way to go. There were 915 deaths representing a 16.6% drop in the last 7 days, It’s a while since the mid-week figure was below 1,000. The rate of deaths has dropped back to 10.4/100k.

For hospitals, 31,670 were inpatients on 2nd February. A further 2,375 were admitted yesterday. 3,625 are on ventilators. All coming down slowly.

The vaccination figures continue to increase bringing greater protection to us all. 10,490,487 first jabs have now been given. And 501,957 2nd doses have been given; remember it is 2-3 weeks after the first dose before you have significant protection.

Please keep everything going in the right direction. In the meantime, stay at home, stay apart. Watch from a distance as the numbers of cases drop and the number immunised goes up, The NHS could still be overwhelmed if we relax.

Stay kind, stay alert and above all stay safe.

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