Still Waiting for a Panacea

There has been much effort in trying to find treatments that will save lives in the Covid-19 pandemic. One, much-touted possibility, was Remdesivir, produced by the US company Gilead. Although a small US study claimed it reduced the time patients needed to spend in hospital, a much larger (with 3000 patients in each of the treatment and the control groups) by the Solidarity programme of the World Health Organisation found it had no effect on deaths over 28 days of treatment (https://www.theguardian.com/world/2020/oct/16/remdesivir-has-very-little-effect-on-covid-19-mortality-who-finds-trial-drug-coronavirus). In spite of this, Gilead have signed (prior to these test results) a contract with the European Commission, worth £733m, to deliver 500,000 doses of the medication. The Solidarity study attracted 12,000 patients from 30 countries and also investigated the anti-malarial Hydroxychloroquine, the HIV antiretroviral Lopinavir and interferon (interferons are antiviral agents, that prevent viruses invading new cells). None of these treatments (at the doses used and in the ways they were administered) had a statistically significant benefit by reducing mortality. The tests are, however, properly randomised designs that can (unlike some others) be completely trusted. The search goes on.

Halls of Pestilence?

I have pointed out, on several occassions, that the type of accommodation generally provided for undergraduate students at UK universities facilitates viral transmission. The rooms are small, often poorly ventilated (sometimes the windows cannot be opened on 'safety' grounds) and the students are frequently clustered around shared kitchen, sitting and laundry provision. When one student tests positive for Covid-19, the rest of their cluster are generally required to remain in their rooms for at least 10 days. This can mean students not being able to sample any fresh air and, in some cases, having to rely on contacts in other clusters to shop for their food and leave it outside. I have heard, in recent days, of some universities now paying cleaners to come in, once a week, to clean surfaces in the shared areas (whilst the students remain in their bedrooms). Although any improvement to cleanliness is to be welcomed, this is tokenistic. Given what we now know about Covid-19 transmission, this is likely to have a very minimal effect. The disease is not much dependent on viruses left on surfaces and, even if it were, a once a week clean is not going to achieve much. Most of the viral transmission occurs via aerosols (droplets in the air), as crowded people breathe the air from infected colleagues. So small, contained groups will tend to pass on the infection as they talk or as they simply share space. I appreciate that it would be more expensive and probably require building work but improving ventilation (by better air conditioning?) would be a much more effective means of limiting transmission.

Time is of the Essence!

I am surprised that a current member of the SAGE committee has had to remind leaders of the UK Government's (it has little to do with the NHS) expensive 'Test and Trace' system, that returns of results needs to be fast for the process to have any chance of working (https://www.theguardian.com/world/2020/oct/18/coronavirus-test-results-must-come-in-24-hours-says-sage-scientist). The 'Test and Trace' operatives seem fixated on the numbers of tests (because it makes them appear to be active?) rather than speed. The SAGE expert reckons, that delaying results for longer than 24 hours, means a very poor rate of tracing of contacts (he even suggests that fewer tests would be a better strategy if it speeded up the results). As it is, studies confirm that remarkably few contacts are actually traced and, once traced, many do not choose to effectively self-isolate. News, that the police are (despite promises to the contrary) to be given names of people testing positive, is also likely to be a disincentive for people to use the 'NHS' (again, not really an appropriate label) app to help tracing. We don't seem to be fixing this 'broken' system at all quickly.

Dune Wars

The shifting dune systems in Aberdeenshire are a protected Site of Special Scientific Interest because of their rare plants. In spite of this, the Aberdeenshire council have (even after appeals) given full planning permissions for the creation of a second golf course there for Donald Trump (https://www.theguardian.com/us-news/2020/oct/17/new-trump-golf-course-provokes-fury-in-scotland). This is in spite of condemnations by conservationalists and the fact that Mr Trump's promised jobs bonanza in relation to the first golf course (on the same site), never materialised. I never cease to be amazed at the short-termism that is often apparent in planning departments. It's not just a good walk that is being spoiled.

Reinfection Taken Seriously?

I appreciate that finally there now appears to be some reticence to put Covid-19 'facts' out there, before people are certain of the verity. I am, however, somewhat surprised that it has taken 'government scientists' until now to point to the high liklihood of reinfections with the virus (https://www.theguardian.com/world/2020/oct/17/covid-reinfections-to-be-expected-as-virus-spreads-say-government-scientists ). I'm only surprised because a) they are now drawing parallels with the 4 coronaviruses that cause the common cold, where infection leads to perhaps only 6 months of immunity and b) they were very quick, in the early days of the pandemic, to talk about possible 'herd immunity'. Clearly, there is no 'herd immunity' protection for the common cold (it comes round every year). I have noted in earlier posts that, although it is difficult to validate reinfections (you have to be lucky with testing), there have been suggestions of their existence for quite some time. The scientists now note that immune protection from Sars-Cov-2 seems quite short-lived (perhaps less than 6 months?). They seem very interested in the case of one man from Hong Kong, who was identified as reinfected, whilst passing through London from Spain. His second infection appeared to be asymptomatic. It is unclear (but likely?) whether he was shedding virus and could transmit the infection. If reinfections can be both asymptomatic and infective, this raises problems for both 'test and trace' and 'social isolation' as strategies to deal with the pandemic. I would not, however, base too much on one (perhaps atypical?) case. There have been other suggestions that a reinfection can the worse than the first time round.

Hedgehog Highway

The British, in villages, don't just talk about the weather. With the right encouragement, chat about hedgehogs can improve social cohesion. Hedgehogs are, once common insectivores, that are now in rapid decline due to their tendency to end up as road traffic accidents (coiling up, is no defence against a speeding car!). There is an interesting account of the village of Kirtlington in Oxfordshire, where Chris Powles has encouraged the setting up of a 'hedgehog highway' (https://www.theguardian.com/environment/2020/oct/17/prickly-business-hedgehog-highway-knits-a-village-together-kirtlington-oxfordshire-aoe). He noted, that these territorial slug and snail eaters (benefitting horticulture) were often constrained by walls around gardens and had no place to go except onto roads. Hedgehogs are nocturnal beasts that can travel up to a mile each night. Chris consequently encouraged people, in Kirtlington to construct holes, ramps and staircases in the walls of their gardens. These enabled the hedgehogs to move throughout the entire village more safely. A varity of methods were used to confirm that hedgehogs used these features. What is more remarkable, is that chatting about hedgehogs seems to have solved some of the long-established human feuds in the village. A side-effect of simple conservation?

Plane Sailing?

A study, carried out in the USA, is seemingly quite reassuring about potential Covid-19 transmissions, whilst on a traditional passenger air flight (https://news.sky.com/story/coronavirus-revealed-the-risk-of-exposure-to-covid-19-on-a-passenger-plane-12105228). Admittedly, the study was only carried out on 2 types of Boeing planes and assumed that all the seats were occupied. It was also assumed that every passenger (and flight attendent?) safely wore a facemask for the entire journey. One might question whether this is realistic for babies and people with phobias. People would also presumably eat and drink on a long flight. In the study, passengers didn't move around the cabin (what about using the toilet?). It was estimated that, if all the previous criteria applied and only one passenger had a Covid-19 infection, the rest of the passengers would have to be on the aircraft for 54 hours to receive a critical viral dose. It was also pointed out that the air was changed on these 2 aircraft types every 6 minutes. It all sounds very good but the idiosyncrasies of the many humans (as well as there possibly being more than 1 Covid-19 positive person on the flight), make this an overly simplistic calculation. I don't think passenger flight is as safe as implied and there is the added problem of moving the virus around the globe. One should also note that airports are likely to be locations where viral transmission is quite likely.