India variant outbreak in the UK

[url]https://flutrackers.com/forum/forum/internet-communication/avian-flu-diary/915553-uk-growing-concerns-over-the-b-1-617-2-variant-s-impact-on-reopening-society[/url] or https://flutrackers.com/forum/forum/internet-communication/avian-flu-diary/915553-uk-growing-concerns-over-the-b-1-617-2-variant-s-impact-on-reopening-society ;

It should be noted that the mantra that there is `no evidence' that this variant is more severe or evades the vaccine is based more on a lack of data than anything else. As the following expert reaction, posted on the Science Media Centre website, makes clear - there is a lot about this variant we don't know yet.

Whether B.1.617.x turn out to be a tempest in a teasmade, or something we'll seriously have to contend with in the months ahead, remains to be seen.

DJ-see also Dr. John Campbell [url]https://www.youtube.com/watch?v=eO6oSJbBwbE&t=1s[/url] or https://www.youtube.com/watch?v=eO6oSJbBwbE&t=1s 

DJ-No evidence often means "we do not yet know" - so no evidence of vaccine escape, more severe disease means "we do not (yet) know if the India variants bring more severe disease, vaccine escape...

May 17 will see more reopenings in the UK-with sequencing taking 10-14 days the real number of India-variants in the UK must be already in the thousends...Insane to be reopening on this basis ! 

Those who spread the variant most have not been vaccinated, may not get tested (in part because of "legal status"...). 

History keeps repeating itself...

India variant is spreading everywhere.  It's even in the rural areas of Kansas.  Areas of the state are reporting low vaccination rates.  

DJ-The UK is about four weeks ahead of the EU/US with the India-variant wave. This story is not only about the UK !

-Dr. John Campbell-Friday update is most about the fourt wave in the UK [url]https://www.youtube.com/watch?v=uJrfPFTk3pU[/url] or https://www.youtube.com/watch?v=uJrfPFTk3pU ; UK, Cases, + 8,125, Highest since February 26  Confirmed infections up 58.1% week on week   Deaths, + 17 70 million vaccines administered Indian/Delta variant, doubling every 4.5 to 11.5 days in English 60% per cent more infectious than Kent/Alpha variant 5% of Indian variant infections are in the fully vaccinated 

DJ-The UK may now be in a growing crisis where the EU/US may end up in july. We came out from wave three-UK variant-now face wave rour-India variant-and are reopening...with limited vaccine protection. 

[url]https://flutrackers.com/forum/forum/welcome-to-the-scientific-library/vaccines-aa/917212-nat-med-impact-of-vaccination-on-new-sars-cov-2-infections-in-the-united-kingdom[/url] or https://flutrackers.com/forum/forum/welcome-to-the-scientific-library/vaccines-aa/917212-nat-med-impact-of-vaccination-on-new-sars-cov-2-infections-in-the-united-kingdom ; The largest reductions were observed for symptomatic infections and/or infections with a higher viral burden. Overall, COVID-19 vaccination reduced the number of new SARS-CoV-2 infections, with the largest benefit received after two vaccinations and against symptomatic and high viral burden infections, and with no evidence of a difference between the BNT162b2 and ChAdOx1 vaccines.
DJ Pre-India/Delta variant numbers. 

[url]https://flutrackers.com/forum/forum/europe-aj/europe-covid-19-sept-13-2020-may-31-2021/917263-johnson-set-to-delay-lockdown-easing-in-england-by-one-month[/url] or https://flutrackers.com/forum/forum/europe-aj/europe-covid-19-sept-13-2020-may-31-2021/917263-johnson-set-to-delay-lockdown-easing-in-england-by-one-month DJ-Higher risk means more restrictions-to save lives !

[url]https://flutrackers.com/forum/forum/internet-communication/avian-flu-diary/917225-uk-phe-technical-briefing-revised-risk-assessment-household-transmission-study-on-covid-variant-b-1-617-2-delta[/url] or https://flutrackers.com/forum/forum/internet-communication/avian-flu-diary/917225-uk-phe-technical-briefing-revised-risk-assessment-household-transmission-study-on-covid-variant-b-1-617-2-delta ;

Despite being well off its massively high daily case counts of just a few months ago - since early May the UK has seen a gradual tripling of daily COVID cases - as the Delta (B.1.617.2) variant becomes increasingly entrenched (see BBC Covid-19: Delta variant makes up 91% of new UK cases).

We've excerpts from three updates this morning; the latest Technical Briefing (#15), a revised Risk Assessment on the Delta variant, and a PHE Study showing increased household transmission of the Delta Variant (compared to B.1.1.7).

First stop, the largest (77-page PDF), and most detailed document of this week's data dump; the UK's latest technical briefing. Given its size, we'll only look at the summary. Follow the link to read it in its entirety.

Principal changes and findings this week are:

• for the first time this week, published figures include genotyping assay data, using a highly specific mutation as an indicator of a probable Delta variant case
• the most recent data show 74% of sequenced cases and 96% of sequenced and genotyped cases are Delta.
• the 28-day case fatality rate for Delta remains low (0.1%), though mortality is a lagged indicator and the vast majority of cases are still within the 28 days of follow-up required.
• secondary attack rates have been iterated and remain higher for Delta than Alpha in both traveller and non-traveller cases and amongst both household and non-household contacts
• early data from both England and Scotland demonstrate an increased risk of hospitalisation with Delta compared to Alpha
• the majority of outbreaks managed by health protection teams and exposure settings identified through contact tracing are attributed to Delta variant
• -
• The $64 question remains - how effective will current vaccines be in protecting against this highly transmissible variant? - and on that point, the jury is still out. The UK's latest assessment states:
  Epidemiological and laboratory evidence of reduced vaccine effectiveness
  
  There are now analyses from England and Scotland supporting a reduction in vaccine effectiveness for Delta compared to Alpha. This is more pronounced after one dose (absolute reduction in vaccine effectiveness against symptomatic infection of approximately 15% to 20% after 1 dose). Iterated analysis continues to show vaccine effectiveness against Delta is higher after 2 doses but that there is a reduction for Delta compared to Alpha.
  
  There is uncertainty around the magnitude of the change in vaccine effectiveness after 2 doses of Oxford-AstraZeneca vaccine. Although this is observational data subject to some biases, it holds true across several analytic approaches and the same effect is seen in both English and Scottish data. It is strongly supported by pseudovirus and live virus neutralisation data from multiple laboratories. There are no data on whether prevention of transmission is affected. The analysis of vaccine effectiveness against hospitalisation is in process. The acquisition of the mutation K417N, which may be antigenically significant, in a small number of cases is noted.
  The overall assessment now reads:
  
  Delta is predominant and all analyses find that it has a very substantial growth advantage. The observed high growth rate is likely to be due to a combination of transmissibility and immune escape; there is still geographic heterogeneity and a probable contribution from place-based context. Iterated analyses this week continue to support our previous estimates of vaccine effectiveness and hospitalisation risk.
  
  The priority investigations are vaccine effectiveness against hospitalisation and death, further investigations of secondary attack rates, characterisation of the generation time, viral load and period of infectivity, and epidemiological studies of reinfections.
• -
• Interpretation Overall, we found increased household transmission of COVID-19 associated with B.1.617.2 compared to B.1.1.7. These findings show households are important settings for rapid transmission of the lineage B.1.617.2. With household settings being an important factor in wider community spread, strategies to prevent transmission in these settings are vital to control the COVID-19 pandemic.
  (SNIP)
  Discussion This study found a 64% increase in the odds of household transmission associated with infection with B.1.617.2 SARS-CoV-2 variant compared to B.1.1.7, following adjustment for the index cases’ vaccination status, as well as sex, ethnicity, IMD and age group.

DJ-In my opinion the India/Delta variant is a major risk both for the EU and US. We still have time for action to slow down the spread. But based on unrealistic numbers (see scenario's Dutch CDC is using much lower numbers then one finds both in PANGOLIN or GISAID-other countries may use own data/wishfull thinking as well) and "summer/vaccines" will save us we are reopening, allowing international air travel, mass gatherings...Did we not learn anything from how India did get into its crisis ? 

Again-I am NOT an expert-I hope to be wrong. But if we do see India variant creating yet again another healthcrisis-with HCWers exhausted-next month I wonder how good "experts" are...

Here is a good one (or not) for you data experts

See this paper from PHE in the UK

https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwii9bSsxJvxAhUCdBQKHfKEBvkQFnoECAIQAA&url=https%3A%2F%2Fassets.publishing.service.gov.uk%2Fgovernment%2Fuploads%2Fsystem%2Fuploads%2Fattachment_data%2Ffile%2F993198%2FVariants_of_Concern_VOC_Technical_Briefing.pdf&usg=AOvVaw0wL7jRaG8AhgpuXN8pMJI2

Page 15

The number of "delta" cases, those in hospital and those dead since 01Feb 2021

Unvaxed 19573 cases of which 23 died

Fully vaxed and more than 14 days post the 2nd vax dose 1785 cases of which 12 died

So the death rate rate for vax'd people was higher than that for unvax'd people

Oh dear.....

The most likely explanation has to do with Age.   Older people, who from all data are far more vulnerable than younger people, were among the first to be vaccinated.  Thus they are the first to be double vaccinated.  Of the three groups in the report that have received at least one dose the older age group (those who have completed the vaccination cycle) are the worst hit.  both in terms of hospitalization and in deaths.

The second likely explanation is that too some extent the Indian (Delta) variant is able to evade the vaccine protection - again, if this was the case, this is hitting older people harder than younger people.

For the overall effect of vaccination look to how countries like Isreal and the UK brought down their rates substantially.  And while USA has reduced its rates it has not been as successful in limiting deaths as countries with a higher rate of vaccine.  

ps. as most of the Delta cases were under the 28 day limit, one has to wait another couple of weeks for more complete data.  There is noise that the Delta variant can evade the vaccine, but we will have to wait to see it the data holds up.