I am reminded again this week of the (I fear slightly misquoted) Vic Reeves comment that ‘89.2 % of statistics are inaccurate.’ My local newspaper, here in Bristol, has been running scary stories that ‘the South West has the fastest growth in new Covid cases outside London’ and an R rate ‘likely to be above 1.’ This is very worrying for many people; my elderly neighbour has returned to self-isolation.
However, consider this. Suppose the whole of the South West has the lowest number of cases, say 0.2 per 100,000 or 11.2 for the 5.6 million estimated people residing here. If, tomorrow, one of these people reported their symptoms and, through tracing and testing, it was found that 20 others who had been in the same pub had the virus, the total for the region would now be 31.2 (or 0.56 per 100,000). And if it was assumed that all 20 had been infected in the same pub (highly unlikely), we have an R value based upon this site of 20!
Local spikes are likely and need both accurate detection and (over to you, Mr Hancock) rapid release of data to contain them. Ironically, we should welcome episodes such as the closure of the pub in Burnham-upon-Sea as it contains the local spike and maintains an overall level of infection in the South West that is very low. A much better representation of the data is still to be found at https://digital.nhs.uk/dashboards (figure 1) where the South West is unrecognisable from the place described in the local press. Infection rate, numbers of cases, R values; they all reflect reality differently and need careful interpretation.
Vaccine
Today saw the publication of results from the chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) trial in Oxford we mentioned a few weeks back.1 Healthy adults, aged 18 to 55 years and selected from a sample of 1,077 people with no history of SARS-CoV-2 infection or of any Covid-19-like symptoms, were randomly assigned to receive ChAdOx1 nCoV-19 at a dose of 5×1010 viral particles or a control as a single intramuscular injection. The first results are showing that ‘the injection results in rapid induction of both humoral and cellular immune responses against SARS-CoV-2, with increased responses after a second dose.’ In other words, people taking the vaccine produce antibodies that detect the spike proteins on SARS-CoV-2. Also, the injections appear to be safe.
Great news that now needs further verification with an expanded phase III trial that should include people over 55 years of age.
Hats Off to the NIHR
While many aspects of the UK response to the pandemic have been unquestionably dubious to say the least, our response in terms of research has been second to none. I was reminded of this during the latest in the excellent Royal Society of Medicine webcasts last week (see www.rsm.ac.uk/resources/rsm-live). The 30 minute webcast comprised an interview with Dr Divya Manek of the National Institute for Health Research (NIHR) and Professor Graham Cooke, a key researcher into Covid-19 (figure 2). The NHIR describe themselves ‘as working in partnership with the NHS, universities, local government, other research funders, patients and the public, we deliver and enable world-class research.’
Figure 2
Working within the NHS without any other infrastructure ensures that trials can be designed and established far quicker than is possible than those set up in other countries or by multinational companies. A good example of this has been the speed with which the Recovery Trial has been able to offer results on key issues of treatment. In all, the NIHR has been able to recruit upwards of 130,000 people to take part in well-designed trials, including selective sampling when required such as people in specific ethnic cohorts. For this reason, as Manek pointed out, ‘the NIHR has attracted praise from groups and companies across the globe and who are choosing the UK because of the speed with which a trial can be set up.’
On a less positive note, Cooke noted that ‘we have to recognise that UK research has benefitted from the very high case numbers.’ I am sure this will be fodder for a spin doctor somewhere. However, as the cases are thankfully reducing in number now, it is likely that phase III trials, such as that for the vaccine mentioned in the last section, may have to recruit from overseas countries such as Brazil.
The NIHR website (www.nihr.ac.uk/covid-studies) is well worth a look for updates on research that is up to date and non-commercial or political.