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Covid-19

Covid-19 disease is caused by the SARS-CoV-2 virus, and emerged in Wuhan, China, in late 2019. It’s believed that the virus had been circulating in anim­al populations (perhaps bats or pangolins…) for some time before making the jump to afflicting humans – and also to transmission directly from human to human.

The original strain of the virus was already of high concern because it is highly infectious (transmissible via aerosols), causes no symptoms in at least some fraction of people (so they may not realise they’re unwitting carriers of the virus), and has a death rate of about 0.1% (on par with the Spanish Flu, although more likely to kill the elderly and those with pre-existing health conditions).

The number of Covid-19 patients who’ve required hospitalisation has completely overwhelmed hospital systems in many parts of the world. Even in the developed world, neoliberal governments have spent decades slashing hospital funding to the bare minimum and imposing death by a thousand cuts with “efficiency dividends”… this meant that those systems had basically no slack to pick up, no surge capacity available, to deal with the dramatic uptick in admissions caused by Covid-19.

Transmission

It took health authorities in many parts of the world a very long time to acknowledge it, but SARS-CoV-2 spreads largely through aerosols, minute infectious particles that are light enough to become suspended in the air. Some implications of this are:

  • Indoor spaces are incredibly risky, particularly ones with poor ventilation. Numerous cases have been linked to air conditioning units, e.g. pushing and pulling air through a restaurant’s dining room or a call centre’s open plan office, or even building-wide, multi-head AC units that have resulted in air being shared between separate apartments. If people must be indoors, these spaces must be well-ventilated.
  • Prior to the Delta variant, transmission was basically unknown outdoors. The Delta variant is sufficiently infectious that outdoor transmission is known to be occurring now though, especially in crowded spaces where people are staying still for a long time (e.g. stadiums).
  • Masks help to reduce your risk. Even ordinary surgical or reusable cloth masks help, even though they’re not foolproof like the N95s reserved for frontline workers. If both an infected person and a potential infectee are wearing masks, that reduces the risk a lot more than if it’s just one or the other.
  • Social distancing also helps, but it also depends on whether you’re indoors or outdoors and how long you spend 1.5m away from somebody. If you’re 1.5m apart all day long in a poorly-ventilated indoor space, the risk is still pretty high.
  • The duration of contact is critically important then, clearly. For a long time, the ruling class was arguing till they were blue in the face that “schools are perfectly safe”, but this was clearly a lie told for economic reasons, not the truth. With the Delta variant, now, we’re seeing how schools are massive vectors for disease.

Variants

In the time since the original strain of the virus spread across the world, a number of other variants have sprung up. Some of these are:

  • Alpha (B.1.1.7): Once called the “Kent” or “UK variant”, this is 30%–50% more infectious and results in a 50% greater hospitalisation rate compared to the original strain of SARS-CoV-2. However, vaccines seem to work almost as well against the Alpha strain (minus E484K mutation) as against the original.
    • E484K mutation: This mutation – also seen in the Beta and Gamma strains – reduces the effectiveness of existing vaccines. It’s currently seen in a minority of Alpha strain cases.
  • Beta (B.1.351): Once called “the South African variant”, this is about 25% more infectious than the original strain, although data on differences to hospitalisation/mortality rates is lacking. Vaccines in general are thought to be less effective preventing infection or the development of symptoms with this variant compared to the original, but they retain their effectiveness preventing severe disease (including the risk of hospitalisation or death).
  • Gamma (P.1): Once called “the Brazilian variant”. About 40% more infectious than the original and believed to increase the risk of hospitalisation or death by an unknown amount. This variant is more resistant to vaccines than the original, but less resistant than the Beta strain.
  • Delta (B.1.617.2): First detected in India, and seems to be significantly nastier even than previous variants. Believed to be 100% more infectious than the original strain, and 85% more likely to result in hospitalisation compared to Alpha (~177% more likely compared to the original strain). Vaccines are slightly less effective against Delta than the original strain, but still offer significant protection.
  • Kappa (B.1.617.1): This one evolved shortly before Delta in the same place, but seems to have been swiftly outcompeted by it. In Melbourne we had an outbreak of – and lockdown in response to – the Kappa variant in late May/early June, 2021.
  • Lambda (C.37): This variant was first detected in Peru in August 2020. It seems to have spread particularly in the Americas (although most countries don’t have the capability to test which strain of SARS-CoV-2 people are positive to, so it’s hard to tell how much). It’s known to have more resistance to antibodies than other strains, and is thought to be more infectious than e.g. Alpha and Gamma.

Vaccines

There are a number of different vaccines being used in different countries around the world, spanning a few different technologies (e.g. Pfizer and Moderna use mRNA tech, AstraZeneca is an adenovirus vaccine, Novavax is a protein subunit vaccine, and Coronavac uses inactivated virus particles). Pretty much all of them are more effective preventing severe illness and death than minor symptoms, and more effective preventing minor symptoms than asymptomatic infection, meaning that no matter how many breakthrough infections are associated with different vaccines they are still highly effective preventing the severe illness that people are really worried about. Here’s a quick summary of the major brands:

  • Pfizer/BioNTech (a.k.a. Comirnaty): As of 18 August 2021, the NSW Government estimates that ≥ 7 days after the second dose, this is 89% effective against symptomatic Alpha-strain Covid-19, 87% against symptomatic Delta strain Covid-19, and 84% against Beta and Gamma strain Covid-19.
  • AstraZeneca/Oxford: The NSW Government only has data on its effectiveness ≥ 14 days after the first dose, so these numbers are not comparable to the Pfizer ones. But at that stage, it estimates ~67% effect­iveness against symptomatic Alpha or Delta, and 48% effect­iveness against symptomatic Beta or Gamma.
  • Moderna: ≥ 7 days after dose 2 (same standard as Pfizer above), this is 92% effective against the Alpha strain. ≥ 14 days after dose 1 (same standard as AZ above), this is 77% effective against Beta or Gamma, and 72% effective against Delta.
  • Novavax: The NSW Government’s figures are a bit all over the place from here on out, but broadly as effective as Pfizer against the Alpha strain. For the Beta strain, it’s about 50–65% effective preventing moderate to severe disease at ≥14 and ≥28 days after one dose, and 73–82% effective preventing severe to critical disease at the same intervals after one dose. Apparently not tested against the other strains.
  • Johnston & Johnston/Janssen: Notable as a one-dose option, making it useful to reach certain populations. Estimated 85% effectiveness against symptomatic Beta-strain disease, and 71% effective preventing hospitalisation for the Delta strain. Another study, which didn’t look at specific variants, reported 66% effectiveness against developing symptoms.
  • Sinovac-Coronavac: Its effectiveness against symptomatic Covid-19 seems to vary widely in different trials (from 50% in Brazil to 90% in Indonesia), but like all the other vaccines it seems very effective at preventing hospitalisations and deaths (around 85–95% efficacy). It has been used widely throughout the developing world.
  • Bharat-Covaxin: Uses a similar technology to Coronavac. 64% effective at preventing asymptomatic infection, 78% at preventing symptomatic disease and over 90% at preventing hospitalisation or death, according to the manufacturer’s interpretation of studies. Approx. 65% effectiveness against the Delta strain (I’m assuming that’s the “symptomatic disease” metric again).
  • Sputnik V: An adenovirus vaccine, like AstraZeneca and J&J. Was controversial because Russia seemed to have rushed and possibly falsified initial studies, but subsequent “trustworthy” studies seem to have backed those results up (roughly 73% effectiveness against symptoms and 90% against severe disease).
  • Convidecia: Is a one-dose adenovirus vaccine, similar to J&J, with similar efficacy (66% against symptoms and 80% against severe disease in early 2021 trials). Chinese-designed.

My personal take on what I have read is: mRNA vaccines (like Pfizer and Moderna) seem more effective reducing the chance of infection or symptoms than other vaccines, but all the vaccines available are very effective reducing the risk of severe disease, hospitalisation and death.

In general, variants reduce the effectiveness of the first generation of vaccines by some amount, but researchers are still working on them all the time and I anticipate that one day, it’ll be a matter of going to get an annual booster shot which has been tweaked for the latest forms of the virus (like is currently available for influenza).

There are still some unresolved issues with regards to vaccines, like how long protection lasts (Israel seems to have found protection waning already at six months – but I’ve also read reports that the longer the intervals bet­ween first and second doses, the longer protection might last), and how we can distribute vaccines equitably around the world. Wealthy countries have in many cases purchased multiple times the number they actually need to vaccinate their entire populations, while many poor countries don’t have anywhere near enough to even vaccinate everyone once.

Social Implications

The pandemic has, obviously, far-reaching social and economic implications that go well beyond its mere existence as a virus or a disease. In brief, here are some of those.

Border Closures

In Australia and New Zealand, for example, our borders have been largely “closed” to all other countries (and only sometimes open to each other). In Australia, we’ve also seen the introduction of internal borders between states, for the first time since the Spanish Flu. We’ve converted hotels into ad hoc quarantine facilities, which have seen numerous leaks (especially with more infectious variants like Delta) because they were simply not built for rooms to be airtight, isolated bubbles.

The closure of Australia’s international border has also resulted in the stranding of thousands of Australian citizens abroad. There are only a limited number of quarantine hotel places, so there are caps on the number of people who can fly in. Airlines have been notorious for jacking up prices, and cancelling the tickets of economy-class passengers so they can bring more business or first-class passengers in under their cap, instead. Some people have seen tickets cancelled three, four or six times. In some cases, passage has been made conditional on testing negative to Covid-19 immediately beforehand. There was a two-week period in which Australians in India were forbidden to come home at all, under threat of jail time.

All these measures, it is argued, violate the inalienable right of a citizen to return to their home country that exists under international law. They’re very popular, though.

Casual Workers, Freelancers, etc.

Every time a lockdown is announced, a huge number of people in industries like hospitality, non-essential retail, the arts and more find themselves suddenly without income. The right wing likes to use these people’s existence as an argument to not lockdown, and just “learn to live with the virus” and “let it rip”. This should not be the argument at all, because even if we had a higher rate of vaccination than we do, this would still result in a high number of infections, of which we know about 8% need hospitalisation and 0.1% will die. Our hospital system absolutely cannot cope with this, and ordinary people should not be offered up as sacrificial lambs, risking Long Covid and worse, for the sake of capitalists' profits.

What it does actually demonstrate is the need for generous financial support during lockdowns. For the very first lockdown in 2020, we had a “Jobkeeper” program whereby most workers got $1,500 per fortnight (but not if you were a casual who’d been at your employer for less than a year, sadly), as well as a temporary doubling of the unemployment benefit to ~$1,100 per fortnight (renamed to “Jobseeker” at the same time). Neither program was perfect, but they were overall very good at providing a safety net for people who’d otherwise have been screwed during lockdowns. So, naturally, neither Jobkeeper nor the doubling of Jobseeker exist any more, and NSW is totally mystified why cases keep growing among insecure, low-income workers in Western Sydney 🤷🏻‍♀️

Rent relief is another measure that really should exist, both for residential rentals and small businesses that cannot trade (or are very limited) during lockdowns.

Long Covid

Perhaps less so in Australia, but in many countries it seems likely that there will be a large population of people with the symptoms known collectively as “Long Covid”. As far as I can tell, these symptoms are basically the same as ME/CFS symptoms, and “Long Covid” is effectively a shorthand for “ME/CFS caused specifically by Covid-19”. (ME/CFS itself is known to follow on from an earlier viral infection, and is thought to be the result of the immune system going “too far” in tackling the virus and beginning to target the body itself.)

Just as there are people who, offensively, try to dismiss ME/CFS sufferers as lazy people whose problems would all be cured if they’d just get up and do some exercise, there already seem to be people trying to argue the same for “Long Covid”, with various media reports suggesting it’s “psychosomatic” or “hypochondria”. This needs to be fought against, for sure.


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