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^{The Friday Report – Issue 25}

By Matthew Fletcher, John Roberts & Dan Ryan

COVID-19 Actuaries Response Group – Learn. Share. Educate. Influence.

COVID-19 is still one of the hottest topics for scientific papers and articles. The COVID‑19 Actuaries Response Group will provide you with a regular Friday update with a curated list of the key papers and articles that we’ve looked at recently.

Modelling

Susceptibility to misinformation about COVID-19 around the world

A new research article (link) sets out a study carried out to look at susceptibility to COVID-19 misinformation, and its influence on behaviour, in various countries across the world. Its findings are based on large-scale national surveys conducted in April and May 2020.

Participants were asked a range of numeracy questions which were designed to capture their ability to understand quantitative information, as well as questions about the extent to which they complied with public health guidance (for example, washing hands, wearing a face mask). Other questions asked related to aspects such as vaccination against COVID-19 and trust in how the crisis was being handled, as well as common examples of health-related misinformation (for example, ‘5G networks may be making us more susceptible to the coronavirus’).

Fortunately, the majority of people surveyed did not report finding the misinformation credible (for example, at most around 16% of the sample found the 5G conspiracy reliable); however, it was found that there were factors that appeared to influence susceptibility – factors such as higher age and exposure to information about the virus via social media were linked to higher susceptibility, whereas higher trust in scientists and (in particular) higher numeracy were reliably linked to lower susceptibility.

The researchers suggest that developing critical thinking skills may be an effective strategy to combat misinformation about COVID-19.

Clinical and Medical

Vaccines on hold

It is highly reassuring that regulators and the pharmaceutical industry have stressed the importance of ensuring high standards for the vaccine trials that are ongoing around the world. The historic safety pledge signed by 9 pharmaceutical companies was without precedent, and reflected concerns that the process could be influenced by external forces.

The words have been borne out by actions. Trials of the vaccine developed by AstraZeneca and the University of Oxford were halted on September 9 after a participant developed transverse myelitis, a rare condition involving inflammation of the spinal cord, and was hospitalised. This followed an earlier halt in July where a participant experienced neurological symptoms but was later ascribed to previously undiagnosed multiple sclerosis. Trials have since restarted in the UK, Brazil, South Africa and India, but remain on hold in the USA pending further investigation by the FDA.

Earlier this week, the phase 3 trial was paused for Johnson & Johnson’s vaccine candidate being developed by Janssen Pharmaceutical Companies because of “an unexplained illness in a study participant”.

These setbacks have not affected the two vaccines that are expected to be approved first, according to Dr. Moncef Slaoui, scientific head of Operation Warp Speed in the USA. These are the vaccine candidates from Moderna and Pfizer using novel mRNA vaccine technology, and expectations are that 30 million doses of each will be available for distribution in January.

For those interested in learning more about the challenges facing the various different vaccine trials, there was an excellent symposium convened by Johns Hopkins University and University of Washington on 6 October on “Preserving the Scientific Integrity of Getting to COVID-19 Vaccines.”

Effectiveness of anti-viral drugs

Interim results were released today from the World Health Organisation’s Solidarity Therapeutic Trial across 30 countries that has been examining the benefits of four treatments that are being used on hospitalised patients with COVID-19. These treatments are remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon regimes, and all were repurposed for use with COVID-19.

The results conclude that these regimens appear to have little or no effect on 28-day mortality, the duration of hospital stay and the need for artificial ventilation. This follows an earlier update on 6 July when the WHO accepted the Solidarity Trial’s recommendation to discontinue the trial’s hydroxychloroquine and lopinavir/ritonavir arms.

Almost 500 hospitals have been recruited into the WHO Solidarity Trial, and further investigations are ongoing on newer antiviral drugs, immunomodulators and monoclonal antibodies.

Healthcare acquired infections in hospital

A report (link) highlights the problem of healthcare acquired infections. This was a major issue in the first wave, particularly with availability of PPE, and its re-emergence is of concern as hospitalisations rise again. We hope to share more insights on this topic in a future Bulletin.

COVID-19 and anti-coagulation

In the early months of the pandemic it became apparent that many COVID-19 patients were suffering from microclots, disrupting blood flow and most likely caused by damage to the endothelial cells of the blood vessels.

Standard treatment is now that all adult hospital admissions with COVID-19 should receive thromboprophylaxis with low molecular weight heparin, a blood thinning agent, unless there is reason to suspect an increased risk from bleeding.

More recent news from the community illustrates the delicate nature of the balance that needs to be struck when attempting to prevent blood clotting. The Medicines and Healthcare products Regulatory Agency (MHRA) has been alerted by King’s College Hospital (London) about the impact of lockdown on patients taking warfarin (Speed et al, 2020), an old but still widely used blood-thinning agent whose levels have to be tightly monitored to prevent uncontrolled bleeding. Various reasons were advanced, including treatment with antibiotics, increased alcohol consumption, reduced consumption of green vegetables rich in vitamin K and the impact on medical adherence from social isolation.

Data

Nature – Report on Excess Mortality

A report published in Nature (link) summarises excess mortality in 21 industrialised countries over the course of the first wave. It will be of little surprise to see some familiar countries showing significant excess mortality − possibly of more interest are those countries which appear to have escaped relatively unscathed, including several in Central and Eastern Europe.

ONS Surveillance Report

The latest report published today (link) shows continued increases in infectivity in England, with numbers infected during the week reported of 336,000 (up from 224,000), or 1 in 160 people (1 in 240). New infections per day are estimated at 27,900 (17,200).

The regional analysis shows some signs of a levelling off in the North East and Yorkshire regions, although the narrative expresses extreme caution in over-interpreting these early signs. In a similar way, a slight lowering for those aged over 70 is treated with caution, although the most marked change in age groups is a slowing of the increase in the young adult group (Year 12 (age 16-17) to age 24)

R Estimate

The latest estimate of R for the UK is put at between 1.3 and 1.5 (compared with 1.2 to 1.5 last week). As usual this estimate is based on those with symptoms and requiring healthcare, so is lagged by a couple of weeks in relation to the current position. For England SAGE estimates 1.2 to 1.4, and this is very consistent with our own estimate, published yesterday, based on hospital admissions in England.

Based on recent hospital admissions our estimate of R is around 1.3 at the last point we can estimate.

Obviously there is significant regional variation, which we discuss below. /2 pic.twitter.com/ZptE0PkwHD

— COVID-19 Actuaries Response Group (@COVID19actuary) October 15, 2020

ONS Analysis of Mortality by Ethnicity

ONS has today released another of its excellent analyses (link), this time focusing on the impact of ethnicity for COVID-related mortality. It is widely known that minority groups have suffered considerably greater mortality than that for the white population, and the report seeks to understand the factors behind this.

The headline finding is that socio-economic and geographic factors are the key influences in the observed excess mortality for minorities. However, once these are taken into consideration there is still a statistically significant excess. A further analysis by existing health conditions appears to show no clear pattern of influence to explain the residual excess, with results varying by different ethnicities.

Other

Great Barrington and John Snow

What do a sleepy Oxfordshire village and an England cricketer from the 1970s have to do with COVID? Nothing as it happens, but both appear to be the titles of competing petitions which have diametrically opposing views as to the best way to manage the pandemic.

First off was the Great Barrington Declaration (link), named after the venue in the US where it was written and signed (although the town itself has now publicly distanced itself from the petition (link)). It advocates an approach of minimising restrictions and allowing herd immunity to build up in advance of a vaccine becoming available.

In response, the John Snow memorandum (link) (named after one of the founding figures of modern epidemiology) was published in The Lancet, initially with the signatories of 80 experts. It supports the approach adopted by most governments, of varying levels of restrictions to suppress infectivity levels.

Both of these petitions have since been signed by large numbers supporting their objectives, and discussed at length in social and traditional media.

And Finally …

New restrictions imposed in the Netherlands this week (link) include the closure of cannabis cafés, although take-away service is still permitted until 8pm. Similarly, shops are only permitted to sell soft drugs until 8pm, leading us to ask whether harder substances are still available beyond that time?

https://www.johnsnowmemo.com/sign.html If you are a scientist, researcher or healthcare workers you can sign the John Snow memorandum here.

16 October 2020