Dear Courtfield Patient,
It is a pleasure to be able to write a newsletter containing such positive news!
Since we last wrote, the news of the extraordinary scientific breakthrough of 3 highly effective vaccines, should entitle us to feel realistically optimistic about a return to a more ‘normal’ life by next summer.
This does not, however, mean that COVID 19 is going to go away, and it is absolutely vital that as the vaccine program rolls forward, that we remain vigilant with respect to social distancing, hand washing, and mask wearing indoors. This is particularly important during January and February, when respiratory pathogens are traditionally most active.
At Courtfield we have recorded only 3 new cases in the past month, down from 5 in September and 15 in October. All patients had modest (mainly respiratory symptoms) only.
This reflects the national picture of a 30% reduction in positive tests in the past 2 weeks and an associated reduction in hospital admissions.
Nationally, the latest ONS statistics show that 99% of patients who contract Covid make a full recovery-even the majority of over 90’s recover.
THE VACCINE HAS ARRIVED
Since the last Newsletter, 3 vaccines have completed phase 3 trials and reported very positive results.
Two of these vaccines (produced by Pfizer/BioNTech and Moderna) use a new technique (using messenger RNA-see below) and both show over 90% effectiveness in producing a satisfactory antibody response The Oxford/Astra Zeneca vaccine uses more traditional techniques (i.e., using a fragment of the virus-the spike protein) and has reported 65%-95% effectiveness depending on which dosing regime is used.
Evidence from previous vaccines has shown that this level of effectiveness will still be sufficient to protect the population as a whole.
The Pfizer vaccine was the first to receive official approval this week, but is not really very ‘user-friendly’, as it has to be stored at minus 70c, comes in batches of 975 doses, has to be individually prepared and then used within a few days of “defrosting”.
Whilst the National vaccination programme will start next week with this vaccine, its use will probably be restricted to mass vaccinations of large organisations such as hospitals (where it can also be stored), or possibly for mass vaccination centres if established. The Government has received 800,000 doses for this first phase of the vaccination programme (which prioritises hospital and care home staff and residents)
We suspect that thereafter we are more likely to use the Moderna or Oxford/AstraZeneca vaccine (if approved) which come in individual doses and can be safely stored in a standard vaccine fridge for several weeks.
All require a 2 dose regime, given 3 weeks apart.
The UK has ordered the largest number (60 million doses) of the Oxford/Astra Zeneca vaccine. It also has the advantage of being 1/5 of the price of the Pfizer one! (Moderna costs £25 per dose, Pfizer £15, and Oxford/Astra Zeneca £3)
HOW DO THESE VACCINES WORK?
Traditional vaccines (such as the Oxford/Astra Zeneca vaccine) are made up of small or inactivated doses of the whole disease-causing organism, or the proteins that it produces, which are introduced into the body to provoke the immune system into mounting a response.
Messenger RNA vaccines, in contrast, trick the body into producing some of the viral proteins itself. Once inside a cell, mRNA is used as a template to build a protein that the immune system then detects as “foreign” and starts to produce a defensive response to them.
Interestingly, evidence from cancer research suggests that mRNA in vaccines could also stimulate a part of the immune system known as the “innate immune system”, providing an extra layer of defence via T cell immunity.
BUT ARE THE NEW VACCINES SAFE?
Messenger RNA technology is not a completely new technique -it has been known about since 1990, but only in the past few years has it been possible to produce it in a stable form to be of practical use
Most work on using mRNA to provoke an immune response has so far been focused on treating cancer, with tumour mRNA being used to help people’s immune systems recognise and respond to the proteins produced by their specific tumours.
Side effects have mainly been limited to short lived soreness at the vaccination site and fever, which are the 2 main side effects reported in the COVID vaccine trials for both the messenger RNA vaccines (and the more traditional Oxford/Astra Zeneca vaccine).
The safety data on mRNA vaccines is however limited to the experience of the 40,000 volunteers over the past 3 months who took part in the trials, compared to the decades of experience with more traditional vaccines such as the Oxford one.
HOW DO WE GET THE VACCINE?
Unfortunately, it is still not clear, exactly how the vaccine will be distributed nor who will be administering it
We do know that it will be rolled out in stages with the most vulnerable being vaccinated first, initially using the Pfizer vaccine.
The government have set up a structured/tiered programme based on vaccinating those most at risk first, as advised by the Joint Committee on Vaccination and Immunisation (JCVI) as set out below
1. Residents in a care home for older adults and their carers
2. All those 80 years of age and over. Frontline health and social care workers
3. All those 75 years of age and over
4. All those 70 years of age and over. Clinically extremely vulnerable individuals
5. All those 65 years of age and over
6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
7. All those 60 years of age and over
8. All those 55 years of age and over
9. All those 50 years of age and over
The above list (approximately 30 million people) does not include those under 16 with underlying conditions, but we expect this to be reviewed in the next few day.
The UK Government has exclusive access to the vaccine and it has been made clear this week, that it will NOT be made available to the Private Sector, at least until the above groups have been vaccinated, or until the vaccine becomes more widely available (there are currently 8 other vaccines in phase 3 trials). This however may not be until early Summer.
Whilst we have been preparing our own lists of vulnerable patients at Courtfield, the Government has so far failed to respond to offers for help in vaccinating patients in the Private Health Sector.
IT IS THEREFORE VITALLY IMPORTANT THAT THOSE OF OUR PATIENTS WHO EXCLUSIVELY USE THE INDEPENDENT/PRIVATE SECTOR, AND WHO BELONG TO ANY OF THE 9 CATEGORIES LISTED ABOVE, REGISTER WITH A LOCAL NHS GENERAL PRACTITIONER TO ENSURE THAT THEY ARE INCLUDED IN THE VACCINE ROLL-OUT OVER THE NEXT FEW MONTHS, AS IT IS LIKELY THAT ELIGIBLE INDIVIDULALS WILL BE IDENTIFIED VIA NHS GP LISTS.
PLEASE LET US KNOW IF YOU HAVE DONE SO AND WE WILL BE HAPPY TO SEND ANY RELEVANT MEDICAL HISTORY TO YOUR NHS GP (of course subject to your consent).
The “underlying health conditions”” (Categories 4 and 6 above) identified by the JCVI are set out below.
• Chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and severe asthma
• Chronic heart disease (and vascular disease) 6
• Chronic kidney disease
• Chronic liver disease
• Chronic neurological disease including epilepsy
• Down’s syndrome
• Severe and profound learning disability
• Solid organ, bone marrow and stem cell transplant recipients
• People with specific cancers
• Immunosuppression due to disease or treatment
• Asplenia and splenic dysfunction
• Morbid obesity
• Severe mental illness Individuals within these risk groups
DO I HAVE TO TAKE THE VACCINE?
No-but if you do not take the vaccine you will remain vulnerable to this pernicious illness with its myriad complications such as “Long Covid”( see last month’s newsletter).
It is not yet known whether being vaccinated will prevent transmission of the virus, so it is possible that there will not be protection from other members of the population being vaccinated (sometimes referred to as “herd immunity”).
COVID 19 is likely to be with us for many years to come and without the protective antibodies acquired through vaccination you will remain at risk-especially in the Autumn and Winter.
CAN I HAVE IT IF I AM PREGNANT?
There is currently no safety data on pregnancy and the vaccine should therefore be avoided in pregnancy.
RAPID TESTING AND REDUCING QUARANTINE
In addition to the news about the vaccine, the other significant positive news this month has been the proposed change to quarantine regulations which are due to come into force on December 15th.
This will allow quarantine to be reduced from 14days to 5 days subject to a negative “rapid” or “lateral flow” test.
Frustratingly – as reported in previous newsletters, the Government has still not approved any of the rapid tests available.
NHS England have so far tested 40 rapid tests and rejected 31. One (the one that was used in Liverpool) was deemed to be reasonably satisfactory, but a BMJ article last week which reviewed the evidence (Oxford/Porton Down study) concluded that it was ‘not fit for purpose’, because it was not sensitive enough i.e. missed too many positive cases.
This study also showed that the accuracy of the test varies with who is doing it i.e.:
79.2% sensitivity if carried out by a “trained scientist” (but still therefore missing 1 in 5 positive cases)
73% sensitivity if carried out by a trained healthcare worker
58% if carried out by a self-trained member of the public (i.e., missing nearly 1 in 2 positive cases).
There are still 8 lateral flow kits to be tested-including the one that we have bought a small supply of at Courtfield
We will therefore only be offering a lateral flow test once one has been approved as being suitably accurate.
In the interests of safety, we will only continue to offer the lab based PCR test (99% sensitivity)-turnaround time in most cases is now 24hrs-but please allow at least 48hrs if travelling.
Christmas at Courtfield
Apart from the four-day Christmas break, and three-day New Year break, we will be open throughout the holiday period.
We are able to continue testing up to and including Christmas Eve, and one of us will ensure that written certified results are sent out by email, over the Xmas and New Year bank holiday period for those of you that are travelling during that time.
The arrival of the vaccine means that we really are moving back to a more normal world.
The roll out will take many months, so it is still vitally important to keep up with the social distancing, hand washing and mask wearing.
All of us at Courtfield wish you the very best for the holiday period and will continue to keep you updated on all matters to do with COVID via this Newsletter.