Other things this pandemic has taught me

This is not a health blog. 

This is a technical blog with a science/engineering perspective. So, when I post something about health, infectious diseases, vaccinations etc. I post it from that perspective. I make the assumption that the best scientific information we have available that is accepted by peak bodies is true and correct. To that end I post links to primary and secondary sources. If you want to argue the science, go argue it with the actual professionals. I'm not that arrogant that I think I know better than professionals in their field.

It's also not a political blog. In fact, in the extra categories, you won't see anything on politics. You'll see critical thinking, the scientific method... and possibly a few recipes as well as some creative writing and a few personal observations.

I've also posted elsewhere some snarky things about what this pandemic has taught me: particularly with regard to how much people value the lives of others over money and willingness to forgo some temporary discomfort in order to  safeguard other people. It's been sobering to say the least.

There are also some other things that this pandemic has taught me, from a futurist perspective. There are lessons to be learnt. Will we remember them or go back to business as usual?

Many of us are more productive when working from home

I still think offices have a place, but not like they used to. Many employers are champing at the bit to get people 'back to work' when they have been working this entire time, often with much higher productivity. For some reasons, there are inept managers still among us that think that someone working from home is somehow having a holiday. My prediction is that many workplaces will suffer a drop in productivity when workers are forced back into the office.

A long time ago at a previous workplace, I negotiated a 40% work from home. After a trial, it was increased to 60% by my boss because he could see the extra productivity he was getting from me. However, he had problems with his boss. They didn't like it one bit. The reasons they gave were:

 - How will you know he's working?

 - If others find out, they'll want to do it too.

Hopefully, I won't need to explain why these reasons are so ridiculous.

You don't need to go to meetings

Before the pandemic there were more than a dozen meeting collaboration tools around. Now there's basically two: Zoom and Teams. The latter really only exists because it integrates into the MSOffice suite and it can also be your phone system. I'll throw Teamviewer in as a third, but its primary use is for support - plus it's dear as poison. Zoom comes out on top in my books because it runs on literally anything and all you need is a subscription. Teams is only useful in medium to large organisations.

At the start of the pandemic, there were huge teething problems: microphones not working, cameras either not working or people didn't have them. We didn't know the 'rules' of zoom meetings (muting etc). But we're all past that now. Plus we learnt an important thing: Most of the time, we didn't need to be at that meeting. We could have sent an email. Meetings got shorter. People learnt to be concise. If we weren't really involved, we could mute, turn the camera off, and continue working on whatever we were working on - or just look at facebook.

Nobody wants to go back to face to face meetings. Nobody wants to spend time driving across town, parking, paying tolls, waiting for everyone to be free, struggling to setup your notebook to work with the projector, then using up the obligatory one hour in the board room trying to pad out a meeting.

We can do pretty much everything on zoom. Usually we can do it better.

You can be anywhere in the world

This will probably turn out to be a downside. As employers work out the first two points, they will probably decide that employing someone to do your job in India or The Philippines will save a lot of money. So to you, that may make you think you can live anywhere and still keep your job, the reality is that you may be introduced to new members of your 'team' that are offshore and need to be trained by you in all aspects of your job.

Of course, this is just an extension of globalisation. The pros and cons of which are outside of this discussion. How it affects you is the overarching issue. I've already seen this happening with one large company I know transitioning to IT support being offered by an Indian based company. I worked with my counterpart in the handover. His skillset was roughly equal to mine and we held similar positions. However, because he lives in India, his salary was about half that of mine. By Indian standards, that was great - he was paid very well. The point is that this disparity will continue to drive knowledge based jobs offshore to a much greater extent than it will permit you to move to Tasmania.

The CBD will become the place where people live more so than where they work    

Nobody wants commercial real estate in the city anymore. Offices have emptied. Those that are left attract vastly lower rentals than before. For an industry driven by debt, no back will lend at anything near the value of the resource. 

Residential properties in cities, however, have boomed. Restrictions in travel meant that if you wanted to go to the city, you had to live there. As more people move to the cities to live, prices rise and suddenly commercial developments are now being restructured as residential. In fact, the highest value seem s to be in the commercial/residential mix. Where there is a residential building, with shops and cafes at ground floor, and gyms, day care, professional suites, schools, universities, small offices etc. at the lower levels. Some include green space and play grounds creating a fully self contained living environment free from unnecessary commuting. 

In the suburbs, an office is an essential room

Two of the rooms in our house have now been converted to offices. My wife and I worked out we couldn't really share an office with me working full time from home. In house auctions, it has been noticed that homes with a dedicated and separate office command much higher prices than those that don't. Even more so if the office has an external entrance or easy courier access.

I spend way more time in my home office than I do in the loungeroom or bedroom. For me, it has become the most important room in the house.

You don't have to "go" shopping

With home delivery of goods, click and collect, home shopping, that trip to the shopping mall isn't necessary any more. But try and buy local and not from Amazon.

Restaurants and cafes aren't a luxury

Fast Food chains will weather the pandemic. Your local family owned Italian restaurant may not. Many that adapted to the pandemic: with simpler menus, delivery friendly foods, contactless trading etc. seem to have done okay. If you enjoy going to your local restaurant as a treat every couple of months, make sure you patronise them regularly during lockdown. Otherwise, they may not be there afterwards.

Self-care isn't self-indulgent

As a poor uni student, I learnt that if I treated myself to an iced-chocolate once a fortnight, I didn't feel so poor. It was something simple I could look forward two that made me feel just a little bit special.

Pampering is vital to well-being. Activities that once felt indulgent became essential to our health and equilibrium, and that self-care mindset is likely to endure. Whether it is permission to take long bubble baths, tinkering in the shed, planting a tree in the backyard, watching a pay-per-view on netflix, anything that helps you to feel better about yourself will not only help you, it will help those around you.

We don't store enough food and provisions

The big lesson we should have learnt is we must have 1-2 months supply of non-perishable food and provisions: toilet paper, rice, pasta, flour, sugar, long life milk, cleaning products, toiletries, tinned food, water - all of things things can become very scarce in hours if there is panic buying. Perishables don't suffer as much. These things are easy to store, cheap to buy and you suffer if you don't have them. So get them and avoid panic buying.

Some jobs are essential

Every military in the world has reserve forces. The basic idea is to take a young person, train them to be a soldier in peacetime through a very small imposition of their time and give them some money to make a sweet deal. In Australia, the general commitment is one night per week, one weekend a month, two weeks a year. For that, you receive some tax free dollars and training as a soldier. The quid pro quo is that anytime up until twenty years after you leave the reserve you can be activated. This allows the military to keep a small military during peacetime, but rapidly expand it in case of war with already trained soldiers. 

We realise the value of this for ware. We should now realise we need this in case of a long term medical emergency such as a pandemic. The recent bushfires show that we need this for other emergency services as well.

So, we should have reserve paramedics, nurses, orderlies etc. People that have a basic level of training in a profession. Enough to assist the permanent staff during a crisis. Consequently, other emergency services such as fire fighters and police deputies should be included as well.

We won't prepared for the next one

This pandemic was and is pretty bad. But it could be a lot worse. Until Delta, the reproductive factor was relatively low (2.4). Delta changed everything, but at least it didn't start out with Delta's reproductive rate (estimated at 9.0).

The mortality rate (at around 2%-3%) whilst bad, was at least within the realms of manageability. If the mortality rate was 10% or higher, we may have well seen major civilisation changes: civil war, anarchy, financial system collapse. The previous two coronavirus outbreaks (SARS and MERS) had mortality rates of 10% and 90% respectively. Fortunately, both had low reproductive rates. The black plague had a mortality rate of around 50%.

Experts universally agree this isn't the last outbreak. There will be more. Statistically, the next one will be much worse. But we aren't prepared for it. We're still struggling to deal with the current one. We've learnt a lot, yes, and we've developed some incredible medical preventions and treatments.But as this pandemic trails off and either disappears or becomes endemic, the money for further research will disappear very quickly.

COVID-19: AstraZeneca Vaccine and Blood Clots

There's a huge amount of misinformation floating around about COVID-19 and in particular, the AstraZeneca vaccine and the issue of blood clots. Media reporting is partly to blame for simultaneously sensationalising and glossing over important information. So I thought it was about time to present the facts of the issue. I will source all statements made, if I miss anything out - let me know.

I'll add a caveat here: I'm not a medical expert. Don't get medical advice from social media or even blogs like mine. Go to your doctor. What I've done is glean what I can from the information that is publicly available. I may be wrong on many points, so apply a good deal of critical thinking to what I've written here as you should to any information that is presented to you: particularly if it claims to be authoritative.

COVID-19 Vaccines in general

There are currently four vaccines that are authourised for use in preventing the SARS-CoV-2 infections. Technically, they are in phase IV global post-licensure surveillance. They are:

• Pzifer-BioNTech (mRNA)
  
• Moderna (mRNA)
  
• J&J/Janssen (viral vector)
  
• Oxford/AstraZeneca (viral vector)
  

Other vaccines are in different stages of development. Most of these will not make it into public release. Now that there are already vaccines in production and distribution, any vaccines further developed will have to demonstrate they are better than those currently available. Not listed is the Chinese based Sinovac vaccine called CoronaVac and the Russian Gamaleya (Sputnik V) vaccine. Both of these vaccines use traditional production techniques making them cheap to produce but they have poor effectiveness profiles. Many third world countries have opted to use them, but not a single western nation has.

The numbers change daily. You can follow the progress of vaccine candidates here. For those who claim the vaccines haven't been tested, download the daily R&D blueprint and check any trial link you link. Thousands of clinical trials for safety & effectiveness have been and are being conducted.

Oxford-AstraZeneca (AZ) Vaccine

The method used to provoke an immune response is called "viral vector'. It uses a modified version of a different virus - called the vector. This vector is injected intramuscularly and enters the cells of the muscle. From there, the vector manufactures a spike protein identical to that found uniquely on the surface of the SARS-CoV-2 virus that causes COVID-19. The cell then displays the protein on its surface. Our immune system recognises it shouldn't be there and triggers an immune response targeted at the spike protein. Since the body is fighting an 'infection', we have the usual symptoms that accompany an immune response. This includes injection site pain, fever, lethargy, feeling 'sick' etc. However these are immune response reactions, not an actual disease. Different people will have different responses. source

At the end of the process, our bodies have learnt how to protect us against this infection. Effectiveness after two vaccines vary according to the variant encountered. Certainly, this vaccine is much less effective than the Pfzer vaccines (>90%). However, best data to date shows at worst it is 61.7% effective (UK B117 variant) and at best it is 81.5%, with the average being 77.3%. source

A recently published paper in The Lancet is a little more critical, estimating the effectiveness at 67%.

Blood Clots

Once the AZ vaccine was being administered globally, reports started emerging of blood clots at an significant uptick over the background rate. In about 1 in 4 of these, death was the result.

It's important to clarify something here as a sidebar. When you administer a medication to millions of people, large numbers will have 'something' medical happen to them over the month following the administration of the medication. People will have heart attacks, strokes, embolisms etc. that have nothing to do with the administration of the medication. However we do have a good idea of the general rate at which these events occur. In fact, your life insurance company can tell you the percentage chance of any medical event happening to you over the next year. It's quite a well studied science. This is why all adverse events that happen following vaccination are reported. This reporting is mandatory and the reports are publicly available and searchable. In Australia, it is the DAEN (Database of Adverse Events Notification). In the United states it is VAERS (Vaccine Adverse Event Reporting System). Researchers compare adverse events with the rate that normally occurs. When there is an 'uptick' in an event, it is investigated. In the case of serious events, they are all investigated thoroughly as a public health measure.

At first, since the number was very low, there was skepticism that the AZ vaccine was the cause as vaccines have never been known to cause blood clots. Vaccines are injected intramuscularly not intravenously and have not direct connection with blood.

From the investigations, however, the AZ vaccine has been identified as the likely cause in over 100 cases. From these numbers, it is likely the incidence of a blood clot from the AZ vaccine is about 1 in 1 million. The phase III clinical trials involved 20,000 people who received the vaccine. Blood clots were not observed in any of the participants.

UPDATE 30 Sep 2021: We have a lot more data on the incidence. With increased surveillance for TTS, including very minor instances (headaches, thigh soreness etc) there have been 125 reported cases in Australia out of 9.6 million vaccinations. This makes the chance of a blood clot 1 in 76,800. Now, that's a lot higher than one in a million, but remember, these include minor cases. Of those 125 people, 8 people died, six of them women. This is a mortality rate of 1 in 1.2 million. Certainly much better than catching COVID, but since there is an alternative, if you are female and under 50, definitely don't get the AZ vaccine, get the Pfizer or Moderna instead. See  ‘Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca’

source

How can the AstraZeneca vaccine cause blood clots?

So far, experts do not know, however there are some conjectures. Foremost amongst these is that in rare cases, the vaccine also induces and immune reaction against a protein found in blood platelets. On the sniff factor, this sounds (at least) like a good explanation. 

Patients with blood clots were found to have antibodies against Platelet Factor 4 (PF4) which is a symptom of heparin-induced thrombocytopenia. So it may be the case that those patients have this disease already, but it is undiagnosed and the vaccine triggers this response. People are only tested for this if they present to hospital with a blood clot. Blanket testing of people would be pointless because of false positives according to Baye's Theorem.

However, everything is still conjecture at the moment. The reality is that we don't know if it is the adenovirus (the vector) or the spike protein is linked to the clots.

What do we know?

In simplistic bullet point form, this is everything we do know:

• It occurs at a rate of approximately 1 in 76,800 1 million people
  
• It mostly affects women under 55
• Heparin-induced thrombocytopenia is more common in women than men and less likely to be diagnosed at a young age.
• Blood clots are a symptom of COVID-19. You are far more likely to get a blood clot from COVID-19 than from the AZ vaccine.
• To put the risk into comparison, the risk of DVT from flying longer than four hours is 0.079% or 1 in 1265. The risk of a blood clot from taking oral contraceptives is around 0.04% or 1 in 2500.

So, is it safe?

Relative to what?

Taking the AZ vaccines is certainly safer than getting COVID-19 by several orders of magnitude. Millions of people have died from COVID-19 compared to the 25 people that have died probably because of the AstraZeneca vaccine. In addition, antivaxers are lying about adverse reactions by posting fake testimonials to social media. People inundated with hundreds of personal stories may find it compelling, but the reality is that this vaccine is still far safer than not only most other medical interventions, but safer than most daily activities such as driving and eating.

It's only natural to be concerned about risks we hear about in the media regularly or on social media, particularly for activities we don't regularly undertake. But in reality, if you are concerned about the risk of taking the AZ vaccine: Don't fly in a plane, don't drive a car and don't take paracetamol. All of these have higher risk profiles by several orders of magnitude.

However, if we are looking at the risk of taking the AZ vaccine compared to the Pfizer vaccine, then yes. Take the Pfizer vaccine anytime. The Pfizer vaccine will knock you around more - many people need a day or two off work after having it. But its effectiveness is MUCH higher and serious adverse event reports do not statistically exceed the background rate (despite what you facebook group might say).

Achieving Herd Immunity

Besides protecting the individual, the purpose of vaccines is to reduce the R(Eff) rate below 1. For COVID-19, R0=2.4. Herd Immunity (s) = 1-1/R0 = 58.33%.

This means that we need to vaccinate 87% of the population with the AZ vaccine, or 62% of the population with the Pfizer vaccine. However, the higher the rate the better. Anything below these numbers will lead to outbreaks. Leaving children out of the equation (no COVID-19 vaccine has been certified for paediatric use) then it is impossible to achieve herd immunity with the AZ vaccine.