View of a medical practitioner: On herd immunity and effective Covid medicines

by Lorraine Williamson
herd immunity and Covid pill

Medical examiner questions about herd immunity and will there be effective medicines against Covid? 

For a personal impression of life in Spain and Covid, asks Dr. Jan Otto Landman to share his views on the Covid-19 pandemic. He lives and works in Spain (Costa del Sol), arriving more than 20 years ago. His medical practice is in Torremolinos. 

December has brought already a lot of snow for large parts of northern Spain. However, in the south, it is still dry and sunny. So dry that the reservoirs are now at an alarmingly low level. Furthermore, there is so little snow in the Sierra Nevada near Granada that there is only limited skiing. A handful of tourists are still sunbathing on the beaches, albeit often behind windbreaks.

Tourism and Covid

Tourism from Northern Europe is at a low ebb. You would think the beautiful weather and the favourable Covid situation here should be an incentive for tourists. Especially, among others, the Dutch and Flemish who are currently living with grey skies and restrictive measures. But no, the situation in these countries apparently generates a feeling of insecurity that cannot be reconciled with travelling.  

In our practice, we get a lot of questions from holidaymakers about the booster shot. A number of our patients have now received this here in Spain, after submitting a vaccination certificate and ID. In Torremolinos, these are provided, among other places, in the Ambulatorio on Calle Nerja 7. 

Outbreak hospital staff Málaga 

December is the month of Christmas dinners in Spain. Málaga was world news in the field of COVID for a while last week. At a Christmas dinner organised by the IC staff of the university hospital Carlos Haya (a name that was officially banned a few years ago because it refers to a celebrity of the Franco dictatorship) no fewer than 68 of the 173 participants turned out to be infected. However, because they had all been vaccinated three times, the consequences remain limited for the time being. So far, all infected persons have had none or only mild symptoms. Furthermore, the hospital expects to be able to absorb the loss of infected staff itself. For the time being, the advice from the regional health authorities is to cancel all Christmas gatherings of hospital staff. 

Life at the Costa del Sol continues quite normally 

As said before: the number of infections in the Málaga province is increasing, but pressure on hospitals remains very low. Out of the 1.7 million inhabitants, there are only 90 admissions due to corona. Life here, except for the obligation to wear face masks in public indoor spaces, therefore seems to continue quite normally. The weather is pleasant, terraces are full and there is no curfew or early closing times of the catering industry. The booster campaign is progressing well, and the number of third injections is approaching 5 million. Furthermore, over 90% of the population older than 12 years has had at least 2 injections. 

Herd immunity 

Vaccines have saved hundreds of thousands of lives in Europe. But despite the high Covid vaccination coverage, herd immunity will probably never be the case. At the beginning of the pandemic, the opinion was still prevailing that herd immunity would be achieved with vaccination coverage of 60 to 80%. However, mutations have made the virus more contagious, and vaccinated people, although to a significantly lesser extent, continue to transmit the virus. As the situation is now, vaccinated people will become less seriously ill after being infected and unvaccinated people, in particular, will be at greater risk of hospitalisation. Herd immunity against Covid is unfortunately not in the offing. So, to limit pressure on healthcare it remains important that a large part of the population is fully vaccinated. 

Effective medicines against Covid 

Unvaccinated, vaccinated with underlying diseases and people with an immune disorder who are unable to build up sufficient immunity after vaccination, continue to have an increased risk of a serious form of corona and therefore of hospitalisation. For these groups in particular, it is of great importance that effective medicines are available against Covid.  

At the beginning of the pandemic, many hopes were pinned on drugs such as hydroxychloroquine (which turned out to be ineffective) and Remdesvir (not very effective). Later came the immunosuppressants that suppress the derailed immune response that can occur in the third week of the disease and is often fatal. The main immune suppressant is the long-standing and inexpensive dexamethasone. Monoclonal antibodies can also be administered in a hospital in case of severe illness. However, we always had to wait for medicines that have an effect at an earlier stage of the disease, so that hospital admissions are prevented. 

Promising developments 

Currently, there are some promising developments that could become available in early 2022. They are antivirals from MSD (molnupiravir) and Pfizer (Paxlovid). A major advantage is that they are effective in an early phase of the disease. And can simply be taken at home by the patient as a 5-day course. Paxlovid in particular appears to be very effective, according to the pharmaceutical company, the drug prevents 89% of hospital admissions and deaths. This drug could play a crucial role in the treatment of patients with symptoms that are not (yet) severe enough to require hospitalisation.  

With a high vaccination rate and vaccines that remain effective, this could well mean the end of the overload of care by Covid and therefore also the end of far-reaching restrictive measures. The EMA, the European Medicines Agency, has already started the approval procedures for the antivirals and they are expected to become available this winter. The United States has already ordered many millions of doses of both drugs. Both pharmaceutical companies have promised to make antivirals available to developing countries at cost. 

We used to dream of a “White Christmas”, nowadays we would be very happy with a normal Christmas, cosy in a restaurant or at home with family and friends. In Spain, the situation in hospitals is now so favourable that the national government has already promised that there will be no restrictions around the holidays. Let’s see how that plays out later, but this windfall is in for now.

The good news from this Blog is that there will most likely be effective drugs against Covid in the short term that will help us control the pandemic. Until then: stay healthy! 

Jan Otto Landman, MD, PhD

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