All EOS blogs All Spain blogs  Start your own blog Start your own blog 

Thoughts from Pontevedra, Galicia, Spain

Random thoughts from a Brit in the North West. Sometimes serious, sometimes not. Quite often curmudgeonly.

Thoughts from Pontevedra, Galicia, Spain: 11 April 2021
11 April 2021 @ 10:34

Night’s candles are burnt out, and jocund day stands tiptoe on the misty mountain tops.

Spanish life is not always likeable but it is compellingly loveable.  

- Christopher Howse: 'A Pilgrim in Spain'

NOTE: If you want to know more about Galicia, click here. Detailed info on Pontevedra coming soon. 

Covid 

Side-effects:

1. The Economist: With millions vaccinated, rare side-effects of jabs are emerging: The challenge is to sort them from the medical emergencies that happen every day. See the 1st article below for more.

2. The Telegraph: It's all in the telling: Why Europe's approach to the AstraZeneca jab differs from ours. Different circumstances and regulatory judgments about risk explain more than politics and a clash of nations. See the 2nd article below if you can't access this.

The UK: A huge ‘side-effect’ which perhaps only rapid effective vaccination can ameliorate: NHS England data shows there's been a ‘shocking’ rise in cancer patients not being treated due to Covid-19 concerns. Fears have been raised that survival rates are going backwards. 

Cosas de España/Galiza

More trouble for Brits trying to get to Spain without a TIE.

And possibly why this is happening.

The Spanish Stonehenge - The Dolmen of Guadalperal. 

Directly opposite my house on the other side of Pontevedra city, there’s a massive horizontal gash in the hillside. This is the future - unnecessary? - A57 by-pass. On  which work hasn’t been done for months. Possibly more than a year. This seems to because there’s a spat between the regional and national governments as to when work should re-start. So, it could well be Pontevedra’s version of the AVE high-speed train and I might not see the completion of the road in my life-time. After all, the A54 from Santiago to Lugo still doesn’t arrive there, years after it reached wherever it currently ends.

María's Level Ground: Day 7.

The UK

Richard North on the recent royal death: The excessive coverage diminishes the event. Gone are those two crucial elements of dignity and restraint, the exaggerated response inviting irritation and even ridicule in what should be a solemn occasion.  So marked is the retreat from anything resembling a news agenda, that it has prompted the Independent to publish a piece headed: “All the news you missed amid wall-to-wall Prince Philip coverage”

A Times columnist: A death turned into a circus. How he would have hated all this flannel. What, she asked, was the point of it? Her own reply: Arse-covering mostly.

Here in Spain, there was less reverence. Here, for example, is a chap in El Mundo: Philip of Edinburgh: the hedonist and womaniser who realised his role was to inseminate the Queen and take a step backwards. Perhaps Philip is the example of the perfect consort of our time, more so than  the late Henrik, former husband of Queen Margaret of Denmark and, of course, the disgraced Prince Claus, who ended up as a victim, as he was the husband of Queen Beatrix of the Netherlands.

Elsewhere, El Mundo reports that: For more than 7 decades, the marriage between Elizabeth II and Prince Philip has been rock-solid, although at various times there has been talk of problems between the couple and some alleged infidelities on the part of the Duke, which have always been denied in public. Despite living under guard, it is said that he always found the opportunity to satisfy his desires, even to share women with a friend. He was linked to women such as Daphne du Maurier, married to a man who worked in the prince's office; Hélène Cordet, his childhood friend and mother of one of his godchildren; Pat Kirkwood, one of the most beautiful and reputed artists in London with legs so beautiful they were known as 'the 8th wonder of the world'. One of his most talked-about affairs was, in the 1970s, with Susan Ferguson, mother of the Duchess of York, Sarah, ex of his son Andrew.

I haven't read even a line of the hundreds of articles/eulogies in the British press* and - like most viewers - have switched off the wall-to-wall coverage on TV but I must admit I don't recall ever reading of Felipe’s affairs. So, I have no idea whether the reports are true or not. They might well be. But - given the egregious conduct of ex King Juan Carlos - I guess it's comforting for the Spanish to be able to make the infidelities of the royals of other countries the main tack to take on reporting of his death.

* But I have just read this: Philip, the equal opportunities offender: I think my favourite Prince Philip moment came when he was talking to a group of deaf youngsters, while a loud steel band played nearby. “Deaf? No wonder,” he said, thus in about 3 words managing to enrage the more sensitive souls in both the deaf community and the Afro-Caribbean community. Perhaps, with his sad passing, we should elect someone whose job it is to be rude to anybody who feels they should never be offended. We will miss Phil the Greek for his sense of duty and loyalty too. Especially when you look at what we’re left with.

Spanish 

It's feature of life in Spain that all Anglo names are hispanised. So ‘Phillip Duke of Edinburgh’ become Felipe Duque de Edinburgo. In contrast, it's impossible to imagine Juan Carlos being labelled John Charles in the British media. Seems just basic respect to me . . 

Finally  . . . 

Yesterday there were hundreds more hits than usual here, possibly because these were Russian bots picking up on a mention of the Crimea. If so, today's 2nd mention should produce another crop. On reflection, perhaps it was many of the wealthy Russians down on the Cost del Crime.

ARTICLES

1. With millions vaccinated, rare side-effects of jabs are emerging: The challenge is to sort them from the medical emergencies that happen every day.

Chris Witty, England’s chief medical officer, vividly recalls a nerve-racking moment on December 8th 2020. That was the day when England became the first country to roll out a covid-19 vaccine, a jab developed by Pfizer and BioNTech. Near midnight on vaccination day one “We were discussing it and just thinking ‘What are we dealing with here? These are small numbers and we’ve already had several dangerous near misses’,” said Dr Whitty in a recent talk at the Royal Society of Medicine. In some people, it had turned out, the vaccine sets off anaphylaxis, a life-threatening allergic reaction. But this is rare. It occurred just once among the 22,000 or so people vaccinated in the trial, which could have been by chance. Now, with hundreds of millions vaccinated, the rate at which it occurs is clearer: five per million.

Fortunately, this side-effect is not only extremely rare but shows up soon after the jab. And treatment for it exists. Everyone who receives the Pfizer vaccine is now asked to stick around for 15 minutes, just in case. There have been no deaths from anaphylaxis related to the vaccine.

As millions of jabs of various covid-19 vaccines are administered every day, such rare adverse reactions will inevitably emerge. On April 7th both Britain’s health officials and the European Medicines Agency (EMA), which regulates drugs in the European Union, said there is strong evidence that AstraZeneca’s covid-19 vaccine may be linked with very rare blood clots, often in the brain or the abdomen. The EMA experts reached their conclusion based on a review of 86 reported cases, 18 of which were fatal. Britain’s experts reached the same conclusion from data on 79 cases, 19 of which were fatal. Both the EMA and Britain’s drug regulator concluded that the vaccine’s benefits outweigh the potential risk of the clots. But Britain’s officials, armed as usual with some nifty charts for their televised briefing, said that for people under 30 the risks and benefits from the vaccine were “finely balanced”, so a different jab may be preferable.

The investigation of the suspected clots from the AstraZeneca jab has been a prime example of the challenge of sorting the signal of a vaccine’s side-effects from the cacophony of medical emergencies that happen to millions of people every day. Vaccine-safety experts have two ways to untangle whether a rare medical problem is caused by a vaccine, says Kathryn Edwards of the Vanderbilt University School of Medicine, in Nashville, Tennessee. They can compare its rate in vaccinated people against the “background” rates of it that are observed in the unvaccinated. And they can look for unusual features of the medical condition being investigated.

The first signals emerged in late February, when doctors in several European countries noticed clusters of blood clots in people recently given the AstraZeneca jab, some of whom died. Most were women under 60, which was not terribly surprising because many EU countries were, at first, not convinced that the jab worked in the elderly and used it largely for essential workers, such as nurses, teachers and social-care workers—professions in which most employees are women.

The EMA’s data as of March 22nd suggested that the rate of brain clots in people under the age of 60 who had had Astra­Zeneca’s vaccine was one in 100,000—higher than would be expected normally. Precisely how much higher, though, is hard to tell. The rates of such rare and difficult-to-diagnose conditions vary a lot by country, age and sex. Estimates of the incidence of such brain clots have ranged from 0.22 to 1.57 cases per 100,000 people per year, and they are more common in younger people and women.

As doctors began to look more closely, something curious emerged. Many patients with suspected clots from the vaccine had unusually low levels of platelets. These are fragments of special precursor cells that float in the blood. Their job is to form blood clots (they rush to the site of a cut or other bleeding). Low platelet levels therefore usually result in uncontrolled bleeding, not clots.

With this new information to hand, Britain’s medical regulators searched their data on vaccinated people for the unusual tandem of clots and low platelet counts. They found four cases per million people vaccinated, a rate several times lower than in the EU. One explanation is that Britain, unlike the rest of Europe, had used the jab primarily in older people. The rate at which the clots occurred in Britain declined steadily with age. Importantly, Britain’s experts found that the clots occurred as much in men as they did in women.

This combination of blood clots and low platelet counts is something that doctors know how to diagnose and treat, says Jean Marie Connors, a haematologist at Brigham and Women’s Hospital, in Boston. It resembles a condition seen in some people who are given heparin, a drug used widely to treat blood clots. For unknown reasons, some people develop an immune reaction to heparin, which results in blood clotting so profound that it depletes their platelets. The same reaction appears to be provoked by the vaccine.

Medical societies in several countries have already issued guidelines to doctors on how to spot and treat this rare reaction to the AstraZeneca vaccine. With vigilance and appropriate care, the extremely rare deaths that may result from it will become even rarer.

2. It's all in the telling: Why Europe's approach to the AstraZeneca jab differs from ours. Different circumstances and regulatory judgments about risk explain more than politics and a clash of nations

We humans like nothing better than storytelling - and the more familiar the book the better. It’s why the tragedy of Romeo and Juliet has been told a thousand times. Explaining things via common narrative is one of our many tricks for making sense of the world quickly.

The oldest story of them all is the clash of nations and it’s through this prism the story of the AstraZeneca jab in Europe is oft told. How else to explain why the European Union began by limiting the vaccine's use in the old only to reverse ferret, prioritise the elderly and then restrict its use in the young? 

The truth, of course, is more complicated. The bumpy ride the AstraZeneca vaccine has had in Europe (and North America) has much more to do with the different ways in which regulators approach evidence and judge risk than politics. Differing circumstances have also played an important role.

The initial decision of some countries, France and Germany included, to restrict the use of the vaccine to younger age groups stems from the fact the vaccine was not well tested among older cohorts in the original trials, where only 13 per cent of participants were age 65 and older. Add to this the fact that the tolerance and effectiveness of many vaccines falls away in older age groups and the argument for prudence becomes apparent - even though it was never clear cut. 

As The Telegraph reported at the time, the European Centre For Disease Control (ECDC) was making this point long before any vaccines had been licenced. In a paper published on October 26 it said: “Before pursuing this [age-based] approach, acceptable levels of vaccine safety and efficacy need to be demonstrated among older adults. At this stage, this information is not known”.

Instead, the ECDC recommended an “adaptive” approach - one which would flex as more was learnt about the jabs. 

With a glut of AstraZeneca vaccine coming our way and a second wave of the virus brewing, the UK authorities emphasised the other side of the risk-reward equation. Yes, there was a lack of evidence for the vaccine in older groups, but there was plenty of data to show Covid-19 kills older people at a much higher rate. 

The risk of death from Covid for during a surge in the virus is 1-in-1,848 for a healthy 70 year old man, according to Oxford's QCovid calculator. This compares to 1-in-250,000 for a 30 healthy year old - a 135-fold difference.

With hindsight, the UK authorities made the right call. The AstraZeneca jab and others have turned out to be extremely effective in older groups and the decision to prioritise them is estimated to have saved about 10,000 lives in the UK to date. Following its “adaptive” strategy, Europe has rightly followed suit.

But what of the decision in parts of Europe and Canada to now restrict the vaccine to older groups - those above 55 or 60. How to make sense of that?

The same culture of caution - shaped by differing circumstances - may again help explain it. Europe was hit disproportionately hard by scandal following the 2009 swine flu pandemic when the Pandemrix vaccine, widely distributed to health care workers, was linked with rare cases of narcolepsy. Some 1,300 people have been affected among the roughly 30 million vaccinated across Europe, but with only around 100 in the UK. 

Scientists in Germany and Scandinavia, in particular, have become black-belts in pharmacovigilance in the wake of the scandal; few if any are as good at analysing the thousands of adverse reaction reports that flow in when a new drug is launched. They are expert at sifting the early signals of a problem from the mountains of incoming chaff.

It was Norwegian and German regulators who first spotted the rare blot clogging issue now linked to the AstraZeneca jab. The UK authorities last week said they have since identified 79 cases here, putting the estimated incidence risk at about 1-in-250,000. 

The reported rate “varies very much with how good the reporting system in a member state is and how good cases are being identified”, said a spokesman for the EMA last week. “In Germany, a lot of work has been done and I think there is a reporting rate of 1-in-100,000.

“We know that in the UK the reporting rate is much lower, so that can have many many causes, but for the moment I think it's safe to assume that the reporting rate is around 1-in-100,000.”

In the UK, we have now followed suit and offered a choice of vaccines to those under the age of 30. But in other countries the cut off is higher - 55 in Canada, for instance.

It is important to note that these decisions are not (for the moment at least) driven by the incidence of clots being higher in the young. There is as yet no firm data to show the risk varies with age, or indeed sex. Instead, the decision to restrict the use of the vaccine in the young comes from the other side of the equation - the much lower Covid risk in younger cohorts.

Why the difference in ages? Again that has more to do with circumstance than politics. In Europe, they currently have more of the Pfizer and Moderna vaccine and so can offer more choice. In the UK, we are more reliant on AstraZeneca - for the moment at least.



Like 0




0 Comments


Leave a comment

You don't have to be registered to leave a comment but it's quicker and easier if you are (and you also can get notified by email when others comment on the post). Please Sign In or Register now.

Name *
   
Spam protection: 
 
Your comment * (HTML not allowed)
 
 
(Items marked * are required)



 

This site uses cookies. By continuing to browse you are agreeing to our use of cookies. More information here. x