What the * Is Happening Now? September Covid Policy update with Dr Esmerelda & Lovely Lydia

What the * Is Going On Now??

Dr Farah Shahi @Dresmerelda and Lydia Finney @lovely_._lydia talk through the medical and the political situation re Covid 19 .. Recorded on the 8th September 2021

Lydia: Good evening, everyone. Tonight, Dr. Esmerelda, Farah and I will be talking about Covid, UK government approach, everything that's going on. And the idea is to give everyone kind of handrail to see how we're going.

(Farah @DrEsmerelda joins the chat)

Lydia: I was just saying: Plan for this evening is to talk about the situation. What's going on, back to school. Lots of things are happening at the beginning of September because everything happens at the beginning of September. Where are we, what's going on and what's the government policy. So you are the medical clinical aspect and I'm the political person. And between us, we will be able to explain everything (Farah laughs).. almost everything. I also might stipulate at this stage that I certainly come at this from a UK government perspective.

So that predominantly covers England, it is slightly wider than that, but only in some aspects. So where shall we start? Shall we start with children early years, the kind of back to school elements of this. Do we want to start by talking about some recent JCVI decision on children? Well 12- 15 years old specifically.

Farah: Yeah, I think, because I think that's probably the thing that a lot of people are probably most confused and worried about right this minute. And it kind of ties in then to what goes on with the schools generally. I mean, from my perspective, I recorded those Instagram stories last week fully expecting them (JCVI) to change their mind. And there were kind of like a few reasons why I thought they would. Firstly, we were getting more data from the US and from a US perspective, it's really quite reassuring in terms of the risk benefit balance of giving twelve to 15 year olds the vaccine.

But as I said in the stories, it's really difficult to compare the US and the UK right now, partly because they have pockets that are just aren't vaccinated in the same way that we've got much better, broader coverage, I think over here.

So that was the first thing I thought might sway them. the second thing was and at the time I wasn't sure if this was government pressure (I think it probably was) in that NHS England were setting up preparing to vaccinate 12 to 15 year olds. But I wasn't sure if that just meant that actually, the JCVI has said 'actually, we probably will' and therefore people were sort of getting things ready behind the scenes. It wasn't abundantly clear. I wondered whether the Scottish data might come through and help, but it's really early data.

And then finally, I think the the fact.. So as I said at the end of that video, other ways of protecting our kids and there are ways.. And will come on to this.. That the government clearly aren't that interested in maintaining and that can obviously sway that benefit risk balance in terms of whether you vaccinate or not.

Lydia: What struck me just having a look at it was that the JCVI decision to say 'on balance, we don't think we're going to vaccinate 12-15 year olds'. They very much said in all other contexts, the JCVI have made decisions, and the government has done that. And then this context, they said, 'well, on a clinical basis, this our... it's a bit difficult, but this is the side we're falling on, but it's very marginal. Government now make a decision.' And the Chief Medical Officers are now.. We're still waiting for that kind of official decision.

And I had a quick look around what's happening elsewhere in the world and as you said America, they're vaccinating 12-15 year olds. France, Spain, Italy, Netherlands, are all vaccinating their 12-15 year olds. Sweden and Germany are the only ones not doing it and us at the moment. So I just thought that was quite interesting that people have fallen on different sides of this, and it does sound like it is really marginal.  What's your personal take?

Farah: So when you actually look at the JCB statement is still incredibly sensible. And as you say, they threw it out because there are things that they might not necessarily be considering right now, that actually there are other experts that can get involved. No bearing in mind, the JCVI, their thing is Vaccines, like they love doing vaccines

Lydia: It's in their job title.

Farah: It is literally their thing.

So, you know, you kind of expected that they would, given that you could see that benefit risk from the US data. But like I say it's kind of different because when they drill down into the specifics of why they've made this decision, as you say, the benefit for children is marginal based on the UK data, that we've got certain modelling predictions, but they quite openly state that some of those modelling predictions aren't all that clear. There are sides either way for how this could go in terms of risk benefit margin.

And I'm going to put a post out later tonight which kind of shows those figures. But essentially what they're saying is that there are 90-odd hospitalizations that could be prevented by vaccinating 12 to 15 year olds in that category, and they're looking specifically at children themselves.

Lydia: So that's not associated with adults hospitalizations...

Farah: So they're not looking at the wider setting, which is partly why they want other people to be involved. But their argument is that that's not really quite their remit, like they're not necessarily working just to keep transmission down in the general settings.

There may be benefit in terms of peer to peer transmission of children, but they're looking really specifically at children themselves. So on that basis within children, you've got sort of 90 odd hospitalisation rate from their data, and it's hard to pick apart from the way they've written it, whether that's based on previous or partly to do with future modelling, it's kind of tricky. But then if you look at the data that's come out of the US in this sort of under 17 groups, there are about 60 or cases of this very rare and myocarditis, I think it's a million courses of vaccines within 12 to 15 or in the US that saves, like 500 odd hospitalisations because their rates and children have been so high, and it's hard to pick apart.

Like I said, whether that is because of Delta and it could well be or whether it's because of how well vaccinated the adults are, because of community transmission... So there are kind of things around this that are quite important. The thing that would sway the JCVI to say 'yes, there's a definitely a margin here' is if and we're getting data on this coming out at the moment from the US, you expect that the risk myocarditis will be higher with COVID, then it will be with the vaccines

But actually working out the exact figure of that is slightly more difficult. And the JCVI state that actually the cases of myocarditis that they've seen.. And this is coming from Adam Finn's Twitter account. He was saying that actually the case of myocarditis they've seen so far has been associated with this rare inflammatory disorder that, you see, children with Covid predominantly. But actually, we don't know that the vaccines are going to prevent those cases of this rare inflammatory disorder to start with. So it's kind of it's like right on the edge.

And the benefit is still for vaccination. And nobody is saying that the vaccines are unsafe. That's not what anyone saying. Different countries will have to make different decisions. It's just that risk benefit margin and is kind of similar to what we saw with the Oxford vaccine when the rare blood clotting and bleeding disorder came out and actually a time where rates are really, really high, the benefit is clear across all age groups. But when rates lower then actually the benefits or under thirties of having the AZ vaccine over something else is not as clear.

Lydia: I think this is something that I said to you generally from a policy point of view that since we've moved out of the lock down element of "everybody stay home", then inevitably the public health message becomes incredibly complicated, and no one country's approach is going to be identically mirrored by another country's approach in terms of policy in terms of vaccination. You know, we can separate out what are the benefits of the vaccine. And as you say, the benefit is still all the vaccine over the side effects.

And as you've also said, a lots of other people have said to that usually with the side effectively be worried about in vaccines actually has a higher chance of getting those with covid, whatever your age group, that with the vaccination and I think that this is something that people think going back to and back to is that the concern about vaccine side effects. Actually if you get Covid, you are considerably more likely to get those side effects, no matter what. So that's really interesting what you were just saying there about the other bits and pieces that are around this.

 I was looking through all the policies today and it's really interesting that across the board from the UK government, they're basically saying, "right, we're just going to step back now and you guys are going to work this out. Here's some guidance, but basically this is it " And I'm actually just going to read out, this is across all of their documents. So something that they said in terms of what their approach is now, which is that they are £moving away from stringent restrictions in everyone's day day lives towards advising people on how to protect themselves and others alongside targeted interventions to reduce risk£  and then a thing about learning to live with the virus.

So this is very much a kind of standing back and i don't know to what extent people know what the changes are. But there are no more bubbles in schools as far as the government is concerned, the priority is for them to get children back to school, an early is back to nursery or whatever it might be. And then also young people, basically everyone getting back to face to face is something that is a priority. But I think what's different from last year is that there's definitely a lot more caution than there was last year. I mean last year we'd just gone through "Eat Out to Help Out"

Farah: Don't get me started on that. It had a very funny name, that was about the only thing that amused me about it.

Lydia: Yeah if you compare last year to this year. Last year, it was definitely Gung Ho.. This year, while they want people to go back to face to face in every setting, there's also a lot of caution with it as well. But just looking through the policies just basically assume everyone is now to look after themselves. Pretty much how I read all the policies. And I think what's also interesting to looking at the JCVI... The MHRA our medicines regulator approved the vaccine, Pfizer Vaccines for 12 and upwards full stop.

And then it's up to the JCVI whether they're going to roll this out after that. So 12-15 year olds, as we say, we don't yet know what the policy is.  Clinically extremely vulnerable youngsters 12-15 can get the vaccine and then it's 16 and upwards is the the point anyone can go and get a vaccine.

Farah: One dose so far.

Lydia: One thing that they're going to bring in as of later September is we're going to have Vaccine certification for venues

it like theatres and night clubs and stuff like that. But what's interesting is that as soon as you're 18, they actually view it as 18 and a half, and they give you this six months where you're still treated as a child.  Basically, after 18, you would normally be considered an adult in terms of this covidt policy for needing a Covid certification in order to get to go to a night club, whatever. But for obviously 18 year olds, getting your second dose for that certification, you basically have six months to do that to get both your doses.

And so it's actually 18 and a half before you will need a covid certification. Do you see what I mean? Yeah, it.

Farah: I'm surprised that they didn't just make it based on your coverage from the vaccine, because if you can get it at 17 and then within three months of being 18 you can get your second dose

Lydia: Basically give them the opportunity to get their second dose. So after 18 and a half, that's when you would actually be denied entry to a nightclub. If you didn't have your covid certification.

Farah: I suppose that's... What do you think

Lydia: (big pause and a shrug) well.. a policy is a policy. I was like, okay, well, if you're going to introduce something where people can't access something you have to give them the opportunity to access it. And giving them six months is more than enough based on the idea that by the end of September, (they're still saying) all adults will be offered their doses, their two doses for over 18s, so that's mid September. So in the next week or they should have covered that. So that policy is coming in. I mean, everything is geared towards giving people back face to face.

And somebody asked me earlier about immunocompromised people. You already did some stories on that today, but someone was asking 'what's the policy now for people shielding' I was like, there is no policy. The policy is that you look yourself.  Across the board, the policy is look after to yourself. And we now have the the vaccination element whereby.. You've talked about having a booster dose. That's basically you 'perk' for being clinically, extremely vulnerable. As far as I can see, is that you will be first in line for a booster, which you talked about already.

Farah: I think the good thing is, though, I think the working from home idea probably isn't going to go away very easily. But obviously that doesn't cover people who are in the more marginalised group who don't have the option that's the difficulty. They might be people who have the shielding letter to say, 'actually, the reason why I can't do it.' It yeah, the thing we have to get it back to normal at some point. Like, it's not like I don't disagree with that premise, and we are going to see covid becoming endemic. That's clearly the way this is going.

My issue is around messaging that makes people think that everything is totally fine now, because actually it's not when the rest of the world is where it's at. I mean, that's what we saw with Delta. So I don't disagree with that, I just kind of think our messaging around masks in particular was awful.

Lydia: I think the communication will continue to be awful. Where are the campaigns explaining this? We've got a  complicated public health message to get across.  Where are the campaigns? I don't see campaigns.

One of the other issues is the extent to which a booster is the answer when there are still so many people but haven't had any vaccines at all, in terms of how the world gets over this.

Farah: I mean, there are members of the JCVI who have quite publicly said, no, it's not just folly, but it's stupid. And I agree because it's not that I don't think we might need boosters or a third primary for everybody. That is a possibility. I don't deny that at all. I just, I think it's very short sighted in the long term because I think, you know, there's always a danger that you're going to have unmitigated variant mutations that are happening in certain parts of the world, and we know we're in a global community.

We are, and we should treat it as such. I'm not pleased about it. Put it that way. But I think it's probably going to come because at the end of that statement about the Immunosuppressed, they made specific mention. So I think they're still voting on it. And some of that will be just dependent on the data that comes about. If the data overwhelmingly says that, like the UK citizenship isn't protected, then it's very difficult, I think, politically to argue, not to protect your citizens, even if on a global scale, that that idea should be different.

Lydia: I would agree. I was just kind of touching on the whole thing of vaccine efficacy. I did hear a thing today which I thought was really interesting about explaining the vaccine efficacy issue. And lots of people have covered this in a very good ways. Including Charlotte from Epidummiology is done it really well.  Saying that a lot of it came from Israel and in terms of a hugely vaccine protected population, and then they've had their rise in cases and so on. And so in case I will no matter have vaccinated and you're still going to have issues.

But that's also partly Delta. But the point that I thought was really interesting. And I want to see if you agree with this, was you can understand the kind of waning of efficacy if we look in the antibodies. But what we're missing is the concept that when you've had a vaccine that your body has seen like a blueprint of how it tackles the virus. And therefore, if you're exposed again, it's like, oh, I actually do know how to do this. And those people who do get covid

Having been fully vaccinated, they will have a less serious disease and they will less likely to transmit. And this kind of idea that the vaccines are still very much working and doing a huge job, but also remembering that they were never designed to stop you getting covid. They were designed to stop you having severe disease and death. Is that something that you would agree with as well?

Farah: Sort of. So my problem with the data from Israel is that, I mean, I haven't looked at it for a while now so I haven't seen whether there's been like new iterations of that data. But the first set of that data that was talking about, we've got a waning of antibody in a certain age group. Well, what does that mean? So like you say, it's about protection against severe disease, principally. Ideally, it would be against transmission at all or primary infection at all. But with Delta is I mean, the question for me, is it Delta

that's the problem or is it the immunity is waning? And a lot of the time when Stuff's coming out that it's not very clear to me that that distinction has been made because it's a difficult distinction to make. But also there are other vaccines that we have that we don't necessarily have a persistent circulating antibody levels for. So even though we know that your level of antibody does serve as some sort of correlate protection, we still don't know the cut off for what that means.

Maybe over time it will look like it's waned, but it hasn't overall. So I just think there are questions that we haven't quite answered yet that don't necessarily mean we have to have a boaster. But I'm intrigued as to what JCVI have to say, because obviously have access to data that I just don't have access to you. And like I said, I know there are a lot of people, including the chair Andy Pollard isn't allowed in on the covid vaccine stuff because he was involved in the Oxford vaccine group.

So it's conflict of interest, but he's quite publicly stated that they (the vaccines) should be going abroad. We shouldn't be just completely boosting everybody. The third primary in immunosuppressed people, that makes total sense and I was all for that. But for everybody else. I'm just not hugely convinced. Yeah, compared to vaccinating everyone else internationally.

Internationally, it's really interesting. So we covered children and the JCVI and so on and young people and the immunocompromised. I mean, are there any topics that kind of stand out to you that we need to be aware of at this time?

Farah: I think the travel stuff is probably going to get more interesting. I read today that they're talking about change in the travel ban list and getting rid of Amber and Green or something.

Because what interests me about that is I know that there are some people in some countries that you would say they had really good vaccine coverage, but they are signed kind of lumped into an area of the world, and therefore they are on the red list. So there's things like this that are going to be difficult because I don't necessarily agree with that. You can't just lump off sections of the world. But then our travel staff has never been abundantly clear to me.

Lydia: No... no, I mean, I've had a lot of criticism on our whole approach on the travel aspect. I think, because the UK has a lot of money from being a hub and maybe less so post Brexit, but think how many planes come through Heathrow we are definitely a hub in the way that say Australia is not, that New Zealand is not. And I think the kind of impetus to restart travel, I think, is massively driven by the airline and tourism industry, not surprisingly, because it's huge.

Farah: It's not as though it's not important, or that people don't have the right to travel. I mean, it is actually enshrined in your rights, in terms of your human rights that you should be able to travel. And I don't disagree with that principle. The thing that kind of made things slow at the beginning to hold the progress because the WHO, were very much in favour of keeping that movement. And actually, you know, there's an argument now, looking back in retrospect, that we should just shut things sooner for a bit.

Lydia: I also had an opinion today, which I thought was interesting, which was because we were so focused on what was coming out of China and we didn't we didn't react to what was coming out of Europe.

Farah: Oh God yeah, I've got a set of posts on this. It's like the blue column about travel and how we got it wrong, basically. And at one point we shut off for places like Iran. We didn't cut off the whole of Italy, just Northern Italy, and then we focussed everything else on the Far East, and actually everything was coming out of Spain at the time, like when you actually sequenced and looked back at the sample to test a huge spike that was related to people coming back from Spain, for example, not to pick on Spain or anything. That's not what I mean.

Lydia: This maybe plagued a lot of everything we've done and you can't discount at it all, but racism is a massive part of this. I think that that's been a major part of it. I don't think you can discount that entirely from policy. And also, I think as previous experience with SARS, that people expected it to stay in one part world and not trouble to Europe, which has a different perception.

So I think as humans, we get things wrong a lot, and we will probably will continue to. I'm sure now I'm just conscious of the time and I'm seeing some questions pop up. Are you ready to launch into some questions?

Farah: I mean, one thing I would say before we go to questions, I think from a personal point of view, in terms of opening up, I don't really have a problem with the idea of trying to open up a bit more. Like I say, it's a messaging around it. So if we are being told that it's our individual responsibility, then there are ways that we can ourselves both still have fun and also be aware of that personal responsibility and that's things like trying to keep up with our lateral flows as much as possible.

I can be bad at that sometimes. Like if I'm not going in then I won't do it as often. I mean, that's fine. But like, you know, it can get tricky to keep on top of things like this. But keeping on top of wearing a mask, it's like a minimum. It's not that hard to do, really. I don't think for most people, the vast majority of people and just being aware of each other comfort preferences and personal space. So there will be people who really don't want to come anywhere near you and there's no need to be offended or upset by that, be aware of it.

I think we just need to be kind really.

Lydia: I agree. My personal experience everywhere I've been, and that may be immensely affected by the fact that I live in rural Suffolk and I'm desperately middle class. But most places that I have been, most people are wearing masks. But then, what's public transport? That doesn't exist where I live so that's a bit different. And I know lots of people have different experiences of that. I think the other thing that I'm interested in is that just kind of without doing a big comparison of around the world and so on, because there's some very different policies out there.

I'm interested in our levels of comfort or not when it comes to increases in hospitalizations and deaths, because we there is currently an uptick in our numbers. Across the UK, there has been some Association with kids going back to school, but equally people saying that's not just kids. That's also because everyone else is also meeting at the school gates and then the play dates and then people are also go back to work. So it's not just kids. I think my perception is that there seems to be a much greater comfort with what seem to be much higher numbers than maybe we've accepted before.

I mean, do you think that that's inappropriate? That comfort?

Farah: Yeah. Because I think even though it's great that the vaccines haven't weakened the link between infection and hospitalisation, the risk with Delta is higher. That's the first thing. And Secondly, case numbers do matter. It's not like they don't matter. Still, at this point, they do in the future. They may not matter quite so much. We may have a better barrier and herd immunity than we've got at the moment, but at the moment, they really do still matter. I mean, that's one of the things that the JCVI one of the reasons they've thrown it out, because even though, as I said in that story, schools aren't the hub of infection, you kind of expect them to be.

It's more about the community around them and the adults around them. But but one reasonable argument is to try and reduce case numbers, even if that's from a child benefit point, peer to peer transmission as opposed to child to adult transmission. And that's one of the things that they're going to be looking at. I can kind of see them going to be honest, we like a one dose policy, and I don't think people should be too perturbed or upset or worried, regardless of the policy is

I don't think people should worry about whatever the end result is, because whatever the end result is, there will be a reason for it. And we'll all find out later this week.

Lydia: I'm just seeing a couple of kind of comments coming in there about schools. I would just remind people that all schools actually have their own policies. So at the moment, as I said at the beginning, the government has really stepped back in terms of any kind of involvement in what schools or universities do. There's guidance. But the individual policy for school can differ wildly. And you'll have two that have completely different approaches to how they do things.

So it's very difficult to compare your experience and consider it universal, because in fact, everyone's got a very different experience depending on the approach of your particular school. So someone asked me "what's the policy on bubbles? Because this is my child's bubble has just closed" as far as the government is concerned, bubbles don't exist in more. There are no more bubbles as far as they're concerned. But schools might have kept them. So it's all really different, and that will go across the board, and it'll be the same in workplaces.

this is the problem with common sense rather than a policy, is that you're going to have different interpretations. And I think, as you said, I've been clear about what your boundaries are in terms of what you're hugging, or not, how you're going to go back things that's a personal choice and to respect those personal choices is very, very important.

Farah: I agree. I do feel for schools. I think it's really hard. I mean why is it that a Head teacher should necessarily understand the nuances of a pandemic ... seriously when was that in the job description?

Lydia: Well, exactly. I've got a couple of things I will share after this. I'm just seeing a couple of points coming up about this. But the general guidance to schools and what parents should know, I'll share. The government's done one particular document or that I'll share that afterwards. The Guardian also did quite a good approach to it. But it is your individual school that decides how it's going to do it? So the general guidance is basically " Hands Face Space Ventilation." That's it really. And there is some guidance for if it's escalating, but they're pretty much like you're on your own now.

Okay. Shall we dive into Q and A?

There was one earlier I'll just pick up on which was about wearing masks on the bus rather than wearing them in the classroom. Farah, do you want to go into the general mask thing?

Farah: My feeling and I've had quite strong disagreement with some other people. But my feeling is that and it has been to the entire pandemics that anybody who is above twelve, or anybody is in secondary school should be masking as much as possible. There will be individuals that can't cope with that. And I get that. And to be fair, I'm a clinician and an infectious diseases clinician. So my perspective is going to be different to an educational expert. For example. He will say that actually there may be issues with that in terms of classroom development and in terms of communication within schools.

And maybe it's me being slightly naive on that point. That is a possibility. But I don't know. I think for the vast majority of secondary school kids, it couldn't be that difficult, really. I mean, we've seen, with the greatest of respect to the Americans, not they've been the best example to follow on Covid but they've managed it with their children a lot, you know, in terms of masking to I just don't think it's that difficult for us to continue with making in terms of why the bus and not classrooms.

I think it's hard to exactly justify, but I think the theory is mostly in terms of how many people in a smaller space. Essentially, it's like a ventilation thing. But, you know, come winter when the windows are closed, I'm not sure that you're going to have much difference in some schools are bigger than others, and some have better ventilation than others. I think the Department of Health, we're talking about giving school CO2 monitors. To help them identify pockets of poor ventilation. But then absolutely nothing to help them do anything about it other than maybe have your school Assembly outside.

I think it's something Gavin Williamson said..

And I was like, great. So in the middle of winter you're going to have your Assembly outside? You're not..

Lydia: It feels that became it feels like we came to the ventilation point really late. Florence Nightingale talked about ventilation. This is one of her big things. The Victorians wanted these huge windows open and so on. And we've actually actually closed down a lot of ventilation because of letting heat out And I think the kind of ventilation point and outside is always better. Better ventilation is better, just not allowing droplets to spread around whether that's with a mask or with good ventilation .. Again where there is the repeated communication on this?

Farah: So I think TFL have been quite sensible on masks, actually, somebody was just commenting that masks would still be one on public transport according to TFL. The problem is that they can't really enforce it now. And that's the issue is that they can't stop people from taking the bus or the tram or whatever.. Tube because they're not wearing a mask. So it just gets really tricky.

Lydia: Just to go back to an earlier point about the kind of risk to children. I mean, the thing that's being repeated again and again and again, the older you are sort of on a very basic scale. The older you are, the more at risk of Covid you are and the younger you are, the less at risk of Covid you are. And you've said previously about the risk of children generally being quite low and the general experience of covid. I hear that repeated a lot, and I suppose I also just rings in an alarm bell my head in in the same way that across the Covid pandemic we've said, well, it's only vulnerable people that really get ill with Covid and we know that that's not always the case. I mean, as things continue to come out, do you feel that they're getting the messaging on children right in general?

Farah: I don't think I get in it abundantly wrong. Put it that way. I think when case rates for higher, the risk is always higher for everybody. I think that's part of the problem. Like I said, I think the focus really should be on secondary school, the risk is higher there than it is even with junior schools. But as you say, it's not completely risk free. Nobody is saying it's completely risk free. And I don't know, I think it's really difficult. It's one of those things where time will tell.

 I think that's one of the reasons why I think they probably will go for at least one dose vaccine in an attempt to try and reduce that peer to peer transmission. Because one thing that the JCVI had to point out was that what they're comparing their rates to in terms of previous and in terms of working on the modelling is having previously had some measures in schools. And so therefore it's really difficult to predict what's going to happen when you've got no measures and high rates in the communities as it is.

But it's also fair to say that there are still about 6 million adults who haven't been vaccinated. We're very caught up with the children aspect, but actually the focus needs to be on those 6 million adults. And I think that's why really there's a push to do the vaccine passport idea, which initially I was less keen on in an internal point of view. But the more I think about it, the more it's kind of like smoking, but like anti smoking, so you can choose to do it to yourself.

That doesn't mean you have a right to be inside smoking around everyone else. And similarly, you can choose not to have the vaccine for yourself. But why does that give you the right to then put other people at risk? So it kind of comes down to that choice, then, doesn't it, to you?

Lydia: I still err on the side of that vaccination should be voluntary, but at the same time, you've still got a public need whether it be smoking, whether it be have vaccinations. And it's interesting that a lot of other European countries have already introduced this. Germany has introduced this, France has introduced this, and they've not only already done it, but they've actually gone further. So it's not just big venues, it's also cafes and so on. And also remember, those countries were considerably behind the UK when it came to running out their programmes.

So it's interesting that they brought those measures in much earlier than we have. Vaccine Passports aren't going to come in until the middle of September, and then it's still quite a narrow basis. So I think it's interesting that I feel like the angst has died down a bit on that.

Farah: It's hard to compare us with France, for example, because France has a very strongly vaccine hesitant country, which I hadn't actually appreciated. And then there are data that suggests that those people who are on the fence and not really sure, but not completely against the idea they're more likely to do it if they a direct benefit to themselves. So that can come in a number of forms, so in the US, they've tried it with entering into a lottery or winning a prize. And I think we've tried something fairly similar over here, but ultimately, for some people, that stick is the only thing that will that will make them get it.

I mean, I can't imagine being that desperate to go to nightclub myself at any age. Maybe I'm just dull, but I think there's some people where that's the only thing that will really make them go "Actually, I can see a benefit now for myself, so therefore I'll do it. "But it's a tricky one

Lydia: There was just a question on why younger children shouldn't wear masks as in under 12s. Do you want to just cover that one quickly?

Farah: There's a bit that is in my Yellow "Kids and Covid" post from ages ago, which there's a picture of in my Delta Kids in Covid highlight may recently, but basically the risk is lower of those kids even being infected to start with, we think and as far as I can tell, the data on that hasn't changed massively. I'm not against children under eleven masking, especially if, like I said at this point in a pandemic, I don't think that's a problem, but I don't think it's as important as those over eleven or twelve and secondary schools, and that's usually because that's the age group that you tend to see the highest rates in and they're at risk of being symptomatic and you get so that's it.

 Lydia: Just answering another question on why didn't the government kind of masking a stronger communication on masking? I really don't know. Frankly.

Farah: No. No that was a definite mistake. It was. It was definitely. When they came to open up on the 19th of July, like I said, the modelling that they based the opening up on in terms of rates over the summer was based on proper messaging to help people mitigate their own behaviour and behaviour is the thing that's always the most difficult thing to model because people will do what they want. So they kind of anticipated from their modelling that the messaging would be  it's not a definite legal requirement;  however, like this is a really strong thing that we expect you to do. What actually came out was "Oh you don't need to mask...  oh, wait, crap. You do need to mask!".

Lydia: Massive fail. In my view, it's so basic. Scotland has a TV campaign. Yes where are our TV campaigns? The only time I ever hear Covid campaigns on bloody classic FM. You need them everywhere, frankly.

In terms of measures to protect kids: As I said, I share what the government has shared, which is basically "hands-face-space". It's about washing hands, keeping hygiene, reducing contact. In general, all of these things have been the same throughout the pandemic, just being very sensible about cases.

Crucially: One of the things that came about in the policy over schools is that if you children are in contact with a positive case, they are not required to self isolate, only if they are a positive case themselves. That is now a policy. So one of the things I've been kind of uncomfortable to talk about is whether the government is actually trying to get kids infected, because on the one hand, I think that that sounds bizarre. And on the other hand, that's also what appears to be happening.

And they seem to be quite clear. They're like "we want everyone to get together." And do you think that is a policy? I also like to say that what the company government does consciously I think is a bit in big inverted commas like the stuff they do by mistake also happens. Do you think that's an actual policy to let kids get infected?

Farah: Sort of. So there's a really good article at the end of the "Delta, Kids and Covid"  highlight that the BBC wrote and it's the first time I see people publicly address the fact that we're kind of aiming for a mix now at this point of both vaccination and infection immunity. So it's not just kids either. I think that policy kind of applies to young people in a way, because you're essentially getting a free, if risky boost that you then don't need to boost with the vaccine later if you see what I mean.

And there are benefits for that. I'm not going to lie and say that it's a completely stupid idea, because it's not. When it comes to kids, there are other viruses, the time that can build immunity to. I think the difficulty at the moment is that that might work in, say, five to eleven group in particular, because they're less likely to be symptomatic and they're less likely to be at risk apart from those to the severely immunosuppressed or the odd case, unfortunately, that gets really sick. And we see that with other things like RSV. (Respiratory Syncytial Virus) But with kids over twelve, that sort of middle ground of working out whether Norris the time to do it or not.

The difficulty is if you start saying that you're going to vaccinate kids over twelve, then you kind of lost that policy unless you make it a rates based idea. Because then you're kind of making policy to always fascinate over twelve. And I think that is then potentially tricky as well. So it's a nuanced discussion, to be quite honest, there are benefits. The other thing to say, by the way, mentioned RSV is that actually one of the things that they might be also considering is the potential pressure on hospitals, paediatric hospitals in terms of RSV cases, because we're seeing a lot of respiratory diseases that are now out of season.

So rather than having RSV at the normal time, we're seeing surges in RSV as kids are getting together. And that can be risky for the younger age groups. So you don't want it to then get in the older age groups. And so that might also potentially be something that they're looking at in terms of working out when to vaccinate.

Lydia: There are so many things to juggle in this, and you can understand why they're taking so much time over this as to what they do.

Farah: The problem is you can't wait forever. You have to make a decision.

Someone is asking about vaccination centres or whether they'll do it in schools. If we do decide to vaccinate, I suspect, but I don't know, but I suspect they'll probably set it up in school in the way that they do with the other vaccine campaigns. I think that'll probably be the easier thing. And that was another argument that the JCVI came out is how much time kids will have to miss for getting your vaccine fever afterwards and feeling a bit rubbish.

It's not that it's completely outside of... It's not like a really decision in terms of, oh, it won't affect them or it will affect them.

 Lydia: that's a good point as well is that I think the vast majority of people I've spoken to have had some kind of like seeing crap off the vaccine, and some people have been laid out completely for a day or so. Others not so much and others completely fine.

So I think that's also an element that maybe hasn't been acknowledged publicly in government policy, but it's obviously something that is also been considered. That a vaccination programme has other impacts as well, and it really isn't. an easy decision. Just looking at the comments..

I definitely see a lot of concern about cases coming from kids or schools being brought home to more vulnerable people at home and also vulnerable kids in school. Certainly the policy is that it's up  to school to the side. What they do, there is no overall policy. What do you seek to kind of reassure people in terms of the risks of kids bring covid home? And and you are saying earlier, it's also about the rates infection overall.

Farah: I mean, it's not like there's no risk at all. We know that kids can have a similar by relate to adults, so it's not like that's outside the realm of possibility. It's just that that risk is likely very much lower now that most adults have been vaccinated, which is why they're going with that side of things. And to be fair, the JCVI have said that that benefit outweighs that risk for a child who's got a vulnerable caregiver. And I think that's really sensible, because that is my worry, really for the rest of the world, there are so many kids at risk of losing their primary caregiver at the moment because their adults aren't vaccinated.

So it's not that you shouldn't be concerned. You know, I've got vulnerable people that I see, and when I see them, I try and keep my distance, make sure that we're in a well ventilated space. We don't sit too closely when we're eating, depending on things for a while I'd wear a mask round them, I don't do that quite so much now because we just make sure everything's more ventilated and we keep a real distance. And I always do a lateral flow before I go and see them say it's just trying to mitigate those risks a little.

 Lydia: I'm just going take the final question here. Just touch on one thing that somebody asked about, " had we covered the Immunosuppressed and booster vaccines?" I'll just say again, that Farah did some stories on this, I assume you'll do a highlight on this at some point, but that's something that we talked about. And we did talk about it a little bit earlier on in terms of what the policy was, which is "look after yourself" according to the government. So the last question I'm going to come to is 'what do we think about not having to isolate if you live with a positive case, if you're fully vaccinated or under 18.'

And the purpose is that if you are in contact with a positive case, then you get a PCR test. And if you test negative, then you don't have to isolate if you are under 18 or if you are fully vaccinated. Farah what do you think?

Farah: do you know the timing of when that PCR has to be done? Because I'd need to double check.

Lydia: No and I think that is very

although it might be advised by test and trace, and it might be completely individual one when that person tested positive. They do use the whole flow thing of when you've got infected and so on. They do take that into account when they suggest it. So maybe that's advice that they give.

Farah: I was surprised that they didn't extend it for household cases. I minded less in terms of general cases, given the general policy of the government in terms of trying to open up. I was kind of a bit surprised, to be honest, that it wasn't with household cases. There are some areas that are slightly different. And again, it's been left to the individual. But for example, some NHS Trust's  will mandate that actually you do have to isolate unless you are such an important person on shift that night, like the consultant for ICU  right for you, and no one else can cover you. Then they might release you earlier with a negative test or a negative lateral flow. I mean, the thing with hospitals is you can test pretty quickly because we've got our own system set up. Generally, I'm less keen on letting people from households because household transmission is important. But to be fair, there is an argument that shows there are data that we have that shows that household transmission is lower when everything else is vaccinated. Nothing is entirely cemented. It is that balance of risk- benefit. I'd have preferred if they said you could isolate still isolate if you have a house case. But they didn't.

Lydia: No they didn't do that. My general feeling is that things are very much returning to normal. I think pre-covid normal. I think there's still some mask wearing, but not enough. I think that the communication from the government is just not enough on what is still a very complex situation. We are all being encouraged to do more face to face and to do that return to normal. But I think the lack of communication and also I just have a feeling that while lots of experts have said that we hope they will not have to return a lock downs and so on.

I think the point at which the government has to kind of reign stuff in I think that I personally feel that we might expect some of that in the Autumn.

Farah: I think there will probably will be a few firefighting lockdowns ahead of because of the NHS and the pressure that the NHS is under to be honest, because we're still getting quite high cases not like it was in the same way, but cases are still quite high, to the point that some trusts are again have to cancel elective procedures. And when I say elective some of those cancer operations so I can see that that will come ahead because as well come winter we're going to have flu circulating more.

We've got several viruses, that are now out of season that are going to impact on kids and adults. I think the NHS is expecting a hard winter to be quite honest.

Lydia:  I also heard some kind of concerns about flu and saying that because we had such low flu rates the past couple of years that actually quite a few people's immunity might be a bit out of date in terms of Flu vaccines and so on. So, very much not over. Certainly not on certainly not UK certainly, not for the world. I feel like we've covered what is going on now. In two or three weeks we might need to do this time again.

It feels like we're standing on shifting stands a little bit, but this is still an evolving process when there are so many things that are still to be worked out because so much that is we don't know. We haven't been here before and so it's sort of treading lightly and not getting too excited about snogging your next door neighbour, for example.

Farah: Do you want to snog your next door neighbour Lydia?

Lydia: I was just plucking something at random. It could mean someone on the bus. I don't know. Don't lick strangers. That's still a thing.

Farah: Is that our closing comment? Don't lick strangers.

Lydia: I'm going to stop on the question there. This is your last time Farah to say something before I say good night to everybody. I'm going to say that we're going to have I will have a transcript this available as soon as I can after this, which I open off my website. But any closing comments for you?

Farah: No, just everybody keep doing your best and the way and I've got my mind set on it is it's like a slow transition.  I will probably start doing a few more things over time, but I will still try and do that with a sense of personal responsibility as well.

Well, thank you so much. Your time and as I said, we might have to do this more often! It was really interesting going over all the policies today, and I like, okay, there's no policy, it's all do yourself

Farah: I'm glad that's what you came up with because I'm thinking I'm pretty sure that's how I interpreted stuff

Lydia: I will certainly share a couple of things after this. But, yeah, thank thanks so much for this Farah and thanks to joining us. And good evening.