Roughly 40 participants, all active in Finland, were invited to participate and nearly 30 were able to at this first meeting. The meeting was conducted under the Chatham House Rules to encourage open discussion (hence no names are mentioned in this summary).
What is known about how the virus is transmitted?
Most agreed that scientific evidence evaluating transmission, super-spreader events, etc. points to both droplet and aerosol transmission - though there was not universal agreement on the degree aerosol transmission had been absolutely proven. Agreement that surfaces are unlikely to be a major source of infection.
Is the new strain (B.1.1.7 ‘UK’) more transmissible and result in more severe disease? What is estimated proportion of cases now in Finland and what should we expect in next two months with no further action?
Data was shown by several experts from UK, Denmark and Finland. There was consensus that B.1.1.7 is more transmissible and poses a clear and present danger in Finland. Data presented showed that in all locations, this strain has become the dominant strain in the population in a relatively short time – in general the proportion of B.1.1.7 cases doubles in as little as ten days and in several locations has jumped from 20% of cases to 80% of cases in one month. In the UK and Ireland, B.1.1.7 grew rapidly in the period before Christmas when restrictions were relaxed. The UK’s sharp lockdown occurred after 75% of cases were B.1.1.7 and had driven a major overall rise in case numbers. By contrast Denmark implemented a strong lockdown starting at Christmas when B.1.1.7 only accounted for 2-3% of cases but the massive surge in total number of cases was avoided and numbers have come down substantially in Denmark in recent weeks.
In Finland, B.1.1.7 has grown rapidly in recent weeks and is now estimated to account for more than 50% of cases in the HUS region, though as yet not as much in the rest of the country. Clinicians expressed strong concern that case numbers - overall and in hospital and ICU - have started to rise rapidly in the past week. The UK & Denmark experience suggests that very strict and comprehensive measures, including school and bar and restaurant closures, may be needed unless immediate action is taken to prevent a strong surge in infections powered by this more infectious strain. While not known at the time of the meeting, the view of the group was in agreement with the stricter warnings given from THL the next day.
Vaccines were developed quickly - are they safe?
Full consensus that vaccines were safe and that everyone who can, should receive them. Discussion point raised around when vaccines will be sufficiently tested to be offered to children - this point will be further discussed as no immediate consensus on which types of vaccines and what evidence should be required. It was noted that trials in children older than 12 are ongoing and in younger children now being planned. Initial data, especially from Israel, indicate that the mRNA vaccines provide excellent protection (at least 90%) against the original virus variant. Astra Zeneca’s vaccine was somewhat less effective against infection, but all vaccines reduced significantly the severity of illness.
Are vaccines effective against the new British (B.1.1.7) strain or South African Strain (B.1.351)
Data was shown and consensus that vaccines were effective, perhaps only slightly less, against the B.1.1.7 variant mentioned above that is becoming dominant in Finland. The Astra-Zeneca vaccine has been shown to be less effective against preventing infection from the B.1.351 variant, though the impact on severe disease/death has not been determined. This does suggest that we should not assume that new variants will all be treated by the same vaccine.
Are they shown to prevent disease or reduce severity of disease? Both? Does this distinction matter?
This was not yet actively discussed - but opinions differed on the importance of this distinction and how conclusively one can determine the distinction. Early results from UK and Israel suggest both infections and severe disease are reduced.
How quickly do vaccines take effect?
Expert agreement on the fact that for mRNA vaccines (Moderna, Pfizer/BioNT), high vaccine efficacy (VE) achieved already at 11 days after first dose, though two doses required for maximum efficacy. For adenovirus vector vaccines (AVV) (Astra-Zeneca) VE emerges later - at about 21 days post-vaccination - with second dose at 8-12 weeks.
Why has Finland done so well – at least until now?
Finland has, so far, done better than many western countries in dealing with Covid-19. Infection rates, hospitalizations and deaths have been low while the GDP dropped 2.9% in 2020. The reasons to this have not been analyzed in depth. While low population density, remote location, rule-abiding population are among standard reasons given for this success, other contributors may include decentralized organization of the Finnish health care system. Finland has experienced some super-spreader events in relatively small cities and towns, but they have been successfully contained through effective local tracking and quarantines. The capital region by contrast has at times lost the capacity to track comprehensively. During the meeting little discussion was devoted to this question but the tracking system was highlighted as one potential success factor.
Other epidemiological points noted briefly were observations that in Finland, a clear decrease or even absence of patients with signs and symptoms of clinical covid pneumonitis during a five-week period during June and July 2020 was observed. While not unique to Finland, this was clearly visible in the patient recruitment of WHO solidarity Finland adaptive trial. Further data from virus sequencing was presented which showed that the dominant strains when the pandemic returned in the Fall were different than those in the Spring - suggesting that it was in Finland possible to largely eliminate the virus. An additional Finnish study was noted which showed no patient-to-personnel transmission when FFP-type masks were worn.
One sobering conclusion from the meeting is that we will likely have to take preventive measures against Covid-19 and its variants for a long time. It appears however that we will be able to manage both the virus and the economy relatively well with vaccines in the longer term. The primary immediate concern is that we can keep the B.1.1.7 variant in check, if necessary, with sufficiently strong measures taken decisively and quickly. The payoff of this strategy is exceptionally high now that vaccines are already within reach.
Consensus was also reached that the group should continue to meet and discuss these issues as current epidemic and vaccine scenarios are quite volatile at the moment and there are many other issues that would benefit from open discussion among experts who have different viewpoints on important matters. Presenting our findings and possible recommendations publicly would also be desirable.
List of attendees (those who wanted their name to appear):
Organizers are marked with a star