Jump to content

Taking it to the Streets - Covid-19 #12


Fragile Bird

Recommended Posts

1 hour ago, Jeor said:

Absent a vaccine, the economic hardship is likely to continue for a depressingly long time

Honestly, I think if it becomes clear that a vaccine isn't going to happen I think the economy might end up opening back up quicker. If there's nothing realistic to aim for in terms of actually resolving the outbreak I think people will mostly just give up on social distancing. More people will die but I don't think there's going to be the collective will to go on like this indefinitely.

Link to comment
Share on other sites

7 minutes ago, ljkeane said:

Honestly, I think if it becomes clear that a vaccine isn't going to happen I think the economy might end up opening back up quicker.

I can see your point, but I think it's going to be hard to reach a point of clarity where a vaccine isn't going to happen, so I don't think it will make the economy open up sooner or later really. Whether it eventually comes or not, the length of the shutdown is going to be dictated by the human will to hold out, which is shorter than the time it will take to get any vaccine. The collective will is already starting to fray in a place like the USA.

The worst case scenario is that a vaccine isn't found, the shutdowns nevertheless break, and collective waves of death and disease ensue - and then subsequently a zombified economy where consumer confidence is low and human economic behaviour is heavily distorted for a long time. That will be  devastating, and the only exit strategy in that case is herd immunity or hoping that the virus mutates into a less lethal form, while the world is forced to experiment with MMT and UBI.

Link to comment
Share on other sites

3 hours ago, Jeor said:

With all of these vaccines going on, there's going to be massive demand for large human trial populations which could be tricky to source. It could go either way, people might be desperate to try something out, or they might be especially worried about an untested vaccine knowing that this thing could still kill you.

It's probably not going to be a big problem with the first few vaccines to get into human trials but might be tricky if a lot start having trials, particularly if early failures for other vaccines reduces enthusiasm.

3 hours ago, Jeor said:

And I'm no immunologist, but how do you test whether a vaccine works without deliberately exposing people to COVID-19? I suppose you could do an antibody count and compare that to people who've contracted it in the past and see if they match up. But that's assuming that once you've got it you can't get it again, which is still an open question.

I assume they would compare infection rates over a period of several months between people who get the vaccine and the control group who get a placebo

Of course, if there isn't much virus circulating at the time then you don't learn anything, but it doesn't look likely to be a problem at the moment (although it would be a nice problem to have). There was some speculation about choosing a country for trials which seems to be at the start of an outbreak.

3 hours ago, Jeor said:

I still don't hold out great hope for a vaccine in the near future, even in spite of all of the resources being directed towards it globally. This article here quotes the UK's chief medical officer, who notes that immunity wanes quickly as previous coronaviruses have been shown to mutate and the possibility of reinfection has not been ruled out yet. On top of this, there's also the fact that a vaccine for other coronaviruses has never been produced before (although that might be more a reflection of supply/demand than the medical possibility).

For the other coronaviruses it seems it would have been difficult to properly test a vaccine against them, since SARS and MERS disappeared fairly quickly. I don't know whether anyone has tried to develop a vaccine against the common cold coronaviruses in the past, but it doesn't feel like there would be demand for it.

2 hours ago, Fragile Bird said:

Sorry, I should have been clearer. What surprised me is how far along human testing is. This is a novel virus, and here they are in human trials already!

I think they said they had been doing work on developing a vaccine against the MERS coronavirus which probably gave them a bit of a head-start against the Covid-19 coronavirus. It's still impressively fast, though.

1 hour ago, Jeor said:

I can see your point, but I think it's going to be hard to reach a point of clarity where a vaccine isn't going to happen

One of the articles I was reading recently pointed out that the different vaccine efforts are using radically different methods of development and the first ones to go into trials like the Oxford study are using methods that are very new and haven't lead to any approved vaccines against other diseases. The article said more traditional methods such as trying to use a weakened coronavirus are also being tried but may take longer to be tested in humans because they have to be careful they've weakened the virus enough. That means early failures don't necessarily rule out other methods succeeding, but it may end up being a bit of a marathon.

Link to comment
Share on other sites

2 hours ago, Jeor said:

I can see your point, but I think it's going to be hard to reach a point of clarity where a vaccine isn't going to happen, so I don't think it will make the economy open up sooner or later really. Whether it eventually comes or not, the length of the shutdown is going to be dictated by the human will to hold out, which is shorter than the time it will take to get any vaccine. The collective will is already starting to fray in a place like the USA.

The worst case scenario is that a vaccine isn't found, the shutdowns nevertheless break, and collective waves of death and disease ensue - and then subsequently a zombified economy where consumer confidence is low and human economic behaviour is heavily distorted for a long time. That will be  devastating, and the only exit strategy in that case is herd immunity or hoping that the virus mutates into a less lethal form, while the world is forced to experiment with MMT and UBI.

Though these aren't the same diseases and don't have the same causes, the model for what will happen without isolation and / or a vaccine is what happened with the Black Death.  It hit Europe in the mid-14th century, and returned constantly after that, constantly reducing the population and taking hits from the economy, causing famine and other diseases.  Europe's population and economy didn't recover for over 200 years, and part of the economic recovery, such as it was and whom it affected, was due to the resource extraction of the Western Hemisphere, and slaving Africa.  There were whole regions and towns that just disappeared and never returned, recovery or not.

However devastating wars and famines did not stop, nor did the oppression of the poor and plundering of the other classes by the nobility.

In any case deathcultchief cannot afford to have the disease be finished until he at least kills the post office, can cancel the election, and keep killing off blue voters.  Here's one great way he's going to do it, now that NY looks as though through isolation we're beginning to stretch toward a plateau:

https://www.towleroad.com/2020/04/trump-forces-1000-west-point-cadets-to-return-to-new-york-so-he-can-deliver-commencement/

Bringing back a 1000 people from all over the country ... recipe for another leap in infection and death.

 

 

Link to comment
Share on other sites

2 hours ago, ljkeane said:

Honestly, I think if it becomes clear that a vaccine isn't going to happen I think the economy might end up opening back up quicker. If there's nothing realistic to aim for in terms of actually resolving the outbreak I think people will mostly just give up on social distancing. More people will die but I don't think there's going to be the collective will to go on like this indefinitely.

I think it depends on how much is learned about the lingering effects of the virus on the human body. There's been plenty of stories on recovered patients like "X number of patients requiring dialysis due to kidney problems" and "Y number of patients with permanent lung damage" and so on. 

If it becomes confirmed that distressingly high numbers of people can suffer from these problems after recovery, and in particular if it's also confirmed that immunity is short-lived or non-existent, I'm not sure the economy ever will open back up again. Not anything like it was before.

It's not too difficult to see most people eventually talking themselves into believing "well, I won't be the 1 in 100 person who dies from this," especially if there doesn't appear to be any hope of relief on the horizon. But I wonder how many of those people would also be willing to talk themselves into believing "well, I won't be the 1 in 4 person who suffers from a life-altering malady that hurts my quality of life and shortens my estimated lifespan by 10-20 years."

Link to comment
Share on other sites

1 hour ago, DireWolfSpirit said:

Starting Monday masks will be mandatory at our work facilities. 

My place finally made it mandatory on Tuesday of this week, and that was only because the Governor made the statewide call. 

Before that I’d say about 25% were wearing masks, and half of those would push them down to talk to other people... despite having multiple cases in my immediate area. Absolute craziness.

Link to comment
Share on other sites

NYC refused to shut down subways, sent Covid patients back to their nursing home instead of Javit's Center or the navy ship, and told EMTs not to resuscitate. Those questionable decisions all point to the direction of magnifying the crisis. WTF is going on there?

Link to comment
Share on other sites

1 hour ago, Fez said:

I think it depends on how much is learned about the lingering effects of the virus on the human body. There's been plenty of stories on recovered patients like "X number of patients requiring dialysis due to kidney problems" and "Y number of patients with permanent lung damage" and so on. 

If it becomes confirmed that distressingly high numbers of people can suffer from these problems after recovery, and in particular if it's also confirmed that immunity is short-lived or non-existent, I'm not sure the economy ever will open back up again. Not anything like it was before.

It's not too difficult to see most people eventually talking themselves into believing "well, I won't be the 1 in 100 person who dies from this," especially if there doesn't appear to be any hope of relief on the horizon. But I wonder how many of those people would also be willing to talk themselves into believing "well, I won't be the 1 in 4 person who suffers from a life-altering malady that hurts my quality of life and shortens my estimated lifespan by 10-20 years."

While it's way too early to say anything conclusive, my understanding is that longer-term effects, like lung damage and ARDS, are more prevalent in people who had severe symptoms (e.g. people who needed ICU/ventilators). This wouldn't really be in the "1-in-4" territory, particularly for the under-60 crowd. 

ETA: I totally agree with your overall point though. It's harder to see a return to "normality" if these long-term effects are prevalent. 

Link to comment
Share on other sites

Out in Cajun Country, west Louisiana, friends report the good old boyz is a'riden' 7 to a vehicle, drinkin' beer, laughing and shooting their gunz.  They haz their freedum and liburpty all together.

Link to comment
Share on other sites

10 minutes ago, mcbigski said:

NYC refused to shut down subways, sent Covid patients back to their nursing home instead of Javit's Center or the navy ship

 

I distinctly recall that the naval ship was explicitly not for patients diagnosed with or suspected of having SARS, and that they were there to help ease the burden of non-SARS patients. Did that change?

As to the Javits center, I mean, they hardly used it at all, for anyone.

As to nursing homes, FWIW, we did similar in Gothenburg with no ill effects here. Elderly were placed in a separate floor after they were released and believed to be recovering, to isolate them until they were negative, in part to provide care more appropriate for them by staff at the homes rather than taking up the time of nurses and doctors.

 

10 minutes ago, mcbigski said:

, and told EMTs not to resuscitate.

 

I mean, spending ten or twenty minutes in close physical contact with someone whose heart has stopped due to the virus would really put them at a risk of getting infected themselves. The air they pump into them with a BVM bag may have a viral filter in place, but ... I don't know. Every EMT and other health professional who gets sick has an outsized negative impact on the capacity of the health care system.

10 minutes ago, mcbigski said:

Those questionable decisions all point to the direction of magnifying the crisis. WTF is going on there?

It's called a crisis and making very hard choices.

Link to comment
Share on other sites

9 hours ago, Ran said:

 

They've tested 500 staff at Danderyd hospital (in the Stockholm region) and preliminary results are "much higher" than 2%-3% reported recently by a hospital in Wuhan. Will be interesting to see what that number is. Of course, hospital staff are generally much more at risk of infection than the general public, so whatever the result doesn't necessarily apply to Stockholm's population at large.

Some more info on this here, including that they plan to release the results from the staff tests at Danderyd Hospital on Monday. Translating:

Quote

 In the tests we have done so far, the answer has been right on everyone. It is one hundred percent in both directions, both sensitivity and specificity. As a researcher, they say that one hundred percent does not exist, but so far the result is very good, says Sophia Hober.

She believes the positive result is because the test not only used a protein from the virus but used many variants at the same time.

- There must be signals from two different parts of the virus's proteins simultaneously for the response to be interpreted as positive. Others have chosen some, which gives a greater risk of getting a positive response, even though the person has not been ill. We have seen that in negative controls, if we had only selected a protein we would have had several cases where we thought the person had the virus, even though the blood we tested was from 2019, says Sophia Hober.

Also, this led me to their private partner, SciLifeLab, which had a press release with a bit of additional information concerning their test. I don't much about these things, but surely testing against 50 or so protein variants makes it more time consuming? 

 

Link to comment
Share on other sites

2 hours ago, Ran said:

I distinctly recall that the naval ship was explicitly not for patients diagnosed with or suspected of having SARS, and that they were there to help ease the burden of non-SARS patients. Did that change?

Yes, that was the original plan, and then there wasn't much demand for its beds and everyone was upset that it wasn't being used, so they decided to also open up to covid patients. But even then, there wasn't much need for it as the temporary facilities had opened up in the city. So Cuomo said last week that they don't need it, and the plan is for it to move on to its next mission.

Link to comment
Share on other sites

2 hours ago, Ran said:

I distinctly recall that the naval ship was explicitly not for patients diagnosed with or suspected of having SARS, and that they were there to help ease the burden of non-SARS patients. Did that change?

As to the Javits center, I mean, they hardly used it at all, for anyone.

As to nursing homes, FWIW, we did similar in Gothenburg with no ill effects here. Elderly were placed in a separate floor after they were released and believed to be recovering, to isolate them until they were negative, in part to provide care more appropriate for them by staff at the homes rather than taking up the time of nurses and doctors.

 

I mean, spending ten or twenty minutes in close physical contact with someone whose heart has stopped due to the virus would really put them at a risk of getting infected themselves. The air they pump into them with a BVM bag may have a viral filter in place, but ... I don't know. Every EMT and other health professional who gets sick has an outsized negative impact on the capacity of the health care system.

It's called a crisis and making very hard choices.

Yes, you recall correctly as to the initial mission, but that changed when almost no one got transferred there for treatment.  Though 2 I think of the patients that did tested positive once they got there.  So they changed the policy to also treat Covid patients there.  I think less than 100 or so patients in total were treated there before they sailed out though.

It would be nice if there were no ill effects in the nursing homes around here, but something in the treatment protocols must be different.  Or maybe it's partly a classification issue, as there are financial incentives in the US for Covid designations right now.

As for the DNR orders, the higher ups rescinded quickly it when the responders themselves told them basically to fuck off.  When you start to make multiple decisions that shade towards making the crisis worse, I have to consider cui bono.  Shut down the beaches, but keep the subways going?  Albeit at reduced service so that the trains stay full.  Again, WTF?

Link to comment
Share on other sites

8 hours ago, ljkeane said:

Honestly, I think if it becomes clear that a vaccine isn't going to happen I think the economy might end up opening back up quicker. If there's nothing realistic to aim for in terms of actually resolving the outbreak I think people will mostly just give up on social distancing. More people will die but I don't think there's going to be the collective will to go on like this indefinitely.

As eradication is not a realistic prospect in the medium term (unlike SARS and MERS) then longterm management of an endemic disease is the only option. Where a vaccine is on the horizon then going harder with keeping disease numbers down until a vaccine comes online is a good policy, as it limits severe disease with possible chronic sequelae and deaths. If a vaccine is not on the horizon then longterm management is at policy of attempting to protect particularly vulnerable populations and opening up movement and activities for while trying to make sure the health system is not overrun while the disease works its way through the general population hopefully with some therapeutics at least as effective as the 'flu therapeutics. While a vaccine is in the Schrodinger's Cat situation countries are going to be in a better or worse situation when that box is finally open and we know where we stand based in significant measure on the current policies of the health authorities of the country.

 

Link to comment
Share on other sites

I think some serious thought does need to be given to coming up with an alternative plan to a vaccine. Right now it seems everyone is just throwing helicopter money at the problem and shutting down society, in the belief that a vaccine is inevitable and everything will be able to open up again. All of the money governments are spending has been characterised as a "bridge" to tide us over until normality resumes, but that's far from certain.

I'm not advocating a straight herd immunity strategy - that would overload hospitals and result in far too many preventable deaths. Plus from a conceptual point of view, herd immunity itself is not a proven theory for COVID-19; the influenza vaccine has to be adjusted annually, and the common cold has never stood still.

Which leaves us with a strategy for living with this, endemic in the population. I think governments will have to move more towards guidelines rather than enforceable social distancing, as society won't cope with a constant police state. One area where governments may have to legislate is around workplace laws and liability. I hope that, alongside waiting for a vaccine, there are taskforces out there looking at all the alternative things that would have to happen if one isn't found.

Link to comment
Share on other sites

10 hours ago, Fragile Bird said:

Sorry, I should have been clearer. What surprised me is how far along human testing is. This is a novel virus, and here they are in human trials already!

There were human trials last month. Doing human trials happens early. It isnt that special.

Link to comment
Share on other sites

Apparently WHO recently came out with a statement that there is no hard evidence for recovered patients being immune from reinfection, so "immunity passports" aren't totally justified at the moment. Which from a controlled study point of view is probably true, but I think that with the China and Korea experience it seems reasonably likely that reinfection in people with a good antibody response is unlikely. So I hope some more robust studies will soon clear up this uncertainty.

A responsible govt will have a pathway to vaccination plan and a no vaccine plan.

Regarding the challenge of producing a vaccine vs Coronaviruses here is an abstract from a 2004 paper that was considering vaccine potential for SARS:

Quote

Severe acute respiratory syndrome (SARS) emerged in China and spread globally as a human pandemic. It is caused by a new coronavirus (CoV) of suspect animal origin. The emergence of SARS stunned medical scientists, but veterinary virologists had previously recognized CoVs as causing fatal respiratory or enteric disease in animals with interspecies transmission and wildlife reservoirs. Because of its public health impact, major efforts are focused on development of SARS vaccines. Occurrence of CoV disease at mucosal surfaces necessitates the stimulation of local immunity, having an impact on the vaccine type, delivery and adjuvant needed to achieve mucosal immunity. Such immunity is often short-lived, requires frequent boosting and may not prevent re-infection, all factors complicating CoV vaccine design. SARS vaccine efforts should be enhanced by understanding the correlates of protection and reasons for the success or failure of animal CoV vaccines. This review will focus on studies of immunity and protection in swine to the enteric CoV, transmissible gastroenteritis (TGEV) versus the respiratory variant, porcine respiratory CoV (PRCV), comparing live, inactivated and subunit vaccines, various vaccine vectors, routes and adjuvants. In addition avian infectious bronchitis CoV (IBV) vaccines targeted for protection of the upper respiratory tract of chickens are discussed. Unfortunately, despite long-term efforts, effective vaccines to prevent enteric CoV infections remain elusive, and generally live, but not killed vaccines, have induced the most consistent protection against animal CoVs. Confirmation of the pathogenesis of SARS in humans or animals models that mimic SARS may further aid in vaccine design and evaluation.

https://www.ncbi.nlm.nih.gov/pubmed/15742624

Bolded are significant concerns. However the good news is that vaccines have been developed for Coronavirus diseases in animals, even if they have been of limited success most of the time. So while a vaccine may not be a silver bullet, it may still be a useful weapon in managing the disease long term.

The World organization for Animal Health international trade recommendations includes recommendations for vaccination of birds for avian bronchitis, but it does not include any recommendations for vaccination of pigs for Transmissible gastroenteritis. So as indicated in the abstract, vaccines for respiratory forms of Coronavirus are more effective than GI forms of Coronavirus.

I'm still hopeful for a vaccine and think countries should be basing their control measures on an expectation there will be one, but I am not certain there will be one. It is interesting that GI symptoms are known but uncommon for COVID19.

Link to comment
Share on other sites

10 minutes ago, The Anti-Targ said:

Regarding the challenge of producing a vaccine vs Coronaviruses here is an abstract from a 2004 paper that was considering vaccine potential for SARS:

https://www.ncbi.nlm.nih.gov/pubmed/15742624

Interesting reading. Unfortunately the more I'm reading about it, the more pessimistic I am that a vaccine will be found, as you can tell from my last few posts. I haven't completely given up on finding one, but I'm moving very much into the second half of the "hope for the best, plan for the worst" mantra.

 

Link to comment
Share on other sites

6 minutes ago, Jeor said:

Interesting reading. Unfortunately the more I'm reading about it, the more pessimistic I am that a vaccine will be found, as you can tell from my last few posts. I haven't completely given up on finding one, but I'm moving very much into the second half of the "hope for the best, plan for the worst" mantra.

 

I think there is still reason for optimism. If the current phase of trials is showing that there is antibody response to the vaccine then that is good. Stay positive until there is an actual reason to be negative. In the case of Australia and NZ we don't want all of our effort so far in squashing the virus to come to naught. The interesting electoral possibility creeping up on us is timing of when any definitive vaccine news may arrive. Our election is set for September. If there is positive news about potential vaccine by then that will validate the approach the government has taken to strongly suppress the virus, so good for the re-election chances of the current govt. If the vaccine news is negative by then this will cause people to be critical of the govts strong actions (especially the opposition will go on attack for the actions weakening the economy "unnecessarily") which will give the opposition an advantage going into the election. Even though I think the govt is doing the right thing based on the information currently at hand it will be easy for the opposition to spin things in their favour among the not very scientifically (or economically) literate if the vaccine news is bad. I say economically not literate because a huge amount of the economic hit we will take is due to overseas factors: drop in international tourist arrivals, drop in international student arrivals, drop in exports of a lot of high value products. Even the naysayers against the govt's actions are not advocating for opening up the borders to all and sundry and recognise that there is not much we can do to stimulate international markets for our products. But it won't stop critics with as political agenda from blaming the domestic control actions for all of the economic effects.

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...