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Fragile Bird

Taking it to the Streets - Covid-19 #12

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Wonders of wonders, our daily tabloid Aftonbladet has a pretty cool special piece discussing how to understand various charts and what they say about progress of COVID-19 in various countries, and how to compare them. If you use Google Chrome, the translation feature works very well.

 

 

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1 minute ago, Ormond said:

They will give the vaccine to people who are essential workers in health care or other fields where some exposure to COVID-19 is going to happen anyway, with of course testing them for antibodies first to make sure they have not already been exposed. The researchers don't deliberately expose people to COVID-19 themselves, they find people who would be exposed whether the vaccine was being tested or not.

Ah, that makes sense, thanks. Yes, obviously there'd be ethical research issues that must have been worked through with previous vaccines and so on.

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).

Absent a vaccine, the economic hardship is likely to continue for a depressingly long time (pun sort of intended, although I know it's a real serious situation for many people reading this). I think the next best thing would be to find better treatment techniques, whether that is drug-related (antivirals) or simply better knowledge of how to recognise and treat the virus for better patient outcomes. Something that makes people feel a little more confident to go out, knowing that contracting the virus is not going to be a possible death sentence, especially if you're in a vulnerable risk category.

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7 hours ago, ithanos said:

Finished what by September or October? I suspect it is only Phase I-II. According to the wiki on vaccine candidates, the earliest duration date of the 10 candidates they've tabled is November 2020 from a US-South Korea development. The others roll on into 2021 and a couple into 2023.

 

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!

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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.

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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.

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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.

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Posted (edited)
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.

 

 

Edited by Zorral

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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."

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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.

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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?

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Posted (edited)
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. 

Edited by Paxter

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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.

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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.

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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? 

 

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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.

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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?

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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.

 

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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.

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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.

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