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Fragile Bird

Taking it to the Streets - Covid-19 #12

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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.

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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.

 

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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.

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6 hours ago, Paxter said:

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. 

I think it's a mixed bag on whether the severe long term effects only follow on from a severe episode of the virus. I'm sure it's true for some, but the seeming elevated risk of stroke in younger people seems to hit even with otherwise mild symptoms, and the danger of severe strokes is of substantial damage to the brain

https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/#click=https://t.co/dh225tjP9t

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Yes, the NZ election will be an interesting one. While Ardern is getting plaudits all around the world and is obviously quite popular internationally, closer to home it looks like she's more vulnerable, having to rely on coalition partners to form government. I can't imagine New Zealand First and the Greens make for easy bedfellows.

Notwithstanding the likelihood of a vaccine and my pessimistic outlook on the global situation, I am still pretty optimistic about the domestic context, Australia and NZ are doing really well. And if it comes down to it, I think we both could survive leading relatively normal lives within prolonged closed borders. Obviously certain industries (airlines, tertiary education) will be taking some pretty big lumps which is not to be underestimated, but as an overall society there's no doubt in my mind that Australians and NZers will be able to manage.

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41 minutes ago, Jeor said:

Yes, the NZ election will be an interesting one. While Ardern is getting plaudits all around the world and is obviously quite popular internationally, closer to home it looks like she's more vulnerable, having to rely on coalition partners to form government. I can't imagine New Zealand First and the Greens make for easy bedfellows.

Notwithstanding the likelihood of a vaccine and my pessimistic outlook on the global situation, I am still pretty optimistic about the domestic context, Australia and NZ are doing really well. And if it comes down to it, I think we both could survive leading relatively normal lives within prolonged closed borders. Obviously certain industries (airlines, tertiary education) will be taking some pretty big lumps which is not to be underestimated, but as an overall society there's no doubt in my mind that Australians and NZers will be able to manage.

It's worked for 3 years, but I don't see it working for another 3 full years. Something would need to change in the balance of seats for Labour to be able to lead a coalition for another full 3 years. Labour and the Maori party would need to mend fences and those two + Greens would need to be able to get a majority. I'm not sure the numbers are looking good for that unless Jacinda gets Labour a big Covid bounce and gets clseish to an absolute majority so that they only need a handful of seats from coalition partners.

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48 minutes ago, The Anti-Targ said:

It's worked for 3 years, but I don't see it working for another 3 full years. Something would need to change in the balance of seats for Labour to be able to lead a coalition for another full 3 years. Labour and the Maori party would need to mend fences and those two + Greens would need to be able to get a majority. I'm not sure the numbers are looking good for that unless Jacinda gets Labour a big Covid bounce and gets clseish to an absolute majority so that they only need a handful of seats from coalition partners.

Why would Labour mend fences with the Maori wing of the National Party?

To be honest, I suspect Labour would rather like to continue its arrangement with New Zealand First, and leave the Greens on the outside (where else are they going to go?).

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1 hour ago, Jeor said:

Yes, the NZ election will be an interesting one. While Ardern is getting plaudits all around the world and is obviously quite popular internationally, closer to home it looks like she's more vulnerable, having to rely on coalition partners to form government. I can't imagine New Zealand First and the Greens make for easy bedfellows.

What Winston wants, Winston gets, and the Greens have nowhere else to go.

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4 hours ago, Jeor said:

I'm not advocating a straight herd immunity strategy - that would overload hospitals and result in far too many preventable deaths.

It doesn't have to overload hospitals so long as social distancing is enough to push R to around 1 or a little under to account for how long it takes from infection to successful recovery for hospitalization. 

The main preventable death would concern elder care, as nursing homes are very vulnerable. The only obvious course I can think of is recruiting and training people who have immunity to work in these hospices. Maybe pay current workers a massive amount to get them to isolate with the people under their charge for 2-3 months, to get a cohort of immune (either naturally or through deliberate variolation) who can be rotated in after that, or something...  

4 hours ago, Jeor said:

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.

To be fair, influenza vaccine needs regular updating because it mutates rapidly. Coronavirii are generally slower to mutate

 

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1 hour ago, Ran said:

It doesn't have to overload hospitals so long as social distancing is enough to push R to around 1 or a little under to account for how long it takes from infection to successful recovery for hospitalization.

True enough. One of the silver linings in COVID-19 causing such fear is that even when things open back up again, a significant percentage of the population will probably stay more or less home-bound and most of those that go out will be taking precautions. So regardless of what governments do, society will dictate a gradual opening and this might keep hospitals within their capacity.

Another variable to throw into the mix is the "normal" influenza season coming up for the southern hemisphere. Australia and NZ probably not great examples given the low rates of infection but countries in South America as well as places like South Africa will give the northern hemisphere a preview of how the interaction between the influenza and COVID-19 seasons plays out. One of the other silver linings in all this is that the general influenza season might be much lesser in potency this year. People will be taking more precautions around their health and contagiousness in general, so maybe the flu will have a weak year.

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Oh for fuck's sake!

I'm so, so, sooo sick of this whole online learning nonsense!

So I've started the day having a severe headache, getting greeted by a newspaper article where parents are complaining about lazy teachers who don't do enough to communicate with their students. After weeks of frustration of nobody in my school knowing who the admin for the official Berlin learning platform is and their support not reacting to my question either, I decided to just make my courses and throw them into my school without any kind of structure. I name my course, push the button and...

... get the message that now I have to wait for my course to be manually created by the support team. The support team that didn't react to any of my mails for the last two weeks!

... Germany is a lost case. This is not digital teaching, this is sticks and stones....

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I'm only 20 minutes in, but so far this is a really good video on immunity and vaccine development. I recommend everyone find the time to watch.

There is also a bit of time spent talking about reinfection and re-emergence, both of which can be curve balls for herd immunity approaches.

 

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Posted (edited)

A friend who works as a caretaker for the elderly told me today that people at his workplace asked when the testing of all staff and clients our goverment promised two weeks ago is supposed to happen. They were told that the same press conference promise by the goverment is the only thing the organization that runs the retirement home he works at has heard about it. 

One of his co-workers was moved to a retirement home which has covid-19 cases because her husband already works there and they want to minimize the risk. 

Support by the goverment is non-existent according to him and most of the rules they are supposed to enforce are most likely illegal because retirement homes are not prisons.

Edited by Luzifer's right hand

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Posted (edited)
10 hours ago, The Anti-Targ said:

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.

There are almost 900000 people worldwide listed as recovered according to the Worldometers site so it feels like it should be possible to monitor whether any of them get a new infection.

I think the WHO are right to be cautious with their statements without firm evidence, and I think there's still a big unknown about how long any immunity might last for. I don't see how immunity passports can really work without some idea of that.

The vaccine paper linked to is interesting, although I'd also be curious about how much more has been learned about coronavirus vaccines in the 16 years since it was written.

Edited by williamjm

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3 hours ago, The Anti-Targ said:

I'm only 20 minutes in, but so far this is a really good video on immunity and vaccine development. I recommend everyone find the time to watch.

 

Asian Boss has been doing good work with these informative interviews with experts.

That said, if herd immunity doesn't work, neither do vaccines.

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6 hours ago, Jeor said:

when things open back up again, a significant percentage of the population will probably stay more or less home-bound and most of those that go out will be taking precautions

On what hard basis are you stating this as a fact, other than pulling it out of your whosis, fer pete's sake.  Fer pete's sake look at what's going on RIGHT NOW, all over the place.  It's anything but what you're saying.  Plus, you know dragging over a 1000 people across the country to hear a speech that deathcultchief wants them to hear him give, and many many many other such events.  It's not even as though after this West Point says it's reopening, which means those 1000 people will again have to return to from where they were dragged.  My how much contagion can one get from 1000 people traveling across country, sitting / standing next to each other for hours, and then doing it all over again.

This is what we're going to see, thus wave after wave of this burning through populations.

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So do you all think it's a safe course of action to restart economies and reopen businesses, starting in May/June, for European nations? Are we truly out of the woods? 

Or do you all think that restrictions should stay in place much longer, because the fall in new cases and new deaths many countries have been reporting over the past few days, couple weeks is merely a calm before another storm? 

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49 minutes ago, RhaenysBee said:

So do you all think it's a safe course of action to restart economies and reopen businesses, starting in May/June, for European nations? Are we truly out of the woods? 

The next phase in the Italian response is a quite cautious step (restaurants open for take away, solo exercise permitted, public spaces open with conditions). I don’t think anyone is claiming that Europe is “out of the woods”.

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Posted (edited)
28 minutes ago, Paxter said:

The next phase in the Italian response is a quite cautious step (restaurants open for take away, solo exercise permitted, public spaces open with conditions). I don’t think anyone is claiming that Europe is “out of the woods”.

You are right, I can’t tell if it has been claimed by the authorities of any country, I don’t keep up with all the news that closely. It was a figure of speech. 
Still, my feeling is that after two months of fear, anxiety, caution, lockup, tens of thousands of deaths and hundreds of thousands of cases, that is what the public wants to finally hear or at least hope. That is what crippled, struggling economies pray for, that is what governments and politicians long to finally announce.

We are very well in the middle of the woods here but instead of looking where we step, all eyes are above, on the little birds singing news of Austria reopening shops, Germany reopening schools, etc. (I should get out of this woodland metaphor while I still can) Our latest news is that the government will announce steps to ease restrictions on 4th May, although we haven’t exactly seen a steady fall in cases. We just hope so very much that we are on the same pattern as and get to follow in the footsteps of Germany and Austria (as if this had ever resulted in a favorable outcome for us). And I cant help but feel like it’s too good to be true. As terrible as it sounds, I keep feeling like it had been too easy for us, that we hadn’t yet seen the worst of it. And I’m scared that if we ease restrictions (note that we never had a full lockdown in the first place), it will just come back and bite us in the arse ten times harder. I don’t think that’s worth it for the sheer sake of boosting the morale.

I don’t know. This is all a personal impression based on nothing but late night thoughts swirling in a tired brain. 

Edited by RhaenysBee

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8 hours ago, Ran said:

Asian Boss has been doing good work with these informative interviews with experts.

That said, if herd immunity doesn't work, neither do vaccines.

That's not necessarily true and a very faulty assumption to decide that one might as well not bother waiting for a vaccine because there is effectively no difference between vaccinating and herd immunity by mass infection.

Vaccines use adjuvents that additionally stimulate the immune response to antigens over and above the natural immune response. Vaccines can concentrate the main antigens that generate the best immune response. If the natural virus elicits a good antibody response but a weak T-cell response then the vaccine can be engineered to boost the T-cell response. Vaccines can be given safely multiple times to augment immune response and prolong the period of immunity. Herd immunity only works if post recovery immunity lasts for an extended period AND if substantial numbers of recovered people aren't latent carriers. Vaccination works in the presence of latent carriers because vaccination doesn't create latent carriers whereas a herd immunity approach definitely does (if it is a feature of the disease). A vaccine may need an annual booster because the immune response may still not be very long lasting, which might be a pain but it's better than possibly getting the actual disease every year and risking death or severe illness and chronic sequelae each time.

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